Ethnicity-specific BMI cutoffs for obesity based on type 2 diabetes risk in England: a population-based cohort study.
BACKGROUND: National and global recommendations for BMI cutoffs to trigger action to prevent obesity-related complications like type 2 diabetes among non-White populations are questionable. We aimed to prospectively identify ethnicity-specific BMI cutoffs for obesity based on the risk of type 2 diabetes that are risk-equivalent to the BMI cutoff for obesity among White populations (>/=30 kg/m(2)).
METHODS: In this population-based cohort study, we used electronic health records across primary care (Clinical Practice Research Datalink) linked to secondary care records (Hospital Episodes Statistics) from a network of general practitioner practices in England. Eligible participants were aged 18 years or older, without any past or current diagnosis of type 2 diabetes, had a BMI of 15.0-50.0 kg/m(2) and complete ethnicity data, were registered with a general practitioner practice in England at any point between Sept 1, 1990, and Dec 1, 2018, and had at least 1 year of follow-up data. Patients with type 2 diabetes were identified by use of a CALIBER phenotyping algorithm. Self-reported ethnicity was collapsed into five main categories. Age-adjusted and sex-adjusted negative binomial regression models, with fractional polynomials for BMI, were fitted with incident type 2 diabetes and ethnicity data.
FINDINGS: 1 472 819 people were included in our study, of whom 1 333 816 (90.6%) were White, 75 956 (5.2%) were south Asian, 49 349 (3.4%) were Black, 10 934 (0.7%) were Chinese, and 2764 (0.2%) were Arab. After a median follow-up of 6.5 years (IQR 3.2-11.2), 97 823 (6.6%) of 1 472 819 individuals were diagnosed with type 2 diabetes. For the equivalent age-adjusted and sex-adjusted incidence of type 2 diabetes at a BMI of 30.0 kg/m(2) in White populations, the BMI cutoffs were 23.9 kg/m(2) (95% CI 23.6-24.0) in south Asian populations, 28.1 kg/m(2) (28.0-28.4) in Black populations, 26.9 kg/m(2) (26.7-27.2) in Chinese populations, and 26.6 kg/m(2) (26.5-27.0) in Arab populations.
INTERPRETATION: Revisions of ethnicity-specific BMI cutoffs are needed to ensure that minority ethnic populations are provided with appropriate clinical surveillance to optimise the prevention, early diagnosis, and timely management of type 2 diabetes.
FUNDING: National Institute for Health Research.
|投稿者||Caleyachetty, Rishi; Barber, Thomas M; Mohammed, Nuredin Ibrahim; Cappuccio, Francesco P; Hardy, Rebecca; Mathur, Rohini; Banerjee, Amitava; Gill, Paramjit|
|ジャーナル名||The lancet. Diabetes & endocrinology|
|組織名||Nuffield Department of Population Health, University of Oxford, Oxford, UK;;Warwick Medical School, University of Warwick, Coventry, UK. Electronic address:;email@example.com.;Warwick Medical School, University of Warwick, Coventry, UK; Warwickshire;Institute for the Study of Diabetes, Endocrinology and Metabolism, University;Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.;MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara,;The Gambia.;Warwick Medical School, University of Warwick, Coventry, UK.;Social Research Institute, University College London, London, UK.;Department of Non-Communicable Disease Epidemiology, London School of Hygiene and;Tropical Medicine, London, UK.;Institute of Health Informatics, University College London, London, UK.|