Why are Asians at Higher Risk?
Studies have shown that Asians are at higher risk of developing type 2 diabetes, when compared with people of European ancestry.1 Asians are more likely to develop the disease even at a lower BMI. This means that even though some Asian populations currently have a lower prevalence of overweight and obese individuals than populations in the West, they have a disproportionately high percentage of people with diabetes.1 Currently, 60% of the world’s diabetic population is Asian.2
This higher risk may be because Asians, especially South Asians, are more likely to have less muscle and more abdominal fat, which increases insulin resistance. For example, even though Indian newborns have a lower average body weight compared to white newborns, Indian newborns have higher levels of body fat and insulin.3 Imaging technology that measures fat in humans has shown that Asians of a healthy BMI have more fat around organs and in the belly area than Europeans with the same BMI.1
If you are Asian, rather than just calculating BMI, measure the length around your waist (your waist circumference) to predict your diabetes risk more accurately.4 You can measure waist circumference by putting a tape measure around your body just above your hipbone, usually at the level of your belly button. Even if you have a normal BMI, an “apple-shaped body” (with excess fat around the waist) increases your diabetes risk. Your target measurement for waist circumference should be less than or equal to 90 cm (35.5 in) for men and 80 cm (31.5 in) for women.5
Even if you are not overweight, you can still be at high risk for diabetes. Asians are also at risk of developing diabetes due to certain diet and lifestyle trends.
•Urbanization and modernization have led to less walking, less biking, and less daily physical activity.
•Nearly 50% of adult men in Asian countries smoke regularly,1 which is associated with higher abdominal fat and a 45% increased risk of developing diabetes.6
•White rice and other refined grains, which are linked to increased risk of diabetes, make up a large proportion of daily energy intake in Asian diets.2
•Unhealthy trans fats and saturated fats, such as palm oil, are often used as cooking oils.
•Due to globalization, fast food is much more common and widely available. In one Singapore study of more than 43,000 Chinese adults, those who ate Western-style fast food more than twice a week had a 27% increased risk of developing diabetes compared to those who reported eating little or no fast food.2
•Poor nutrition when a mother is pregnant means that when that the baby grows up, he or she will be more likely to have high blood sugar, especially if rapidly transitioning to a diet high in refined carbohydrates, sugary beverages, or fatty Western fast foods.6-9
•Air pollution, an increasing problem in Asia, may also increase risk of insulin resistance and diabetes.10
Read more about the relationship between diabetes risk and Asian diets and lifestyle.
References:
1 Chan JC, Malik V, Jia W, et al. Diabetes in Asia: epidemiology, risk factors, and pathophysiology. JAMA. 2009;301(20):2129-2140.
2 Malik V, Willett WC, Hu FB. Global obesity: trends, risk factors and policy implications. Nat Rev Endocrinol. 2013;9(1):13-27.
3 Yajnik CS, Lubree HG, Rege SS, et al. Adiposity and hyperinsulinemia in Indians are present at birth. J Clin Endocrinol Metab. 2002;87(12):5575-5580.
4 Huxley R, James WP, Barzi F, et al. Ethnic comparisons of the cross-sectional relationships between measures of body size with diabetes and hypertension. Obes Rev. 2008;9 Suppl 1:53-61.
5 BMI Calculator. Asian American Diabetes Initiative Web site. http://aadi.joslin.org/content/bmi-calculator. Accessed August 12, 2013.
6 Hu FB. Globalization of diabetes: The role of diet, lifestyle, and genes. Diabetes Care. 2011;34(6):1249-1257.
7 Yajnik CS. Nutrient-mediated teratogenesis and fuel-mediated teratogenesis: two pathways of intrauterine programming of diabetes. Int J Gynaecol Obstet. 2009;104 Suppl 1:S27-31.
8 Ravelli ACJ, van der Meulen JHP, Michels RPJ, et al. Glucose tolerance in adults after prenatal exposure to famine. Lancet. 1998;351:173-177.
9 Li Y, He Y, Qi L, et al. Exposure to the Chinese famine in early life and the risk of hyperglycemia and type 2 diabetes in adulthood. Diabetes. 2010;59:2400-2406.
10 Pearson JF, Bachireddy C, Shyamprasad S, Goldfine AB, Brownstein JS. Association between fine particulate matter and diabetes prevalence in the U.S. Diabetes Care. 2010;33(10):2196-2201.