Visceral Adiposity Does Not Explain Increased Rates of Diabetes among Asian, Black, and Hispanic Individuals—A Cross-Sectional Analysis of NHANES 2011-2018

Introduction and Objective: Studies have shown U.S. Asian (AS), Black (BL), and Hispanic (HIS) individuals have higher rates of diabetes mellitus (DM) compared to White (WH) individuals. Our aim was to determine if body composition as defined by visceral adipose tissue (VAT) and lean mass index (LMI) could explain this disparity. Methods: Our cross-sectional study analyzed the body composition data of 9,212 subjects ages 20-59 from National Health and Nutrition Examination Survey (NHANES) 2011-2018. DM was defined by A1c ≥6.5% or self report. Dual energy X-ray absorptiometry was used to examine VAT and LMI with VAT measured at the L4-L5 vertebral interspace in grams. Logistic regression models were created with DM as the outcome, while examining VAT and LMI and controlling for age, gender, race, height, education, and income. Results: Among 1,432 AS, 1,993 BL, 2,302 HIS, and 3,485 WH, WH had the lowest rates of DM (5.4%). Among those with DM, WH had the highest VAT (914.3 g ± 231.7 g) and nearly 50% higher VAT than AS and BL (628.8 g ± 261.2 g and 613.8 g ± 313.5 g, respectively). With or without controlling for body composition, AS, BL, and HIS had higher odds of DM compared to WH (OR 1.86-4.83, P<0.05). This was re-demonstrated after use of race-specific norms of LMI and VAT. When analyzing the associations of body composition on odds of DM, every 1 kg/m2 of LMI (OR 1.17, p<0.001) and 100 g of VAT (OR 1.26, 95% CI 1.20-1.33, p<0.001) were associated with DM. BL and HIS had similar or lower odds of DM with increases in VAT, while AS had higher odds than WH (OR in BL 1.17, in HIS 1.26, in AS 1.54, in WH 1.26, per 100 g increase in VAT, p<0.05 for all). Conclusion: Body composition as defined by VAT and LMI does not explain the increased rates of DM found among AS, BL, and HIS when compared to WH. Other biological factors and non-biological factors need further study to better understand racial differences in DM rates. Disclosure: L.S. Alemu: None. K. Chopra: None. R. Jain: Consultant; Ascendis Pharma A/S, Guidepoint Consulting. Other Relationship; Ascendis Pharma A/S, Amolyt Pharma, MBX Biosciences. Research Support; Amgen Foundation.