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. 2021 Jul;9(7):419-426.
doi: 10.1016/S2213-8587(21)00088-7. Epub 2021 May 11.

Ethnicity-specific BMI cutoffs for obesity based on type 2 diabetes risk in England: a population-based cohort study

Rishi Caleyachetty  1 , Thomas M Barber  2 , Nuredin Ibrahim Mohammed  3 , Francesco P Cappuccio  4 , Rebecca Hardy  5 , Rohini Mathur  6 , Amitava Banerjee  7 , Paramjit Gill  4
Affiliations

Ethnicity-specific BMI cutoffs for obesity based on type 2 diabetes risk in England: a population-based cohort study

Rishi Caleyachetty et al. Lancet Diabetes Endocrinol. 2021 Jul.

Erratum in

Abstract

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/m2).

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/m2 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/m2 in White populations, the BMI cutoffs were 23·9 kg/m2 (95% CI 23·6-24·0) in south Asian populations, 28·1 kg/m2 (28·0-28·4) in Black populations, 26·9 kg/m2 (26·7-27·2) in Chinese populations, and 26·6 kg/m2 (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.

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Conflict of interest statement

Declaration of interests PG is a trustee of the South Asian Health Foundation, is part funded by the National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands, and is a NIHR senior investigator. All other authors declare no competing interests.

Figures

Figure 1
Figure 1
Study profile CRPD=Clinical Practice Research Datalink.
Figure 2
Figure 2
Age-adjusted and sex-adjusted BMI cutoffs in minority ethnic populations in England equivalent to a BMI cutoff of 30·0 kg/m2 in White populations in relation to type 2 diabetes incidence The incidence of type 2 diabetes for a BMI of 30·0 kg/m2 in the White population can be read off the graph at the intersection of the grey horizontal line and the fitted line for the White population.
Figure 3
Figure 3
Age-adjusted and sex-adjusted BMI cutoffs in minority ethnic subgroups in England equivalent to a BMI cutoff of 30·0 kg/m2 in White populations in relation to type 2 diabetes incidence The incidence of type 2 diabetes for a BMI of 30·0 kg/m2 in the White population can be read off the graph at the intersection of the grey horizontal line and the fitted line for the White population.
Figure 4
Figure 4
Age-adjusted and sex-adjusted BMI cutoffs in minority ethnic populations in England equivalent to a BMI cutoff of 25·0 kg/m2 in White populations in relation to type 2 diabetes incidence The incidence of type 2 diabetes for a BMI of 25·0 kg/m2 in the White population can be read off the graph at the intersection of the grey horizontal line and the fitted line for the White population.
See this image and copyright information in PMC

Comment in

  • Obesity: what's in a word?
    Cummings DE, Rubino F. Cummings DE, et al. Lancet Diabetes Endocrinol. 2021 Jul;9(7):408-409. doi: 10.1016/S2213-8587(21)00122-4. Epub 2021 May 11. Lancet Diabetes Endocrinol. 2021. PMID: 33989536 No abstract available.

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