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Black New Yorkers with Type 2 Diabetes: Afro-Caribbean Immigrants Have Lower BMI and Lower Waist Circumference than African Americans

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Abstract

Objective

Using the 2013/2014 New York City (NYC) Health and Nutrition Examination Survey (NYCHANES) data, this exploratory study examined whether (a) type 2 diabetes (diabetes) prevalence differed between NYC Afro-Caribbeans and African Americans; (b) anthropometric, biochemical, and sociodemographic diabetes profiles differed between and within groups; and (c) diabetes odds differed between and within groups.

Methods

Diabetes was defined as prior diagnosis, HbA1c ≥ 6.5% (7.8 mmol/L), or fasting glucose ≥ 126 mg/dL. Weighted logistic regression estimated diabetes odds by nativity and either waist circumference (WC) (cm) or BMI (kg/m2). All regression models controlled for age, hypertension, gender, education, income, marital status, physical activity, and smoking.

Results

Among Afro-Caribbeans (n = 81, 65% female, age (mean ± SE) 49 ± 2 years, BMI 29.2 ± 0.7 kg/m2) and African Americans (n = 118, 50% female, age 47 ± 2 years, BMI 30.3 ± 0.9 kg/m2), Afro-Caribbeans with diabetes had lower BMI (29.9 ± 0.8 kg/m2 vs. 34.6 ± 1.7 kg/m2, P = 0.01) and lower WC (102 ± 2 cm vs. 114 ± 3 cm, P = 0.002) than African Americans with diabetes. Afro-Caribbeans with diabetes had lower prevalence of obesity (33.2% vs. 74.7%) and higher prevalence of overweight (57.2% vs. 13.5%) (P = 0.02) than African Americans with diabetes. Odds of diabetes did not differ between Afro-Caribbeans and African Americans. In models predicting the effect of WC, diabetes odds increased with WC (OR = 1.07 (95% CI 1.02, 1.11), P = 0.003) and age (OR = 1.09 (95% CI 1.03–1.15), P = 0.003) for African Americans only. In models predicting the effect of BMI, diabetes odds increased for Afro-Caribbeans with age (OR = 1.06 (1.01, 1.11)*, P = 0.04) and hypertension (OR = 5.62 (95% CI 1.04, 30.42), P = 0.045), whereas for African Americans, only age predicted higher diabetes odds (OR = 1.08 (95% CI 1.03, 1.14), P = 0.003).

Conclusions

In NYC, Afro-Caribbeans with diabetes have lower BMI and lower WC than African Americans with diabetes, but odds of diabetes do not differ. Combining African-descent populations into one group obscures clinical differences and generalizes diabetes risk.

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References

  1. Lundy De La Cruz N, Jessup J, Murray L, Health of Black New Yorkers by country of birth. New York City, in: Epi Data Brief, New York City Department of Health and Mental Hygiene, New York, NY, 2016.

  2. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, Michos ED, Miedema MD, Muñoz D, Smith SC, Virani SS, Williams KA, Yeboah J, Ziaeian B. ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation. 2019;140(2019):e596–646.

    PubMed  PubMed Central  Google Scholar 

  3. Murphy SL, Xu JQ, Kochanek KD, Arias E, T.-V. B., Deaths: final data for 2018, National Vital Statistics Rep, 69 2020.

  4. US Census QuickFacts New York City, New York, in: U.S.C. Bureau (Ed.), United States Census Bureau, 2020. 2020;

  5. Horlyck-Romanovsky MF, Wyka K, Echeverria SE, Leung MM, Fuster M, Huang TTK. Foreign-born Blacks experience lower odds of obesity but higher odds of diabetes than US-born Blacks in New York City. J Immigr Minor Health. 2019;21:47–55.

    Article  PubMed  Google Scholar 

  6. Horlyck-Romanovsky MF, Fuster M, Echeverria SE, Wyka K, Leung MM, Sumner AE, Huang TTK. Black immigrants from Africa and the Caribbean have similar rates of diabetes but Africans are less obese: the New York City Community Health Survey 2009–2013. J Racial Ethn Health Disparities. 2019;6:635–45.

    Article  PubMed  Google Scholar 

  7. Paul SK, OwusuAdjah ES, Samanta M, Patel K, Bellary S, Hanif W, Khunti K. Comparison of body mass index at diagnosis of diabetes in a multi-ethnic population: a case-control study with matched non-diabetic controls. Diabetes, obesity metabol. 2017;19:1014–23.

    Article  Google Scholar 

  8. Goff LM, Ladwa M, Hakim O, Bello O. Ethnic distinctions in the pathophysiology of type 2 diabetes: a focus on black African-Caribbean populations. Proceed Nutr Soc. 2020;79:184–93.

    Article  CAS  Google Scholar 

  9. Allister-Price C, Craig CM, Spielman D, Cushman SS, McLaughlin TL. Metabolic markers, regional adiposity, and adipose cell size: relationship to insulin resistance in African-American as compared with Caucasian women. Int J Obes (Lond). 2019;43:1164–73.

    Article  CAS  PubMed  Google Scholar 

  10. Ford ND, Narayan KM, Mehta NK. Diabetes among US- and foreign-born Blacks in the USA. Ethn Health. 2016;21:71–84.

    Article  PubMed  Google Scholar 

  11. Tillin T, Sattar N, Godsland IF, Hughes AD, Chaturvedi N, Forouhi NG. Ethnicity-specific obesity cut-points in the development of type 2 diabetes – a prospective study including three ethnic groups in the United Kingdom. Diabet Med. 2015;32:226–34.

    Article  CAS  PubMed  Google Scholar 

  12. ATP III guidelines at-a-glance quick desk reference, in, National Heart, Lung, and Blood Institute, National Institutes of Health, 2001.

  13. Kabakambira JD, Baker RL Jr, Briker SM, Courville AB, Mabundo LS, DuBose CW, Chung ST, Eckel RH, Sumner AE. Do current guidelines for waist circumference apply to black Africans? Prediction insulin resistance waist circumference among Africans living America, BMJ glob health. 2018;3:e001057.

    PubMed  Google Scholar 

  14. Yu SS, Castillo DC, Courville AB, Sumner AE. The triglyceride paradox in people of African descent. Metab Syndr Relat Disord. 2012;10:77–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Bentley AR, Rotimi CN. Interethnic differences in serum lipids and implications for cardiometabolic disease risk in African ancestry populations. Glob Heart. 2017;12:141–50.

    Article  PubMed  Google Scholar 

  16. Miljkovic-Gacic I, Bunker CH, Ferrell RE, Kammerer CM, Evans RW, Patrick AL, Kuller LH. Lipoprotein subclass and particle size differences in Afro-Caribbeans, African Americans, and white Americans: associations with hepatic lipase gene variation. Metab, Clin Exp. 2006;55:96–102.

    Article  CAS  PubMed  Google Scholar 

  17. Ross R. Does exercise without weight loss improve insulin sensitivity? Diabetes Care. 2003;26:944–5.

    Article  PubMed  Google Scholar 

  18. Adult physical inactivity prevalence maps by race/ethnicity, in, Centers for Disease Control and Prevention, 2020.

  19. W.B. White, L.R. Cain, E.J. Benjamin, A.P. DeFilippis, M.J. Blaha, W. Wang, V. Okhomina, R.J. Keith, M. Al Rifai, S. Kianoush, M.D. Winniford, R.M. Robertson, A. Bhatnagar, A. Correa, M.E. Hall, High-intensity cigarette smoking is associated with incident diabetes mellitus in Black adults: the Jackson Heart Study, Journal of the American Heart Association, 7 (2018).

  20. N.R. Bennett, D.K. Francis, T.S. Ferguson, A.J.M. Hennis, R.J. Wilks, E.N. Harris, M.M.Y. MacLeish, L.W. Sullivan, Disparities in diabetes mellitus among Caribbean populations: a scoping review, Int J Equity Health, 14 2015.

  21. Commodore-Mensah Y, Matthie N, Wells JBDS, Himmelfarb CD, Cooper LA, Chandler RD. African Americans, African immigrants, and Afro-Caribbeans differ in social determinants of hypertension and diabetes: evidence from the National Health Interview Survey. J racial ethnic health disparities. 2018;5:995–1002.

    Article  Google Scholar 

  22. Thomas SC, Umer A, Commodore-Mensah Y, Davidov D, Abildso CG. Length of residence and cardiovascular health among Afro-Caribbean immigrants in New York City. J Racial Ethn Health Disparities. 2019;6:487–96.

    Article  PubMed  Google Scholar 

  23. Bennett NR, Francis DK, Ferguson TS, Hennis A, Wilks RJ, Harris E, MacLeish M, Sullivan LW. Disparities in diabetes mellitus among Caribbean populations: a scoping review. International journal for equity in health. 2015;14:23.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Thorpe LE, Greene C, Freeman A, Snell E, Rodriguez-Lopez JS, Frankel M, Punsalang A Jr, Chernov C, Lurie E, Friedman M, Koppaka R, Perlman SE. Rationale, design and respondent characteristics of the 2013–2014 New York City Health and Nutrition Examination Survey (NYC HANES 2013–2014). Prev Med Rep. 2015;2:580–5.

    Article  PubMed  PubMed Central  Google Scholar 

  25. L. Khosla, S. Bhat, L.A. Fullington, M. Horlyck-Romanovsky, F. , HbA 1c Performance in African descent populations in the United States with normal glucose tolerance, prediabetes, or diabetes: a scoping review, preventing chronic disease, 2021.

  26. Ford ES, Li C, Sattar N. Metabolic syndrome and incident diabetes: current state of the evidence. Diabetes Care. 2008;31:1898–904.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Waist circumference and waist-hip ratio. report of a WHO Expert Consultation, Geneva, 8–11 December 2008, in. Geneva, Switzerland: World Health Organization; 2008.

    Google Scholar 

  28. Getting your cholesterol checked, in, Centers for Disease Control, 2020.

  29. Healthy People 2010 leading health indicators at a glance, in, National Center for Health Statistics, Centers for Disease Control and Prevention, 2015.

  30. U.S. Department of Health and Human Services. The health consequences of smoking—50 years of progress: a report of the surgeon general. , in, Centers for Disease Control and Prevention, Atlanta: U.S. , 2014.

  31. Diabetes care in the hospital. standards of medical care in diabetes-2020. Diabetes Care. 2020;43:S193-s202.

    Article  Google Scholar 

  32. Allister-Price C, Craig CM, Spielman D, Cushman SS, McLaughlin TL. Metabolic markers, regional adiposity, and adipose cell size: relationship to insulin resistance in African-American as compared with Caucasian women. Int J Obes. 2005;43(2019):1164–73.

    Google Scholar 

  33. Cunningham-Myrie C, Younger-Coleman N, Tulloch-Reid M, McFarlane S, Francis D, Ferguson T, Gordon-Strachan G, Wilks R. Diabetes mellitus in Jamaica: sex differences in burden, risk factors, awareness, treatment and control in a developing country. Tropical Med Int Health. 2013;18:1365–78.

    Article  Google Scholar 

  34. Rao G, Powell-Wiley TM, Ancheta I, Hairston K, Kirley K, Lear SA, North KE, Palaniappan L, Rosal MC. Identification of obesity and cardiovascular risk in ethnically and racially diverse populations: a scientific statement from the American Heart Association. Circulation. 2015;132:457–72.

    Article  PubMed  Google Scholar 

  35. O.T. Hardy, M.P. Czech, S. Corvera, What causes the insulin resistance underlying obesity, Current Opinion in Endocrinology, Diabetes and Obesity, (2012).

  36. S.V. Eastwood, T. Tillin, H.-M. Dehbi, A. Wright, N.G. Forouhi, I.F. Godsland, P.H. Whincup, N. Sattar, A.D. Hughes, N. Chaturvedi, Ethnic differences in associations between fat deposition and incident diabetes and underlying mechanisms: the SABRE study, Obesity, (2015).

  37. V. Raygor, F. Abbasi, L.C. Lazzeroni, S.H. Kim, E. Ingelsson, G.M. Reaven, J.W. Knowles, Impact of race/ethnicity on insulin resistance and hypertriglyceridaemia, Diabetes and Vascular Disease Research, (2019).

  38. Gregory Cohn, Gerardo Valdes, D.M. Capuzzi, Pathophysiology and treatment of the dyslipidemia of insulin resistance, Current Cardiology Reports, 2001.

  39. L. Meyer, E.M. Susan, Frighi, F. Burden, H.A.W. Neil, R.H. Rury, C.T. Robert, UK Prospective Diabetes Study. XII: Differences between Asian, Afro-Caribbean and white Caucasian type 2 diabetic patients at diagnosis of diabetes. UK Prospective Diabetes Study Group, Diabetic Medicine, 1994.

  40. Goff LM, Griffin BA, Lovegrove JA, Sanders TA, Jebb SA, Bluck LJ, Frost GS. Ethnic differences in beta-cell function, dietary intake and expression of the metabolic syndrome among UK adults of South Asian, black African-Caribbean and white-European origin at high risk of metabolic syndrome. Diab Vasc Dis Res. 2013;10:315–23.

    Article  PubMed  Google Scholar 

  41. Chaturvedi N, Jarrett J, Morrish N, Keen H, Fuller JH. Differences in mortality and morbidity in African Caribbean and European people with non-insulin dependent diabetes mellitus: results of 20 year follow up of a London cohort of a multinational study. BMJ. 1996;313:848–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Ladwa M, Bello O, Hakim O, Shojaee-Moradie F, Boselli ML, Charles-Edwards G, Peacock J, Umpleby AM, Amiel SA, Bonadonna RC, Goff LM. Ethnic differences in beta cell function occur independently of insulin sensitivity and pancreatic fat in black and white men. BMJ Open Diabetes Res Care. 2021;9:e002034.

    Article  PubMed  PubMed Central  Google Scholar 

  43. G.J. Miller, G.H. Maude, G.L. Beckles, Incidence of hypertension and non-insulin dependent diabetes mellitus and associated risk factors in a rapidly developing Caribbean community: the St James survey, Trinidad, J Epidemiol Community Health, 50 1996.

  44. P. Deedwania, Hypertension, dyslipidemia, and insulin resistance in patients with diabetes mellitus or the cardiometabolic syndrome: benefits of vasodilating β‐blockers, Journal of Clinical Hypertension, 2011.

  45. M. Dhall, D. Kshetrimayum Surmala, Nilupher, G. Urvashi, T. Renu, T. Renu, K. Satwanti, Hypertension and its correlate with general and central adiposity: a study among urban population of Delhi, diabetes and metabolic syndrome: Clinical Research and Reviews, 2018.

  46. T.S. Ferguson, N.O. Younger-Coleman, M.K. Tulloch-Reid, N.R. Bennett, A. Rousseau, J. Knight-Madden, M. Samms-Vaughan, D. Ashley, R.J. Wilks, Factors associated with elevated blood pressure or hypertension in Afro-Caribbean youth: a cross-sectional study, PeerJ, 2018.

  47. Stein E, Kushner H, Gidding S, Falkner B. Plasma lipid concentrations in nondiabetic African American adults: associations with insulin resistance and the metabolic syndrome. Metabolism. 2007;56:954–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Plaza D, Audebert C, Domenach H. Transnational return migration to the English-speaking Caribbean. Rev Eur Migr Int. 2008;24:115–37.

    Article  Google Scholar 

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Acknowledgements

Author FW was supported by the Division of Intramural Research, National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health. Author MFH-R was supported by City University of New York. Author TSM was supported by NIMHD under a contract with Information Management Services, Inc. Author MF was supported by the Macaulay Honors Program at City University of New York, and authors SB and LK were students at State University of New York Medical School. The authors are grateful for statistical support and guidance from Dr. Lohuwa Mamudu.

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Authors and Affiliations

  1. Department of Health and Nutrition Sciences, Brooklyn College, City University of New York, Brooklyn, NY, USA

    Margrethe F. Horlyck-Romanovsky & Maria Farag

  2. Center for Health Promotion, Brooklyn College, City University of New York, New York, NY, USA

    Margrethe F. Horlyck-Romanovsky

  3. College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA

    Sonali Bhat & Lakshay Khosla

  4. Information Management Services, Inc, Calverton, MD, USA

    Timothy S. McNeel

  5. Division of Intramural Research, National Institute On Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA

    Faustine Williams

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  1. Margrethe F. Horlyck-Romanovsky
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Contributions

MFH-R, MF, SB, LK, and FW conceptualized the study. MFH-R and TSM researched data and conducted the data analysis. MF, LK, SB, FW, and MFH-R wrote the manuscript. MFH-R, MF, SB, LK, TSM, and FW reviewed/edited the manuscript.

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Correspondence to Margrethe F. Horlyck-Romanovsky or Faustine Williams.

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Author MFH-R is the guarantor and takes full responsibility for the contents of this article. The content is solely the responsibility of the authors and does not necessarily reflect the views of the funding institutions. Use of these data does not imply the funding institutions agree or disagree with any presentations, analyses, interpretations, or conclusions herein, nor were they involved in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

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Institutions where work was completed: Brooklyn College, City University of New York, New York, NY; Information Management Services, Inc., Calverton, MD; and National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD.

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Horlyck-Romanovsky, M.F., Farag, M., Bhat, S. et al. Black New Yorkers with Type 2 Diabetes: Afro-Caribbean Immigrants Have Lower BMI and Lower Waist Circumference than African Americans. J. Racial and Ethnic Health Disparities 10, 1933–1946 (2023). https://doi.org/10.1007/s40615-022-01375-7

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