Association between obesity phenotypes of insulin resistance and risk of type 2 diabetes in African Americans: The Jackson Heart Study

Sean Lee, Mary E. Lacy, Mathew Jankowich, Adolfo Correa, Wen Chih Wu

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Objective: To determine whether insulin resistance (IR) measured by homeostasis model of insulin resistance (HOMA-IR) can further stratify diabetes risk in African Americans (AAs) beyond obesity and identify obese, low risk and non-obese, high risk individuals. Methods: Using the Jackson Heart Study cohort, we categorized participants without diabetes into four phenotypes: non-obese/insulin-sensitive, non-obese/IR, obese/insulin-sensitive and obese/IR. Obesity was defined as BMI ≥ 30 or BMI 25–30 plus an increased waist circumference. IR was defined as HOMA-IR ≥ 2. We used modified Poisson regression models to estimate the incident risk-ratios (IRR) of diabetes across these phenotypes adjusting for potential confounders and HbA1c. Results: Among 3219 AAs without diabetes, 14.0% were non-obese/insulin-sensitive, 24.6% non-obese/IR, 6.2% obese/insulin-sensitive, and 55.3% obese/IR. The overall crude incidence rate of diabetes was 29.91 cases/1000 person-years. In fully-adjusted models, compared to the non-obese/insulin-sensitive group, the relative risk of diabetes was highest in obese/IR (IRR = 2.35; 95% CI: 1.53, 3.60), followed by non-obese/IR (IRR = 1.59; 95% CI: 1.02, 2.46), and non-significant for the obese/insulin-sensitive (IRR = 1.70; 95% CI: 0.97, 2.99) group. Conclusions: HOMA-IR can further stratify diabetes risk in AA adults beyond obesity, identifying non-obese high-risk and lower-risk obese individuals. However, diabetes risk should still be carefully monitored in obese populations despite insulin sensitivity.

Original languageEnglish
Article number100210
JournalJournal of Clinical and Translational Endocrinology
StatePublished - Mar 2020

Bibliographical note

Funding Information:
The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the U.S. Department of Health and Human Services or the Department of Veterans Affairs. Appendix A

Funding Information:
The authors gratefully acknowledge the staff and participants of the Jackson Heart Study for their contributions. The funders of the study had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review or approval of the manuscript or the decision to submit for publication. The Jackson Heart Study is supported by contracts HHSN268201300046C , HHSN268201300047C , HHSN268201300048C , HHSN268201300049C , HHSN268201300050C from the National Heart, Lung, and Blood Institute and the National Institute on Minority Health and Health Disparities . The authors thank the participants and data collection staff of the Jackson Heart Study.

Publisher Copyright:
© 2019


  • Adiposity
  • Black race
  • Diabetes mellitus
  • Insulin sensitivity
  • Overweight

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology


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