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

doi:10.1016/j.jcte.2019.100210

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 journal › Article › peer-review

13 Scopus citations

Abstract

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 language	English
Article number	100210
Journal	Journal of Clinical and Translational Endocrinology
Volume	19
DOIs	https://doi.org/10.1016/j.jcte.2019.100210
State	Published - 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

Keywords

Adiposity
Black race
Diabetes mellitus
Insulin sensitivity
Overweight

ASJC Scopus subject areas

Endocrinology, Diabetes and Metabolism
Endocrinology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.jcte.2019.100210

Cite this

@article{c90ac73e34624567a4d943132f62c725,

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

abstract = "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.",

keywords = "Adiposity, Black race, Diabetes mellitus, Insulin sensitivity, Overweight",

author = "Sean Lee and Lacy, {Mary E.} and Mathew Jankowich and Adolfo Correa and Wu, {Wen Chih}",

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: {\textcopyright} 2019",

year = "2020",

month = mar,

doi = "10.1016/j.jcte.2019.100210",

language = "English",

volume = "19",

}

TY - JOUR

T1 - Association between obesity phenotypes of insulin resistance and risk of type 2 diabetes in African Americans

T2 - The Jackson Heart Study

AU - Lee, Sean

AU - Lacy, Mary E.

AU - Jankowich, Mathew

AU - Correa, Adolfo

AU - Wu, Wen Chih

N1 - 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

PY - 2020/3

Y1 - 2020/3

N2 - 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.

AB - 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.

KW - Adiposity

KW - Black race

KW - Diabetes mellitus

KW - Insulin sensitivity

KW - Overweight

UR - http://www.scopus.com/inward/record.url?scp=85075839272&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85075839272&partnerID=8YFLogxK

U2 - 10.1016/j.jcte.2019.100210

DO - 10.1016/j.jcte.2019.100210

M3 - Article

AN - SCOPUS:85075839272

VL - 19

M1 - 100210

ER -

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

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this