Visceral adiposity does not explain increased diabetes rates in Black and Hispanic people in NHANES 2011-2018

Abstract Context Asian, Black, and Hispanic individuals in the United States have higher rates of diabetes mellitus (DM) when compared to White individuals. It is not clear if these differences could be related to visceral adipose tissue (VAT). Objective To investigate the risk of diabetes across racial groups while adjusting for differences in VAT. Our secondary objective was to examine the association of VAT on the risk of diabetes and assess for differences by race. Methods Participants aged 18-59 years from the National Health and Nutrition Examination Survey (NHANES) 2011-2018 underwent questionnaires, hemoglobin A1c testing, and total body dual-energy x-ray absorptiometry with VAT measurement. DM was defined by A1c ≥ 6.5% or self-report. We analyzed the odds ratio (OR) of DM by race with and without controlling for body composition. Results Among 1431 Asian, 1992 Black, 2302 Hispanic, and 3482 White participants, White participants had the lowest rates of DM (5.6%). Among those with DM, White participants had the highest VAT (914 g ± 232 g). Asian, Black, and Hispanic individuals had higher odds of DM compared to White individuals when controlling for covariates (OR 1.77-2.38, P < .05), and these associations were unchanged or strengthened when controlling for body composition. However, there was a stronger association between VAT and DM in Asian vs White participants (OR 1.54 vs OR 1.27 per 100 g increase in VAT, P-for-interaction = .004). Conclusion VAT does not explain the higher rates of DM among Black and Hispanic individuals compared to White individuals. Other biological and nonbiological factors need further study to better understand this disparity.