ORIGINAL PAPER Ethnic Disparities in the Association of Body Mass Index with the Risk of Hypertension and Diabetes Robert J. Wong • Christina Chou • Sidhartha R. Sinha • Ahmad Kamal • Aijaz Ahmed Published online: 26 November 2013 Ó Springer Science+Business Media New York 2013 Abstract Despite having lower body mass index (BMI) compared to other ethnic groups, Asians continue to develop significant metabolic diseases such as hypertension and diabetes. To evaluate the disparate association of BMI and risk of hypertension and diabetes in Asians. We ret- rospectively studied 150,753 adults from the 1985–2011 California Behavioral Risk Factor Survey. Trends in prevalence of obesity, hypertension, and diabetes were stratified by ethnicity. Multivariate logistic regression models evaluated the incremental effect of one unit BMI increase on risk of hypertension and diabetes and the dis- parate risks of hypertension and diabetes at different BMI thresholds. Asians had the lowest BMI among all groups. However, the impact of increasing BMI on risk of hyper- tension and diabetes was significantly greater in Asians. For each one unit increase in BMI, Asians were signifi- cantly more likely to have hypertension (OR 1.15; 95 % CI 1.13–1.18) compared to non-Hispanic whites, blacks, and Hispanics. Similar trends were seen for diabetes (Asians: OR 1.15; 95 % CI 1.13–1.18). The risk of hypertension in Asians with BMI C 22 was similar to non-Hispanic whites with BMI C 27 and blacks with BMI C 28. The risk of diabetes in Asians with BMI C 28 was similar to non- Hispanic whites with BMI C 30. Despite lower overall BMI compared to other groups, weight gain in Asians is associated with significantly higher risks of hypertension and diabetes. Compared to other ethnic groups, similar risks of hypertension and diabetes are seen in Asians at much lower BMI. Keywords Obesity Á Racial disparities Á Metabolic syndrome Á Asians Introduction Obesity is a global epidemic leading to significant increa- ses in the burden of obesity-related diseases such as cor- onary artery diseases, hypertension, and diabetes [1–4]. Ethnic disparities in obesity prevalence exist, with higher obesity rates in several ethnic minority groups such as blacks and Hispanics [5–11]. Concurrent with the higher rates of obesity, greater prevalence of obesity-related dis- eases are also seen in these ethnic minorities. This dis- proportionate burden of disease in certain ethnic minorities has been attributed to disparities in socioeconomic status, including education level, household income, and access to healthy food options [5–17]. Asians as a group generally have lower body mass index (BMI) and lower prevalence of obesity compared to other race/ethnic groups [7, 8, 18, 19]. Despite lower prevalence of obesity, higher rates of metabolic syndrome have been reported in Asians compared to other ethnic groups at similar BMI levels [7]. Furthermore, racial/ethnic dispari- ties in BMI correlation with percentage body fat are well known. Compared to non-Hispanic whites, blacks have higher lean mass and lower fat mass, whereas higher cen- tral and visceral adiposity distribution are seen in Asians [20–24]. Greater central adiposity distribution is associated R. J. Wong Á C. Chou Á S. R. Sinha Á A. Kamal Á A. Ahmed (&) Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, 750 Welch Road, Suite 210, Stanford, Palo Alto, CA 94304, USA e-mail: aijazahmed@stanford.edu R. J. Wong e-mail: rwong123@stanford.edu A. Kamal Division of Gastroenterology and Hepatology, Santa Clara Valley Medical Center, San Jose, CA, USA 123 J Community Health (2014) 39:437–445 DOI 10.1007/s10900-013-9792-8