• Unjali P Gujral, Eric Vittinghoff, Morgana Mongraw-Chaffin, Dhananjay Vaidya, Namratha R Kandula, Matthew Allison, Jeffrey Carr, Kiang Liu, NarayanK M VenkatKMVFrom Emory University, Atlanta, Georgia; University of California, San Francisco, San Francisco, and University of California, San Diego, San Diego, California; Wake Forest School of Medicine, Winston-Salem, North Carolina; Johns Hopki, and Alka M Kanaya.
• From Emory University, Atlanta, Georgia; University of California, San Francisco, San Francisco, and University of California, San Diego, San Diego, California; Wake Forest School of Medicine, Winston-Salem, North Carolina; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, and Northwestern University, Evanston, Illinois; and Vanderbilt University, Nashville, Tennessee.
• Ann. Intern. Med. 2017 May 2; 166 (9): 628-636.

BackgroundThe relationship between body weight and cardiometabolic disease may vary substantially by race/ethnicity.ObjectiveTo determine the prevalence and correlates of the phenotype of metabolic abnormality but normal weight (MAN) for 5 racial/ethnic groups.DesignCross-sectional analysis.Setting2 community-based cohorts.Participants2622 white, 803 Chinese American, 1893 African American, and 1496 Hispanic persons from MESA (Multi-Ethnic Study of Atherosclerosis) and 803 South Asian participants in the MASALA (Mediators of Atherosclerosis in South Asians Living in America) study.MeasurementsPrevalence of 2 or more cardiometabolic abnormalities (high fasting glucose, low high-density lipoprotein cholesterol, and high triglyceride levels and hypertension) among normal-weight participants was estimated. Correlates of MAN were assessed by using log-binomial models.ResultsAmong normal-weight participants (n = 846 whites, 323 Chinese Americans, 334 African Americans, 252 Hispanics, and 195 South Asians), the prevalence of MAN was 21.0% (95% CI, 18.4% to 23.9%) in whites, 32.2% (CI, 27.3% to 37.4%) in Chinese Americans, 31.1% (CI, 26.3% to 36.3%) in African Americans, 38.5% (CI, 32.6% to 44.6%) in Hispanics, and 43.6% (CI, 36.8% to 50.6%) in South Asians. Adjustment for demographic, behavioral, and ectopic body fat measures did not explain racial/ethnic differences. After adjustment for age, sex, and race/ethnicity-body mass index (BMI) interaction, for the equivalent MAN prevalence at a BMI of 25.0 kg/m2 in whites, the corresponding BMI values were 22.9 kg/m2 (CI, 19.5 to 26.3 kg/m2) in African Americans, 21.5 kg/m2 (CI, 18.5 to 24.5 kg/m2) in Hispanics, 20.9 kg/m2 (CI, 19.7 to 22.1 kg/m2) in Chinese Americans, and 19.6 kg/m2 (CI, 17.2 to 22.0 kg/m2) in South Asians.LimitationCross-sectional study design and lack of harmonized dietary data between studies.ConclusionCompared with whites, all racial/ethnic minority groups had a statistically significantly higher prevalence of MAN, which was not explained by demographic, behavioral, or ectopic fat measures. Using a BMI criterion for overweight to screen for cardiometabolic risk may result in a large proportion of racial/ethnic minority groups being overlooked.Primary Funding SourceNational Institutes of Health.

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