Visceral Adiposity Does Not Explain Increased Diabetes Rates in Black and Hispanic People in NHANES 2011-2018

Abstract Context Asian (AS), Black (BL), and Hispanic (HIS) individuals in the United States have higher rates of diabetes mellitus (DM) when compared to White (WH) 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 DXA with VAT measurement. DM was defined by A1c ≥6.5% or self-report. We analyzed the odds ratio of DM by race with and without controlling for body composition. Results Among 1,431 AS, 1,992 BL, 2,302 HIS, and 3,482 WH, WH had the lowest rates of DM (5.6%). Among those with DM, WH had the highest VAT (914 g ± 232 g). AS, BL, and HIS had higher odds of DM compared to WH when controlling for covariates (OR 1.77-2.38, P<0.05), and these associations were unchanged or strengthened when controlling for body composition. However, there was a stronger association between VAT and DM in AS versus WH (OR 1.54 vs OR 1.27 per 100 g increase in VAT, p-for-interaction=0.004). Conclusion VAT does not explain the higher rates of DM among BL and HIS compared to WH. Other biological and non-biological factors need further study to better understand this disparity.