Abstract 66: US Asian and Pacific Islander Adolescents With Obesity Have Triple the Risk of Prediabetes When Compared to Non Hispanic White Children
Authors: Njuguna Veronica W , Greenspan Louise C , Chandra Malini , Bacong Adrian M , Darbinian Jeanne A , Chu Clarence E , Lo Joan C , Rodriguez Luis A 
Published: May 2024

Introduction:
Race and ethnicity and elevated body mass index (BMI) are risk factors for pre-diabetes (preDM) among adolescents. We recently observed high preDM prevalence among aggregated US Asian and Pacific Islander (API) children with obesity, but data pertaining to disaggregated API subgroups remain limited.

Aim:
To examine the risk of preDM among API subgroups compared to non-Hispanic White (NHW) adolescents with obesity.

Methods:
This retrospective study included 3233 API and 4150 NHW children age 13-17y with obesity and without DM who were identified at preventive health well-child visits in 2016-2019 and had hemoglobin A1c (HA1c) measured within 1 year of the visit. Visit data included self-reported diet/lifestyle behaviors and BMI measurement. PreDM (outcome) was defined by HA1c 5.7-6.4%. Obesity was categorized as Class 1-3 based on BMI percent of the 95th BMI percentile (obesity threshold). Four obesogenic behaviors were ascertained from clinic data: Fruit/vegetable consumption <5 servings/day; juice/sugary beverage intake >12 ounces/day; exercising <60 minutes/day; and screen time 2+ hours/day. A neighborhood deprivation index (NDI) was calculated using area of residence and 2010 US Census data. Log binomial regression was used to examine the association of API ethnicity and preDM, reporting relative risk (RR) and 95% confidence intervals [CI].

Results:
The cohort included 210 Chinese, 900 Filipino, 200 South Asian, 132 Southeast Asian, 283 Native Hawaiian/Pacific Islander (NHPI), 1508 other/unspecified API ethnicity, and 4150 NHW children. Overall, 22.4% of API vs 9.4% NHW (p<0.001) children had preDM. PreDM prevalence ranged from 19.1% for Chinese, 21.7% for Filipino, 22.5% for South Asian, 24.2% for Southeast Asian, to 26.5% for NHPI subgroups. After adjusting for age, sex, NDI, obesity class, and obesogenic health behaviors, risk of preDM was about 3-fold higher (RR 2.9 [2.6-3.4] for API compared to NHW adolescents, ranging from RR 2.5 [1.8-3.6] for Chinese, RR 2.8 [2.3-3.4] for Filipino, RR 3.1 [2.2- 4.4] for South Asian, RR 3.2 [2.1-4.9] for Southeast Asian, RR 3.3 [2.5-4.4] for NHPI, and RR 3.0 [2.5-3.5] for other/unspecified API children. Obesity severity (RR 1.4 [1.2-1.6] for Class 2 and RR 2.1 [1.7-2.6] for Class 3 compared to Class 1 obesity) was also associated with preDM risk.

Conclusion:
PreDM risk was about 3-fold higher for API compared to NHW children with obesity even after adjusting for sociodemographic, lifestyle, and BMI differences. The risk of preDM ranged from 2.5-fold to 3.3-fold higher for the major API subgroups, especially Southeast Asian and Filipino groups compared to NHW children. These findings highlight the importance of preDM screening among API children and demonstrate heterogeneity of risk among API subgroups. Future efforts should focus on effective screening and monitoring of at-risk populations to prevent progression to Type 2 DM.