A 45-year-old Japanese-American man with a BMI of 23 kg/m2 and a waist circumference of 92 cm has a higher risk for type 2 diabetes compared with Caucasians. How should his risk be classified?

A 45-year-old Japanese-American man with a BMI of 23 kg/m2 and a waist circumference of 92 cm has a higher risk for type 2 diabetes compared with Caucasians. How should his risk be classified?

• A. Increased
• B. Decreased
• C. Unchanged
• D. Cannot be determined

Answer: (A)

This question highlights how ethnicity modifies diabetes risk beyond what BMI alone suggests. In many East Asian populations, including Japanese, individuals can have higher metabolic risk at lower BMI and smaller waist sizes due to greater visceral fat and relative beta-cell vulnerability. A BMI of 23 kg/m2 might appear normal, but the waist circumference of 92 cm indicates central obesity, which is strongly linked to insulin resistance. Taken together, these factors point to an increased risk for type 2 diabetes compared with Caucasians, so the classification is Increased.

This question highlights how ethnicity modifies diabetes risk beyond what BMI alone suggests. In many East Asian populations, including Japanese, individuals can have higher metabolic risk at lower BMI and smaller waist sizes due to greater visceral fat and relative beta-cell vulnerability. A BMI of 23 kg/m2 might appear normal, but the waist circumference of 92 cm indicates central obesity, which is strongly linked to insulin resistance. Taken together, these factors point to an increased risk for type 2 diabetes compared with Caucasians, so the classification is Increased.