Ethnic Admixture Affects Diabetes Risk in Native Hawaiians: The Multiethnic Cohort

BACKGROUND/OBJECTIVES: Obesity and diabetes rates are high in Native Hawaiians (NH) who commonly have mixed ancestries. Persons of Asian ancestry experience a high risk of type 2 diabetes despite the relatively low body weight. We evaluated the impact of ethnic admixture on diabetes risk among NH in the Multiethnic Cohort (MEC). METHODS/SUBJECTS: Based on self-reports, 11,521 eligible men and women were categorized into NH/white, NH/other, NH alone, NH/Asian, and the most common three ancestry admixture, NH/Chinese/white. Cox proportional hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated with the NH/white category as the reference group; covariates included known confounders, i.e., body mass index (BMI), dietary and other life-style factors. RESULTS: The NH alone category had the highest proportion of overweight and obese individuals and the NH/Asian category the lowest proportion. During 12 years of follow-up after cohort entry at 56 years, 2,072 incident cases were ascertained through questionnaires and health plan linkages. All NH categories had higher HRs than the NH/white category before and after adjustment for BMI. In fully-adjusted models, the NH/Asian category showed the highest risk (HR=1.45; 95%CI: 1.27–1.65), followed by NH/other (HR=1.20; 95%CI: 1.03–1.39), NH/Chinese/white (HR=1.19; 95%CI: 1.04–1.37), and NH alone (HR=1.19; 95%CI: 1.03–1.37). The elevated risk by Asian admixture was more pronounced in normal weight than overweight/obese individuals. CONCLUSIONS: These findings indicate that Asian admixture in NHs is associated with higher risk for type 2 diabetes independent of known risk factors and suggest a role for ethnicity-related genetic factors in the development of this disease.