🧬 Ancestry gradient persists after adiposity adjustment

In the Mexico City Prospective Study cross-sectional analysis of 134,548 Mexican adults, higher Indigenous American (AMR) genomic ancestry tracked with higher prediabetes and Type 2 Diabetes (T2DM) prevalence—even after adjusting for adiposity and other risk factors (fully adjusted OR per +20% AMR: T2DM 1.33; prediabetes 1.18). Across AMR tenths, T2DM prevalence rose from 13.5% to 23.4% and prediabetes from 19.2% to 26.3%.

Why It Matters To Your Practice

• Genetic susceptibility may help explain why many Mexican patients develop dysglycemia at younger ages and/or lower BMI than expected.

• Even after accounting for socioeconomic status, lifestyle, and adiposity, the ancestry–T2DM gradient persisted—supporting earlier, more intensive prevention in higher-risk groups.

• Risk was stronger in women and younger adults, highlighting groups to prioritize for screening and counseling.

Clinical Benefits

• Earlier identification: consider timely HbA1c screening (and repeat intervals) in Mexican/Indigenous-ancestry patients, even when BMI is not markedly elevated.

• More tailored counseling: reinforce that “normal weight” does not equal “low risk” for T2DM in all populations; emphasize diet quality, activity, sleep, and cardiometabolic risk reduction.

• Stronger prevention ROI: the study suggests population-targeted prevention could better match underlying susceptibility than one-size-fits-all thresholds.

Managing Risks

• Avoid genetic determinism: ancestry is not destiny—frame this as risk stratification that strengthens (not replaces) lifestyle and evidence-based preventive care.

• Use ancestry thoughtfully: genomic ancestry is not routinely measured; don’t substitute crude assumptions for patient-centered history, social context, and standard risk factors.

• Equity and stigma: discuss risk without reinforcing bias; ensure access to screening, nutrition support, and diabetes prevention programs.

The Bottom Line

• In a large Mexico City cohort, higher AMR ancestry was linked to higher prediabetes and T2DM prevalence, and the association remained after adiposity adjustment (OR per +20% AMR: T2DM 1.33; prediabetes 1.18).

• For NPs/PAs, the practical takeaway is earlier, more intensive, culturally responsive prevention and screening strategies for Mexican/Indigenous-ancestry patients—especially women and younger adults.