Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men

• Published in: The American journal of clinical nutrition Vol. 81; no. 3; pp. 555 - 563
• Main Authors: Wang, Y, Rimm, E.B, Stampfer, M.J, Willett, W.C, Hu, F.B
• Format: Journal Article
• Language: English
• Published: Bethesda, MD American Society for Clinical Nutrition 01-03-2005; American Society for Clinical Nutrition, Inc
• Subjects: Abdomen - anatomy & histology; abdominal fat; adipocytes; Adipose Tissue - anatomy & histology; Adipose Tissue - metabolism; Aged; Biological and medical sciences; Body Composition - physiology; Body Mass Index; Cohort Studies; Comparative analysis; Diabetes; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - etiology; Feeding. Feeding behavior; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Health risk assessment; Humans; Male; Men; Middle Aged; noninsulin-dependent diabetes mellitus; Obesity; Obesity - complications; overweight; Predictive Value of Tests; Prospective Studies; Reference Standards; Risk Factors; Sensitivity and Specificity; Vertebrates: anatomy and physiology, studies on body, several organs or systems; waist circumference; Waist-Hip Ratio; waist-to-hip ratio; Endocrinopathy; Type 2 diabetes; Human; Obesity; Adiposity; Nutrition disorder; Risk factor; Metabolic diseases; Nutritional status; Comparative study
• ISSN: 0002-9165; 1938-3207
• DOI: 10.1093/ajcn/81.3.555

Background: Obesity is a strong risk factor for type 2 diabetes. However, few studies have compared the predictive power of overall obesity with that of central obesity. The cutoffs for waist circumference (WC) and waist-to-hip ratio (WHR) as measures of abdominal adiposity remain controversial. Objective: The objective was to compare body mass index (BMI), WC, and WHR in predicting type 2 diabetes. Design: A prospective cohort study (Health Professionals Follow-Up Study) of 27 270 men was conducted. WC, WHR, and BMI were assessed at baseline. Covariates and potential confounders were assessed repeatedly during the follow-up. Results: During 13 y of follow-up, we documented 884 incident type 2 diabetes cases. Age-adjusted relative risks (RRs) across quintiles of WC were 1.0, 2.0, 2.7, 5.0, and 12.0; those of WHR were 1.0, 2.1, 2.7, 3.6, and 6.9; and those of BMI were 1.0, 1.1, 1.8, 2.9, and 7.9 (P for trend < 0.0001 for all). Multivariate adjustment for diabetes risk factors only slightly attenuated these RRs. Adjustment for BMI substantially attenuated RRs for both WC and WHR. The receiver operator characteristic curve analysis indicated that WC and BMI were similar and were better than WHR in predicting type 2 diabetes. The cumulative proportions of type 2 diabetes cases identified according to medians of BMI (greater than or equal to 24.8), WC (greater than or equal to 94 cm), and WHR (greater than or equal to 0.94) were 82.5%, 83.6%, and 74.1%, respectively. The corresponding proportions were 78.9%, 50.5%, and 65.7% according to the recommended cutoffs. Conclusions: Both overall and abdominal adiposity strongly and independently predict risk of type 2 diabetes. WC is a better predictor than is WHR. The currently recommended cutoff for WC of 102 cm for men may need to be reevaluated; a lower cutoff may be more appropriate.