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Waist size predicts type 2 diabetes risk

Waist circumference predicts risk of type 2 diabetes independently of BMI

Louise Prime

Wednesday, 06 June 2012

Waist circumference predicts risk of incident type 2 diabetes independently of body mass index, research has found. The study, published in this week’s PLoS Medicine, found that the association was particularly strong in women.

A large collaboration of international researchers, led from the MRC Epidemiology Unit at Addenbrooke’s Hospital, Cambridge, reanalysed data from the InterAct case-control study. This study followed 340,234 people of European descent for a mean of 11.7 years, giving a total of 3.99 million person-years’ follow up; during this time, 12,403 incident cases of type 2 diabetes were confirmed.

The team found that waist circumference and BMI were each independently associated with the risk of developing type 2 diabetes during follow up. Waist circumference was a stronger predictor of diabetes risk in women than it was in men.

People with grade 2 obesity (BMI ≥35kg/m2) who also had a large waist (>102cm for men, 88cm for women) had a considerably higher risk of developing diabetes compared with low-normal weight people (BMI 18.5-22.4) with a smaller waist (<94cm for men, 80cm for women) – the hazard ratio was 22.0 for men and 31.8 for women.

Waist circumference was a greater contributor than BMI to diabetes risk in women, especially. In overweight women, the hazard ratio in those with a BMI 25.0-27.4kg/m2 and a large waist (≥88cm) was 10.3, compared with a hazard ratio of 5.82 in women with a BMI 27.5–29.9kg/m2 and a moderately increased waist (≥80–87.9cm).

The researchers also found that waist measurement enabled them to identify a subgroup of particularly at-risk people in the overweight category. The 10-year cumulative incidence of type 2 diabetes among overweight people (according to their BMI), but who had a large waist, was similar to that among obese people.

The study’s authors propose that measuring waist circumference in overweight people would be an effective strategy in diabetes prevention, because it helps to identify from a large number of overweight people – more than a third of adults in both the UK and the US – those who are at especially high risk of type 2 diabetes and so could benefit most from intervention.

They conclude: “[Waist circumference] is independently and strongly associated with T2D, particularly in women, and should be more widely measured.

“If targeted measurement is necessary for reasons of resource scarcity, measuring [waist circumference] in overweight individuals may be an effective strategy since it identifies a high-risk subgroup of individuals who could benefit from individualised preventive action.”

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