Is the association of type II diabetes with waist circumference or waist-to-hip ratio stronger than that with body mass index?

Qiao, Qing; Nyamdorj, Regzedmaa

doi:10.1038/ejcn.2009.93

Cited by 184 publications

(124 citation statements)

References 58 publications

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“…This has been clearly demonstrated in the general population using BMI, waist circumference, and waist-hip ratio as markers for weight (25,26). Also in this study, diabetic patients showed a significantly higher BMI and waist circumference than the nondiabetic patients.…”

Section: Discussionmentioning

confidence: 59%

Prevalence of diabetes mellitus in 6050 hypopituitary patients with adult-onset GH deficiency before GH replacement: a KIMS analysis

Abs¹,

Mattsson²,

Thunander³

et al. 2013

European Journal of Endocrinology

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Objective: GH deficiency (GHD) in adults is characterized by a tendency toward obesity and an adverse body composition with visceral fat deposit and may thus predispose to the development of type 2 diabetes mellitus. The aim of this study was to assess the observed prevalence proportion (PP) and observed PP over expected PP ratio (standardized prevalence proportion ratio, SPR) of diabetes according to International Diabetes Federation criteria in a large cohort of GH-untreated adult-onset GHD patients. Design and methods: Associations between baseline variables and diabetes prevalence in 6050 GHD patients from KIMS (Pfizer International Metabolic Database) were studied and robust Poisson-regression analyses were performed. Comparisons between baseline status and HbA1c categories in the nondiabetic patients were done with covariance analysis. P values !0.05 were considered statistically significant. Results: PP was 9.3% compared with the expected 8.2%. SPR was 1.13 (95% confidence intervals (95% CIs), 1.04-1.23), which was significantly increased in females (1.23; 95% CI, 1.09-1.38%) but not in males (SPR 1.04; 95% CI, 0.92-1.17%). PP increased significantly by age, familial diabetes, country selection, BMI, waist circumference, number of pituitary deficiencies, and GHD etiology. SPR decreased significantly by age and increased significantly by BMI, waist circumference, and IGF1 SDS. Multiple regression model showed that the most important impact on SPR was from age and BMI. HbA1c values of 6.0-6.5% were found in 9.5% of nondiabetic patients and were associated with higher BMI and waist circumference. Conclusions: GHD is associated with an increased prevalence of diabetes, largely to be explained by the adverse body composition. These data urge toward early initiation of lifestyle modification measures.

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Section: Discussionmentioning

confidence: 59%

Prevalence of diabetes mellitus in 6050 hypopituitary patients with adult-onset GH deficiency before GH replacement: a KIMS analysis

Abs¹,

Mattsson²,

Thunander³

et al. 2013

European Journal of Endocrinology

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“…In a metaanalysis of 32 prospective studies, BMI, waist circumference and WHR had associations with incident type 2 diabetes that were not significantly different [17]. In a review examining variation in the c-statistic (17 prospective studies, 35 cross-sectional studies), Qiao and Nyamdorj found that no measure had consistently higher explanatory power for type 2 diabetes risk [18]. In our study, BMI, waist circumference and WHR had nearly identical associations with type 2 diabetes and AUC OGTT, and similar explanatory power.…”

Section: Resultsmentioning

confidence: 98%

Anthropometric measures and glucose levels in a large multi-ethnic cohort of individuals at risk of developing type 2 diabetes

et al. 2010

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Aims/hypotheses We determined: (1) which of BMI, waist circumference, hip circumference and WHR has the strongest association and explanatory power for newly diagnosed type 2 diabetes and glucose status; and (2) the impact of considering two measures simultaneously. We also explored variation in anthropometric associations by sex and ethnicity. Methods We performed cross-sectional analysis of 22,293 men and women who were from five ethnic groups and 21 countries, and at risk of developing type 2 diabetes. Standardised anthropometric associations with type 2 diabetes and AUC of glucose status from OGTT (AUC OGTT ) were determined using multiple regression. Explanatory power was assessed using the c-statistic and adjusted r 2 . Results An increase in BMI, waist circumference or WHR had similar positive associations with type 2 diabetes, AUC OGTT and explanatory power after adjustment for age, sex, smoking and ethnicity (p <0.01). However, using BMI and WHR together resulted in greater explanatory power than with other models (p< 0.01). Associations were strongest when waist circumference and hip circumference were used together, a combination that had greater explanatory power than other models except for BMI and WHR together (p<0.01). Results were directionally similar according to sex and ethnicity; however, significant variations in associations were observed among these subgroups. Conclusions/interpretation The combination of BMI and WHR, or of waist circumference and hip circumference has the best explanatory power for type 2 diabetes and glucose status compared with a single anthropometric measure. Measurement of waist circumference and hip circumference is required to optimally identify people at risk of type 2 diabetes and people with elevated glucose levels.

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“…Data were inconclusive or insufficient to come to conclusions that special cutoff points would be required for any of the other ethnic groups addressed in the reviews. Qiao and Nyamdorj (2009a) also review data from a diverse set of populations on several continents, and address the issue of ethnicity or population-specific cutoff points, using the risk of type II diabetes as a reference point for evaluating optimal cutoff points. Their review finds evidence of substantial variations in the WC or WHR cutoff points that might be optimal in different countries or regions.…”

Section: Background Reviewsmentioning

confidence: 99%

Body fat distribution and noncommunicable diseases in populations: overview of the 2008 WHO Expert Consultation on Waist Circumference and Waist–Hip Ratio

2009

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A World Health Organization (WHO) Expert Consultation on Waist Circumference (WC) and Waist-Hip Ratio (WHR) was convened in Geneva from 8 to 11 December 2008 to consider approaches to developing international guidelines for indices and action levels in order to characterize health risks associated with these measures of body fat distribution-alternative or complementary to the existing WHO guidelines for assessments of generalized obesity on the basis of body mass index. Six background papers prepared for the Consultation are compiled in this issue. These six papers examine a range of health outcomes and issues, including whether there is a basis for choosing WC over WHR and whether different action levels by gender, age, ethnicity, country or region are warranted. Although guidelines involving WC and WHR are potentially useful and clearly required, the challenges in identifying cutoffs for international guidelines should not be underestimated or oversimplified. The final report and outcomes of the Expert Consultation will be published by WHO. European Journal of Clinical Nutrition IntroductionChronic noncommunicable diseases (NCDs), such as heart disease, hypertension and stroke, diabetes mellitus, as well as various forms of cancer, are significant causes of disability, premature death, impaired quality of life and increasing health-care costs, in low-and middle-income, as well as in high-income countries (WHO, 2000a(WHO, , 2004(WHO, , 2008. Obesityreflecting the accumulation of a potentially harmful level of excess body fat-is a major contributor to the development of NCDs (WHO, 2000b), and has become a global epidemic affecting children and adults alike. Addressing obesity through population-level strategies that promote optimal nutrition, such as appropriate dietary intake and physical activity, is a major focus of the Global Strategy and Action Plan of the World Health Organization (WHO) for the Prevention and Control of Noncommunicable Diseases (NCDs) (WHO, 2000a(WHO, , 2004(WHO, , 2008, complementary to strategies developed to address other aspects of dietary quality, tobacco use and harmful use of alcohol.Surveillance to quantify and track NCDs and their risk factors is a key component of the NCD Action Plan (WHO, 2008), which requires clearly specified diagnostic criteria and classifications. Diagnostic criteria and classifications for obesity potentially relate to both generalized obesity and also to obesity subtypes defined by the distribution of body fat, such as abdominal or central obesity. With respect to generalized obesity in adults, reports of the 1993 WHO Expert Committee (WHO, 1995) kilograms divided by the square of height in metres (kg/m 2 ): overweight (BMI of X25.0) and obesity (BMI of X30), with further gradations of obesity defined by BMI ranges of 30.0-34.9, 35.0-39.9 and X40 based on the severity of the associated risk of comorbidities. These BMI cutoff points were recommended for international use with awareness that the risks are graded along a continuum, and that the risk ...

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Is the association of type II diabetes with waist circumference or waist-to-hip ratio stronger than that with body mass index?

Cited by 184 publications

References 58 publications

Prevalence of diabetes mellitus in 6050 hypopituitary patients with adult-onset GH deficiency before GH replacement: a KIMS analysis

Prevalence of diabetes mellitus in 6050 hypopituitary patients with adult-onset GH deficiency before GH replacement: a KIMS analysis

Anthropometric measures and glucose levels in a large multi-ethnic cohort of individuals at risk of developing type 2 diabetes

Body fat distribution and noncommunicable diseases in populations: overview of the 2008 WHO Expert Consultation on Waist Circumference and Waist–Hip Ratio

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