| Summary: | Background: Obesity is a major risk factor for type 2 diabetes mellitus (T2DM). A proper anthropometric
characterisation of T2DM risk is essential for disease prevention and clinical risk assessement.
Methods: Longitudinal study in 37 733 participants (63% women) of the Spanish EPIC (European Prospective
Investigation into Cancer and Nutrition) cohort without prevalent diabetes. Detailed questionnaire information was
collected at baseline and anthropometric data gathered following standard procedures. A total of 2513 verified
incident T2DM cases occurred after 12.1 years of mean follow-up. Multivariable Cox regression was used to
calculate hazard ratios of T2DM by levels of anthropometric variables.
Results: Overall and central obesity were independently associated with T2DM risk. BMI showed the strongest
association with T2DM in men whereas waist-related indices were stronger independent predictors in women.
Waist-to-height ratio revealed the largest area under the ROC curve in men and women, with optimal cut-offs at
0.60 and 0.58, respectively. The most discriminative waist circumference (WC) cut-off values were 99.4 cm in men
and 90.4 cm in women. Absolute risk of T2DM was higher in men than women for any combination of age, BMI
and WC categories, and remained low in normal-waist women. The population risk of T2DM attributable to obesity
was 17% in men and 31% in women.
Conclusions: Diabetes risk was associated with higher overall and central obesity indices even at normal BMI and
WC values. The measurement of waist circumference in the clinical setting is strongly recommended for the
evaluation of future T2DM risk in women.
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