Long-Term Risk of Incident Type 2 Diabetes and Measures of Overall and Regional Obesity: The EPIC-InterAct Case-Cohort Study
Author(s)
Type
Journal Article
Abstract
Background: Waist circumference (WC) is a simple and reliable measure of fat distribution that may add to the prediction of
type 2 diabetes (T2D), but previous studies have been too small to reliably quantify the relative and absolute risk of future
diabetes by WC at different levels of body mass index (BMI).
Methods and Findings: The prospective InterAct case-cohort study was conducted in 26 centres in eight European
countries and consists of 12,403 incident T2D cases and a stratified subcohort of 16,154 individuals from a total cohort of
340,234 participants with 3.99 million person-years of follow-up. We used Prentice-weighted Cox regression and random
effects meta-analysis methods to estimate hazard ratios for T2D. Kaplan-Meier estimates of the cumulative incidence of T2D
were calculated. BMI and WC were each independently associated with T2D, with WC being a stronger risk factor in women
than in men. Risk increased across groups defined by BMI and WC; compared to low normal weight individuals (BMI 18.5–
22.4 kg/m2
) with a low WC (,94/80 cm in men/women), the hazard ratio of T2D was 22.0 (95% confidence interval 14.3;
33.8) in men and 31.8 (25.2; 40.2) in women with grade 2 obesity (BMI$35 kg/m2
) and a high WC (.102/88 cm). Among the
large group of overweight individuals, WC measurement was highly informative and facilitated the identification of a
subgroup of overweight people with high WC whose 10-y T2D cumulative incidence (men, 70 per 1,000 person-years;
women, 44 per 1,000 person-years) was comparable to that of the obese group (50–103 per 1,000 person-years in men and
28–74 per 1,000 person-years in women).
Conclusions: WC is independently and strongly associated with T2D, particularly in women, and should be more widely
measured for risk stratification. If targeted measurement is necessary for reasons of resource scarcity, measuring WC in
overweight individuals may be an effective strategy, since it identifies a high-risk subgroup of individuals who could benefit
from individualised preventive action.
type 2 diabetes (T2D), but previous studies have been too small to reliably quantify the relative and absolute risk of future
diabetes by WC at different levels of body mass index (BMI).
Methods and Findings: The prospective InterAct case-cohort study was conducted in 26 centres in eight European
countries and consists of 12,403 incident T2D cases and a stratified subcohort of 16,154 individuals from a total cohort of
340,234 participants with 3.99 million person-years of follow-up. We used Prentice-weighted Cox regression and random
effects meta-analysis methods to estimate hazard ratios for T2D. Kaplan-Meier estimates of the cumulative incidence of T2D
were calculated. BMI and WC were each independently associated with T2D, with WC being a stronger risk factor in women
than in men. Risk increased across groups defined by BMI and WC; compared to low normal weight individuals (BMI 18.5–
22.4 kg/m2
) with a low WC (,94/80 cm in men/women), the hazard ratio of T2D was 22.0 (95% confidence interval 14.3;
33.8) in men and 31.8 (25.2; 40.2) in women with grade 2 obesity (BMI$35 kg/m2
) and a high WC (.102/88 cm). Among the
large group of overweight individuals, WC measurement was highly informative and facilitated the identification of a
subgroup of overweight people with high WC whose 10-y T2D cumulative incidence (men, 70 per 1,000 person-years;
women, 44 per 1,000 person-years) was comparable to that of the obese group (50–103 per 1,000 person-years in men and
28–74 per 1,000 person-years in women).
Conclusions: WC is independently and strongly associated with T2D, particularly in women, and should be more widely
measured for risk stratification. If targeted measurement is necessary for reasons of resource scarcity, measuring WC in
overweight individuals may be an effective strategy, since it identifies a high-risk subgroup of individuals who could benefit
from individualised preventive action.
Date Issued
2012-06-05
Date Acceptance
2012-04-24
Citation
PLOS Medicine, 2012, 9 (6)
ISSN
1549-1277
Publisher
Public Library of Science
Journal / Book Title
PLOS Medicine
Volume
9
Issue
6
Copyright Statement
© 2012 Langenberg et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
License URL
Subjects
Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
MEDICINE, GENERAL & INTERNAL
BODY-MASS INDEX
WAIST CIRCUMFERENCE
ABDOMINAL ADIPOSITY
PRIMARY-CARE
NUTRITION
MELLITUS
CANCER
PARTICIPANTS
ASSOCIATION
PREVENTION
Publication Status
Published
Article Number
e1001230