Abstract
BackgroundBody mass index (BMI) cut-off values (>25 and >30) that predict diabetes risk have been well validated in Caucasian populations but less so in Asian populations. We aimed to determine the BMI threshold associated with increased type 2 diabetes (T2DM) risk and to calculate the proportion of T2DM cases attributable to overweight and obesity in the Thai population.MethodsParticipants were those from the Thai Cohort Study who were diabetes-free in 2005 and were followed-up in 2009 and 2013 (n = 39,021). We used multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the BMI-T2DM association. We modelled non-linear associations using restricted cubic splines. We estimated population attributable fractions (PAF) and the number of T2DM incident cases attributed to overweight and obesity. We also calculated the impact of reducing the prevalence of overweight and obesity on T2DM incidence in the Thai population.ResultsNon-linear modelling indicated that the points of inflection where the BMI-T2DM association became statistically significant compared to a reference of 20.00 kg/m2 were 21.60 (OR = 1.27, 95% CI 1.00–1.61) and 20.03 (OR = 1.02, 95% CI 1.02–1.03) for men and women, respectively. Approximately two-thirds of T2DM cases in Thai adults could be attributed to overweight and obesity. Annually, if prevalent obesity was 5% lower, ~13,000 cases of T2DM might be prevented in the Thai population.ConclusionsA BMI cut-point of 22 kg/m2, one point lower than the current 23 kg/m2, would be justified for defining T2DM risk in Thai adults. Lowering obesity prevalence would greatly reduce T2DM incidence.
Highlights
Body mass index (BMI) cut-off values (>25 and >30) that predict diabetes risk have been well validated in Caucasian populations but less so in Asian populations
Potential impact of reducing the prevalence of overweight and obesity in the Thai Cohort Study (TCS) Our results suggest that if the prevalence of overweight could be reduced by 5% this could result in a slight reduction in Type 2 diabetes mellitus (T2DM) cases annually in the national Thai population
We found that for the same BMI level the association between BMI and T2DM risk was higher in women and that their T2DM risk was already increased at BMI levels currently considered in the ‘healthy range’ for Caucasian and Asian populations
Summary
Body mass index (BMI) cut-off values (>25 and >30) that predict diabetes risk have been well validated in Caucasian populations but less so in Asian populations. We aimed to determine the BMI threshold associated with increased type 2 diabetes (T2DM) risk and to calculate the proportion of T2DM cases attributable to overweight and obesity in the Thai population. In 2004, the WHO released an additional statement indicating that a range of BMI cut-off points may be necessary for guiding public health action in different Asian populations since the available data were inconsistent [11]. Since publication of these two recommendations, many studies assessed the validity of lower Asian-specific BMI cut-points for assessing diabetes, cardiovascular and mortality risk. We estimated population attributable fractions and number of T2DM cases attributable to overweight and obesity in Thailand
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