Abstract
BackgroundWaist circumference (WC) is positively associated with diabetes, but the association with changes in WC (DWC) is less clear. We investigated the association between DWC and the subsequent risk of diabetes in middle-aged men and women, and evaluated the influence from concurrent changes in body mass index (DBMI).Methodology/Principal FindingsData on 15,577 men and 20,066 women from the Danish Diet, Cancer and Health study were analyzed. Anthropometry was assessed in 1993–97 and 1999–02. Information on diabetes was obtained from The Danish National Diabetes Register. Hazard ratios (HR) were calculated from Cox' proportional hazard models with individuals considered at risk from 1999–02 until December 31 2006. During 5.4 years of follow-up, 1,027 and 876 new cases of diabetes occurred among men and women, respectively. WC was positively associated with diabetes in both sexes also with adjustment for covariates and BMI. DWC was positively associated with diabetes in women, but not in men (HR per 5 cm change = 1.09 (1.04∶1.15) in women, and 1.00 (0.94, 1.07) in men with adjustment for covariates, baseline WC, BMI and DBMI). Associations with DWC were not notably different in sub-groups stratified according to baseline WC or DBMI, or when individuals with diseases or diabetes occurring within the first years of follow-up were excluded.Conclusions/SignificanceWhile this study confirmed that WC is positively associated with the risk of diabetes in middle-aged men and women, it surprisingly showed that changes in WC were not associated with the subsequent risk of diabetes in men, and only weakly positively associated with the risk of diabetes in women. Accordingly, these findings suggest that a reduction in WC may be a weak or insufficient or target for prevention of diabetes in middle-aged men and women.
Highlights
Obesity is a strong risk factor for diabetes [1]
We investigated the association between changes in Waist circumference (WC) and the subsequent risk of diabetes in middle-aged men and women, and evaluated whether the association was influenced by concurrent changes in body mass index. confidence interval. smoking habits (DBMI) (CI) (BMI)
The DBMI was e.g. positively associated with diabetes after adjusting for covariates BMI in 1993–97, WC in 1993–97 and changes in waist circumference. HR (DWC) when cases in the first five years of follow-up were excluded (HR = 1.33 (1.05, 1.68) per kg/ m2 DBMI). This prospective study of middle-aged men and women showed that WC at both recruitment and follow-up, as expected, was strongly and positively associated with the subsequent risk of diabetes with adjustment for BMI
Summary
Obesity is a strong risk factor for diabetes [1]. Weight gain increases the risk of diabetes, and even small reductions in body weight reduce the risk of diabetes [1]. Anthropometric measures of abdominal fatness (e.g. waist circumference (WC)) appears to be more strongly associated with the risk of diabetes than anthropometric measures of general fatness (e.g. body mass index (BMI)) [2,3,4,5,6]. This has predominantly been attributed to accumulation of intra-abdominal fat, which is strongly associated with metabolic complications and possibly with development of diabetes [7,8,9]. We investigated the association between DWC and the subsequent risk of diabetes in middle-aged men and women, and evaluated the influence from concurrent changes in body mass index (DBMI)
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