TY - JOUR
T1 - Long-term risk of incident type 2 diabetes and measures of overall and regional obesity
T2 - The epic-interact case-cohort study
AU - Langenberg, Claudia
AU - Sharp, Stephen J.
AU - Schulze, Matthias B.
AU - Rolandsson, Olov
AU - Overvad, Kim
AU - Forouhi, Nita G.
AU - Spranger, Joachim
AU - Drogan, Dagmar
AU - Huerta, José María
AU - Arriola, Larraitz
AU - de Lauzon-Guillan, Blandine
AU - Tormo, Maria Jose
AU - Ardanaz, Eva
AU - Balkau, Beverley
AU - Beulens, Joline W.J.
AU - Boeing, Heiner
AU - Bueno-de-Mesquita, Bas
AU - Clavel-Chapelon, Françoise
AU - Crowe, Francesca L.
AU - Franks, Paul W.
AU - Gonzalez, Carlos A.
AU - Grioni, Sara
AU - Halkjaer, Jytte
AU - Hallmans, Goran
AU - Kaaks, Rudolf
AU - Kerrison, Nicola D.
AU - Key, Timothy J.
AU - Khaw, Kay Tee
AU - Mattiello, Amalia
AU - Nilsson, Peter
AU - Norat, Teresa
AU - Palla, Luigi
AU - Palli, Domenico
AU - Panico, Salvatore
AU - Quirós, J. Ramón
AU - Romaguera, Dora
AU - Romieu, Isabelle
AU - Sacerdote, Carlotta
AU - Sánchez, María José
AU - Slimani, Nadia
AU - Sluijs, Ivonne
AU - Spijkerman, Annemieke M.W.
AU - Teucher, Birgit
AU - Tjonnel, Anne
AU - Tumino, Rosario
AU - van der, A. Daphne L.
AU - van der Schouw, Yvonne T.
AU - Feskens, Edith J.M.
AU - Riboli, Elio
AU - Wareham, Nicholas J.
PY - 2012/8/13
Y1 - 2012/8/13
N2 - 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/m 2) 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/m 2) 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. Please see later in the article for the Editors' Summary.
AB - 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/m 2) 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/m 2) 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. Please see later in the article for the Editors' Summary.
UR - http://www.scopus.com/inward/record.url?scp=84864659280&partnerID=8YFLogxK
U2 - https://doi.org/10.1371/journal.pmed.1001230
DO - https://doi.org/10.1371/journal.pmed.1001230
M3 - Article
C2 - 22679397
SN - 1549-1277
VL - 9
JO - PLoS medicine
JF - PLoS medicine
IS - 6
M1 - e1001230
ER -