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Huerta, Jose Maria; Tormo, Maria-Jose; Chirlaque, María Dolores; Gavrila, Diana; Amiano, Pilar; Arriola, Larraitz; Ardanaz, Eva; Rodriguez, Laudina; Sanchez, Maria-Jose; & Mendez, Michelle A., et al. (2013). Risk of Type 2 Diabetes According to Traditional and Emerging Anthropometric Indices in Spain, A Mediterranean Country with High Prevalence of Obesity: Results from a Large-Scale Prospective Cohort Study. BMC Endocrine Disorders, 13, 7. PMCID: PMC3575248


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 assessment.
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.


Reference Type

Journal Article

Year Published


Journal Title

BMC Endocrine Disorders


Huerta, Jose Maria
Tormo, Maria-Jose
Chirlaque, María Dolores
Gavrila, Diana
Amiano, Pilar
Arriola, Larraitz
Ardanaz, Eva
Rodriguez, Laudina
Sanchez, Maria-Jose
Mendez, Michelle A.
Salmeron, Diego
Barricarte, Aurelio
Burgui, Rosana
Dorronsoro, Miren
Larranaga, Nerea
Molina-Montes, Esther
Moreno-Iribas, Conchi
Quirós, José R.
Toledo, Estefania
Travier, Noemie
Gonzalez, Carlos A.
Navarro, Carmen