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Long-Term Risk of Incident Type 2 Diabetes and Measures of Overall and Regional Obesity: The EPIC-InterAct Case-Cohort Study

Langenberg, Claudia; Sharp, Stephen J.; Schulze, Matthias B.; Rolandsson, Olov; Overvad, Kim; Forouhi, Nita G.; Spranger, Joachim; Drogan, Dagmar; Maria Huerta, Jose and Arriola, Larraitz, et al. (2012) In PLoS Medicine 9(6).
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... (More)
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. (Less)
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PLoS Medicine
volume
9
issue
6
publisher
Public Library of Science
external identifiers
  • WOS:000305946200005
  • Scopus:84864659280
ISSN
1549-1676
DOI
10.1371/journal.pmed.1001230
language
English
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yes
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0231f964-2826-49ae-996a-dfb210e748c0 (old id 3001805)
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2012-09-03 07:20:41
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2016-11-06 04:36:19
@misc{0231f964-2826-49ae-996a-dfb210e748c0,
  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/m(2)) with a low WC (&lt; 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 &gt;= 35 kg/m(2)) and a high WC (&gt; 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.},
  author       = {Langenberg, Claudia and Sharp, Stephen J. and Schulze, Matthias B. and Rolandsson, Olov and Overvad, Kim and Forouhi, Nita G. and Spranger, Joachim and Drogan, Dagmar and Maria Huerta, Jose and Arriola, Larraitz and de Lauzon-Guillan, Blandine and Tormo, Maria-Jose and Ardanaz, Eva and Balkau, Beverley and Beulens, Joline W. J. and Boeing, Heiner and Bueno-de-Mesquita, H. Bas and Clavel-Chapelon, Francoise and Crowe, Francesca L. and Franks, Paul and Gonzalez, Carlos A. and Grioni, Sara and Halkjaer, Jytte and Hallmans, Goran and Kaaks, Rudolf and Kerrison, Nicola D. and Key, Timothy J. and Khaw, Kay Tee and Mattiello, Amalia and Nilsson, Peter and Norat, Teresa and Palla, Luigi and Palli, Domenico and Panico, Salvatore and Ramon Quiros, J. and Romaguera, Dora and Romieu, Isabelle and Sacerdote, Carlotta and Sanchez, Maria-Jose and Slimani, Nadia and Sluijs, Ivonne and Spijkerman, Annemieke M. W. and Teucher, Birgit and Tjonneland, Anne and Tumino, Rosario and Daphne, L. van der A. and van der Schouw, Yvonne T. and Feskens, Edith J. M. and Riboli, Elio and Wareham, Nicholas J.},
  issn         = {1549-1676},
  language     = {eng},
  number       = {6},
  publisher    = {ARRAY(0xa1c2448)},
  series       = {PLoS Medicine},
  title        = {Long-Term Risk of Incident Type 2 Diabetes and Measures of Overall and Regional Obesity: The EPIC-InterAct Case-Cohort Study},
  url          = {http://dx.doi.org/10.1371/journal.pmed.1001230},
  volume       = {9},
  year         = {2012},
}