Associations between general and abdominal adiposity and mortality in individuals with diabetes mellitus

Am J Epidemiol. 2011 Jul 1;174(1):22-34. doi: 10.1093/aje/kwr048. Epub 2011 May 26.

Abstract

Individuals with diabetes mellitus are advised to achieve a healthy weight to prevent complications. However, fat mass distribution has hardly been investigated as a risk factor for diabetes complications. The authors studied associations between body mass index, waist circumference, waist/hip ratio, and waist/height ratio and mortality among individuals with diabetes mellitus. Within the European Prospective Investigation into Cancer and Nutrition, a subcohort was defined as 5,435 individuals with a confirmed self-report of diabetes mellitus at baseline in 1992-2000. Participants were aged 57.3 (standard deviation, 6.3) years, 54% were men, the median diabetes duration was 4.6 (interquartile range, 2.0-9.8) years, and 22% of the participants used insulin. Body mass index, as indicator of general obesity, was not associated with higher mortality, whereas all measurements of abdominal obesity showed a positive association. Associations generally were slightly weaker in women. The strongest association was observed for waist/height ratio: In the fifth quintile, the hazard rate ratio was 1.88 (95% confidence interval: 1.33, 2.65) for men and 2.46 (95% confidence interval: 1.46, 4.14) for women. Measurements of abdominal, but not general, adiposity were associated with higher mortality in diabetic individuals. The waist/height ratio showed the strongest association. Respective indicators might be investigated in risk prediction models.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdominal Fat / physiopathology
  • Adult
  • Aged
  • Body Height*
  • Body Mass Index
  • Cohort Studies
  • Confidence Intervals
  • Diabetes Complications / mortality*
  • Diabetes Mellitus / mortality
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / mortality*
  • Europe / epidemiology
  • Female
  • Humans
  • Life Style
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Obesity, Abdominal / complications
  • Obesity, Abdominal / mortality*
  • Obesity, Abdominal / physiopathology
  • Odds Ratio
  • Prevalence
  • Proportional Hazards Models
  • Risk Factors
  • Surveys and Questionnaires
  • Waist Circumference*
  • Waist-Hip Ratio