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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.
PLoS Med 2012; 9(6):e1001230PM

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 (<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.

Authors

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Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22679397

Citation

InterAct Consortium, et al. "Long-term Risk of Incident Type 2 Diabetes and Measures of Overall and Regional Obesity: the EPIC-InterAct Case-cohort Study." PLoS Medicine, vol. 9, no. 6, 2012, pp. e1001230.
InterAct Consortium, Langenberg C, Sharp SJ, et al. Long-term risk of incident type 2 diabetes and measures of overall and regional obesity: the EPIC-InterAct case-cohort study. PLoS Med. 2012;9(6):e1001230.
Langenberg, C., Sharp, S. J., Schulze, M. B., Rolandsson, O., Overvad, K., Forouhi, N. G., ... Wareham, N. J. (2012). Long-term risk of incident type 2 diabetes and measures of overall and regional obesity: the EPIC-InterAct case-cohort study. PLoS Medicine, 9(6), pp. e1001230. doi:10.1371/journal.pmed.1001230.
InterAct Consortium, et al. Long-term Risk of Incident Type 2 Diabetes and Measures of Overall and Regional Obesity: the EPIC-InterAct Case-cohort Study. PLoS Med. 2012;9(6):e1001230. PubMed PMID: 22679397.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term risk of incident type 2 diabetes and measures of overall and regional obesity: the EPIC-InterAct case-cohort study. AU - ,, 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,H 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 - Tjonneland,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, Y1 - 2012/06/05/ PY - 2011/10/23/received PY - 2012/04/24/accepted PY - 2012/6/9/entrez PY - 2012/6/9/pubmed PY - 2012/12/10/medline SP - e1001230 EP - e1001230 JF - PLoS medicine JO - PLoS Med. VL - 9 IS - 6 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. SN - 1549-1676 UR - https://www.unboundmedicine.com/medline/citation/22679397/Long_term_risk_of_incident_type_2_diabetes_and_measures_of_overall_and_regional_obesity:_the_EPIC_InterAct_case_cohort_study_ L2 - http://dx.plos.org/10.1371/journal.pmed.1001230 DB - PRIME DP - Unbound Medicine ER -