title: Body fat distribution and risk of type 2 diabetes in the general population: are there differences between men and women? The MONICA/KORA Augsburg cohort study.
abstract: BACKGROUND
  It remains controversial whether body mass index (BMI), waist circumference (WC), or waist-hip ratio (WHR) is a better risk predictor of type 2 diabetes.
  
  
  OBJECTIVE
  The objective was to examine the sex-specific relevance of WC, WHR, and BMI to the development of type 2 diabetes.
  
  
  METHODS
  The prospective population-based cohort study was based on 3055 men and 2957 women aged 35-74 y who participated in the second (1989-1990) or third (1994-1995) MONICA (Monitoring Trends and Determinants on Cardiovascular Diseases) Augsburg survey. The subjects were free of diabetes at baseline. Hazard ratios (HRs) were estimated from Cox proportional hazards models.
  
  
  RESULTS
  During a mean follow-up of 9.2 y, 243 cases of incident type 2 diabetes occurred in men and 158 occurred in women. Multivariable-adjusted HRs across quartiles of BMI were 1.0, 1.37, 2.08, and 4.15 in men and 1.0, 3.77, 4.95, and 10.58 in women; those of WC were 1.0, 1.15, 1.57, and 3.40 in men and 1.0, 3.21, 3.98, and 10.70 in women; those of WHR were 1.0, 1.14, 1.80, and 2.84 in men and 1.0, 0.82, 2.06, and 3.51 in women. In joint analyses, the highest risk was observed in men and women with a high BMI in combination with a high WC and a high WHR.
  
  
  CONCLUSIONS
  Both overall and abdominal adiposity were strongly related to the development of type 2 diabetes. Because there was an additive effect of overall and abdominal obesity on risk prediction, WC should be measured in addition to BMI to assess the risk of type 2 diabetes in both sexes.
authors.affiliation: GSF National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg, Germany. christa.meisinger@gsf.de
authors.forename: Christa
authors.initials: C
authors.lastname: Meisinger
authors.forename: Angela
authors.initials: A
authors.lastname: Döring
authors.forename: Barbara
authors.initials: B
authors.lastname: Thorand
authors.forename: Margit
authors.initials: M
authors.lastname: Heier
authors.forename: Hannelore
authors.initials: H
authors.lastname: Löwel
mesh_terms: D050153:Abdominal Fat / Q000378:metabolism*; D000328:Adult; D000368:Aged; D001823:Body Composition / Q000502:physiology*; D050218:Body Fat Distribution; D015992:Body Mass Index; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D049629:Waist-Hip Ratio