Relation of central adiposity and body mass index to the development of diabetes in the Diabetes Prevention Program.
BACKGROUND
Greater central adiposity is related to the risk of diabetes.


OBJECTIVE
We aimed to test the hypothesis that central adiposity measured by computed tomography (CT) is a better predictor of the risk of diabetes than is body mass index (BMI), waist circumference (WC), waist/hip ratio (WHR), or waist/height ratio.


METHODS
Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were measured at the L2-3 and L4-5 disc spaces in 1106 of the 3234 participants in the Diabetes Prevention Program. Sex-specific proportional hazards models were used to evaluate the association between VAT and SAT at both cuts, BMI, and other measures of central adiposity as predictors of the development of diabetes.


RESULTS
Men had more VAT than did women. White subjects had more VAT at both cuts than did other ethnic groups. The ratio of VAT to SAT was lowest in African Americans of both sexes. Among men in the placebo group, VAT at both cuts, WC, BMI, waist/height ratio, and WHR predicted diabetes (hazard ratio: 1.79-1.44 per 1 SD of variable). Among women in the lifestyle group, VAT at both cuts predicted diabetes as well as did BMI, and L2-3 was a significantly better predictor than was WC or WHR. SAT did not predict diabetes. None of the body fat measurements predicted diabetes in the metformin group.


CONCLUSIONS
In the placebo and lifestyle groups, VAT at both cuts, WHR, and WC predicted diabetes. No measure predicted diabetes in the metformin group. CT provided no important advantage over these simple measures. SAT did not predict diabetes.
Bray
George A
GA
Pennington Biomedical Research Center, Baton Rouge, LA, USA. dppmail@biostat.bsc.gwu.edu
Jablonski
Kathleen A
KA
Fujimoto
Wilfred Y
WY
Barrett-Connor
Elizabeth
E
Haffner
Steven
S
Hanson
Robert L
RL
Hill
James O
JO
Hubbard
Van
V
Kriska
Andrea
A
Stamm
Elizabeth
E
Pi-Sunyer
F Xavier
FX
D000328:Adult; D001823:Body Composition / Q000502:physiology*; D001827:Body Height / Q000502:physiology; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D005006:Ethnicity; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D050152:Intra-Abdominal Fat / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D008019:Life Style; D008159:Lumbar Vertebrae; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000628:therapy; D011237:Predictive Value of Tests; D011322:Primary Prevention; D016016:Proportional Hazards Models; D012307:Risk Factors; D012737:Sex Factors; D050151:Subcutaneous Fat / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D049629:Waist-Hip Ratio
D007004:Hypoglycemic Agents; D008687:Metformin