Abdominal fat from spine dual-energy x-ray absorptiometry and risk for subsequent diabetes.
BACKGROUND
Abdominal obesity is a major risk factor for diabetes. Dual-energy x-ray absorptiometry (DXA) of the lumbar spine provides an index of abdominal fat.


OBJECTIVE
Our objective was to examine the hypothesis that DXA-derived abdominal fat measurement in women undergoing osteoporosis investigation predicts risk for subsequent diagnosis of diabetes.


METHODS
This historical cohort study was derived from the Manitoba Bone Density Program Database for the Province of Manitoba, Canada.


METHODS
30,252 nondiabetic women aged 40 yr and older were referred for baseline osteoporosis assessment with DXA between January 1990 and March 2007.


METHODS
Each woman's longitudinal provincial health service record was assessed for the presence of diabetes diagnosis codes after DXA testing.


RESULTS
During 5.2 + or - 2.6 yr of observation, 1252 (4.1%) women met the case definition for diabetes. A greater proportion of abdominal fat from spine DXA was strongly related to subsequent diabetes diagnosis in models adjusted for age, body mass index, and other comorbidities. Those in the highest quintile had 3.56 (95% confidence interval = 2.67-4.75) times the risk for subsequent diabetes diagnosis compared with those in the lowest (reference) quintile. Fat from hip DXA was not predictive of subsequent diabetes after adjustment for the same variables (1.00, 95% confidence interval = 0.79-1.26).


CONCLUSIONS
Predictive information about diabetes risk can be obtained from spine DXA scans performed for osteoporosis risk assessment. This is consistent with evidence linking abdominal fat with insulin resistance and the metabolic syndrome.
Leslie
William D
WD
University of Manitoba, Winnipeg, Canada R2H 2A6. bleslie@sbgh.mb.ca
Ludwig
Sora M
SM
Morin
Suzanne
S
D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001823:Body Composition; D015519:Bone Density; D002170:Canada; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006306:Health Surveys; D006801:Humans; D007333:Insulin Resistance; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000150:complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012307:Risk Factors