title: Risk of type 2 diabetes according to traditional and emerging anthropometric indices in Spain, a Mediterranean country with high prevalence of obesity: results from a large-scale prospective cohort study.
abstract: BACKGROUND
  Obesity is a major risk factor for type 2 diabetes mellitus (T2DM). A proper anthropometric characterisation of T2DM risk is essential for disease prevention and clinical risk assessement.
  
  
  METHODS
  Longitudinal study in 37 733 participants (63% women) of the Spanish EPIC (European Prospective Investigation into Cancer and Nutrition) cohort without prevalent diabetes. Detailed questionnaire information was collected at baseline and anthropometric data gathered following standard procedures. A total of 2513 verified incident T2DM cases occurred after 12.1 years of mean follow-up. Multivariable Cox regression was used to calculate hazard ratios of T2DM by levels of anthropometric variables.
  
  
  RESULTS
  Overall and central obesity were independently associated with T2DM risk. BMI showed the strongest association with T2DM in men whereas waist-related indices were stronger independent predictors in women. Waist-to-height ratio revealed the largest area under the ROC curve in men and women, with optimal cut-offs at 0.60 and 0.58, respectively. The most discriminative waist circumference (WC) cut-off values were 99.4 cm in men and 90.4 cm in women. Absolute risk of T2DM was higher in men than women for any combination of age, BMI and WC categories, and remained low in normal-waist women. The population risk of T2DM attributable to obesity was 17% in men and 31% in women.
  
  
  CONCLUSIONS
  Diabetes risk was associated with higher overall and central obesity indices even at normal BMI and WC values. The measurement of waist circumference in the clinical setting is strongly recommended for the evaluation of future T2DM risk in women.
authors: Department of Epidemiology, Murcia Regional Health Authority, Murcia, Spain. mjose.tormo@carm.es.
authors: José María
authors: JM
authors: Huerta
authors: María-José
authors: MJ
authors: Tormo
authors: María-Dolores
authors: MD
authors: Chirlaque
authors: Diana
authors: D
authors: Gavrila
authors: Pilar
authors: P
authors: Amiano
authors: Larraitz
authors: L
authors: Arriola
authors: Eva
authors: E
authors: Ardanaz
authors: Laudina
authors: L
authors: Rodríguez
authors: María-José
authors: MJ
authors: Sánchez
authors: Michelle
authors: M
authors: Mendez
authors: Diego
authors: D
authors: Salmerón
authors: Aurelio
authors: A
authors: Barricarte
authors: Rosana
authors: R
authors: Burgui
authors: Miren
authors: M
authors: Dorronsoro
authors: Nerea
authors: N
authors: Larrañaga
authors: Esther
authors: E
authors: Molina-Montes
authors: Conchi
authors: C
authors: Moreno-Iribas
authors: José Ramón
authors: JR
authors: Quirós
authors: Estefanía
authors: E
authors: Toledo
authors: Noémie
authors: N
authors: Travier
authors: Carlos A
authors: CA
authors: González
authors: Carmen
authors: C
authors: Navarro
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