title: BMI and waist circumference are associated with impaired glucose metabolism and type 2 diabetes in normal weight Chinese adults.
abstract: OBJECTIVE
  To examine the associations of BMI and waist circumference with glucose metabolism and (pre)diabetes among adults with BMI < 25 kg/m².
  
  
  METHODS
  We conducted a cross-sectional study in a nationally representative sample (10,098 men and 17,454 women) of Chinese adults aged ≥ 20 years with BMI < 25 kg/m². Glucose levels after at least 10 hours of overnight fasting, at 30 minutes and at 120 minutes after a standard 75-g oral glucose load were measured. Associations of BMI and waist circumference with outcomes were examined by general linear models for continuous outcomes and by logistic regression models for dichotomous outcomes.
  
  
  RESULTS
  Among those with BMI < 25 kg/m², 18.8% of men and 17.1% of women had abnormal glucose metabolism, including 4.9% of men and 3.8% of women with undiagnosed type 2 diabetes. For each SD increase in BMI (2.1 kg/m²) and waist circumference (8.3 cm), fasting glucose levels increased by 0.128 and 0.170 mmol/L in men, and by 0.112 and 0.167 mmol/L in women, respectively; the corresponding increases for 2-hour post-load glucose levels were 0.121 and 0.217 mmol/L in men, and 0.241 and 0.362 mmol/L in women. When simultaneously included in the same model, these associations with waist circumference were stronger than with BMI.
  
  
  CONCLUSIONS
  Obesity measures are associated with abnormal glucose metabolism and diabetes, with central obesity playing a more prominent role than general obesity in Chinese population with BMI < 25 kg/m². Chinese diabetes prevention and treatment programs should incorporate targeting of normal weight adults with central obesity.
authors.affiliation: Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA.
authors.forename: Shengxu
authors.initials: S
authors.lastname: Li
authors.affiliation: China-Japan Friendship Hospital, Beijing, China.
authors.forename: Jianzhong
authors.initials: J
authors.lastname: Xiao
authors.affiliation: Peking University Peoples' Hospital, Beijing, China.
authors.forename: Linong
authors.initials: L
authors.lastname: Ji
authors.affiliation: Sun Yat-sen University Third Hospital, Guangzhou, China.
authors.forename: Jianping
authors.initials: J
authors.lastname: Weng
authors.affiliation: Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Weiping
authors.initials: W
authors.lastname: Jia
authors.affiliation: Chinese PLA General Hospital, Beijing, China.
authors.forename: Juming
authors.initials: J
authors.lastname: Lu
authors.affiliation: Xiangya Second Hospital, Hunan, China.
authors.forename: Zhiguang
authors.initials: Z
authors.lastname: Zhou
authors.affiliation: Peking University First Hospital, Beijing, China.
authors.forename: Xiaohui
authors.initials: X
authors.lastname: Guo
authors.affiliation: Shanxi Province People's Hospital, Shanxi, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Liu
authors.affiliation: The First Affiliated Hospital, Chinese Medical University, Liaoning, China.
authors.forename: Zhongyan
authors.initials: Z
authors.lastname: Shan
authors.affiliation: The Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu, China.
authors.forename: Dalong
authors.initials: D
authors.lastname: Zhu
authors.affiliation: Qilu Hospital, Qilu Hospital of Shandong University, Shandong, China.
authors.forename: Li
authors.initials: L
authors.lastname: Chen
authors.affiliation: Henan Province People's Hospital, Henan, China.
authors.forename: Zhigang
authors.initials: Z
authors.lastname: Zhao
authors.affiliation: West China Hospital, Sichuan University, Sichuan, China.
authors.forename: Haoming
authors.initials: H
authors.lastname: Tian
authors.affiliation: Xijing Hospital, Fourth Military Medical University, Shaanxi, China.
authors.forename: Qiuhe
authors.initials: Q
authors.lastname: Ji
authors.affiliation: Xinjiang Uygur Autonomous Region's Hospital, Xinjiang, China.
authors.forename: Jiapu
authors.initials: J
authors.lastname: Ge
authors.affiliation: The Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.affiliation: Fujian Provincial Hospital, Fujian, China.
authors.forename: Lixiang
authors.initials: L
authors.lastname: Lin
authors.affiliation: China-Japan Friendship Hospital, Beijing, China.
authors.forename: Zhaojun
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA.
authors.forename: Jiang
authors.initials: J
authors.lastname: He
authors.affiliation: China-Japan Friendship Hospital, Beijing, China. Electronic address: ywying_1010@163.com.
authors.forename: Wenying
authors.initials: W
authors.lastname: Yang
mesh_terms: D000005:Abdomen; D050154:Adiposity; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D018149:Glucose Intolerance / Q000097:blood / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000097:blood / Q000453:epidemiology* / Q000473:pathology; D015995:Prevalence; D012307:Risk Factors; D055105:Waist Circumference; D055815:Young Adult
chemical_list: D001786:Blood Glucose
keywords: BMI; China; Glucose metabolism; Type 2 diabetes; Waist circumference