title: Anthropometric markers and their association with incident type 2 diabetes mellitus: which marker is best for prediction? Pooled analysis of four German population-based cohort studies and comparison with a nationwide cohort study.
abstract: OBJECTIVE
  To compare the association between different anthropometric measurements and incident type 2 diabetes mellitus (T2DM) and to assess their predictive ability in different regions of Germany.
  
  
  METHODS
  Data of 10,258 participants from 4 prospective population-based cohorts were pooled to assess the association of body weight, body mass index (BMI), waist circumference (WC), waist-to-hip-ratio (WHR) and waist-to-height-ratio (WHtR) with incident T2DM by calculating HRs of the crude, adjusted and standardised markers, as well as providing receiver operator characteristic (ROC) curves. Differences between HRs and ROCs for the different anthropometric markers were calculated to compare their predictive ability. In addition, data of 3105 participants from the nationwide survey were analysed separately using the same methods to provide a nationally representative comparison.
  
  
  RESULTS
  Strong associations were found for each anthropometric marker and incidence of T2DM. Among the standardised anthropometric measures, we found the strongest effect on incident T2DM for WC and WHtR in the pooled sample (HR for 1 SD difference in WC 1.97, 95% CI 1.75 to 2.22, HR for WHtR 1.93, 95% CI 1.71 to 2.17 in women) and in female DEGS participants (HR for WC 2.24, 95% CI 1.91 to 2.63, HR for WHtR 2.10, 95% CI 1.81 to 2.44), whereas the strongest association in men was found for WHR among DEGS participants (HR 2.29, 95% CI 1.89 to 2.78). ROC analysis showed WHtR to be the strongest predictor for incident T2DM. Differences in HR and ROCs between the different markers confirmed WC and WHtR to be the best predictors of incident T2DM. Findings were consistent across study regions and age groups (<65 vs ≥ 65 years).
  
  
  CONCLUSIONS
  We found stronger associations between anthropometric markers that reflect abdominal obesity (ie, WC and WHtR) and incident T2DM than for BMI and weight. The use of these measurements in risk prediction should be encouraged.
authors.affiliation: Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany German Center for Diabetes Research (DZD), München-Neuherberg, Germany.
authors.forename: Saskia
authors.initials: S
authors.lastname: Hartwig
authors.affiliation: Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany German Center for Diabetes Research (DZD), München-Neuherberg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kluttig
authors.affiliation: Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Tiller
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Fricke
authors.affiliation: Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany.
authors.forename: Grit
authors.initials: G
authors.lastname: Müller
authors.affiliation: German Center for Diabetes Research (DZD), München-Neuherberg, Germany Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Schipf
authors.affiliation: German Center for Diabetes Research (DZD), München-Neuherberg, Germany Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Henry
authors.initials: H
authors.lastname: Völzke
authors.affiliation: Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.
authors.forename: Michaela
authors.initials: M
authors.lastname: Schunk
authors.affiliation: German Center for Diabetes Research (DZD), München-Neuherberg, Germany Institute of Epidemiology II, Helmholtz Zentrum München, Neuherberg, Germany.
authors.forename: Christa
authors.initials: C
authors.lastname: Meisinger
authors.affiliation: Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Schienkiewitz
authors.affiliation: Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
authors.forename: Christin
authors.initials: C
authors.lastname: Heidemann
authors.affiliation: Institute for Medical Informatics, Biometry, and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Moebus
authors.affiliation: Institute for Medical Informatics, Biometry, and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.
authors.forename: Sonali
authors.initials: S
authors.lastname: Pechlivanis
authors.affiliation: Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Werdan
authors.affiliation: German Center for Diabetes Research (DZD), München-Neuherberg, Germany Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Kuss
authors.affiliation: Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Teresa
authors.initials: T
authors.lastname: Tamayo
authors.affiliation: Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Haerting
authors.affiliation: Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany German Center for Diabetes Research (DZD), München-Neuherberg, Germany Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Karin Halina
authors.initials: KH
authors.lastname: Greiser
mesh_terms: D000886:Anthropometry; D015992:Body Mass Index; D001835:Body Weight; D015331:Cohort Studies; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000453:epidemiology; D055105:Waist Circumference; D065927:Waist-Height Ratio; D049629:Waist-Hip Ratio
keywords: EPIDEMIOLOGY; PUBLIC HEALTH