title: Best anthropometric discriminators of incident type 2 diabetes among white and black adults: A longitudinal ARIC study.
abstract: OBJECTIVE
  To determine which anthropometric measures are the strongest discriminators of incident type 2 diabetes (T2DM) among White and Black males and females in a large U.S. cohort.
  
  
  METHODS
  We used Atherosclerosis Risk in Communities study data from 12,121 participants aged 45-64 years without diabetes at baseline who were followed for over 11 years. Anthropometric measures included a body shape index (ABSI), body adiposity index (BAI), body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), waist to height ratio (WHtR), and waist to hip to height ratio (WHHR). All anthropometric measures were repeated at each visit and converted to Z-scores. Hazard ratios and 95% confidence intervals adjusted for age were calculated using repeated measures Cox proportional hazard regression analysis. Akaike Information Criteria was used to select best-fit models. The magnitude of the hazard ratio effect sizes and the Harrell's C-indexes were used to rank the highest associations and discriminators, respectively.
  
  
  RESULTS
  There were 1,359 incident diabetes cases. Higher values of all anthropometric measures increased the risk for development of T2DM (p < 0.0001) except ABSI, which was not significant in White and Black males. Statistically significant hazard ratios ranged from 1.26-1.63 for males and 1.15-1.88 for females. In general, the largest hazard ratios were those that corresponded to the highest Harrell's C-Index and lowest Akaike Information Criteria values. Among White and Black males and females, BMI, WC, WHR, and WHtR were comparable in discriminating cases from non-cases of T2DM. ABSI, BAI, and WHHR were inferior discriminators of incident T2DM across all race-gender groups.
  
  
  CONCLUSIONS
  BMI, the most commonly used anthropometric measure, and three anthropometric measures that included waist circumference (i.e., WC, WHR, WHtR) were the best anthropometric discriminators of incident T2DM across all race-gender groups in the ARIC cohort.
authors.affiliation: Institute of Public and Preventive Health, Augusta University, Augusta, Georgia, United States of America.
authors.forename: Dale S
authors.identifier: http://orcid.org/0000-0001-8778-5661
authors.initials: DS
authors.lastname: Hardy
authors.affiliation: School of Nursing, Saint Louis University, St. Louis, Missouri, United States of America.
authors.forename: Devita T
authors.initials: DT
authors.lastname: Stallings
authors.affiliation: College of Nursing, Augusta University, Augusta, Georgia, United States of America.
authors.forename: Jane T
authors.initials: JT
authors.lastname: Garvin
authors.affiliation: Department of Biostatistics and Epidemiology, Augusta University, Augusta, Georgia, United States of America.
authors.forename: Hongyan
authors.initials: H
authors.lastname: Xu
authors.affiliation: Program in Physical Therapy and Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America.
authors.forename: Susan B
authors.initials: SB
authors.lastname: Racette
mesh_terms: D000328:Adult; D000886:Anthropometry; D050197:Atherosclerosis / Q000453:epidemiology*; D044383:Black People / Q000706:statistics & numerical data*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D012307:Risk Factors; D044465:White People / Q000706:statistics & numerical data*