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Epidemiologic Reviews Advance Access published online on May 10, 2007
Epidemiologic Reviews, doi:10.1093/epirev/mxm008
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Epidemiologic Reviews Copyright © 2007 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.

Article

Comparison of Body Mass Index, Waist Circumference, and Waist/Hip Ratio in Predicting Incident Diabetes: A Meta-Analysis

Gabriela Vazquez1, Sue Duval1, David R. Jacobs, Jr.1 and Karri Silventoinen2

1 Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
2 Department of Public Health, University of Helsinki, Helsinki, Finland

Correspondence to Gabriela Vazquez, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South Second Street, Suite 300, Minneapolis, MN 55454 (e-mail: vazquez{at}epi.umn.edu).

accepted for publication February 19, 2007.

Body mass index, waist circumference, and waist/hip ratio have been shown to be associated with type 2 diabetes. From the clinical perspective, central obesity (approximated by waist circumference or waist/hip ratio) is known to generate diabetogenic substances and should therefore be more informative than general obesity (body mass index). Because of their high correlation, from the statistical perspective, body mass index and waist circumference are unlikely to yield different answers. To compare associations of diabetes incidence with general and central obesity indicators, the authors conducted a meta-analysis based on published studies from 1966 to 2004 retrieved from a PubMed search. The analysis was performed with 32 studies out of 432 publications initially identified. Measures of association were transformed to log relative risks per standard deviation (pooled across all studies) increase in the obesity indicator and pooled using random effects models. The pooled relative risks for incident diabetes were 1.87 (95% confidence interval (CI): 1.67, 2.10), 1.87 (95% CI: 1.58, 2.20), and 1.88 (95% CI: 1.61, 2.19) per standard deviation of body mass index, waist circumference, and waist/hip ratio, respectively, demonstrating that these three obesity indicators have similar associations with incident diabetes. Although the clinical perspective focusing on central obesity is appealing, further research is needed to determine the usefulness of waist circumference or waist/hip ratio over body mass index.

body fat distribution • body mass index • diabetes mellitus, type 2 • meta-analysis • obesity • waist-hip ratio

BMI, body mass indexCI, confidence intervalRR, relative riskSD, standard deviationWC, waist circumferenceWHR, waist/hip ratio


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