Associations between general and abdominal adiposity and mortality in individuals with diabetes mellitus

Diewertje Sluik, Heiner Boeing, Jukka Montonen, Tobias Pischon, Rudolf Kaaks, Birgit Teucher, Anne Tjønneland, Jytte Halkjaer, Tina L Berentzen, Kim Overvad, Larraitz Arriola, Eva Ardanaz, Benedetta Bendinelli, Sara Grioni, Rosario Tumino, Carlotta Sacerdote, Amalia Mattiello, Annemieke M W Spijkerman, Daphne L van der, Joline W BeulensYvonne T van der Schouw, Carl Martin Peter Nilsson, Bo Hedblad, Olov Rolandsson, Paul W Franks, Ute Nöthlings

    75 Citations (Scopus)


    Individuals with diabetes mellitus are advised to achieve a healthy weight to prevent complications. However, fat mass distribution has hardly been investigated as a risk factor for diabetes complications. The authors studied associations between body mass index, waist circumference, waist/hip ratio, and waist/height ratio and mortality among individuals with diabetes mellitus. Within the European Prospective Investigation into Cancer and Nutrition, a subcohort was defined as 5,435 individuals with a confirmed self-report of diabetes mellitus at baseline in 1992-2000. Participants were aged 57.3 (standard deviation, 6.3) years, 54% were men, the median diabetes duration was 4.6 (interquartile range, 2.0-9.8) years, and 22% of the participants used insulin. Body mass index, as indicator of general obesity, was not associated with higher mortality, whereas all measurements of abdominal obesity showed a positive association. Associations generally were slightly weaker in women. The strongest association was observed for waist/height ratio: In the fifth quintile, the hazard rate ratio was 1.88 (95% confidence interval: 1.33, 2.65) for men and 2.46 (95% confidence interval: 1.46, 4.14) for women. Measurements of abdominal, but not general, adiposity were associated with higher mortality in diabetic individuals. The waist/height ratio showed the strongest association. Respective indicators might be investigated in risk prediction models.
    Original languageEnglish
    JournalAmerican Journal of Epidemiology
    Issue number1
    Pages (from-to)22-34
    Number of pages13
    Publication statusPublished - 2011


    • Abdominal Fat
    • Adult
    • Aged
    • Body Height
    • Body Mass Index
    • Cohort Studies
    • Confidence Intervals
    • Diabetes Complications
    • Diabetes Mellitus
    • Diabetes Mellitus, Type 2
    • Europe
    • Female
    • Humans
    • Life Style
    • Male
    • Middle Aged
    • Multivariate Analysis
    • Obesity, Abdominal
    • Odds Ratio
    • Prevalence
    • Proportional Hazards Models
    • Questionnaires
    • Risk Factors
    • Waist Circumference
    • Waist-Hip Ratio


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