Department of Primary Care and Population Health, University College London Medical School, Hampstead Campus, Rowland Hill St, London NW3 2PF, UK.
Diabetologia. 2010 May;53(5):890-8. doi: 10.1007/s00125-010-1670-7. Epub 2010 Feb 10.
AIMS/HYPOTHESIS: The aim of this study was to examine whether waist circumference (WC) or WHR improve diabetes prediction beyond body mass index in older men and women, and to define optimal cut-off points.
In this prospective study, non-diabetic men (n = 3,519) and women (n = 3,404) aged 60-79 years were followed up for 7 years. There were 169 and 128 incident cases of type 2 diabetes in men and women, respectively.
BMI, WC and WHR all showed strong associations with incident type 2 diabetes independent of potential confounders. In men, the adjusted relative risks (top vs lowest quartile) were 4.71 (95% CI 2.45-9.03) for BMI, 3.53 (95% CI 1.92-6.48) for WC and 2.76 (95% CI 1.58-4.82) for WHR. For women, the corresponding relative risks were 4.10 (95% CI 2.16-7.79), 12.18 (95% CI 4.83-30.74) and 5.61 (95% CI 2.84-11.09) for BMI, WC and WHR, respectively. Receiver-operating characteristic curve analysis revealed similar associations for BMI and WC in predicting diabetes in men (AUC = 0.726 and 0.713, respectively); WHR was the weakest predictor (AUC = 0.656). In women, WC was a significantly stronger predictor (AUC = 0.780) than either BMI (AUC = 0.733) or WHR (AUC = 0.728; p < 0.01 for both). Inclusion of both WC and BMI did not improve prediction beyond BMI alone in men or WC alone in women. Optimal sensitivity and specificity for the prediction of type 2 diabetes was observed at a WC of 100 cm in men and 92 cm in women.
CONCLUSIONS/INTERPRETATION: In older men, BMI and WC yielded similar prediction of risk of type 2 diabetes, whereas WC was clearly a superior predictor in older women.
目的/假设：本研究旨在探讨腰围（WC）或腰臀比（WHR）是否能在老年人中提高糖尿病的预测能力，超过体重指数（BMI），并确定最佳截断点。
在这项前瞻性研究中，随访了年龄在 60-79 岁之间的非糖尿病男性（n=3519）和女性（n=3404）7 年。男性和女性分别有 169 例和 128 例 2 型糖尿病新发病例。
BMI、WC 和 WHR 均与 2 型糖尿病的发生有很强的关联，独立于潜在的混杂因素。在男性中，与最低四分位数相比，调整后的相对风险（最高 vs 最低四分位数）分别为 BMI 4.71（95%CI 2.45-9.03）、WC 3.53（95%CI 1.92-6.48）和 WHR 2.76（95%CI 1.58-4.82）。对于女性，相应的相对风险分别为 BMI 4.10（95%CI 2.16-7.79）、WC 12.18（95%CI 4.83-30.74）和 WHR 5.61（95%CI 2.84-11.09）。受试者工作特征曲线分析显示，BMI 和 WC 在男性糖尿病预测中也有类似的关联（AUC=0.726 和 0.713）；WHR 是最弱的预测因子（AUC=0.656）。在女性中，WC 是一个明显更强的预测因子（AUC=0.780），而 BMI（AUC=0.733）或 WHR（AUC=0.728；均<0.01）。在男性中，WC 和 BMI 联合使用并不能改善 BMI 单独预测的效果，在女性中，WC 单独使用也不能改善预测效果。男性 WC 为 100cm，女性 WC 为 92cm 时，预测 2 型糖尿病的敏感性和特异性最佳。
结论/解释：在老年男性中，BMI 和 WC 对 2 型糖尿病风险的预测能力相似，而 WC 在老年女性中是明显更好的预测因子。
