Predictors of incident diabetes mellitus in Basrah, Iraq.
New-onset diabetes was associated with a 90% increase in risk of all-cause mortality and a 120% increase in risk of cardiovascular mortality compared with study participants without diabetes. The aim of this study was to study prospectively the predictors of incident diabetes mellitus in Basrah, Iraq, with special emphasis on predictive performance of the four anthropometric variables of obesity, namely body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHpR) or waist-to-height ratio (WHtR).
A total of 13,730 subjects (7,101 males and 6,629 females) diabetes-free at baseline were followed for a mean of 5 years (January 2001 to end of December 2006).
There were 935 (6.80%) cases of incident diabetes (513 males and 422 females). All anthropometric indices (BMI, WC, WHpR, WHtR) were higher among those with incident diabetes (p < 0.001). In both sexes, WHpR has the strongest associations with incident diabetes that was gender-insensitive (AUC = 0.74 in males and 0.72 in females) followed by WC and then BMI which has the weakest association with incident diabetes. On multivariable logistic regression, only hypertension (OR 1.66; 95% CI 1.41-1.96; p < 0.001) was associated with incident diabetes. All anthropometric indices were significantly associated with incident diabetes except WHtR. There was no association between incident diabetes and gender, age, stroke, and ischemic heart disease.
In both sexes, WHpR has the strongest associations with incident diabetes, followed by WC then BMI which has the weakest association with incident diabetes, while WHtR has no association. Hypertension is the only non-anthropometric variable associated with incident diabetes.
Mansour AA
，Al-Jazairi MI
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References of anthropometric indices of central obesity and metabolic syndrome in Jordanian men and women.
To set references and evaluate the associations between the predictive powers of the anthropometric indices of obesity, particularly central obesity, including body mass index (BMI), waist circumference (WC), waist to hip ratio (WHpR) and waist to height ratio (WHtR), and the risk factor accumulations of ≥ 2 of the components of the metabolic syndrome (MS) in a group of Jordanian men and women.
Five hundreds subjects were randomly selected from among the visitors attending several family clinics in Amman. Obesity was assessed using BMI, WC, WHpR and WHtR anthropometric indices. MS risk factors as defined by the International Diabetes Federation were determined. Receiver operating characteristic curve (ROC) analysis was used to determine the predictive powers and the cut off points of each index associated with increased MS risk.
There were 212 men and 288 women with age ranged 20-85 years. Optimal cut off points of BMI, WC, WHpR for MS diagnosis in men were 28.4 kg/m(2), 97.8 cm and 0.89, respectively. In women, these were 30.3 kg/m(2), 95.6 cm and 0.84, respectively. WHtR was 0.61 in both genders. Area under the curve (AUC) of ROC analysis for identifying of MS (≥ 2 risk factors) was the highest for WHpR (AUC=0.71), followed by WHtR (AUC=0.67), WC (AUC=0.64) and BMI (AUC=0.59) in men; whereas in women WHpR, WHtR and WC were almost equal (AUC=0.76, 0.75 and 0.74, respectively), followed by BMI (AUC=0.67). Correlation coefficients (r) between WHpR and MS risk factors were the strongest among the other obesity indices, followed by WC and WHtR. WHpR correlated significantly with FBG (r=0.27, p<0.01), systolic blood pressure (r=0.20, p<0.01), TGs (r=0.24, p<0.01) and HDL-C (r=-0.39, p<0.01). The respective r-values between WC and WHtR and each MS risk factors were: FBG (r=0.15, p<0.001 or r=0.13, p<0.01), systolic blood pressure (r=0.16, p<0.01 or r=0.11, p<0.05), TGs (r=0.20, p<0.01 or r=0.14, p<0.01) and HDL-C (r=-0.25, p<0.01 or r=-0.11, p<0.01).
This study showed that BMI tended to be the weakest index for identifying MS risk factors in both sexes. WHpR exhibited the best predictive index for MS, particularly in men. Almost similar predictive powers of WHtR, WHpR and WC for identifying MS risk factors were seen in women. WHtR had the highest sensitivity for MS diagnosis among obesity indices in men and its boundary value was the same for both men and women. These cut off values of obesity particularly waist circumference should be advocated and used in Arab Jordanians until larger cross sectional studies shows different results.
Al-Odat AZ
，Ahmad MN
，Haddad FH
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