Sensitivity and specificity of anthropometrics for the prediction of diabetes in a biracial cohort.

OBJECTIVE To evaluate the ability of body mass index, waist circumference, waist-to-hip ratio, and combinations of these variables to discriminate individuals who will develop diabetes in adulthood. RESEARCH METHODS AND PROCEDURES Data were from 45- to 64-year-old men and women who were members of the Atherosclerosis Risk in Communities cohort. The analysis sample consisted of 12,814 African American and white participants who were free of diabetes at baseline. Body mass index, waist circumference, waist-to-hip ratio, and diabetes incidence (defined as one glucose measure > or =126 mg/dL after fasting for at least 8 hours, one nonfasting glucose measure > or =200 mg/dL, and self-report of diabetes or report of taking medication for diabetes). RESULTS 1515 new cases of diabetes were identified over the 9-year follow-up. Areas under receiver operating characteristic curves ranged from 0.66 to 0.73 for single measures. The curves were smooth, with no indication of a threshold. Waist tended to have the highest receiver operating characteristic statistic in all groups, but differences were small. DISCUSSION The three anthropometric indices tested were approximately equivalent in their ability to predict diabetes. Sensitivity and specificities differed among ethnic and gender groups.

[1]  J. Tuomilehto,et al.  Abdominal Obesity and Physical Inactivity as Risk Factors for NIDDM and Impaired Glucose Tolerance in Indian, Creole, and Chinese Mauritians , 1991, Diabetes Care.

[2]  S. Haffner,et al.  Incidence of Type II Diabetes in Mexican Americans Predicted by Fasting Insulin and Glucose Levels, Obesity, and Body-Fat Distribution , 1990, Diabetes.

[3]  E. DeLong,et al.  Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. , 1988, Biometrics.

[4]  W. Mueller,et al.  The Diabetes Alert study: growth, fatness, and fat patterning, adolescence through adulthood in Mexican Americans. , 1984, American journal of physical anthropology.

[5]  P. Whincup,et al.  Prospective study of risk factors for development of non-insulin dependent diabetes in middle aged British men , 1995, BMJ.

[6]  M. Harris,et al.  Prevalence of Adult-Onset IDDM in the U.S. Population , 1994, Diabetes Care.

[7]  S. Haffner,et al.  Role of Obesity and Fat Distribution in Non-insulin-dependent Diabetes Mellitus in Mexican Americans and Non-Hispanic Whites , 1986, Diabetes Care.

[8]  A. Folsom,et al.  Increased incidence of diabetes mellitus in relation to abdominal adiposity in older women. , 1991, Journal of clinical epidemiology.

[9]  A. Folsom,et al.  Correlates of body fat distribution. Variation across categories of race, sex, and body mass in the atherosclerosis risk in communities study. The Atherosclerosis Risk in communities (ARIC) Study Investigators. , 1995, Annals of epidemiology.

[10]  P. Björntorp,et al.  The Influence of Body Fat Distribution on the Incidence of Diabetes Mellitus: 13.5 Years of Follow-up of the Participants in the Study of Men Born in 1913 , 1985, Diabetes.

[11]  J. Halter,et al.  Differential effects of BMI on diabetes risk among black and white Americans. , 1998, Diabetes care.

[12]  P. Raskin,et al.  Report of the expert committee on the diagnosis and classification of diabetes mellitus. , 1999, Diabetes care.

[13]  P. Schreiner,et al.  Is fasting insulin concentration inversely associated with rate of weight gain? Contrasting findings from the CARDIA and ARIC study cohorts , 1998, International Journal of Obesity.

[14]  P. Savage,et al.  Diabetes incidence in Pima indians: contributions of obesity and parental diabetes. , 1981, American journal of epidemiology.

[15]  J. Hanley,et al.  The meaning and use of the area under a receiver operating characteristic (ROC) curve. , 1982, Radiology.

[16]  L. Chambless,et al.  Reliability of body fat distribution measurements. The ARIC Study baseline cohort results. Atherosclerosis Risk in Communities Study. , 1995, International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity.

[17]  A. Folsom,et al.  The Atherosclerosis Risk in Communities (ARIC) Study: design and objectives. The ARIC investigators. , 1989, American journal of epidemiology.

[18]  A. Folsom,et al.  Differences between respondents and nonrespondents in a multicenter community-based study vary by gender and ethnicity , 1996 .

[19]  P. Wahl,et al.  Association of Elevated Fasting C-Peptide Level and Increased Intra-Abdominal Fat Distribution With Development of NIDDM in Japanese-American Men , 1990, Diabetes.

[20]  P. Vokonas,et al.  Obesity and body fat distribution in relation to the incidence of non-insulin-dependent diabetes mellitus. A prospective cohort study of men in the normative aging study. , 1992, American journal of epidemiology.

[21]  Daniel L. McGee,et al.  Determinants of incident non-insulin-dependent diabetes mellitus among blacks and whites in a national sample. The NHANES I Epidemiologic Follow-up Study. , 1993, American journal of epidemiology.

[22]  D. Williamson,et al.  Report from a Centers for Disease Control and Prevention Workshop on use of adult anthropometry for public health and primary health care. , 2001, The American journal of clinical nutrition.

[23]  B. Isaksson,et al.  Dietary habits and incidence of noninsulin-dependent diabetes mellitus in a population study of women in Gothenburg, Sweden. , 1989, The American journal of clinical nutrition.

[24]  M. Carroll,et al.  Overweight and obesity in the United States: prevalence and trends, 1960–1994 , 1998, International Journal of Obesity.

[25]  G A Colditz,et al.  Weight as a risk factor for clinical diabetes in women. , 1990, American journal of epidemiology.

[26]  L. Sjöström,et al.  Adiposity and adipose tissue distribution in relation to incidence of diabetes in women: results from a prospective population study in Gothenburg, Sweden. , 1989, International journal of obesity.

[27]  S. Haffner,et al.  Waist circumference as the best predictor of noninsulin dependent diabetes mellitus (NIDDM) compared to body mass index, waist/hip ratio and other anthropometric measurements in Mexican Americans--a 7-year prospective study. , 1997, Obesity research.

[28]  S. Haffner,et al.  Clinical Characteristics of Type II Diabetic Subjects Consuming High Versus Low Carbohydrate Diets in Mexico City and San Antonio, Texas , 1994, Diabetes Care.

[29]  P. Rust,et al.  Black women have smaller abdominal girths than white women of the same relative weight. , 1994, Journal of clinical epidemiology.

[30]  G A Colditz,et al.  Obesity, Fat Distribution, and Weight Gain as Risk Factors for Clinical Diabetes in Men , 1994, Diabetes Care.

[31]  A. Folsom,et al.  Incident type 2 diabetes mellitus in African American and white adults: the Atherosclerosis Risk in Communities Study. , 2000, JAMA.