Waist-Circumference Phenotype and Risk of Type 2 Diabetes



Waist phenotypes (waist circumference, waist-to-hip ratio and waist-to-height ratio) are associated with type 2 diabetes as demonstrated in many studies and confirmed in meta-analyses of prospective studies from various studies. Evidence for the association is stronger for waist circumference and waist-to hip ratio. A verdict is yet to be made with respect to the nature of the association of waist-to-height ratio with type 2 diabetes. The clinical and epidemiologic appeal for the use of waist phenotypes is irrefutable. Waist measurement is simple and requires only a measuring tape and a weighing scale. Effective translation of the use of waist phenotype into clinical practice to predict type 2 diabetes may help in reversing the increasing trend of type 2 diabetes.


Waist Circumference Abdominal Obesity Visceral Adipose Tissue International Diabetes Federation Pool Relative Risk 
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Atherosclerosis risk in communities


Area under curve


Body mass index


International Diabetes Federation (IDF)


National Cholesterol Education Program-Adult Treatment Panel III


National Heart, Lung, and Blood Institute


National Institute of Health


  1. Allison DB, Paultre F, Goran MI, Poehlman ET, Heymsfield SB. Statistical considerations regarding the use of ratios to adjust data. Int J Obes Relat Metab Disord. 1995;19:644–52.PubMedGoogle Scholar
  2. Ashwell M: Obesity risk: importance of the waist-to-height ratio. Nurs Stand. 2009;23:49–54.PubMedGoogle Scholar
  3. Björntorp P. The association between obesity, adipose tissue distribution and disease. Acta Med Scandinavica Supplementum. 1988;723:121–34.Google Scholar
  4. Bjorntorp P. “Portal” adipose tissue as a generator of risk factors for cardiovascular disease and diabetes. Arterio­sclerosis. 1990;10:493–6.PubMedCrossRefGoogle Scholar
  5. Carey VJ, Walters EE, Colditz GA, Solomon CG, Willett WC, Rosner BA, Speizer FE, Manson JE. Body fat distribution and risk of non-insulin-dependent diabetes mellitus in women: The Nurses’ Health Study. Am J Epidemiol. 1997;145:614–9.PubMedCrossRefGoogle Scholar
  6. Cassano PA, Rosner B, Vokonas PS, Weiss ST. 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. Am J Epidemiol. 1992;136:1474–86.PubMedGoogle Scholar
  7. Chei CL, Iso H, Yamagishi K, Tanigawa T, Cui R, Imano H, Kiyama M, Kitamura A, Sato S, Shimamoto T. Body fat distribution and the risk of hypertension and diabetes among Japanese men and women. Hypertens Res. 2008;31:851–7.PubMedCrossRefGoogle Scholar
  8. Fox CS, Massaro JM, Hoffmann U, Pou KM, Maurovich-Horvat P, Liu CY, Vasan RS, Murabito JM, Meigs JB, Cupples LA, D’Agostino RB Sr, O’Donnell CJ.: Abdominal visceral and subcutaneous adipose tissue compartments: Association with metabolic risk factors in the Framingham Heart Study. Circulation. 2007;116:39–48.PubMedCrossRefGoogle Scholar
  9. Gruson E, Montaye M, Kee F, Wagner A, Bingham A, Ruidavets JB, Haas B, Evans A, Ferrières J, Ducimetière P, Amouyel P, Dallongeville J. Epidemiology: Anthropometric assessment of abdominal obesity and coronary heart disease risk in men: the PRIME Study Heart. 2009. Online First doi:10.1136/hrt.2009.171447.Google Scholar
  10. Hadaegh F, Zabetian A, Harati H, Azizi F. Waist/height ratio as a better predictor of type 2 diabetes compared to body mass index in Tehranian adult men–a 3.6-year prospective study. Exp Clin Endocrinol Diabetes. 2006;11:310–5.CrossRefGoogle Scholar
  11. Haffner SM, Valdez RA, Hazuda HP, Mitchell BD, Morales PA, Stern MP. Prospective analysis of the insulin resistance syndrome (syndrome X). Diabetes. 1992;41:715–22.PubMedCrossRefGoogle Scholar
  12. Han TS, van Leer EM, Seidell JC, Lean MEJ. Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample. Br Med J. 1995;311:1401–5.CrossRefGoogle Scholar
  13. Harris MM, Stevens J, Thomas N, Schreiner P, Folsom AR. Associations of fat distribution and obesity with hypertension in a bi-ethnic population: the ARIC study. Atherosclerosis Risk in Communities Study. Obes Res. 2000;8:516–24.PubMedCrossRefGoogle Scholar
  14. Kaye SA, Folsom AR, Sprafka JM, Prineas RJ, Wallace RB. Increased incidence of diabetes mellitus in relation to abdominal adiposity in older women. J Clin Epidemiol. 1991;44:329–34.PubMedCrossRefGoogle Scholar
  15. Kissebah AH, Vydelingum N, Murray R, Evans DJ, Hartz AJ, Kalkhoff RK, Adams PW.: Relation of body fat distribution to metabolic complications of obesity. J Clin Endocrinol Metabol. 1982;54:254–60.CrossRefGoogle Scholar
  16. Kronmal RA: Spurious correlation and the fallacy of the ratio standard revisited. J R Statist Soc A. 1993;156:379–92.CrossRefGoogle Scholar
  17. Lee CM, Huxley RR, Wildman RP, Woodward M. Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis. J Clin Epidemiol. 2008;61:646–53.PubMedCrossRefGoogle Scholar
  18. Lemieux S, Prud’Homme D, bouchard C, Despres JP. Anthropometric correlates to changes in visceral adipose tissue over 7 years in women. Int J Obes Relat Metab Disord. 1996;20:618–24.PubMedGoogle Scholar
  19. Lu M, Ye W, Adami HO, Weiderpass E. Prospective study of body size and risk for stroke amongst women below age 60. J Intern Med. 2006;260:442–50.PubMedCrossRefGoogle Scholar
  20. McNeely MJ, Boyko EJ, Shofer JB, Newell-Morris L, Leonetti DL, Fujimoto WY. Standard definitions of overweight and central adiposity for determining diabetes risk in Japanese Americans. Am J Clin Nutr. 2001;74:101–7.PubMedGoogle Scholar
  21. Meisinger C, Doring A, Thorand B, Heier M, Lowel H. Body fat distribution and risk of type 2 diabetes in the general population: are there differences between men and women? The MONICA/KORA Augsburg cohort study. Am J Clin Nutr. 2006;84:483–9.PubMedGoogle Scholar
  22. Misra A, Wasir JS, Vikram NK. Waist circumference criteria for the diagnosis of abdominal obesity are not applicable uniformly to all population and ethnic groups. Nutrition. 2005;21:969–76.PubMedCrossRefGoogle Scholar
  23. Molarius A, Seidell JC. Selection of anthropometric indicators for classification of abdominal fatness – a critical review. Int J Obes Relat Metab Disord. 1998;22:719–27.PubMedCrossRefGoogle Scholar
  24. National Institute of Health/National Heart Lungs and Blood Institute. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults–The Evidence Report. Obes Res. 1998;6:51S–209S.Google Scholar
  25. Okosun IS, Chandra KM, Boev A, Boltri JM, Choi ST, Parish DC, Dever GE. Abdominal adiposity in U.S. adults: prevalence and trends, 1960–2000. Prev Med. 2004;39:197–206.PubMedCrossRefGoogle Scholar
  26. Rimm AA, Hartz AJ, Fischer ME. A weight shape index for assessing risk of disease in 44,820 women. J Clin Epidemiol. 1988;41:459–65.PubMedCrossRefGoogle Scholar
  27. Sakurai M, Miura K, Takamura T, Ishizaki M, Morikawa Y, Nakamura K, Yoshita K, Kido T, Naruse Y, Kaneko S, Nakagawa H. J-shaped relationship between waist circumference and subsequent risk for Type 2 diabetes: an 8-year follow-up of relatively lean Japanese individuals. Diabet Med. 2009;26:753–9.PubMedCrossRefGoogle Scholar
  28. Salans, LB, Knittle JL, Hirsch J. The role of adipose cell size and adipose tissue insulin sensitivity in the carbohydrate intolerance of human obesity. J Clin Invest. 1968;7:153–65.CrossRefGoogle Scholar
  29. Schmidt MI, Duncan BB, Canani LH, Karohl C, Chambless L. Association of waist-hip ratio with diabetes mellitus. Strength and possible modifiers. Diabetes Care. 1992;15:912–4.PubMedCrossRefGoogle Scholar
  30. Seppala-Lindroos A, Vehkavaara S, Hakkinen AM, Goto T, Westerbacker J, Sovijarvi A, Halavaara J, Yiki-Jarvimen H. Fat accumulation in the liver is associated with defects in insulin suppression of glucose production and serum free fatty acids independent of obesity in normal men. J Clin Endocrinol Metabol. 2002;87:3023–8.CrossRefGoogle Scholar
  31. Snijder MB, Dekker JM, Visser M, Bouter LM, Stehouwer CDA, Kostene PJ, Yudkin JS, Heine RJ, Nijpels G, Seidell JC. Associations of hip and thigh circumferences independent of waist circumference with the incidence of type 2 diabetes: the Hoorn Study. Am J Clin Nutr. 2003;77:1192–7.PubMedGoogle Scholar
  32. Vague J. The Degree of Masculine Differentiation of Obesities. A factor determining predisposition to diabetes, atherosclerosis, gout, and uric calculous disease. Am J Clin Nutr. 1956;4:20–34.PubMedGoogle Scholar
  33. Vazquez G, Duval S, Jacobs DR Jr, Silventoinen K. Comparison of body mass index, waist circumference, and waist/hip ratio in predicting incident diabetes: a meta-analysis. Epidemiol Rev. 2007;29:115–28.PubMedCrossRefGoogle Scholar
  34. Wang SL, Pan WH, Hwu CM, Ho LT, Lo CH, Lin SL, Jong YS. Incidence of NIDDM and the effects of gender, obesity and hyperinsulinaemia in Taiwan. Diabetologia. 1997;40:1431–8.PubMedCrossRefGoogle Scholar
  35. Wang Y, Rimm EB, Stampfer MJ, Willett WC, Hu FB. Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men. Am J Clin Nutr. 2005;81:555–63.PubMedGoogle Scholar
  36. Wei M, Gaskill SP, Haffner SM, Stern MP. 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. Obes Res. 1997;5:16–23.PubMedGoogle Scholar
  37. Zhang C, Rexrode KM, van Dam RM, Li TY, Hu FB. Abdominal obesity and the risk of all-cause, cardiovascular, and cancer mortality: sixteen years of follow-up in US women. Circulation. 2008;117:1624–6.CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Institute of Public HealthGeorgia State UniversityAtlantaUSA

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