Comparison of body mass index, waist circumference, and waist/hip ratio in predicting incident diabetes: A meta-analysis

Gabriela Vazquez, Sue Duval, David R Jacobs Jr, Karri Silventoinen

Research output: Contribution to journalReview articlepeer-review

529 Scopus citations


Body mass index, waist circumference, and waist/hip ratio have been shown to be associated with type 2 diabetes. From the clinical perspective, central obesity (approximated by waist circumference or waist/hip ratio) is known to generate diabetogenic substances and should therefore be more informative than general obesity (body mass index). Because of their high correlation, from the statistical perspective, body mass index and waist circumference are unlikely to yield different answers. To compare associations of diabetes incidence with general and central obesity indicators, the authors conducted a meta-analysis based on published studies from 1966 to 2004 retrieved from a PubMed search. The analysis was performed with 32 studies out of 432 publications initially identified. Measures of association were transformed to log relative risks per standard deviation (pooled across all studies) increase in the obesity indicator and pooled using random effects models. The pooled relative risks for incident diabetes were 1.87 (95% confidence interval (CI): 1.67, 2.10), 1.87 (95% CI: 1.58, 2.20), and 1.88 (95% CI: 1.61, 2.19) per standard deviation of body mass index, waist circumference, and waist/hip ratio, respectively, demonstrating that these three obesity indicators have similar associations with incident diabetes. Although the clinical perspective focusing on central obesity is appealing, further research is needed to determine the usefulness of waist circumference or waist/hip ratio over body mass index.

Original languageEnglish (US)
Pages (from-to)115-128
Number of pages14
JournalEpidemiologic Reviews
Issue number1
StatePublished - May 2007

Bibliographical note

Funding Information:
This study was supported by the Division of Diabetes Translation, US Centers for Disease Control and Prevention, contract 200-2001-00061. Conflict of interest: none declared.


  • Body fat distribution
  • Body mass index
  • Diabetes mellitus, type 2
  • Meta-analysis
  • Obesity
  • Waist-hip ratio


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