Stronger Associations of Body Mass Index and Waist Circumference with Diabetes than Waist-Height Ratio and Triglyceride Glucose Index in the Middle-Aged and Elderly Population: A Retrospective Cohort Study.

ABSTRACT

Background: It remains controversial whether body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), or triglyceride glucose (TyG) index has a stronger association with diabetes. The aims of the study were to compare the magnitude of associations of four indicators with diabetes risk. Methods: Data collected from annual health examination dataset in the Xinzheng during 2011 and 2019. A total of 41,242 participants aged ≥ 45 years were included in this study. Cox proportional hazard regression models were used to examine associations between the four indicators and diabetes risk. Results: After 205,770 person-years of follow up, diabetes developed in 2,472 subjects. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of diabetes (highest vs reference group) were 1.92 (1.71-2.16) for BMI, 1.99 (1.78-2.23) for WC, 1.65 (1.47-1.86) for WHtR, and 1.66 (1.47-1.87) for TyG, respectively. In addition, the risk of diabetes increased with baseline BMI (HR 1.30; 95% CI 1.25, 1.35) and TyG (HR 1.25; 95% CI 1.20, 1.30), but the lowest HR was 0.78 (95% CI 0.65-0.92) when WC was approximately 72 cm, and 0.85 (95% CI 0.72-0.99) when WHtR was approximately 0.47 in women. In joint analyses, the highest risk was observed in participants with a high BMI combined with a high WC (HR 2.26; 95% CI 1.98, 2.58). Conclusions: In middle-aged and elderly Chinese population, BMI and WC were more strongly associated with diabetes than WHtR or TyG, especially the combined effect of BMI and WC.