Associations Between General and Abdominal Adiposity and Mortality in Individuals With Diabetes Mellitus

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Individuals with diabetes mellitus are advised to achieve a healthy weight to prevent complications. However, fat mass distribution has hardly been investigated as a risk factor for diabetes complications. The authors studied associations between body mass index, waist circumference, waist/hip ratio, and waist/height ratio and mortality among individuals with diabetes mellitus. Within the European Prospective Investigation into Cancer and Nutrition, a subcohort was defined as 5,435 individuals with a confirmed self-report of diabetes mellitus at baseline in 1992-2000. Participants were aged 57.3 (standard deviation, 6.3) years, 54% were men, the median diabetes duration was 4.6 (interquartile range, 2.0-9.8) years, and 22% of the participants used insulin. Body mass index, as indicator of general obesity, was not associated with higher mortality, whereas all measurements of abdominal obesity showed a positive association. Associations generally were slightly weaker in women. The strongest association was observed for waist/height ratio: In the fifth quintile, the hazard rate ratio was 1.88 (95% confidence interval: 1.33, 2.65) for men and 2.46 (95% confidence interval: 1.46, 4.14) for women. Measurements of abdominal, but not general, adiposity were associated with higher mortality in diabetic individuals. The waist/height ratio showed the strongest association. Respective indicators might be investigated in risk prediction models.


  • Diewertje Sluik
  • Heiner Boeing
  • Jukka Montonen
  • Tobias Pischon
  • Rudolf Kaaks
  • Birgit Teucher
  • Anne Tjonneland
  • Jytte Halkjaer
  • Tina L. Berentzen
  • Kim Overvad
  • Larraitz Arriola
  • Eva Ardanaz
  • Benedetta Bendinelli
  • Sara Grioni
  • Rosario Tumino
  • Carlotta Sacerdote
  • Amalia Mattiello
  • Annemieke M. W. Spijkerman
  • Daphne L. van der A
  • Joline W. Beulens
  • Yvonne T. van der Schouw
  • Olov Rolandsson
  • Ute Noethlings
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Public Health, Global Health, Social Medicine and Epidemiology


  • adiposity, body mass index, diabetes complications, diabetes mellitus, mortality, waist circumference, waist-hip ratio
Original languageEnglish
Pages (from-to)22-34
JournalAmerican Journal of Epidemiology
Issue number1
Publication statusPublished - 2011
Publication categoryResearch