Association of Anthropometric Indices With the Development of Diabetes Among Hypertensive Patients in China: A Cohort Study

Abstract

BackgroundPatients with comorbidity of hypertension and diabetes are associated with higher morbidity and mortality of cardiovascular disease than those with hypertension or diabetes alone. The present study aimed to identify anthropometric risk factors for diabetes among hypertensive patients who were included in a retrospective cohort study.MethodsHypertensive adults without diabetes were recruited in China. Demographic, clinical, biochemical, and anthropometric indices were collected at baseline and during the follow-up. Anthropometric measures included BMI, waist circumference, waist-to-height ratio (WHtR), and waist-to-hip ratio, and several novel indices. To estimate the effect of baseline and dynamic changes of each anthropometric index on risk of new-onset diabetes (defined as self-reported physician-diagnosed diabetes and/or use of hypoglycemic medication, or new-onset FPG≥7.0 mmol/L during follow-up), Cox regression models were used.ResultsA total of 3852 hypertensive patients were studied, of whom 1167 developed diabetes during follow-up. Multivariate Cox regression analyses showed that there was a graded increased risk of incident diabetes with successively increasing anthropometric indices mentioned above (all P<0.05). Regardless of the baseline general obesity status, elevated WHtR was both related to higher risk of diabetes; the HRs (95%CI) of baseline BMI<24 kg/m2 & WHtR≥0.5 group and BMI≥24 kg/m2 & WHtR≥0.5 group were 1.34 (1.05, 1.72), 1.85 (1.48, 2.31), respectively. Moreover, the dynamic changes of WHtR could sensitively reflect diabetes risk. Diabetes risk significantly increased when patients with baseline WHtR<0.5 progressed to WHtR≥0.5 during the follow-up (HR=1.63; 95%CI, 1.11, 2.40). There was also a decreasing trend towards the risk of incident diabetes when baseline abnormal WHtR reversed to normal at follow-up (HR=1.93; 95%CI, 1.36, 2.72) compared with those whose WHtR remained abnormal at follow-up (HR=2.04; 95%CI, 1.54, 2.71).ConclusionsCentral obesity is an independent and modifiable risk factor for the development of diabetes among hypertensive patients. Measuring indices of central obesity in addition to BMI in clinics could provide incremental benefits in the discrimination of diabetes among Chinese hypertensive patients. Dynamic changes of WHtR could sensitively reflect changes in the risk of diabetes. Therefore, long-term monitoring of hypertensive patients using non-invasive anthropometric measures and timely lifestyle intervention could effectively reduce the development of diabetes.

Predicting the 2-Year Risk of Progression from Prediabetes to Diabetes Using Machine Learning among Chinese Elderly Adults

“…Unsurprisingly, consistent with other studies [19][20][21], FPG was the strongest contributor to the models. We also found that the contribution of WC was higher than that of BMI in both forecast periods, which modestly supports the view that the reliability of BMI for determining obesity, a well-known major risk factor for diabetes, was questioned [22] because BMI did not distinguish fat mass from lean mass [23] and WC represented central obesity.…”

The association between weight-adjusted-waist index and increased urinary albumin excretion in adults: A population-based study

“…Therefore, WWI can draw out the benefits of WC and weaken the correlation with BMI, thus reflecting mainly weight-independent centripetal obesity. Several studies have demonstrated the positive association between WWI with new-onset hypertension, diabetes, and even the all-cause and cardiovascular mortality (9)(10)(11). Kim et al confirmed that WWI could be an indicator of fat and muscle composition changes related to aging commonly applicable to all race/ethnic groups (12).…”

The Association between Cardio-metabolic and hepatic indices and anthropometric measures with metabolically obesity phenotypes: a cross-sectional study from the Hoveyzeh Cohort Study

“…The Waist to Hip Ratio (WHR) and Waist to Height Ratio (WHtR) were calculated by dividing WC by HC and Height (cm), respectively. Other Anthropometric indices were calculated based on the following formulae [ 22 , 23 ]:…”