Open Access Research article

Risk of type 2 diabetes according to traditional and emerging anthropometric indices in Spain, a Mediterranean country with high prevalence of obesity: results from a large-scale prospective cohort study

José María Huerta12, María-José Tormo123*, María-Dolores Chirlaque12, Diana Gavrila12, Pilar Amiano24, Larraitz Arriola24, Eva Ardanaz25, Laudina Rodríguez6, María-José Sánchez27, Michelle Mendez8, Diego Salmerón123, Aurelio Barricarte25, Rosana Burgui25, Miren Dorronsoro24, Nerea Larrañaga24, Esther Molina-Montes27, Conchi Moreno-Iribas259, José Ramón Quirós6, Estefanía Toledo105, Noémie Travier11, Carlos A González11 and Carmen Navarro123

Author Affiliations

1 Department of Epidemiology, Murcia Regional Health Authority, Murcia, Spain

2 CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain

3 Department of Sociosanitary Sciences, University of Murcia School of Medicine, Murcia, Spain

4 Public Health Department of Gipuzkoa, Basque Government, San Sebastián, Spain

5 Public Health Institute of Navarra, Pamplona, Spain

6 Public Health Directorate, Asturias, Spain

7 Andalusian School of Public Health, Granada, Spain

8 Center for Environmental Epidemiology Research, Barcelona, Spain

9 Autonomous University of Barcelona, Barcelona, Spain

10 University of Navarra, Pamplona, Spain

11 Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Barcelona, Spain

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BMC Endocrine Disorders 2013, 13:7  doi:10.1186/1472-6823-13-7

Published: 6 February 2013



Obesity is a major risk factor for type 2 diabetes mellitus (T2DM). A proper anthropometric characterisation of T2DM risk is essential for disease prevention and clinical risk assessement.


Longitudinal study in 37 733 participants (63% women) of the Spanish EPIC (European Prospective Investigation into Cancer and Nutrition) cohort without prevalent diabetes. Detailed questionnaire information was collected at baseline and anthropometric data gathered following standard procedures. A total of 2513 verified incident T2DM cases occurred after 12.1 years of mean follow-up. Multivariable Cox regression was used to calculate hazard ratios of T2DM by levels of anthropometric variables.


Overall and central obesity were independently associated with T2DM risk. BMI showed the strongest association with T2DM in men whereas waist-related indices were stronger independent predictors in women. Waist-to-height ratio revealed the largest area under the ROC curve in men and women, with optimal cut-offs at 0.60 and 0.58, respectively. The most discriminative waist circumference (WC) cut-off values were 99.4 cm in men and 90.4 cm in women. Absolute risk of T2DM was higher in men than women for any combination of age, BMI and WC categories, and remained low in normal-waist women. The population risk of T2DM attributable to obesity was 17% in men and 31% in women.


Diabetes risk was associated with higher overall and central obesity indices even at normal BMI and WC values. The measurement of waist circumference in the clinical setting is strongly recommended for the evaluation of future T2DM risk in women.

Diabetes; Anthropometry; Obesity; Abdominal obesity; Body mass index; EPIC; Spain