The Lipid Accumulation Product Is Better Than BMI for Identifying Diabetes: A population-based comparison

Obesity is a strong risk factor for type 2 diabetes. However, few studies have compared the predictive power of overall obesity with that of central obesity. The cutoffs for waist circumference (WC) and waist-to-hip ratio (WHR) as measures of abdominal adiposity remain controversial. The objective was to compare body mass index (BMI), WC, and WHR in predicting type 2 diabetes. A prospective cohort study (Health Professionals Follow-Up Study) of 27 270 men was conducted. WC, WHR, and BMI were assessed at baseline. Covariates and potential confounders were assessed repeatedly during the follow-up. During 13 y of follow-up, we documented 884 incident type 2 diabetes cases. Age-adjusted relative risks (RRs) across quintiles of WC were 1.0, 2.0, 2.7, 5.0, and 12.0; those of WHR were 1.0, 2.1, 2.7, 3.6, and 6.9; and those of BMI were 1.0, 1.1, 1.8, 2.9, and 7.9 (P for trend /=24.8), WC (>/=94 cm), and WHR (>/=0.94) were 82.5%, 83.6%, and 74.1%, respectively. The corresponding proportions were 78.9%, 50.5%, and 65.7% according to the recommended cutoffs. Both overall and abdominal adiposity strongly and independently predict risk of type 2 diabetes. WC is a better predictor than is WHR. The currently recommended cutoff for WC of 102 cm for men may need to be reevaluated; a lower cutoff may be more appropriate.

This review will provide the reader with an update on our understanding of the adverse effects of fatty acid accumulation in non-adipose tissues, a phenomenon known as lipotoxicity. Recent studies will be reviewed. Cellular mechanisms involved in the lipotoxic response will be discussed. Physiologic responses to lipid overload and therapeutic approaches to decreasing lipid accumulation will be discussed, as they add to our understanding of important pathophysiologic mechanisms.

To examine how long-term patterns of weight change affect the risk for diabetes, especially non-insulin-dependent diabetes mellitus, the authors examined the relation of weight change over a period of about 10 years (from the baseline examination in 1971-1975 until the first follow-up examination in 1982-1984) to the 9-year incidence of diabetes mellitus (1984-1992) in a national cohort of 8,545 US adults from the National Health and Nutrition Examination Survey Epidemiologic Followup Study. Diabetes incidence was identified from death certificates, hospitalization and nursing home records, and self-report. In this cohort, 487 participants developed diabetes. The hazard ratios were 2.11 (95% confidence interval (CI) 1.40-3.18) for participants who gained 5- < 8 kg, 1.19 (95% CI 0.75-1.89) for participants who gained 8- < 11 kg, 2.57 (95% CI 1.84-3.85) for participants who gained 11- < 20 kg, and 3.85 (95% CI 2.04-7.22) for participants who gained 20 kg or more compared with participants whose weights remained relatively stable. The authors found no evidence that the results differed by age, sex, or race. They estimated that the population attributable risk was 27% for weight increases of 5 kg or more. Results from this study and other recent studies suggest that the increase in body mass index in the United States that occurred during the 1980s may portend an increase in the incidence of non-insulin-dependent diabetes mellitus with important public health consequences in future years.