A Linear Relationship Between a Body Shape Index and Risk of Incident Type 2 Diabetes: A Secondary Analysis Based on a Retrospective Cohort Study in Japan

Associations and predictive performance of 11 anthropometric measures with incident type 2 diabetes: A prospective cohort study from the UK Biobank

OBJECTIVE

The study aim was to investigate associations of 11 anthropometric measures with incident type 2 diabetes and compare their predictive performance.

METHODS

This prospective cohort study included 161,127 White European UK Biobank participants who were free of diabetes at baseline. Anthropometric measures included height, weight, BMI, A Body Shape Index, waist circumference, waist to hip ratio, waist to height ratio (WHtR), hip circumference, visceral adiposity index, hip index, and anthropometric risk index. The associations were examined using Cox proportional hazard models. The differences in C-index were used to compare predictive performance between BMI and other anthropometric measures.

RESULTS

The median follow-up was 10.0 (interquartile range: 9.3-10.8) years, during which 6315 participants developed type 2 diabetes. All markers except height and hip index were positively associated with incident type 2 diabetes. The strongest associations were found for WHtR (hazard ratio per 1-SD increment: 2.27 [95% CI 2.19-2.35] in women; 1.96 [95% CI 1.90-2.01] in men). Compared with BMI, WHtR and anthropometric risk index had significantly better type 2 diabetes risk discrimination.

CONCLUSIONS

Although most adiposity markers were associated with type 2 diabetes, the magnitude of the associations differed. WHtR had the strongest associations and predictive ability for type 2 diabetes and thus could be a more suitable marker for clinical use.

A Body Shape Index and Its Changes in Relation to All-Cause Mortality among the Chinese Elderly: A Retrospective Cohort Study

Although recent evidence has revealed that a body shape index (ABSI) is correlated with the incidence of death among different ethnicities, there remains a paucity of studies investigating the impact of ABSI on mortality within the Chinese elderly. Our objective was to ascertain the link between ABSI, as well as its alterations over time, and all-cause mortality among Chinese aged 65 y and above. A total of 3789 participants were enrolled from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Cox regressions and restricted cubic splines were employed to assess the association of ABSI and relative changes with all-cause mortality. When nonlinearity was detected, a restricted cubic spline regression was subsequently conducted to compute hazard ratios and 95% confidence intervals. The median survival time was 46 months, and 1342 individuals (35.4%) were reported to have died. ABSI contributed independently to rising death rates among Chinese old populations according to univariate and multivariate Cox regressions. Statistically significant associations were also found stratified by age, sex, and lifestyle. A U-shaped association of ABSI changes with all-cause mortality (p = 0.027) was observed, indicating that old adults with stable ABSI during the follow-up period experienced the lowest risk of mortality. After multivariable adjustment, participants with a 10% reduction in ABSI changes had an increased 9.4% risk of death, while participants with a 10% rise in ABSI changes had an increased 1.9% risk. ABSI and its changes are predictors for all-cause mortality among the elderly Chinese population, which emphasizes the clinical importance of monitoring ABSI and keeping it stable over time.

Diabetes management in people living with dementia in Japan: a qualitative exploration

BACKGROUND

Dementia and diabetes are highly prevalent among the older society in Japan. People living with dementia (PLWD) often face hurdles in managing diabetes. This study explored the perspectives of healthcare providers in Japan regarding diabetes management in PLWD.

METHODS

We conducted a qualitative study using in-depth interviews as a data collection method. A total of 15 physicians and nurses were interviewed. A qualitative content analysis of the codes was performed to generate the themes.

RESULTS

The major themes focused on the management of medications/therapeutic regimen, difficulties of continuing health care, emotional aspects of PLWD for adherence to lifestyle modification, and varying direction and degree of family support for diabetes care.

CONCLUSION

PLWD in Japan face challenges in medication management, food restriction, and lifestyle modification. Policies to engage home visit care workers in medication management, consideration of the emotional aspect of PLWD, and utilisation of social support might help in the proper management of diabetes in PLWD.

Muscle strength and prediabetes progression and regression in middle-aged and older adults: a prospective cohort study

BACKGROUND

Prediabetes progression is associated with increased mortality while its regression decreases it. It is unclear whether muscle strength is related to prediabetes progression or regression. This study investigated the associations of muscle strength, assessed by grip strength and chair-rising time, with prediabetes progression and regression based on the China Health and Retirement Longitudinal Study (CHARLS) enrolling middle-aged and older adults.

METHODS

We included 2623 participants with prediabetes from CHARLS, who were followed up 4 years later with blood samples collected for measuring fasting plasma glucose and haemoglobin A1c. Grip strength (normalized by body weight) and chair-rising time were assessed at baseline and categorized into tertiles (low, middle, and high groups). Prediabetes at baseline and follow-up was defined primarily using the American Diabetes Association (ADA) criteria and secondarily using the World Health Organization (WHO) and International Expert Committee (IEC) criteria. Multinomial logistic regression analysis was applied to obtain the odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

The mean age of included participants was 59.0 ± 8.6 years, and 46.6% of them were males. During follow-up, 1646 participants remained as prediabetes, 379 progressed to diabetes, and 598 regressed to normoglycaemia based on ADA criteria. Participants who progressed to diabetes had lower normalized grip strength than those who remained as prediabetes (0.49 ± 0.15 vs. 0.53 ± 0.15, P < 0.001), but participants who regressed to normoglycaemia showed the opposite (0.55 ± 0.16 vs. 0.53 ± 0.15, P = 0.003). However, chair-rising time was comparable across different groups (P_overall  = 0.17). Compared with participants in low normalized grip strength or high chair-rising time group, those in high normalized grip strength or low chair-rising time group had decreased odds of progression to diabetes (OR 0.62, 95% CI 0.44 to 0.87; and OR 0.69, 95% CI 0.51 to 0.93, respectively) after multivariable adjustment. However, both were unrelated to the odds of regression to normoglycaemia (OR 0.94, 95% CI 0.71 to 1.25; and OR 0.84, 95% CI 0.65 to 1.07, respectively). These outcomes remained generally comparable when prediabetes was defined by WHO or IEC criteria. Higher normalized grip strength but not lower chair-rising time was prospectively associated with lower blood pressure, better glycaemic condition, and lower inflammation (all P ≤ 0.04).

CONCLUSIONS

High muscle strength is associated with reduced odds of progression to diabetes but does not predict regression to normoglycaemia in prediabetes. Future studies are warranted to assess whether increases in muscle strength promote prediabetes regression.

A Prediction Model of the Incidence of Type 2 Diabetes in Individuals with Abdominal Obesity: Insights from the General Population

BACKGROUND

This study aimed to distinguish the risk factors for type 2 diabetes mellitus (T2DM) and construct a predictive model of T2DM in Japanese adults with abdominal obesity.

METHODS

This study was a post hoc analysis. A total of 2012 individuals with abdominal obesity were included and randomly divided into training and validation groups at 70% (n = 1518) and 30% (n = 494), respectively. The LASSO method was used to screen for risk variables for T2DM, and to construct a nomogram incorporating the selected risk factors in the training group. We used the C-index, calibration plot, decision curve analysis, and cumulative hazard analysis to test the discrimination, calibration and clinical significance of the nomogram.

RESULTS

In the training cohort, the C-index and receiver operating characteristic were 0.819 and the 95% CI was 0.776-0.858, with a specificity and sensitivity of 77% and 74.68%, respectively. In the validation cohort, the C-index was 0.853; sensitivity and specificity were 77.6% and 88.1%, respectively. The decision curve analysis showed that the model's prediction was effective and cumulative hazard analysis demonstrated that the high-risk score group was more likely to develop T2DM than the low-risk score group.

CONCLUSION

This nomogram may help clinicians screen abdominal obesity at a high risk for T2DM.

Association Between Chinese Visceral Adiposity Index and Incident Type 2 Diabetes Mellitus in Japanese Adults

BACKGROUND

Obesity is a well-known risk factor for type 2 diabetes mellitus (T2DM). Studies have shown that the Chinese visceral adiposity index (CVAI), a novel visceral adiposity indicator, is positive associated with the risk of T2DM in the Chinese population. This study aimed to investigate the correlation between CVAI and incident T2DM in a Japanese population.

METHODS

We performed a secondary analysis of open-access data from a retrospective cohort study. This study included 15,464 participants who received regular medical examinations at Murakami Memorial Hospital. All participants underwent a questionnaire survey, physical examination, and blood biochemical testing at baseline. The main outcome was new-onset T2DM during follow-up. Cox regression analysis and Kaplan-Meier analysis were used to analyze the risk of CVAI on T2DM, and we conducted smooth curve fitting. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value of CVAI, body mass index (BMI), and waist circumference (WC) for incident T2DM.

RESULTS

During a median follow-up time of 5.39 years, 373 new-onset T2DM events were observed. Kaplan-Meier curves showed that the incidence of T2DM increased as the CVAI increased (log-rank χ ² = 187.1076 and 129.6067 in males and females, respectively, both P <0.001). After adjustment for covariates, per 1 increase of CVAI was associated with a 1.0133-fold and 1.0246-fold higher risk of incident T2DM in males and females, respectively (both P <0.001). Those individuals in the top CVAI quartile group had the highest risk of new-onset T2DM (HR = 3.1568 and 5.8415 in males and females, respectively, both P <0.05). A nonlinear relationship was identified by the smooth fitting curve between CVAI and T2DM events in both genders. ROC analysis indicated that CVAI had better predictive power than BMI and WC in both genders.

CONCLUSION

Our results demonstrate that CVAI was significantly associated with an increased risk of new-onset T2DM in Japanese adults.

Relationship between Body Roundness Index and Risk of Type 2 Diabetes in Japanese Men and Women: A Reanalysis of a Cohort Study

PURPOSE

The purpose of this study was to investigate the association between body roundness index (BRI) and type 2 diabetes (T2DM) in each sex, explore the dose-response relationship between them, and evaluate the predictive value of BRI for T2DM.

MATERIALS AND METHODS

A retrospective cohort study was performed on 15,464 Japanese patients at the Murakami Memorial Hospital. Data on anthropometric indices and biochemical parameters were obtained. Multivariate Cox regression models were used to estimate the hazard ratios (HRs) of incident T2DM associated with BRI. Dose-response relationships were evaluated using a smoothing function analysis and the threshold effect. Receiver operating characteristic curves were used to evaluate and compare the predictive values of BRI, body mass index (BMI), and waist circumference (WC) for T2DM.

RESULTS

During a median 5.4-year follow-up period, 373 subjects were diagnosed with T2DM. After adjusting for age, alcohol intake, smoking status, fatty liver, systolic blood pressure, fasting plasma glucose, glycated hemoglobin, high-density lipoprotein cholesterol, triglycerides, and total cholesterol, the relationship between BRI and T2DM was linear in women (HR (95% CI) for BRI Z score = 1.48 (1.26,1.74)) and curvilinear in men (HR (95% CI) on the left and right of the inflection point = 0.70 (0.44, 1.10) and 1.46 (1.27, 1.67), respectively). Compared with BMI (area under the curve (AUC) = 0.684; p < 0.001) and WC (AUC = 0.700; p=0.007), BRI was the strongest predictor of T2DM in men (AUC = 0.715). Similarly, the AUC of BRI was larger than that of BMI (AUC = 0.757; p=0.966) and WC (AUC = 0.733; p=0.015) in women.

CONCLUSIONS

BRI was positively linearly associated with an elevated risk of incident T2DM in women. In men, the relationship between BRI and T2DM was J-shaped. BRI is an effective indicator of predicting T2DM. Its discriminatory power was higher than that of BMI and WC in both sexes.