Langenberg, ClaudiaSharp, Stephen JSchulze, Matthias BRolandsson, OlovOvervad, KimForouhi, Nita GSpranger, JoachimDrogan, DagmarHuerta, José MaríaArriola, Larraitzde Lauzon-Guillan, BlandineTormo, Maria-JoseArdanaz, EvaBalkau, BeverleyBeulens, Joline W JBoeing, HeinerBueno-de-Mesquita, H BasClavel-Chapelon, FrançoiseCrowe, Francesca LFranks, Paul WGonzalez, Carlos AGrioni, SaraHalkjaer, JytteHallmans, GoranKaaks, RudolfKerrison, Nicola DKey, Timothy JKhaw, Kay TeeMattiello, AmaliaNilsson, PeterNorat, TeresaPalla, LuigiPalli, DomenicoPanico, SalvatoreQuirós, J RamónRomaguera, DoraRomieu, IsabelleSacerdote, CarlottaSanchez-Perez, Maria-JoseSlimani, NadiaSluijs, IvonneSpijkerman, Annemieke M WTeucher, BirgitTjonneland, AnneTumino, Rosariovan der A, Daphne Lvan der Schouw, Yvonne TFeskens, Edith J MRiboli, ElioWareham, Nicholas JSchulze, Matthias B.2013-09-262013-09-262012-06-05Langenberg C, Sharp SJ, Schulze MB, Rolandsson O, Overvad K, Forouhi NG, et al. Long-term risk of incident type 2 diabetes and measures of overall and regional obesity: the EPIC-InterAct case-cohort study. PLoS Med. 2012; 9(6) e10012301549-1277http://hdl.handle.net/10668/1298Journal Article; Research Support, Non-U.S. Gov't;BACKGROUND Waist circumference (WC) is a simple and reliable measure of fat distribution that may add to the prediction of type 2 diabetes (T2D), but previous studies have been too small to reliably quantify the relative and absolute risk of future diabetes by WC at different levels of body mass index (BMI). METHODS AND FINDINGS The prospective InterAct case-cohort study was conducted in 26 centres in eight European countries and consists of 12,403 incident T2D cases and a stratified subcohort of 16,154 individuals from a total cohort of 340,234 participants with 3.99 million person-years of follow-up. We used Prentice-weighted Cox regression and random effects meta-analysis methods to estimate hazard ratios for T2D. Kaplan-Meier estimates of the cumulative incidence of T2D were calculated. BMI and WC were each independently associated with T2D, with WC being a stronger risk factor in women than in men. Risk increased across groups defined by BMI and WC; compared to low normal weight individuals (BMI 18.5-22.4 kg/m(2)) with a low WC (<94/80 cm in men/women), the hazard ratio of T2D was 22.0 (95% confidence interval 14.3; 33.8) in men and 31.8 (25.2; 40.2) in women with grade 2 obesity (BMI≥35 kg/m(2)) and a high WC (>102/88 cm). Among the large group of overweight individuals, WC measurement was highly informative and facilitated the identification of a subgroup of overweight people with high WC whose 10-y T2D cumulative incidence (men, 70 per 1,000 person-years; women, 44 per 1,000 person-years) was comparable to that of the obese group (50-103 per 1,000 person-years in men and 28-74 per 1,000 person-years in women). CONCLUSIONS WC is independently and strongly associated with T2D, particularly in women, and should be more widely measured for risk stratification. If targeted measurement is necessary for reasons of resource scarcity, measuring WC in overweight individuals may be an effective strategy, since it identifies a high-risk subgroup of individuals who could benefit from individualised preventive action.enAntropometríaÍndice de Masa CorporalDiabetes Mellitus Tipo 2Estudios de CohortesMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Diagnostic Techniques and Procedures::Physical Examination::AnthropometryMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Diagnostic Techniques and Procedures::Physical Examination::Body Constitution::Body Weights and Measures::Body Mass IndexMedical Subject Headings::Diseases::Nutritional and Metabolic Diseases::Metabolic Diseases::Glucose Metabolism Disorders::Diabetes Mellitus::Diabetes Mellitus, Type 2Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort StudiesMedical Subject Headings::Check Tags::FemaleMedical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::HumansMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Morbidity::IncidenceMedical Subject Headings::Check Tags::MaleMedical Subject Headings::Named Groups::Persons::Age Groups::Adult::Middle AgedMedical Subject Headings::Diseases::Nutritional and Metabolic Diseases::Nutrition Disorders::Overnutrition::ObesityMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Models, Statistical::Proportional Hazards ModelsMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Risk::Risk FactorsMedical Subject Headings::Phenomena and Processes::Physical Phenomena::Time::Time FactorsMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Diagnostic Techniques and Procedures::Physical Examination::Body Constitution::Body Weights and Measures::Body Size::Waist CircumferenceMedical Subject Headings::Geographicals::Geographic Locations::Europeresearch article22679397open access10.1371/journal.pmed.10012301549-1676PMC3367997