Hepatobiliary Surg Nutr. 2026 Feb 1;15(1):7. doi: 10.21037/hbsn-24-417. Epub 2025 Feb 11.
ABSTRACT
BACKGROUND: In the past decade, diabetes prevalence in China increased significantly, with many cases undiagnosed, particularly in rural areas. Despite the limitations of body mass index (BMI) in assessing visceral fat, obesity indices like waist circumference (WC) and waist-to-height ratio (WHtR) have shown stronger associations with the risk of type 2 diabetes mellitus (T2DM). Few cohort studies, especially in rural China, have examined the predictive power of these obesity indices and their changes on T2DM risk. We aimed to assess sex and age difference in the association between obesity, long-term waist circumference and weight changes with the risk of T2DM among rural Chinese adults.
METHODS: Population-based cohort study of 15,076 adult participants was conducted from 2006.08.11 to 2014.07.19 in rural Deqing, China. Participants were annually followed up for the occurrence of major chronic diseases and vital status through the Deqing electronic health records system from enrollment to December 31st, 2021. Cox proportional hazards model was used to estimate adjusted HR (aHR) and 95% confidence intervals (CIs) for the association of obesity indices and their long-term changes with incident T2DM.
RESULTS: A total of 1,888 cases of incident T2DM were found (incidence: 12.35/1,000 person-years) during the mean follow-up of 10.14±3.64 years. Baseline WC (aHR =1.37, 95% CI: 1.31, 1.43), WHtR (aHR =1.38, 95% CI: 1.32, 1.44), BMI (aHR =1.27, 95% CI: 1.21, 1.32), WHtHR (aHR =1.34, 95% CI: 1.25, 1.43) exhibited statistically significant associations with increased risk of T2DM. Per SD increment of WC and weight changes were associated with a 15% and 13% higher risk of incident T2DM, respectively. Stratification analysis revealed that abdominal obesity indices presented stronger associations among males and those under 60 years, while general obesity markers among females and the elderly.
CONCLUSIONS: Obesity, long-term WC and weight changes increase the risk of incident T2DM among rural adults of eastern China, with modification by sex and age.
PMID:41676777 | PMC:PMC12887344 | DOI:10.21037/hbsn-24-417
