Samuel N Darko1, Karlijn A C Meeks2, William K B A Owiredu3, Edwin F Laing3, Daniel Boateng4, Erik Beune5, Juliet Addo6, Ama de-Graft Aikins7, Silver Bahendeka8, Frank Mockenhaupt9, Joachim Spranger10, Peter Agyei-Baffour11, Kerstin Klipstein-Grobusch12, Liam Smeeth6, Charles Agyemang5, Ellis Owusu-Dabo11. 1. Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana; Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana. Electronic address: s.darko28@gmail.com. 2. Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands; Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, United States. 3. Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana. 4. Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands. 5. Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands. 6. Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK. 7. Regional Institute for Population Studies, University of Ghana, Legon-Accra, Ghana. 8. Mother Kevin Postgraduate Medical School (MKPGMS), Uganda Martyrs University, Kampala, Uganda. 9. Institute of Tropical Medicine and International Health, Charite-University Medicine Berlin, Germany. 10. Department of Endocrinology and Metabolism, Charite-University Medicine Berlin, Berlin, Germany. 11. School of Public Health, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana. 12. Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands; Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Abstract
AIMS: To compare body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) as determinants of type 2 diabetes (T2DM) and determine optimal cut-offs in a sub-Saharan African population. METHODS: Data from the RODAM study including Ghanaians aged 25-70 living in rural Ghana, urban Ghana and Europe were used. Logistic regression was used to assess associations between BMI, WC, WHR and T2DM status, by sex and site. Area under the curve (AUC) were constructed to discriminate between indices and establish performance and cut-off values. RESULTS: WHR had the strongest association with T2DM in men and women across sites, except for rural men. The highest adjusted odds ratio (aOR) and AUC were in rural women for WHR (aOR = 2.09, 95%CI = 1.47-2.99; AUC = 0.71). Among migrants, WHR had higher AUCs compared with BMI (p < 0.01) and WC (p < 0.05). Cut-offs for BMI and WC in men were lower compared with the WHO reference across sites (WC: 85.4-93.7 vs 102 cm, BMI: 23.1-28.2 vs 30.0 kg/m2). CONCLUSIONS: WHR outperformed BMI and WC as anthropometric indices in relation to T2DM among Ghanaian migrants. The lower BMI and WC cut-offs for T2DM than WHO established standards, highlights the need for African specific cut-offs to avoid missing high risk populations.
AIMS: To compare body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) as determinants of type 2 diabetes (T2DM) and determine optimal cut-offs in a sub-Saharan African population. METHODS: Data from the RODAM study including Ghanaians aged 25-70 living in rural Ghana, urban Ghana and Europe were used. Logistic regression was used to assess associations between BMI, WC, WHR and T2DM status, by sex and site. Area under the curve (AUC) were constructed to discriminate between indices and establish performance and cut-off values. RESULTS: WHR had the strongest association with T2DM in men and women across sites, except for rural men. The highest adjusted odds ratio (aOR) and AUC were in rural women for WHR (aOR = 2.09, 95%CI = 1.47-2.99; AUC = 0.71). Among migrants, WHR had higher AUCs compared with BMI (p < 0.01) and WC (p < 0.05). Cut-offs for BMI and WC in men were lower compared with the WHO reference across sites (WC: 85.4-93.7 vs 102 cm, BMI: 23.1-28.2 vs 30.0 kg/m2). CONCLUSIONS: WHR outperformed BMI and WC as anthropometric indices in relation to T2DM among Ghanaian migrants. The lower BMI and WC cut-offs for T2DM than WHO established standards, highlights the need for African specific cut-offs to avoid missing high risk populations.
Authors: Tracy Bonsu Osei; Anne-Marieke van Dijk; Sjoerd Dingerink; Felix Patience Chilunga; Erik Beune; Karlijn Anna Catharina Meeks; Silver Bahendeka; Matthias Bernd Schulze; Charles Agyemang; Mary Nicolaou; Adriaan Georgius Holleboom; Ina Danquah Journal: Nutrients Date: 2021-10-20 Impact factor: 5.717