Relation of central adiposity and body mass index to the development of diabetes in the Diabetes Prevention Program

Background: Greater central adiposity is related to the risk of diabetes. Objective: We aimed to test the hypothesis that central adiposity measured by computed tomography (CT) is a better predictor of the riskofdiabetesthanisbodymassindex(BMI),waistcircumference (WC), waist/hip ratio (WHR), or waist/height ratio. Design: Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were measured at the L2–3 and L4–5 disc spaces in 1106 of the 3234 participants in the Diabetes Prevention Program. Sex-specific proportional hazards models were used to evaluate the association between VAT and SAT at both cuts, BMI, and other measures of central adiposity as predictors of the development of diabetes. Results: Men had more VAT than did women. White subjects had more VAT at both cuts than did other ethnic groups. The ratio of VATtoSATwaslowestinAfricanAmericansofbothsexes.Among menintheplacebogroup,VATatbothcuts,WC,BMI,waist/height ratio,andWHRpredicteddiabetes(hazardratio:1.79–1.44per1SD of variable). Among women in the lifestyle group, VAT at both cuts predicted diabetes as well as did BMI, and L2–3 was a significantly betterpredictorthanwasWCorWHR.SATdidnotpredictdiabetes. None of the body fat measurements predicted diabetes in the metformin group. Conclusions:In the placebo and lifestyle groups, VAT at both cuts, WHR,andWCpredicteddiabetes.Nomeasurepredicteddiabetesin