Waist circumference, relative fat mass index, and body mass index as classifiers of diabetes status: A comparative, cross-sectional analysis in 82 low- and middle-income countries
Year: 2026
Type: other
Abstract: Objective Waist circumference–based measures can improve diabetes risk assessment beyond body mass index (BMI). Yet, evidence to guide their integration into screening guidelines in low- and middle-income countries (LMICs) is limited, particularly to assess risk among individuals at intermediate BMI ranges. We evaluated the associations of waist circumference (WC), relative fat mass (RFM), and BMI with diabetes across 82 LMICs. Research Design and Methods We analyzed individual-level data from nationally representative surveys across 82 LMICs, comprising 598,883 adults aged ≥25 years with a BMI of 18.5–29.9 kg/m². Associations of anthropometric measures with diabetes were estimated as risk ratios using Poisson regression and area under the curve (AUC), stratified by sex and geographic region. Results Pooled diabetes prevalence was 9.1% (95% confidence interval: 8.51–9.68). Overall, risk of diabetes was greatest for WC and RFM at the highest quintile, compared to BMI. The AUC for WC and RFM as a classifier of diabetes status was higher than the AUC for BMI in men (AUC: WC 0.69, RFM 0.69, BMI 0.64) and women (AUC: WC 0.69, RFM 0.69, BMI 0.63). Generally, the AUC for RFM was higher than the AUC for BMI and either higher or equal to WC across regions and sex. Conclusions WC and RFM outperformed BMI as classifiers of diabetes status among adults with a BMI of 18.5–29.9 kg/m2 across 82 LMICs. Inclusion of WC-based measures in diabetes screening guidelines could improve timely diabetes detection and resource allocation in LMICs among individuals at intermediate BMI ranges.
Authors: Jacqueline A. Seiglie, Till Seuring, Felix Teufel, Maja E. Marcus, Michaela Theilmann, Pascal Geldsetzer, Kokou Agoudavi, Glennis Andall-Brereton, Krishna K. Aryal, Brice Wilfried Bicaba, Pascal Bovet, Luisa Campos Caldeira Brant, Garry Brian, Albertino Damasceno, Maria Dorobantu, Farshad Farzadfar, Gladwell Gathecha, Ali Golestani, Mongal Singh Gurung, Mahsa Heidari-Foroozan, Corine Houehanou, Dismand Houinato, Nahla Hwalla, Jutta Jorgensen, Kibachio J Mwangi, Gibson B. Kagaruki, Khem B. Karki, Nuno Lunet, Deborah C. Malta, Joao S Martins, Mohammed Msaidie, Omar Mwalim, Bolormaa Norov, Sarah Quesnel-Crooks, Sahar Saeedi Moghaddam, Abla Sibai, Lela Sturua, Lindiwe Tsabedze, Chea Stanford Wesseh, Roy Wong McClure, Sang Gune Yoo, Rifat Atun, Justine I. Davies, Sebastian Vollmer, Till W. Bärnighausen, David Flood, Orison O. Woolcott, Jennifer Manne-Goehler
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W7203753491