Anthropometric and DXA-derived measures of body composition in relation to pre-diabetes among adults

Abdominal obesity is the most common risk factor of pre-diabetes and diabetes. Currently, several types of indices are used for the determination of visceral fat-related abdominal obesity. To better understand the effect of the different adiposity indices, we sought to evaluate the association of different adiposity measurements, assessed using dual-energy X-ray absorptiometry (DXA), and pre-diabetes.

This cross-sectional study included 1184 adults between 18 and 65 years who participated in the Kuwait Wellbeing Study. Anthropometry measurements included body mass index (BMI) and waist-to-hip ratio. Total body fat (TBF) mass, android fat mass, gynoid fat, and visceral adipose tissue (VAT) mass were measured using the Lunar iDXA. Pre-diabetes was defined as 5.7≤HbA1c%≤6.4. Adjusted prevalence ratios (aPRs) and 95% CIs were estimated. Area under the curve (AUC) was estimated for each adiposity measurement as predictor of pre-diabetes.

A total of 585 (49.4%) males and 599 (50.6%) females were enrolled in the study. Increased BMI (aPR _{obese vs normal}=1.59, 95% CI: 1.19 to 2.12), waist-to-hip ratio (aPR _{Q4 vs Q1}=1.25, 0.96 to 1.61), TBF (aPR _{Q4 vs Q1}=1.58, 1.20 to 2.07), android fat (aPR _{Q4 vs Q1}=1.67, 1.27 to 2.20), gynoid fat (aPR _{Q4 vs Q1}=1.48, 1.16 to 1.89), android-to-gynoid fat ratio (aPR _{Q4 vs Q1}=1.70, 1.27 to 2.28), and VAT mass (aPR _{Q4 vs Q1}=2.05, 1.49 to 2.82) were associated with elevated pre-diabetes prevalence. Gynoid fat was associated with pre-diabetes among males (aPR _{Q4 vs Q1}=1.71, 1.22 to 2.41), but not among females (aPR _{Q4 vs Q1}=1.27, 0.90 to 1.78). Moreover, in terms of AUC, VAT had the highest estimated AUC of 0.680, followed by android-to-gynoid fat ratio (AUC: 0.647) and android fat (AUC: 0.646).

Pre-diabetes prevalence increased as adiposity measurements increased, with VAT mass demonstrating the highest AUC for pre-diabetes.