BMI and waist circumference are associated with impaired glucose metabolism and type 2 diabetes in normal weight Chinese adults

Abstract

Aims: To examine the associations of BMI and waist circumference with glucose metabolism and (pre)diabetes among adults with BMI < 25 kg/m².

Methods: We conducted a cross-sectional study in a nationally representative sample (10,098 men and 17,454 women) of Chinese adults aged ≥ 20 years with BMI < 25 kg/m². Glucose levels after at least 10 hours of overnight fasting, at 30 minutes and at 120 minutes after a standard 75-g oral glucose load were measured. Associations of BMI and waist circumference with outcomes were examined by general linear models for continuous outcomes and by logistic regression models for dichotomous outcomes.

Results: Among those with BMI < 25 kg/m², 18.8% of men and 17.1% of women had abnormal glucose metabolism, including 4.9% of men and 3.8% of women with undiagnosed type 2 diabetes. For each SD increase in BMI (2.1 kg/m²) and waist circumference (8.3 cm), fasting glucose levels increased by 0.128 and 0.170 mmol/L in men, and by 0.112 and 0.167 mmol/L in women, respectively; the corresponding increases for 2-hour post-load glucose levels were 0.121 and 0.217 mmol/L in men, and 0.241 and 0.362 mmol/L in women. When simultaneously included in the same model, these associations with waist circumference were stronger than with BMI.

Conclusion: Obesity measures are associated with abnormal glucose metabolism and diabetes, with central obesity playing a more prominent role than general obesity in Chinese population with BMI < 25 kg/m². Chinese diabetes prevention and treatment programs should incorporate targeting of normal weight adults with central obesity.

Keywords: BMI; China; Glucose metabolism; Type 2 diabetes; Waist circumference.

Figure 1

Least square mean levels of fasting glucose, 2 hour glucose, and area under the curve (AUC) glucose adjusted for age, education, leisure-time physical activity, alcohol drinking, family history of type 2 diabetes by BMI or waist circumference decile and sex. P for trend <0.01 in all cases.

Figure 2

Prevalence of impaired fasting glucose, impaired glucose tolerance, and previously undiagnosed type 2 diabetes by BMI or waist circumference decile and sex. P for trend <0.001 in all cases.