Associations of relative fat mass, a new index of adiposity, with type-2 diabetes in the general population

Navin Suthahar*, Kan Wang, Victor W. Zwartkruis, Stephan J.L. Bakker, Silvio E. Inzucchi, Laura M.G. Meems, Tim R. Eijgenraam, Fariba Ahmadizar, Eric G. Sijbrands, Ron. T. Gansevoort, Lyanne M. Kieneker, Dirk J. van Veldhuisen, Maryam Kavousi, Rudolf A. de Boer*

*Corresponding author for this work

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Background: Relative fat mass (RFM) is a novel sex-specific anthropometric equation (based on height and waist measurements) to estimate whole-body fat percentage. Objective: To examine associations of RFM with incident type-2 diabetes (T2D), and to benchmark its performance against body-mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR). Methods: This prospective longitudinal study included data from three Dutch community-based cohorts free of baseline diabetes. First, we examined data from the PREVEND cohort (median age and follow-up duration: 48.0 and 12.5 years, respectively) using Cox regression models. Validation was performed in the Lifelines (median age and follow-up duration: 45.5 and 3.8 years, respectively) and Rotterdam (median age and follow-up duration: 68.0 and 13.9 years, respectively) cohorts. Results: Among 7961 PREVEND participants, 522 (6.6%) developed T2D. In a multivariable model, all adiposity indices were significantly associated with incident T2D (P all<0.001). While 1 SD increase in BMI, WC and WHR were associated with 68%, 77% and 61% increased risk of developing T2D [Hazard ratio (HR) BMI: 1.68 (95%CI: 1.57-1.80), HR WC: 1.77 (95% CI: 1.63-1.92) and HR WHR: 1.61 (95%CI: 1.48-1.75)], an equivalent increase in RFM was associated with 119% increased risk [HR: 2.19 (95%CI: 1.96-2.44)]. RFM was associated with incident T2D across all age groups, with the largest effect size in the youngest (<40 years) age category [HR: 2.90 (95%CI: 2.15-3.92)]. Results were broadly similar in Lifelines (n = 93,870) and Rotterdam (n = 5279) cohorts. Conclusions: RFM is strongly associated with new-onset T2D and displays the potential to be used in the general practice setting to estimate the risk of future diabetes.

Original languageEnglish
Pages (from-to)73-78
Number of pages6
JournalEuropean Journal of Internal Medicine
Publication statusPublished - Mar 2023

Bibliographical note

Funding Information:
Drs. Suthahar, Zwartkruis and de Boer are supported by the Netherlands Heart Foundation (CVON SHE-PREDICTS-HF, grant 2017-21; CVON RED-CVD, grant 2017-11; CVON PREDICT2, grant 2018-30; and CVON DOUBLE DOSE, grant 2020B005), and Dr. de Boer also by a grant from the European Research Council (ERC CoG 818715, SECRETE-HF).

Publisher Copyright:
© 2022 The Author(s)


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