Anthropometric indices and their cut-off points in relation to type 2 diabetes among Ghanaian migrants and non-migrants: The RODAM study
Darko, Samuel N; Meeks, Karlijn A C; K B A Owiredu, William; Laing, Edwin F; Boateng, Daniel; Beune, Erik; Addo, Juliet; de-Graft Aikins, Ama; Bahendeka, Silver; Mockenhaupt, Frank; Spranger, Joachim; Agyei-Baffour, Peter; Klipstein-Grobusch, Kerstin; Smeeth, Liam; Agyemang, Charles; Owusu-Dabo, Ellis
(2021) Diabetes Research and Clinical Practice, volume 173
(Article)
Abstract
Aims: To compare body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) as determinants of type 2 diabetes (T2DM) and determine optimal cut-offs in a sub-Saharan African population. Methods: Data from the RODAM study including Ghanaians aged 25–70 living in rural Ghana, urban Ghana and Europe were used.
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Logistic regression was used to assess associations between BMI, WC, WHR and T2DM status, by sex and site. Area under the curve (AUC) were constructed to discriminate between indices and establish performance and cut-off values. Results: WHR had the strongest association with T2DM in men and women across sites, except for rural men. The highest adjusted odds ratio (aOR) and AUC were in rural women for WHR (aOR = 2.09, 95%CI = 1.47–2.99; AUC = 0.71). Among migrants, WHR had higher AUCs compared with BMI (p < 0.01) and WC (p < 0.05). Cut-offs for BMI and WC in men were lower compared with the WHO reference across sites (WC: 85.4–93.7 vs 102 cm, BMI: 23.1–28.2 vs 30.0 kg/m 2). Conclusions: WHR outperformed BMI and WC as anthropometric indices in relation to T2DM among Ghanaian migrants. The lower BMI and WC cut-offs for T2DM than WHO established standards, highlights the need for African specific cut-offs to avoid missing high risk populations.
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Keywords: Anthropometrics, Ghanaians, Migrants, RODAM study, Type 2 diabetes mellitus, Endocrinology, Internal Medicine, Endocrinology, Diabetes and Metabolism, Journal Article
ISSN: 0168-8227
Publisher: Elsevier Ireland Ltd
Note: Funding Information: The authors are very grateful to the RODAM advisory board members for their valuable support in shaping the methods, to the research assistants, interviewers and other staff of the five research locations who have taken part in gathering the data and, most of all, to the Ghanaian volunteers participating in this project. We gratefully acknowledge J. van Straalen from the Department of Clinical Chemistry, Academic Medical Centre (Amsterdam, the Netherlands) for his valuable support with standardisation of the laboratory procedures, and the Academic Medical Center (AMC) Biobank for support in biobank management and storage of collected samples. The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. This work was funded by the European Commission under the Framework Programme (grant number 278901). K.A.C.M. is supported by the Intramural Research Program of the National Institutes of Health in the Center for Research on Genomics and Global Health (CRGGH). The CRGGH is supported by the National Human Genome Research Institute, the National Institute of Diabetes and Digestive and Kidney Diseases, the Center for Information Technology, and the Office of the Director at the National Institutes of Health (1ZIAHG200362). The funders had no role in the design, conduct and reporting of this study. SND, KACM, WKBAO, EFL, CA, JA, AA, SB, LS, KKG and EOD conceived and designed the study. CA, EB, KM, JA, FM, JS, PA and EOD carried out recruitment of participants and data collection. SND, KACM and DB conducted the statistical analysis and drafted the manuscript under supervision of CA and EOD. All authors contributed to the data interpretation, read and approved the final manuscript. Funding Information: This work was funded by the European Commission under the Framework Programme (grant number 278901). K.A.C.M. is supported by the Intramural Research Program of the National Institutes of Health in the Center for Research on Genomics and Global Health (CRGGH). The CRGGH is supported by the National Human Genome Research Institute, the National Institute of Diabetes and Digestive and Kidney Diseases , the Center for Information Technology, and the Office of the Director at the National Institutes of Health (1ZIAHG200362). The funders had no role in the design, conduct and reporting of this study. Publisher Copyright: © 2021 Elsevier B.V.
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