Waist Circumference, Relative Fat Mass Index, and BMI as Classifiers of Diabetes Status: A Comparative, Cross-sectional Analysis in 82 Low- and Middle-Income Countries

OBJECTIVE: Waist circumference-based measures can improve diabetes risk assessment beyond 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: Individual-level data were analyzed 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% CI 8.51-9.68). Overall, risk of diabetes was greatest for WC and RFM at the highest quintile, compared with 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 than 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

Institutions

Publication Details

Journal
Diabetes Care
Published
2026-08-20
DOI
https://doi.org/10.2337/dc26-0106
Primary Topic
Diabetes, Cardiovascular Risks, and Lipoproteins
Type
article
Field-Weighted Citation Impact
0.00

Funders

Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Waist Circumference, Relative Fat Mass Index, and BMI as Classifiers of Diabetes Status: A Comparative, Cross-sectional Analysis in 82 Low- and Middle-Income Countries

Kokou Agoudavi, D. Flood, Till Seuring, Mahsa Heidari‐Foroozan et al.
Diabetes Care
Diabetes, Cardiovascular Risks, and Lipoproteins
article

Waist Circumference, Relative Fat Mass Index, and BMI as Classifiers of Diabetes Status: A Comparative, Cross-sectional Analysis in 82 Low- and Middle-Income Countries

Kokou Agoudavi, D. Flood, Till Seuring, Mahsa Heidari‐Foroozan, Mongal Singh Gurung, Lela Sturua, Farshad Farzadfar, Orison O. Woolcott, Rifat Atun, Болормаа Норов, Brice Bicaba, Luísa Campos Caldeira Brant, Sang Gune Yoo, Pascal Bovet, Lindiwe Tsabedze, Omar Mwalim, Justine Davies, Chea Stanford Wesseh, Roy Wong McClure, Till W. Bärnighausen, Abla Sibai, Gibson B. Kagaruki, Maja Marcus, Dismand Houinato, Michaela Theilmann, Gladwell Gathecha, Nuno Lunet, Nahla Hwalla, Krishna K. Aryal, Khem B. Karki, Kibachio J. Mwangi, Corine Houehanou, Sebastian Vollmer, Albertino Damasceno, Deborah C. Malta, Jacqueline A. Seiglie, Maria Dorobanţu, Mohammed Msaidie, Jutta Jorgensen, Sahar Saeedi Moghaddam, Pascal Geldsetzer, Glennis Andall-Brereton, Ali Golestani, Garry Brian, Jennifer Manne-Goehler, Felix Teufel, Sarah Quesnel-Crooks, Joao S. Martins
article en

Abstract

OBJECTIVE: Waist circumference-based measures can improve diabetes risk assessment beyond 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: Individual-level data were analyzed 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% CI 8.51-9.68). Overall, risk of diabetes was greatest for WC and RFM at the highest quintile, compared with 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 than 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.

Diabetes CareVol. 49(9)
National Center for Disease Control and Public Health (GE), Universidade Federal de Minas Gerais (BR), University of Copenhagen (DK), Western Cape Department of Health (ZA), Kiel Institute for the World Economy (DE), The University of Texas MD Anderson Cancer Center (US), Harvard University (US), University of Liberia (LR), Emory University (US), Tribhuvan University (NP), Iran University of Medical Sciences (IR), Eduardo Mondlane University (MZ), Universidade do Porto (PT), Heidelberg University (DE), University of Michigan (US), Clinical Emergency Hospital Bucharest (RO), Harvard University Press (US), University Hospital Heidelberg (DE), Port of Spain General Hospital (TT), Costa Rican Department of Social Security (CR), Zanzibar University (TZ), National Center for Communicable Diseases (MN), Massachusetts General Hospital (US), Zanzibar School of Health (TZ), Fred Hollows Foundation (AU), Institute for Globally Distributed Open Research and Education (SE), Stanford Health Care (US), Royal Centre for Disease Control (BT), College of Science, Technology and Applied Arts of Trinidad and Tobago (TT), Ministry of Labour, Social Insurance and Social Solidarity (GR), Université de Parakou (BJ), National University of East Timor (TL), Ministry of Health (KE), Chan Zuckerberg Initiative (United States) (US), Ronin Institute (US), Woman's Hospital (US), Luxembourg Institute of Socio-Economic Research (LU), Centre universitaire de médecine générale et santé publique, Lausanne (CH), Ministry of Health (SC), Caribbean Public Health Agency (TT), Ministry of Health (ME), Harvard Global Health Institute (US), Togolese Ministry of Health (TG), Ministry of Agriculture and Forests (BT), Ministry of Health and Social Welfare (LR), Abt Associates (Nepal) (NP), NIHR Birmingham Biomedical Research Centre (GB), Ministry of Health (SZ), Institut de Recherche en Sciences de la Santé (BF), National Institute for Medical Research (TZ), Tehran University of Medical Sciences (IR), University of Göttingen (DE), University of Birmingham (GB), American University of Beirut (LB)
National Institute of Diabetes and Digestive and Kidney Diseases
Reduced inequalities
Openalex Percentile: Top 10%
Diabetes, Cardiovascular Risks, and Lipoproteins
DOISourceOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.