Waist circumference (WC) is closely associated with various metabolic diseases, including diabetes mellitus (DM), metabolic syndrome, and mortality. However, the correlation between WC and mortality risk varies across populations and has rarely been studied specifically in individuals with diabetes. This study aims to explore the relationships between WC and both all-cause and cardiovascular mortality in people with DM.
Methods
This study utilized participants from the National Health and Nutrition Examination Survey (NHANES) spanning from 2003 to 2018. It included 3,151 women and 3,473 men diagnosed with DM, all of whom had baseline WC measurements. The participants were followed for survival data until December 31, 2019. Cox proportional hazard models were used to adjust for demographic features and other confounding factors. Restricted cubic spline curves and threshold effect analyses were performed separately for men and women. Sensitivity analyses were also conducted to minimize the risk of reverse causality.
Results
Among the 6,624 participants with DM, 621 women and 871 men died during median follow-ups of 6.8 and 6.3 years, respectively. The study found that WC was associated with mortality in different ways between women and men. In women, WC demonstrated a U-shaped relationship with both all-cause and cardiovascular mortality. In contrast, men exhibited a J-shaped trend. The study identified optimal WC thresholds for minimizing mortality risk, which were 107.0 cm for women and 89.0 cm for men.
For women, the hazard ratios for all-cause mortality were:
- 0.97 (95% confidence interval [CI]: 0.96–0.98, P < 0.001) for WC below 107.0 cm
- 1.04 (95% CI: 1.02–1.05, P < 0.001) for WC above 107.0 cm
For men, the corresponding ratios were:
- 0.94 (95% CI: 0.90–0.97, P < 0.001) for WC below 89.0 cm
- 1.03 (95% CI: 1.02–1.05, P < 0.001) for WC above 89.0 cm
Conclusions
The study found that WC demonstrated a U-shaped association with both all-cause and cardiovascular mortalities in women and a J-shaped association in men among U.S. adults with DM, as seen in data from the National Health and Nutrition Examination Survey. These findings highlight the importance of further research into the underlying mechanisms driving these associations, rather than simply promoting preconceived notions about an optimal WC.
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