ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Clinical Diabetes
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1593917
Relationship between traditional and non-traditional obesity parameters and diabetes and early-onset diabetes: an analysis based on a large cohort
Provisionally accepted
- Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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Background: Diabetes mellitus (DM), especially early-onset DM, poses a growing global health challenge. While body mass index (BMI) is commonly used to assess obesity, it does not adequately capture fat distribution or metabolic risk. Alternative indices such as waist-to-height ratio (WHtR) and conicity index (CI) may better predict diabetes risk, particularly in younger populations. Methods: This cohort study included 15,453 participants for overall DM risk analysis (mean follow-up: 6.04 years, range: 0.45–12.96) and 5,584 participants under age 40 for early-onset DM (mean follow-up: 3.38 years, range: 0.47–12.32). Ten obesity-related indices were evaluated. Cox regression models estimated the association between each index and the incidence of DM and early-onset DM. Time-dependent receiver operating characteristic (ROC) curves and C-index are used to assess discriminatory performance. Results: During follow-up, 373 cases of DM and 29 cases of early-onset DM were identified. WHtR showed the strongest association with DM risk (HR per SD = 1.39; 95% CI: 1.24–1.56), while CI had the strongest association with early-onset DM (HR per SD = 2.63; 95% CI: 1.88–3.66). The cardiovascular metabolic index (CMI) had the highest area under the ROC curve (AUC) for assessing short-term DM risk, while lipid accumulation products (LAP) had the highest AUC value for medium- to long-term DM risk. WHtR had the highest AUC of 0.80 in assessing the risk of early-onset DM. Conclusions: Several non-traditional obesity indices, particularly WHtR, CI, CMI, and LAP, are superior to BMI in acessing the risk of DM or early-onset DM. These indices may offer valuable tools for early detection and personalized prevention strategies in clinical practice.
Keywords: diabetes, Early-onset diabetes, Obesity, Body Mass Index, prevention
Received: 14 Mar 2025; Accepted: 25 Aug 2025.
Copyright: © 2025 Luo, Huang, Wang and Zhao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Lei Zhao, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China
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