1311-P: Waist Circumference Measures for Diabetes Screening in Individuals without Obesity from 61 Low- and Middle-Income Countries

Introduction & Objective: Waist circumference-based measures can improve assessment of diabetes risk beyond body mass index (BMI), but greater evidence is needed regarding their use in diabetes screening guidelines in low- and middle-income countries (LMICs). We examined the association of waist circumference (WC), relative fat mass (RFM), and BMI with diabetes across LMICs in individuals without obesity.

Methods: Pooled, cross-sectional analysis of nationally representative, individual-level surveys conducted in 61 LMICs, 2010-2019. We included participants ≥18 years with a BMI ≥18.5 and <30 kg/m2. We used multivariable Poisson regression analysis to assess the relationship between the anthropometric measures of interest and diabetes and compared their performance as classifiers of diabetes status, expressed as the area under the curve (AUC), using ROC analysis.

Results: Among 560,652 participants, diabetes prevalence was 5.8%. Risk of diabetes was greatest for men in East/Southeast Asia in the highest quintile of BMI (RR 5.84 [95% CI: 4.3, 7.9]) and WC (6.34 [4.2, 9.7]) and for women in Latin America & the Caribbean in the highest quintile of RFM (6.02 [3.3, 10.9]), compared to those in the lowest quintile of each anthropometric measure. AUC for WC and RFM were 0.70 and 0.71 for women and 0.69 and 0.70 for men, respectively, compared to 0.66 and 0.65 for BMI. There was substantial variation in the AUC thresholds for each measure by sex and across six world regions.

Conclusions: WC and RFM outperform BMI to assess diabetes risk in individuals without obesity, though there is substantial regional variation in optimal thresholds across LMICs.