Associations of hip and thigh circumferences independent of waist circumference with the incidence of type 2 diabetes: the Hoorn Study

Background: The higher risk of type 2 diabetes in persons with a high waist-to-hip ratio (WHR) or waist-to-thigh ratio (WTR) has mostly been attributed to increased visceral fat accumulation. However, smaller hip or thigh circumference may also explain the predictive value of the WHR or WTR for type 2 diabetes. Objective: This study considered prospectively the association of hip and thigh circumferences, independent of waist circumference, with the incidence of type 2 diabetes. Design: The Hoorn Study is a population-based cohort study of diabetes. A total of 1357 men and women aged 50-75 y and non-diabetic at baseline participated in the 6-y follow-up examination. Glucose tolerance was assessed by use of a 75-g oral-glucose-tolerance test. Baseline anthropometric measurements included body mass index (BMI) and waist, hip, and thigh circumferences. Results: Logistic regression analyses showed that a 1-SD larger hip circumference gave an odds ratio (OR) for developing diabetes of 0.55 (95% CI: 0.36, 0.85) in men and 0.63 (0.42, 0.94) in women, after adjustment for age, BMI, and waist circumference. The adjusted ORs for a 1-SD larger thigh circumference were 0.79 (0.53, 1.19) in men and 0.64 (0.46, 0.93) in women. In contrast with hip and thigh circumferences, waist circumference was positively associated with the incidence of type 2 diabetes in these models (ORs ranging from 1.60 to 2.66). Conclusion: Large hip and thigh circumferences are associated with a lower risk of type 2 diabetes, independently of BMI, age, and waist circumference, whereas a larger waist circumference ix associated with a higher risk. Am J Clin Nutr 2003;77:1192-7. KEY WORDS Hip circumference, thigh circumference, waist-to-hip ratio, waist circumference, BMI, body composition, fat distribution, type 2 diabetes, insulin resistance, the Hoorn Study