Waist-to-Hip Ratio Effective at Predicting Type 2 Diabetes Risk

A woman discusses with her doctor about possibilities for diabetes treatment in a well lit medical facility.
A team of investigators examined the relationship between parameters of body composition and risk of developing type 2 diabetes.

Waist-to-hip ratio was found to be the most reliable predictor of type 2 diabetes (T2D) among all individuals participating in a cross-sectional study, regardless of ethnicity, according to research published in Diabetes Care.

Data from the Healthy Life in an Urban Setting (HELIUS) study were analyzed by researchers at the University of Amsterdam. Body composition features and T2D risk were stratified according to ethnicity.

Male and female participants were of Dutch (n=2034, n=2418), South Asian Surinamese (n=1323, n=1633), African Surinamese (n=1554, n=2443), Ghanaian (n=873, n=1398), Turkish (n=1602, n=1944), or Moroccan (n=1498, n=2352) ethnicity, respectively.

Type 2 diabetes was most common among the South Asian Surinamese population (22.1%) and least frequent among the Dutch population (3.9%).

Body composition measurements better predicted T2D risk among women (receiving operator characteristic curve (ROC) range, 0.71-0.82) compared with men (ROC range, 0.64-0.80). Waist-to-hip ratio had the highest accuracy for both men (area under the ROC [AUC], 0.78; 95% CI, 0.77-0.80) and women (AUC, 0.81; 95% CI, 0.79-0.82).

Waist-to-hip ratio and waist circumference were most strongly associated with T2D (odds ratio [OR] range, 1.29-3.53), and body mass index (BMI) and fat percentage were more weakly associated with T2D (OR range, 1.06-2.92).

No overall interactions between ethnicity and BMI (P =.18), waist-to-hip ratio (P =.06), fat percentage (P =.16), or waist circumference (P =.20) were observed among men for T2D risk.

Among women, significant interactions were observed for BMI (P =.01) and fat percentage (P =.03). Specifically, among Ghanaian (OR, 0.94; 95% CI, 0.89-0.99; P =.02) and Moroccan (OR, 0.94; 95% CI, 0.89-0.99; P =.01) women, there was a significant interaction between BMI and T2D, and among South Asian Surinamese (OR, 0.95; 95% CI, 0.90-1.00; P =.04), Ghanaian (OR, 0.94; 95% CI, 0.89-1.00; P =.04), and Moroccan (OR, 0.93; 95% CI, 0.88-0.99; P =.02) there was a significant interaction between fat percentage and T2D.

This study may have been limited by interobserver variations of body composition measurements.

These data indicated that waist-to-hip ratio was the most accurate and reliable predictor of T2D irrespective of ethnic background.


Zethof M, Mosterd CM, Collard D, et al. Differences in body composition convey a similar risk of type 2 diabetes among different ethnic groups with disparate cardiometabolic risk — The HELIUS Study. Diabetes Care. 2021;44:1-7. doi:10.2337/dc21-0230