Sex-Specific Associations of Android and Gynoid Adiposity with Prediabetes Among U.S. Adults: A Cross-Sectional Analysis of National Health and Nutrition Examination Survey 2011–2016

OBJECTIVE: To investigate sex-specific associations between depot-specific adipose tissue distribution and prediabetes among U.S. adults. METHODS: This cross-sectional analysis included 2993 adults from the 2011-2016 National Health and Nutrition Examination Survey. Android and gynoid fat percentages were measured using dual-energy X-ray absorptiometry. Sex-stratified multivariable logistic regression models were employed to assess these associations, adjusting for demographic, lifestyle, and metabolic covariates. RESULTS: Individuals with prediabetes had significantly higher android and gynoid fat percentages than normoglycemic controls in both sexes. After full adjustment, higher android fat was consistently associated with increased odds of prediabetes in both men [odds ratio (OR) = 1.044, 95% confidence interval (CI): 1.013-1.077] and women (OR = 1.052, 95% CI: 1.023-1.083). In contrast, higher gynoid fat was associated with reduced odds of prediabetes in women only (OR = 0.940, 95% CI: 0.910-0.972), with no significant association observed in men (OR = 0.965, 95% CI: 0.930-1.001). CONCLUSIONS: The association between regional adiposity and prediabetes is fundamentally modified by sex. While android fat is a uniform risk factor, gynoid fat appears to be protective, specifically in women. These findings underscore the necessity of sex-specific assessment of body fat distribution for early cardiometabolic risk stratification.