Anthropometric indices as predictors of type 2 diabetes in a 10-year cohort study from the Yazd Healthy Heart Project

Q: What are the key findings of this study?

Waist-to-hip ratio (highest vs. lowest quartile) was strongly associated with 10-year incident type 2 diabetes (HR 3.09, 95% CI 1.72–5.58), outperforming BMI (HR 1.54) with moderate discrimination (AUC 0.68).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Risk of incident type 2 diabetes in non-diabetic adults (n=1641). Intervention: Anthropometric adiposity indices (specifically highest quartile of waist-to-hip ratio [WHR], as well as BMI, WC, BRI, and ABSI) vs. Lowest quartile of respective anthropometric index (e.g., lowest quartile of WHR). Primary outcome: 10-year incidence of type 2 diabetes (defined as fasting plasma glucose >=126 mg/dL or use of antidiabetic medications) (HR 3.09, 95% CI 1.72-5.58, p=<0.001).

Q: What does this research mean for the field?

Waist-to-hip ratio is strongly associated with 10-year incident type 2 diabetes (HR 3.09, 95% CI 1.72–5.58), outperforming BMI while showing moderate discriminatory ability (AUC 0.68). Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate and compare several anthropometric indices to identify the measure most strongly linked to 10-year type 2 diabetes incidence in an Iranian cohort.

Mohammadtaghi Sarebanhassanabadi; Poria Heshmati Nasab; Farnoosh Ghomi; Parisa Peigan; Pedro Marques-Vidal; Seyedeh Mahdieh Namayandeh; Imane Bagheri

doi:10.1038/s41598-026-62372-y

August 6, 2026Scientific ReportsOpen Access

Anthropometric indices as predictors of type 2 diabetes in a 10-year cohort study from the Yazd Healthy Heart Project

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Key result

High waist-to-hip ratio linked to ~3.1-fold higher risk of incident type 2 diabetes, outperforming BMI.

HR 3.09
95% CI 1.72-5.58
P<0.001
n=1,641

Why the study?

Which anthropometric adiposity index (BMI, WC, WHR, BRI, or ABSI) is most strongly associated with and best predicts the 10-year incidence of type 2 diabetes in non-diabetic Iranian adults?

Key Points

To evaluate and compare several anthropometric indices to identify the measure most strongly linked to 10-year type 2 diabetes incidence in an Iranian cohort.
Prospective cohort study analyzing 1,107 non-diabetic adults (from an initial cohort of 1,641) from the Yazd Healthy Heart Project in Iran followed over 10 years.
Evaluated baseline anthropometric indices (BMI, WC, WHR, BRI, and ABSI) and cardiometabolic covariates using Cox proportional hazards regression models and ROC curve analysis.
During 10-year follow-up, 246 participants developed type 2 diabetes (cumulative incidence: 22.2%; 21.0% in males, 23.6% in females).
In fully adjusted models, all indices were significantly associated with diabetes, with WHR showing the strongest association (highest vs. lowest quartile HR: 3.09, 95% CI: 1.72–5.58, P < 0.001), followed by BRI (HR: 2.19, 95% CI: 1.32–3.63), ABSI (HR: 2.05, 95% CI: 1.22–3.46), WC (HR: 1.97, 95% CI: 1.28–3.03), and BMI (HR: 1.54, 95% CI: 1.04–2.29).
WHR showed the highest discrimination for predicting diabetes incidence (AUC = 0.68, 95% CI: 0.66–0.71), while WC and BRI had AUC = 0.66, ABSI had AUC = 0.66, and BMI demonstrated the lowest accuracy (AUC = 0.58).

Study Design

Type

Cohort (n=1,641)

Multicenter

No

Structured PICO

Which anthropometric adiposity index (BMI, WC, WHR, BRI, or ABSI) is most strongly associated with and best predicts the 10-year incidence of type 2 diabetes in non-diabetic Iranian adults?

P

Population

1,641 non-diabetic urban Iranian adults aged 20–74 years from the Yazd Healthy Heart Project (1,107 with complete follow-up), followed for 10 years to evaluate incident type 2 diabetes.

E

Exposure

Baseline anthropometric adiposity indices evaluated across quartiles: waist-to-hip ratio (WHR), body mass index (BMI), waist circumference (WC), body roundness index (BRI), and A Body Shape Index (ABSI).

C

Comparator

Lowest quartile of each respective anthropometric index (e.g., lowest quartile of WHR); comparative predictive performance across the five anthropometric indices.

O

Outcome

10-year incidence of type 2 diabetes (defined per ADA criteria as fasting plasma glucose >=126 mg/dL or use of antidiabetic medications) over 10 years of follow-up (2005–2006 to 2015–2016).hard clinical

Main Result

Hazard Ratio: 3.09 (95% CI 1.72–5.58)

p-value: p=<0.001

Limitations

Relatively limited number of incident diabetes cases (n=246) and 534 participants lost to follow-up, reducing statistical power and precluding sex-stratified analyses
Single-region population in Yazd, Iran, limiting generalizability to other ethnic or geographic groups
Unmeasured potential mediators and confounders such as detailed dietary composition, genetic factors, and insulin-resistance markers
Waist-to-height ratio (WHtR) was not included in the analytical framework, and reliance solely on baseline anthropometric measurements did not capture dynamic changes over time
Formal assessment of the Cox proportional hazards assumption was not reported, and baseline diabetes diagnosis via single FPG measurement lacked confirmatory repeat testing
Study population drawn from a single region in Iran (Yazd), limiting generalizability to other ethnic or geographic groups
Lack of adjustment for potential mediators/confounders including detailed dietary composition, genetic factors, and insulin-resistance markers
Reliance solely on baseline anthropometric measurements without time-dependent modeling of changes in adiposity over time, and omission of waist-to-height ratio (WHtR)
Formal assessment of the Cox proportional hazards assumption was not reported, and baseline FPG >=126 mg/dL was not confirmed with repeat testing

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Answers are grounded in this paper and cite their sources.

Implication

In an Iranian prospective cohort followed for 10 years, central adiposity measured by waist-to-hip ratio (WHR) was a stronger predictor of incident type 2 diabetes than general obesity (BMI) or novel geometric indices (BRI, ABSI), though overall discrimination remained moderate (AUC 0.68).

Abstract

Obesity, particularly central obesity, is one of the most important risk factors for type 2 diabetes. This study aimed to compare several anthropometric indices and identify the indicator most strongly associated with type 2 diabetes risk in an Iranian population. A total of 1,641 non-diabetic individuals from the Yazd Healthy Heart Project (YHHP) were followed for 10 years. Baseline and follow-up data included demographic, anthropometric, and clinical/biochemical measurements such as LDL, fasting blood sugar (FBS), physical activity, and blood pressure. Statistical analyses, including Cox proportional hazards regression and ROC curve analysis, were used to assess diabetes incidence. Higher quartiles of adiposity indices were associated with adverse cardiometabolic profiles. In fully adjusted models, all anthropometric indices (BMI, WHR, BRI, WC, and ABSI) were significantly associated with the 10-year risk of developing type 2 diabetes (p < 0.05). Among these, WHR showed a relatively stronger association (HR = 3.09, 95% CI 1.72–5.58), although its discriminatory ability remained moderate (AUC = 0.68). These findings suggest that indices reflecting abdominal fat distribution may offer advantages over general obesity measures such as BMI, underscoring the importance of central adiposity in diabetes risk assessment.

Discussion

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Cite This Study

Sarebanhassanabadi et al. (2026) conducted a cohort in Risk of incident type 2 diabetes in non-diabetic adults (n=1,641). Anthropometric adiposity indices (specifically highest quartile of waist-to-hip ratio [WHR], as well as BMI, WC, BRI, and ABSI) vs. Lowest quartile of respective anthropometric index (e.g., lowest quartile of WHR) was evaluated on 10-year incidence of type 2 diabetes (defined as fasting plasma glucose >=126 mg/dL or use of antidiabetic medications) (HR 3.09, 95% CI 1.72-5.58, p=<0.001). Waist-to-hip ratio (highest vs. lowest quartile) was strongly associated with 10-year incident type 2 diabetes (HR 3.09, 95% CI 1.72–5.58), outperforming BMI (HR 1.54) with moderate discrimination (AUC 0.68).

synapsesocial.com/papers/6a76daf2f12abadc79815b52 https://doi.org/10.1038/s41598-026-62372-y

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Anthropometric indices as predictors of type 2 diabetes in a 10-year cohort study from the Yazd Healthy Heart Project

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Anthropometric indices as predictors of type 2 diabetes in a 10-year cohort study from the Yazd Healthy Heart Project

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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