• Navin Suthahar, Kan Wang, Victor W Zwartkruis, BakkerStephan J LSJLDepartment of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands., Silvio E Inzucchi, Laura M G Meems, Tim R Eijgenraam, Fariba Ahmadizar, Eric G Sijbrands, Ron T Gansevoort, Lyanne M Kieneker, Dirk J van Veldhuisen, Maryam Kavousi, and Rudolf A de Boer.
• Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands; Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands. Electronic address: n.suthahar@erasmusmc.nl.
• Eur. J. Intern. Med. 2023 Mar 1; 109: 737873-78.

BackgroundRelative fat mass (RFM) is a novel sex-specific anthropometric equation (based on height and waist measurements) to estimate whole-body fat percentage.ObjectiveTo examine associations of RFM with incident type-2 diabetes (T2D), and to benchmark its performance against body-mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR).MethodsThis prospective longitudinal study included data from three Dutch community-based cohorts free of baseline diabetes. First, we examined data from the PREVEND cohort (median age and follow-up duration: 48.0 and 12.5 years, respectively) using Cox regression models. Validation was performed in the Lifelines (median age and follow-up duration: 45.5 and 3.8 years, respectively) and Rotterdam (median age and follow-up duration: 68.0 and 13.9 years, respectively) cohorts.ResultsAmong 7961 PREVEND participants, 522 (6.6%) developed T2D. In a multivariable model, all adiposity indices were significantly associated with incident T2D (Pall<0.001). While 1 SD increase in BMI, WC and WHR were associated with 68%, 77% and 61% increased risk of developing T2D [Hazard ratio (HR)BMI: 1.68 (95%CI: 1.57-1.80), HRWC: 1.77 (95% CI: 1.63-1.92) and HRWHR: 1.61 (95%CI: 1.48-1.75)], an equivalent increase in RFM was associated with 119% increased risk [HR: 2.19 (95%CI: 1.96-2.44)]. RFM was associated with incident T2D across all age groups, with the largest effect size in the youngest (<40 years) age category [HR: 2.90 (95%CI: 2.15-3.92)]. Results were broadly similar in Lifelines (n = 93,870) and Rotterdam (n = 5279) cohorts.ConclusionsRFM is strongly associated with new-onset T2D and displays the potential to be used in the general practice setting to estimate the risk of future diabetes.Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.

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