Joint association of body mass index and central obesity with cardiovascular events and all-cause mortality in prediabetic population: A prospective cohort study

Objective: To assess the joint association of body mass index (BMI) and central obesity with cardiovascular events and all-cause mortality in prediabetic population. Methods: Altogether 18,703 participants with prediabetes completed follow-up between June 2006 and December 2015 were included in the analyses. Prediabetes was defined as fasting plasma glucose level 5.6-6.9 mmol/L, and without history of diabetes or currently use of hypoglycemic agents. Participants were classified according to the baseline status of BMI as well as the absence/presence of central obesity. We examined these associations in men and women separately. Results: The mean age was 51.5 + 11.1 years, and 85.6% (N=16,002) were male. During a median follow up of 9.0 (interquartile range 8.7-9.2) years, 848 and 88 major CV events occurred in men and women, respectively. Besides, 1111 men and 89 women died. Compared with men of BMI 22-23.9 kg/m(2) and without central obesity, the risk of CV events was increased among men with higher BMI and central obesity (HR 1.32 (95% CI: 1.05-1.67) for BMI 24-27.9 kg/m(2) and 1.31 (1.03-1.66) for BMI >= 28 kg/m(2), respectively); and the risk of all-cause mortality was the lowest among men of BMI 24-27.9 kg/m(2) but without central obesity (0.75, 0.61-0.92). We found no such association in women. Conclusion: Among men with prediabetes, both BMI and waist circumference should be included when evaluating the risks of major CV events and mortality. Measurement of adiposity constitutes a simple and cost-effective strategy to identify those at high-risk population in prediabetes. (C) 2019 Published by Elsevier Ltd on behalf of Asia Oceania Association for the Study of Obesity.