Associations between BMI, waist circumference, central obesity and outcomes in type II diabetes mellitus: The ACCORD Trial

Our study aimed to investigate associations between BMI, waist circumference (WC), and central obesity (CO) with outcomes in patients with type 2 diabetes using data from the ACCORD trial. WC was assessed as a continuous variable. CO was derived as a dichotomous variable using cutoffs from the World Health Organization. BMI was assessed as a continuous and categorical variable using BMI ≤ 24.9 kg/m2 as normal weight, 25–30 kg/m2 as overweight, and >30 kg/m2 as obese. Incident atherosclerotic cardiovascular disease (ASCVD), congestive heart failure (CHF), and all-cause mortality were assessed. Cox proportional hazards were used to assess associations between our predictors and outcomes after adjusting for confounders. Bonferroni correction was used to adjust for multiple comparisons. BMI and WC were associated with CHF [HR (95%CI): 1.41 (1.28–1.56), p ≤ 0.001; 1.43 (1.30–1.58), p ≤ 0.001 respectively] and all-cause mortality [HR (95%CI): 1.20 (1.11–1.30), p ≤ 0.001; 1.22 (1.13–1.37), p ≤ 0.001 respectively], though CO was not associated with any outcome after adjustment. No associations were seen between any adiposity metric and ASCVD. Both BMI and WC independently capture the risk associated with adiposity in type 2 diabetes. However, those considered overweight and obese by BMI, and those with CO were not independently associated with outcomes in this cohort. •Body mass index, waist circumference, and central obesity are measures of adiposity associated with cardiovascular disease.•BMI and waist circumference capture the risk associated with adiposity in individuals with type II diabetes.•Current cut points used to define central obesity do not accurately reflect risk in individuals with type II diabetes.