The research, published on September 8 in JAHA: Journal of the American Heart Association, found that measuring Black adults’ waist circumference was a good indicator on how likely they were to develop diabetes in the future. “I like the idea of using a simple tape measure — something that even people with limited education and limited resources could have access to. This screening could very easily be performed at a health fair held at a church or community center to help identify people who are at risk for developing diabetes,” says Fatima Cody Stanford, MD, MPH, and obesity medicine physician scientist at Massachusetts General Hospital and Harvard Medical School in Boston. Dr. Stanford was not involved in the research.
A Simpler and More Effective Way to Identify People at Risk for Diabetes
Investigators compared a variety of tests that try to predict whether a person will develop diabetes, including measuring waist circumference and the fat tissue that surrounds internal organs, and liver fat, fasting glucose (blood sugar) levels, and hemoglobin A1C tests. A fasting blood sugar test measures the blood sugar after a night of not eating. Normal fast blood sugar is 99 milligrams per deciliter (mg/dL) or lower; 100 to 125 mg/dL indicates prediabetes, and 126 mg/dL or higher indicates diabetes, according to the Centers for Disease Control and Prevention (CDC). The hemoglobin A1C test measures the percentage of a person’s red blood cells that have sugar-coated hemoglobin (hemoglobin is a protein in the blood). An A1C level under 5.7 percent is considered normal, 5.7 to 6.4 percent indicated prediabetes, and a level of 6.5 percent or higher indicates diabetes.
Measuring Waist Circumference Should Be Part of Annual Checkups
The research included a total of 3,959 Black Americans who were part of the long-term Jackson Heart Study at the University of Mississippi in Jackson. Participants were in one of two groups; one group had normal blood sugar and the other group contained people who had been diagnosed with prediabetes because of elevated blood sugar levels. Prediabetes is when a person’s blood sugar levels are higher than normal, but not high enough to be diagnosed as diabetes. An estimated 88 million adults — more than 1 in 3 people — have prediabetes, but more than 8 in 10 of those people aren’t aware they have it, according to the CDC. Prediabetes not only puts a person at risk for developing type 2 diabetes, it’s also associated with an increased risk of heart disease and stroke. There is evidence that if people at risk for diabetes or prediabetes make lifestyle changes, such as eating a healthy diet and getting regular exercise, it can help delay or even prevent them from getting diabetes, says Stanford. Investigators found that waist circumference and measuring visceral fat with a computerized tomography (CT) scan were better at predicting whether a person would develop diabetes than the hemoglobin A1C test in people with normal blood sugar levels. In the group that already had prediabetes, hemoglobin A1C was better at predicting eventual diabetes than waist circumference or a fasting blood sugar test. Visceral fat and liver fat are measured with CT scans, which are costly and expose individuals to radiation, whereas measuring waist circumference is simple and free, said the study’s lead author Joshua J. Joseph, MD, assistant professor of medicine in the division of endocrinology at The Ohio State University Wexner Medical Center in Columbus, in a press release. “We encourage primary care physicians to measure waist circumference during annual physicals, and if needed, suggest healthy lifestyle modifications to help patients improve their waist sizes.”
Black Americans More Likely to Develop Type 2 Diabetes
The prevalence of type 2 diabetes in Black Americans is higher than in white Americans; in 2018, Black adults were 60 percent more likely to be diagnosed with diabetes than white adults, according to the Office of Minority Health, which is part of the U.S. Department of Health and Human Services. Black Americans are also more likely to experience serious complications of diabetes compared with white Americans — in 2017, Black Americans were more than 3 times more likely than white Americans to be diagnosed with end stage renal disease, and more than twice as likely to have a lower limb amputated. Death due to diabetes was double for Black Americans when compared with white Americans, according to the agency. As we continue to try to improve healthcare disparities, it’s important to continue to seek out and utilize cost effective and easy-to-access tests such as measuring waist circumference in order to better identify health risks in the United States and around the world, says Stanford.
Waist Circumference Can Be a Useful Measure — if Done Correctly
Although the study didn’t evaluate specific targets for waist circumference, a waist circumference of 35 inches or more for women, or 40 inches or more for men, is associated with a risk for diabetes, according to the revised Adult Treatment Panel 3 guidelines. While many experts agree that waist circumference is a more useful way to measure risk than body mass index (BMI), you have to do it correctly, says Stanford. “It’s important to measure the waist at the belly button. Many men think that their waist is where they wear their pants or their pant size — that’s not the case,” she says.
