Waist circumference gives a better prediction of diabetes risk than does BMI. This is the conclusion drawn by Silke Feller and her colleagues from the German Institute for Nutritional Research in Potsdam-Rehbrücke, in the current edition of Deutsches Ärzteblatt International (Dtsch Arztebl Int 2010; 107[26]: 470-6).

Current guidelines recommend that the degree of risk of diabetes from overweight should be based on the determination of the body mass index (BMI). It is only recommended to measure the waist circumference when the BMI is greater than 25 points.

Perhaps this strategy should be reconsidered, as the predictive power of waist circumference for diabetes is particularly high for normal and underweight people (BMI < 25). Persons with a BMI of less than 25 points, but with a large waist circumference, have just as high a risk of developing diabetes, as pre-obese (25 < BMI < 30) women and men with low waist circumference.

The development of diabetes is particularly influenced by visceral fat tissue, which is metabolically more active than non-visceral fat. Visceral fat can be more accurately assessed from the waist circumference with people of lower weight than with overweight people, as waist circumference in overweight people contains a high proportion of subcutaneous fat.

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