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Meta-analysis finds BMI, but not waist circumference, associated with prediabetes riskHigher BMI linked to increased prediabetes risk in meta-analysis of 28 studies

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Key Takeaway
Consider BMI, but not waist circumference, as an associated risk marker for prediabetes based on observational meta-analysis.

This meta-analysis synthesized evidence from 28 cohort studies, retrieved from 8,434 records, to examine the association between anthropometric measures of obesity and the risk of developing prediabetes. The analysis focused on body mass index (BMI) and waist circumference (WC) as exposures, with the primary outcome being the development of prediabetes during longitudinal follow-up. The specific populations, settings, and follow-up durations of the included studies were not reported.

The main results showed a significant positive association between BMI and prediabetes risk. When analyzed as a continuous variable, the pooled risk ratio (RR) was 1.10 (95% CI: 1.03, 1.17). For categorical BMI, the RR was 1.52 (95% CI: 1.19, 1.94). A linear dose-response relationship was observed, indicating a 4.6% increase in prediabetes risk for every 1-unit increase in BMI. In contrast, analyses for waist circumference, both as a continuous and categorical variable, found no significant association with prediabetes risk.

Safety and tolerability data were not reported. Key limitations include substantial statistical heterogeneity among the included studies and limited data available for the waist circumference analyses, which weakens the certainty of the null finding for WC. The funding sources and potential conflicts of interest were also not reported.

In practice, these findings support the use of BMI as a risk marker for prediabetes in clinical assessment, underscoring the value of monitoring general obesity for early risk stratification. However, clinicians should interpret these results cautiously as they demonstrate an association, not causation, and prediabetes itself is a surrogate outcome. The lack of a significant finding for waist circumference should not be overgeneralized due to data limitations.

Researchers analyzed data from 28 different studies to understand how body measurements relate to prediabetes risk. They looked specifically at body mass index (BMI) and waist circumference (WC) as indicators of body size and shape. The studies followed people over time to see who developed prediabetes, a condition where blood sugar levels are higher than normal but not yet in the diabetes range.

The analysis found that people with higher BMI had a higher risk of developing prediabetes. For each one-unit increase in BMI, the risk increased by about 4.6%. When comparing people with obesity to those with normal weight, the risk was about 52% higher. Interestingly, waist circumference measurements did not show a clear link to prediabetes risk in this analysis.

It's important to understand that this research shows an association, not proof that higher BMI causes prediabetes. The studies had substantial differences in how they were conducted, which means we should be cautious about drawing firm conclusions. Also, prediabetes itself is an intermediate condition, not a final health outcome like diabetes or heart disease.

This analysis suggests that BMI might be a useful marker for identifying people at higher risk for prediabetes. However, because of the variability between studies and the limited waist circumference data, more consistent research is needed. The findings support current recommendations about monitoring weight as part of overall health assessment.

What this means for you:
Higher BMI was linked to prediabetes risk in research, but findings varied between studies and don't prove causation.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedApr 2026
View Original Abstract ↓
Obesity is a well-established risk factor for diabetes; however, its association with prediabetes remains controversial. Here, we aimed to assess the association between obesity and prediabetes risk. A systematic literature review was conducted using PubMed, Web of Science, Embase, Scopus, and Ovid through 3 May 2025, using keyword searches. We included cohort studies that assessed the association between anthropometric indices, specifically body mass index (BMI), waist circumference (WC), and prediabetes risk, operationalised as the development of prediabetes during the longitudinal investigation. We performed multiple meta-analyses assessing BMI and WC as continuous and categorical variables, including dose-response relationships with prediabetes risk. Of the 8434 records retrieved from the primary search, 28 were included in the meta-analysis. Considering BMI as both a continuous and a categorical variable indicated significant associations with prediabetes risk (risk ratio [RR]: 1.10 (95% CI: 1.03, 1.17) and RR: 1.52 (95% CI: 1.19, 1.94), respectively). The dose-response analysis confirmed a linear association between a 1-unit increase in BMI and a 4.6% increase in the risk of prediabetes. However, there was no significant association between WC and prediabetes risk either as a continuous or categorical variable. This study supports the use of BMI as a risk marker for prediabetes, whereas WC showed no significant association. While substantial heterogeneity and limited WC data warrant caution, the findings underscore the value of monitoring general obesity for early risk stratification and to prevent glycemic deterioration.
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