AIMS/HYPOTHESIS This prospective association study aimed to compare the relationship between each of four obesity indices and mortality risk in people with type 2 diabetes. METHODS The associations of BMI, waist circumference, WHR and A Body Shape Index (ABSI) with all-cause mortality were analysed in 1282 participants of the Fremantle Diabetes Study, followed for up to 20 years after baseline assessment. Models were adjusted for age and other confounders; assessments as continuous measures and by quintile were carried out for men and women separately. Sensitivity analyses were conducted to minimise reverse causality. RESULTS When indices were assessed as continuous variables, there were significant bivariate associations with mortality for: ABSI, which was greater in both men and women who died (p < 0.001); WHR, which was greater in women only (p = 0.033); and BMI, which was lower in women only (p < 0.001). When assessed by quintile, there were significant bivariate associations with mortality for ABSI in men and women (p < 0.001) and BMI in women only (p = 0.002). In Cox models of time to death, adjusted for age, diabetes duration, ethnicity and smoking, ABSI quintiles showed a linear trend for both men (p = 0.003) and women (p = 0.035). Men in the fifth ABSI quintile had an increased mortality risk compared with those in the first quintile (HR [95% CI]: 1.74 [1.24, 2.44]) and women in the fifth ABSI quintile had an increased mortality risk that approached statistical significance (1.42 [0.97, 2.08], p = 0.08). Men in the fifth WHR quintile had an increased mortality risk (1.47 [1.05, 2.06]). There was no association between mortality and BMI or waist circumference in either sex. CONCLUSIONS/INTERPRETATION ABSI was the obesity index most strongly associated with all-cause mortality in Australians with type 2 diabetes. There was no evidence for an obesity paradox with any of the assessed indices. ABSI may be a better index of central obesity than waist circumference, BMI or WHR when assessing mortality risk in type 2 diabetes.

中文翻译：

---

肥胖指数与2型糖尿病死亡率的比较：弗里曼特尔糖尿病研究。

目的/假设这项前瞻性关联研究旨在比较2型糖尿病患者四个肥胖指数与死亡率风险之间的关系。方法在Fremantle糖尿病研究的1282名参与者中分析了BMI，腰围，WHR和体型指数（ABSI）与全因死亡率的关系，并在基线评估后长达20年的时间进行了分析。根据年龄和其他混杂因素对模型进行了调整；男女分别进行了连续评估和五分位数评估。进行敏感性分析以使反向因果关系最小化。结果当将指标作为连续变量进行评估时，存在以下与死亡的显着双变量相关性：ABSI，在死亡的男性和女性中均较高（p <0.001）；WHR，仅在女性中更大（p = 0.033）；体重指数（BMI）仅在女性中较低（p <0.001）。如果按五分位数进行评估，则男性和女性的ABSI死亡率（p <0.001）与女性的BMI显着相关（p = 0.002）。在根据年龄，糖尿病持续时间，种族和吸烟进行调整的Cox死亡时间模型中，男性（p = 0.003）和女性（p = 0.035）的ABSI五分位数均呈线性趋势。与第五个ABSI五分位数男性相比，男性的死亡率风险更高（HR [95％CI]：1.74 [1.24，2.44]），而第五个ABSI五分位数女性具有更高的死亡率风险，接近统计显着性（ 1.42 [0.97，2.08]，p ＝ 0.08）。处于WHR五分之一的男性的死亡风险增加（1.47 [1.05，2.06]）。性别与死亡率和BMI或腰围之间均无关联。结论/解释ABSI是与2型糖尿病澳大利亚人全因死亡率最密切相关的肥胖指数。没有任何证据表明肥胖与任何评估的指标矛盾。在评估2型糖尿病的死亡风险时，ABSI可能是比腰围，BMI或WHR更好的中枢肥胖指数。