Peer-Reviewed Publication
Diabetes Care2026;49(9):1654-1662.September 1, 2026Journal Article
Waist Circumference, Relative Fat Mass Index, and BMI as Classifiers of Diabetes Status: A Comparative, Cross-sectional Analysis in 82 Low- and Middle-Income Countries.
Jacqueline A Seiglie1,2, Till Seuring3, Felix Teufel4, Maja E Marcus5, Michaela Theilmann5, Pascal Geldsetzer6,7, Kokou Agoudavi8, Glennis Andall-Brereton9, Krishna K Aryal10, Brice Wilfried Bicaba11, Pascal Bovet12,13, Luisa Campos Caldeira Brant14, Garry Brian15, Albertino Damasceno16, Maria Dorobantu17, Farshad Farzadfar18, Gladwell Gathecha19, Ali Golestani18, Mongal Singh Gurung20, Mahsa Heidari-Foroozan18, Corine Houehanou21, Dismand Houinato21, Nahla Hwalla22, Jutta Jorgensen23, Kibachio J Mwangi20, Gibson B Kagaruki24, Khem B Karki25, Nuno Lunet26, Deborah C Malta27, Joao S Martins28, Mohammed Msaidie29, Omar Mwalim30, Bolormaa Norov31, Sarah Quesnel-Crooks32, Sahar Saeedi Moghaddam33,34, Abla Sibai35, Lela Sturua36, Lindiwe Tsabedze37, Chea Stanford Wesseh38, Roy Wong McClure39, Sang Gune Yoo40, Rifat Atun41,42, Justine I Davies43,44, Sebastian Vollmer45, Till W Bärnighausen46,47, David Flood48, Orison O Woolcott49,50, Jennifer Manne-Goehler5,46,51
1Diabetes Unit, Massachusetts General Hospital, Boston, MA.
2Department of Medicine, Harvard Medical School, Boston, MA.
3Luxembourg Institute of Socio-Economic Research (LISER), Porte des Sciences, Maison des Sciences Humaines, Esch-sur-Alzette, Luxembourg.
4Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA.
5Brigham and Woman's Hospital, Harvard Medical School, Boston, MA.
6Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA.
7Chan Zuckerberg Biohub-San Francisco, San Francisco, CA.
8Togo Ministry of Health, Lome, Togo.
9Independent consultant, Port of Spain, Trinidad and Tobago.
10Department for International Development/Nepal Health Sector Programme 3/Monitoring Evaluation and Operational Research, Abt Associates, Kathmandu, Nepal.
11Institut Africain de Santé Publique, Ouagadougou, Burkina Faso.
12Ministry of Health, Victoria, Seychelles.
13University Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland.
14Faculty of Medicine, Universidade Federal de Minas Gerais, Minas Gerais, Brazil.
15The Fred Hollows Foundation New Zealand, Auckland, New Zealand.
16Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
17Department of Cardiology, Emergency Hospital of Bucharest, Bucharest, Romania.
18Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
19Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya.
20Health Research and Epidemiology Unit, Ministry of Health, Thimphu, Bhutan.
21National School of Public Health (ENATSE), University of Parakou; Parakou, Benin.
22Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon.
23Institute of Global Health, Department of Public Health and Epidemiology, Copenhagen University, Denmark.
24National Institute for Medical Research, Dar es Salaam, Tanzania.
25Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
26Department of Public and Forensic Health Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal.
27School of Nursing, Federal University of Minas Gerais, Minas Gerais, Brazil.
28Faculty of Medicine and Health Sciences, Universidade Nacional Timor Lorosa'e, Dili, Timor-Leste.
29Ministry of Health, Solidarity, Social Cohesion and Gender, Government of Comoros, Moroni, Comoros.
30Ministry of Health, Zanzibar City, Tanzania.
31National Center for Public Health, Ulaanbaatar, Mongolia.
32Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago.
33Kiel Institute for the World Economy, Kiel, Germany.
34Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
35Epidemiology and Population Health Department, Faculty of Health Sciences American University of Beirut, Beirut, Lebanon.
36Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia.
37Ministry of Health, Mbabane, Eswatini.
38Ministry of Health, Monrovia, Liberia.
39Office of Epidemiology and Surveillance, Costa Rican Social Security Fund, San José, Costa Rica.
40Department of Cardiology, The University of Texas MD Anderson, Houston, TX.
41Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA.
42Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA.
43Institute of Applied Health Research, University of Birmingham, Birmingham, U.K.
44Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
45Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany.
46Harvard Center for Population and Development Studies, Cambridge, MA.
47Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany.
48University of Michigan, Ann Arbor, MI.
49Institute for Globally Distributed Open Research and Education, Los Angeles, CA.
50Ronin Institute, Montclair, NJ.
51Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Abstract
OBJECTIVE: Waist circumference-based measures can improve diabetes risk assessment beyond BMI. Yet, evidence to guide their integration into screening guidelines in low- and middle-income countries (LMICs) is limited, particularly to assess risk among individuals at intermediate BMI ranges. We evaluated the associations of waist circumference (WC), relative fat mass (RFM), and BMI with diabetes ac…
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