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Epidemiology and Population Health

Association of relative fat mass with the incidence of type 2 diabetes: over a decade follow-up from the TLGS

International Journal of Obesity (2025)Cite this article

Subjects

Abstract

Aims and background

Relative fat mass (RFM) is strongly associated with type 2 diabetes (T2DM) and has been shown to be a better predictor than body mass index (BMI) and waist circumference (WC). This study aims to investigate the association between RFM and incident T2DM among adults in the Tehran Lipid and Glucose Study cohort.

Methods

Data from 8419 participants (4716 women; mean age, 40.52 years) were analyzed. Logistic regression was used to assess the association of RFM with insulin resistance, metabolic syndrome, and its components at baseline. Cox proportional hazards models were applied to evaluate the association between RFM and incident T2DM. Wald tests were used to compare RFM hazard ratios (HRs) with those of BMI, WC, and waist-to-hip ratio (WHR) in the Cox model.

Results

Over a median follow-up of 14 years, 1382 individuals (16.42%) developed T2DM. RFM was significantly associated with insulin resistance, metabolic syndrome, and its components at baseline in both men and women. In the multivariable-adjusted model, each standard deviation increase in RFM was associated with a 1.26-fold (1.02–1.57, P = 0.037) higher risk of T2DM in men and a 1.52-fold (1.27–1.81, P < 0.001) higher risk in women. These associations were stronger in younger individuals and remained significant only in women after adjusting for insulin resistance and restricting the analysis to normoglycemic individuals. The increased T2DM risk associated with RFM was comparable to that associated with WC in both men and women (Pdifference > 0.05).

Conclusions

While RFM is strongly associated with the risk of T2DM, particularly in women and younger individuals, it does not outperform WC.

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Fig. 1: Flowchart of participant selection.
Fig. 2: Associations of standardized relative fat mass with prevalent insulin resistance, metabolic syndrome, and its components at baseline.
Fig. 3: Restricted cubic spline analysis of relative fat mass and incident type 2 diabetes.

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Data availability

The datasets analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

This article is part of a thesis done by Mr. Masrouri from the School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. We thank the research team members and TLGS participants for their valuable contributions to the study. The graphical abstract was created with BioRender.com by Dr. Amirhossein Hasanpour.

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Authors and Affiliations

  1. Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Soroush Masrouri, Navid Ebrahimi & Farzad Hadaegh

  2. School of Medicine, Urmia University of Medical Sciences, Urmia, Iran

    Soroush Soraneh

  3. Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Fereidoun Azizi

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  1. Soroush Masrouri
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  2. Navid Ebrahimi
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  3. Soroush Soraneh
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  4. Fereidoun Azizi
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Contributions

SM was responsible for conceiving and designing the study. SM, NE and FH acquired, analysed and interpreted the data. NE, SM, SS, and FH were responsible for drafting the manuscript and incorporating critical revisions. All authors reviewed and approved the final manuscript.

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Correspondence to Farzad Hadaegh.

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The authors declare no competing interests.

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The protocol of the present study, conducted in accordance with principles of the Declaration of Helsinki, was approved by the ethics committee of the Research Institute of Endocrine Sciences of Shahid Beheshti University of Medical Sciences. All participants provided written informed consent.

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Masrouri, S., Ebrahimi, N., Soraneh, S. et al. Association of relative fat mass with the incidence of type 2 diabetes: over a decade follow-up from the TLGS. Int J Obes (2025). https://doi.org/10.1038/s41366-025-01858-7

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