ORIGINAL ARTICLE Are measures of height and leg length related to incident diabetes mellitus? The ARIC (Atherosclerosis Risk in Communities) study Shimon Weitzman Æ Chin-Hua Wang Æ James S. Pankow Æ Maria I. Schmidt Æ Frederic L. Brancati Received: 28 July 2008 / Accepted: 3 June 2009 / Published online: 23 September 2009 Ó Springer-Verlag 2009 Abstract This study was designed to estimate the risk of developing diabetes in relation to adult height components, namely leg length and leg length/height ratio. Data on 12,800 individuals without diabetes were obtained at the baseline examination from the ARIC cohort. Cox propor- tional hazard models were used to estimate hazard rate ratios of diabetes for each 5-cm difference in leg length and 1 SD difference in the leg length/height ratio. During a mean follow-up period of 7.6 years, the age-adjusted incidence per 1,000 person years of follow-up was 25.8, 24.2, 10.4, and 16.2 in African American (AA) women, AA men, white women, and white men, respectively. The hazard ratio for diabetes (95% CI) per 5-cm difference in leg length was 0.85 (0.75–0.95) in white men, 0.79 (0.69– 0.90) in white women, 0.90 (0.75–1.07) in AA women, and 0.99 (0.77–1.27) in AA men, after adjusting for age, parental history of diabetes, parental socioeconomic status, and weight at age 25. The hazard ratio for diabetes per 1 SD difference in leg length/height ratio followed the same trend. Leg length is inversely and independently related to an increased risk of diabetes in middle-age white men and women but not in African-Americans. This sex–race het- erogeneity suggests that nutritional and environmental factors in childhood may modify this risk through different pathways. Keywords Diabetes incidence Á Leg length Á Leg length/height ratio Introduction The positive association between shorter height and glu- cose intolerance in non-pregnant adults was first described in 1991 [1] and further evaluated in women with and without GDM (gestational diabetes mellitus) in Korea [2], Brazil [3], the UK [4], Greece [5], and Australia [6]. This association was similar in the various ethnic groups studied. Adult leg length is a marker of early childhood envi- ronment, since this is the period of fastest leg growth [7], and thus, socioeconomic factors in childhood may influ- ence leg length [8]. Of all components of height, leg length had the strongest association with diabetes in a randomly selected population of women in the UK [9]. Explanations given for these findings remain highly speculative, and include possible undernourishment in early fetal and neo- natal life [3], and exposure to severe chronic infections in childhood [1, 3, 4]. An inverse association between upper leg length and glucose tolerance was also reported in US C.-H. Wang Department of Nutrition, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA J. S. Pankow Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA M. I. Schmidt Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil F. L. Brancati Johns Hopkins University, Baltimore, MD, USA S. Weitzman (&) Department of Epidemiology and Health Services Evaluation, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beersheba 84105, Israel e-mail: weitzman@bgu.ac.il 123 Acta Diabetol (2010) 47:237–242 DOI 10.1007/s00592-009-0145-0