Associations between anthropometric measures of obesity and prediabetes risk: A dose–response meta-analysis of cohort studies

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. © 2026 John Wiley & Sons Ltd.