For our primary objective, the exposure of interest was BMI as a continuous variable (in kg/m2). BMI was automatically calculated through a computer program (“Estació clínica d’atenció primària”) after general practitioners (GPs) or nurses entered the weight (kg) and height (cm) of patients they directly assessed in a standardized manner [14]. For participants without information from that computer program, we calculated the BMI using weight and height data available in their health records (if height was not available on the same date as the weight measurement, we calculated the individuals’ mean height using all available measurements in their health records during adulthood (≥ 18 years) and we chose the closest real height value to the mean). For our secondary objective, we additionally considered WC as an exposure; this indicator was routinely measured by trained health professionals (GPs and nurses) who follow a measurement protocol [15]. WC was measured at the umbilical level, midway between the anterior superior iliac spine and the inferior border of the rib while participants were standing.

We also extracted information on sex (women, men), age (in years), and geographic region of nationality (Spain, European [non-Spanish], Africa, America, and Asia). We assessed socioeconomic status in urban areas using the “Mortalidad en áreas pequeñas Españolas y Desigualdades Socioeconómicas y Ambientales” (MEDEA) deprivation index, which is calculated at the census tract level and was categorized into quintiles by the SIDIAP for anonymization purposes [16]. The first and the fifth quintiles represent the least and most deprived groups of the population living in urban areas of Catalonia, respectively. We included a rural category since the MEDEA index was not available for participants living in those areas. We also extracted information on smoking status (never, former, or current smoker) and alcohol intake (none, low or high). If a participant had more than one record of smoking status and alcohol intake available, we selected the one closest to the index date within a 6-year period (5 years before and 1 year after the first BMI measurement). For type 2 diabetes, we considered any registry of a GP diagnosis (ICD-10 code E11) before the index date. For women, we included information on menopausal status and hormonal replacement therapy (HRT) use, the definitions of which can be consulted in Additional file 1: Appendix S1.

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