Relationships among insulin resistance,obesity,diagnosis of the metabolic syndrome and cardio-metabolic risk

Abstract

The aim of this study is to test the hypotheses that: 1) diagnosing the metabolic syndrome does not effectively identify insulin-resistant (IR) individuals; and 2) waist circumference (WC) is no better than body mass index (BMI) in predicting insulin resistance or the components of the metabolic syndrome (MetS). Measurements of BMI, WC, blood pressure, and fasting plasma glucose, insulin (FPI), triglycerides (TG), and HDL-cholesterol (HDL-C) concentrations were made in 1,300 adults, without known cardiovascular disease (CVD) or drug treatment of hypertension or diabetes. Receiver operating characteristic curves were used to determine the ability of the MetS, and its components, to identify IR individuals. In addition, comparisons were made of CVD risk factors following division of the population into quartiles of FPI concentrations, and univariate and multiple regression analysis used to compare the ability of WC, BMI, and FPI as predictors of MetS components. The MetS was no more effective in identifying IR individuals than several individual components (sensitivity~40%), and IR individuals not identified were at significantly increased CVD risk. FPI concentration was the best predictor of an abnormal glucose, TG, and HDL-C, whereas the adiposity indices were better predictors of abnormal blood pressure. The relationship between BMI and WC with the MetS and its components seemed comparable.

Keywords

Cardiovascular disease insulin resistance metabolic syndrome

References

Reaven GM Role of insulin resistance in human disease. Diabetes 1988; 37: 1595-1607.

Ginsberg H. , Kimmerling G. , Olefsky JM and Reaven GM Demonstration of insulin resistance in untreated adult onset diabetic subjects with fasting hyperglycemia. J Clin Invest 1975; 55: 454-461.

World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications . 1999 Part 1: diagnosis and classification of diabetes mellitus. Geneva: WHO.

Alberti KG and Zimmet PZ Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998; 15: 539-553.

Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486-2497.

Simmons RK , Alberti KG , Gale EA , Colaguri S. , Tuomilehto J. , Qiao O. , et al. The metabolic syndrome; useful concept or clinical tool? Report of a WHO Expert Consultation. Diabetologia 2010; 53: 600-605.

Alberti KG , Eckel RH , Grundy SM , Zimmet PZ , Cleeman JI , Donato KA , et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009; 120: 1640-1645.

Cheal KL , Abbasi F. , Lamendola C. , McLaughlin T. , Reaven GM and Ford ES Relationship to insulin resistance of the adult treatment panel III diagnostic criteria for identification of the metabolic syndrome. Diabetes 2004; 53: 1195-1200.

Liao Y. , Kwon S. , Shaughnessy S. , Wallace P. , Hutto A. , Jenkins AJ , et al. Critical evaluation of adult treatment panel III criteria in identifying insulin resistance with dyslipidemia. Diabetes Care 2004; 27: 978-983.

10.

Sierra-Johnson J. , Johnson BD , Allison TG , Bailey KR , Schwartz GL and Turner ST Correspondence between the adult treatment panel III criteria for metabolic syndrome and insulin resistance. Diabetes Care 2006; 29: 668-672.

11.

Eckel RH , Alberti KG , Grundy SM and Zimmet PZ The metabolic syndrome. Lancet 2010; 375: 181-183.

12.

Salazar MR , Carbajal HA , Aizpurúa M. , Riondet B. , Rodrigo HF , Rechifort V. , et al. Decrease of blood pressure by community-based strategies. Medicina (B Aires) 2005; 65: 507-512.

13.

Salazar MR , Carbajal HA , Curciarello JO , Aizpurúa M. , Adrover RE and Riondet B.

Alanine-aminotransferase: an early marker for insulin resistance?

Medicina (B Aires) 2007; 67: 125-130.

14.

Salazar MR , Carbajal HA , Marillet AG , Gallo DM , Valli ML , Novello M. , et al. Glomerular filtration rate, cardiovascular risk factors and insulin resistance. Medicina (B Aires ) 2009; 69: 541-546.

15.

Olefsky J. , Farquhar JW and Reaven GM Relationship between fasting plasma insulin level and resistance to insulin-mediated glucose uptake in normal and diabetic subjects. Diabetes 1973; 22: 507-513.

16.

Yeni-Komshian H. , Carantoni M. , Abbasi F. and Reaven GM Relationship between several surrogate estimates of insulin resistance and quantification of insulin-mediated glucose disposal in 490 healthy, nondiabetic volunteers. Diabetes Care 2000; 23:171-175.

17.

Zavaroni I. , Bonini L. , Gasparini P. , Barilli AL , Zuccarelli A. , Dall’Aglio E. , et al. Hyperinsulinemia in a normal population as a predictor of non-insulin-dependent diabetes mellitus, hypertension, and coronary heart disease: The Barilla factory revisited. Metabolism 1999; 48: 989-994.