Tracey McLaughlin, MD; Fahim Abbasi, MD; Karen Cheal, MPH; James Chu, MD; Cindy Lamendola, MSN; Gerald Reaven, MD
Grant Support: By National Institutes of Health grants RR000070-40 and RR16071-01.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Gerald Reaven, MD, Division of Cardiovascular Medicine, Falk Cardiovascular Research Center, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305.
Current Author Addresses: Drs. McLaughlin and Chu: Division of Endocrinology, Stanford University School of Medicine, Room S005, Stanford, CA 94305-5103.
Drs. Reaven, Abbasi, and Ms. Lamendola: Division of Cardiovascular Medicine, Falk Cardiovascular Research Center, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305.
Ms. Cheal: Department of Psychiatry, Brigham and Women's Hospital, 350 Longwood Avenue, Suite 201, Boston, MA 02115.
Author Contributions: Conception and design: T. McLaughlin, K. Cheal, J. Chu, G. Reaven.
Analysis and interpretation of the data: T. McLaughlin, G. Reaven.
Drafting of the article: T. McLaughlin, G. Reaven.
Critical revision of the article for important intellectual content: T. McLaughlin, G. Reaven.
Final approval of the article: T. McLaughlin, G. Reaven.
Provision of study materials or patients: T. McLaughlin, F. Abbasi, C. Lamendola, G. Reaven.
Statistical expertise: T. McLaughlin, K. Cheal, G. Reaven.
Obtaining of funding: T. McLaughlin, G. Reaven.
Administrative, technical, or logistic support: T. McLaughlin, F. Abbasi, C. Lamendola.
Collection and assembly of data: T. McLaughlin, F. Abbasi.
Insulin resistance is more common in overweight individuals and is associated with increased risk for type 2 diabetes mellitus and cardiovascular disease. Given the current epidemic of obesity and the fact that lifestyle interventions, such as weight loss and exercise, decrease insulin resistance, a relatively simple means to identify overweight individuals who are insulin resistant would be clinically useful.
To evaluate the ability of metabolic markers associated with insulin resistance and increased risk for cardiovascular disease to identify the subset of overweight individuals who are insulin resistant.
General clinical research center.
258 nondiabetic, overweight volunteers.
Body mass index; fasting glucose, insulin, lipid and lipoprotein concentrations; and insulin-mediated glucose disposal as quantified by the steady-state plasma glucose concentration during the insulin suppression test. Overweight was defined as body mass index of 25 kg/m2 or greater, and insulin resistance was defined as being in the top tertile of steady-state plasma glucose concentrations. Receiver-operating characteristic curve analysis was used to identify the best markers of insulin resistance; optimal cut-points were identified and analyzed for predictive power.
Plasma triglyceride concentration, ratio of triglyceride to high-density lipoprotein cholesterol concentrations, and insulin concentration were the most useful metabolic markers in identifying insulin-resistant individuals. The optimal cut-points were 1.47 mmol/L (130 mg/dL) for triglyceride, 1.8 in SI units (3.0 in traditional units) for the triglyceridehigh-density lipoprotein cholesterol ratio, and 109 pmol/L for insulin. Respective sensitivity and specifity for these cut-points were 67%, 64%, and 57% and 71%, 68%, and 85%. Their ability to identify insulin-resistant individuals was similar to the ability of the criteria proposed by the Adult Treatment Panel III to diagnose the metabolic syndrome (sensitivity, 52%, and specificity, 85%).
Three relatively simple metabolic markers can help identify overweight individuals who are sufficiently insulin resistant to be at increased risk for various adverse outcomes. In the absence of a standardized insulin assay, we suggest that the most practical approach to identify overweight individuals who are insulin resistant is to use the cut-points for either triglyceride concentration or the triglyceridehigh-density lipoprotein cholesterol concentration ratio.
McLaughlin T, Abbasi F, Cheal K, Chu J, Lamendola C, Reaven G. Use of Metabolic Markers To Identify Overweight Individuals Who Are Insulin Resistant. Ann Intern Med. 2003;139:802–809. doi: 10.7326/0003-4819-139-10-200311180-00007
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Published: Ann Intern Med. 2003;139(10):802-809.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism, Obesity.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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