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Use of metabolic markers to identify overweight individuals who are insulin resistant.
Ann Intern Med. 2003 Nov 18; 139(10):802-9.AIM

Abstract

BACKGROUND

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.

OBJECTIVE

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.

DESIGN

Cross-sectional study.

SETTING

General clinical research center.

PATIENTS

258 nondiabetic, overweight volunteers.

MEASUREMENTS

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.

RESULTS

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 triglyceride-high-density lipoprotein cholesterol ratio, and 109 pmol/L for insulin. Respective sensitivity and specificity 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%).

CONCLUSIONS

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 triglyceride-high-density lipoprotein cholesterol concentration ratio.

Authors+Show Affiliations

Stanford University School of Medicine, Stanford, California 94305, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

14623617

Citation

McLaughlin, Tracey, et al. "Use of Metabolic Markers to Identify Overweight Individuals Who Are Insulin Resistant." Annals of Internal Medicine, vol. 139, no. 10, 2003, pp. 802-9.
McLaughlin T, Abbasi F, Cheal K, et al. Use of metabolic markers to identify overweight individuals who are insulin resistant. Ann Intern Med. 2003;139(10):802-9.
McLaughlin, T., Abbasi, F., Cheal, K., Chu, J., Lamendola, C., & Reaven, G. (2003). Use of metabolic markers to identify overweight individuals who are insulin resistant. Annals of Internal Medicine, 139(10), 802-9.
McLaughlin T, et al. Use of Metabolic Markers to Identify Overweight Individuals Who Are Insulin Resistant. Ann Intern Med. 2003 Nov 18;139(10):802-9. PubMed PMID: 14623617.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of metabolic markers to identify overweight individuals who are insulin resistant. AU - McLaughlin,Tracey, AU - Abbasi,Fahim, AU - Cheal,Karen, AU - Chu,James, AU - Lamendola,Cindy, AU - Reaven,Gerald, PY - 2003/11/19/pubmed PY - 2003/12/10/medline PY - 2003/11/19/entrez SP - 802 EP - 9 JF - Annals of internal medicine JO - Ann. Intern. Med. VL - 139 IS - 10 N2 - BACKGROUND: 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. OBJECTIVE: 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. DESIGN: Cross-sectional study. SETTING: General clinical research center. PATIENTS: 258 nondiabetic, overweight volunteers. MEASUREMENTS: 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. RESULTS: 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 triglyceride-high-density lipoprotein cholesterol ratio, and 109 pmol/L for insulin. Respective sensitivity and specificity 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%). CONCLUSIONS: 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 triglyceride-high-density lipoprotein cholesterol concentration ratio. SN - 1539-3704 UR - https://www.unboundmedicine.com/medline/citation/14623617/Use_of_metabolic_markers_to_identify_overweight_individuals_who_are_insulin_resistant_ L2 - https://www.annals.org/aim/fullarticle/doi/10.7326/0003-4819-139-10-200311180-00007 DB - PRIME DP - Unbound Medicine ER -