Is an appropriate cutoff of hypertriglyceridemic waist designated for type 2 diabetes among Chinese adults?

Association of hypertriglyceridemic waist phenotype with metabolic syndrome traits and its diagnostic potential to predict metabolic syndrome in adults with excess body weight: A community-based cross-sectional study

BACKGROUND

The hypertriglyceridemic waist (HTGW) phenotype is a simple measure to identify individuals at increased risk of metabolic syndrome (MetS) traits. The present study aimed to describe the HTGW prevalence, and its associations with MetS traits, and also determine the diagnostic potential of the mirror indices of HTGW phenotype to predict MetS and its components in community-dwelling adults with overweight or obesity in Southern, Sri Lanka.

METHODS

In a cross-sectional study, 300 adults with excess body weight (body mass index >23 kg/m2) were enrolled and examined for the HTGW phenotype (fasting plasma triglyceride concentration ≥1.695 mmol/L and waist circumference >90 and >85 cm in males and females, respectively).

RESULTS

One in five adults with excess body weight had the HTGW phenotype. Phenotype-positive adults had significantly higher fasting plasma glucose (FPG) (p = 0.010), low-density lipoprotein cholesterol (HDL-C) (p < 0.001), total cholesterol (p < 0.001), atherogenic index (p < 0.001), coronary risk index (p = 0.001), triglyceride glucose index (p = 0.040), bioimpedance visceral fat (p = 0.041) and significantly lower HDL-C (p = 0.001) and cardioprotective index (p = 0.009) than those without the HTGW phenotype. Adults with excess body weight and the HTGW phenotype had an increased risk of FPG (odds ratio [OR] = 1.294; 95% confidence interval [CI] 1.051-1.594), atherogenic index (OR = 3.138; 95% CI = 1.559-6.317) and triglyceride glucose index (OR = 3.027; 95% CI = 1.111-8.249). The HTGW phenotype was strongly associated with MetS traits (OR = 16.584; 95% CI = 6.230-44.147). The cut-off values for the product of waist circumference × triglyceride, to identify the risk of having MetS and dyslipidemia among adults with excess body weight were 158.66 and 160.15 cm × mmol/L, respectively.

CONCLUSIONS

The readily available and inexpensive measures of the HTGW phenotype could serve as a clinically useful marker to identify MetS traits in adults with excess body weight.

Association between Hypertriglyceridemic-Waist Phenotype and Risk of Type 2 Diabetes Mellitus in Middle-Aged and Older Chinese Population: A Longitudinal Cohort Study

Current evidence remains inconsistent with regard to the association between different triglyceridemic-waist phenotypes and the risks for type 2 diabetes mellitus (T2DM). We aimed to investigate this association among a retrospective cohort analysis of 6918 participants aged ≥ 45 years in the China Health and Retirement Longitudinal Study (CHARLS). Participants were categorized into four triglyceridemic-waist phenotypes consisting of NWNT (normal waist circumference and normal triglycerides), NWHT (normal waist circumference and high triglycerides), EWNT (enlarged waist circumference and normal triglycerides), and EWHT (enlarged waist circumference and high triglycerides) based on participants’ baseline information. Multivariate log-binomial regression was used to assess the T2DM risk in different phenotypes. Subgroup analysis was conducted to test the robustness of the findings. After 4-years of follow-up, participants with EWHT (Relative Risk [RR]: 1.909, 95% Confidence Interval [CI]: 1.499 to 2.447) or EWNT (RR: 1.580, 95%CI: 1.265 to 1.972) phenotypes had significantly higher likelihood of incident T2DM compared to the NWNT phenotype, whereas the association was not significant for the NWHT phenotype (RR: 1.063, 95%CI: 0.793 to 1.425). The subgroup analyses generally revealed similar associations across all subgroups. Among middle-aged and older adults, we suggested a combined use of waist circumference and triglycerides measures in identifying participants who are at high risk of developing T2DM.

Dose-response association between physical activity and clustering of modifiable cardiovascular risk factors among 26,093 Chinese adults

BACKGROUND

There is uncertain evidence in the dose-response association between overall physical activity levels and clustering of cardiovascular diseases modifiable risk factors (CVDMRF) in Chinese adults. This study examined the hypothesis whether inverse dose-response association between overall physical activity levels and clustering of CVDMRF in Chinese adults exist.

METHODS

Twenty-six thousand ninety-three Chinese adult participants were recruited by two independent surveys in Nanjing and Hefei during 2011 to 2013, from random selected households provided smoking, glucose, lipids, anthropometric, and blood pressure measurements. Logistic regression model was applied to examine the dose-response association between overall physical activity (measured by metabolic equivalent task (MET)- minutes per week) and having ≥1, ≥2, and ≥ 3 CVDMRF (dyslipidemia, hypertension, diabetes, cigarette smoking, and overweight).

RESULTS

An inverse linear dose-response relationship between physical activity and clustering of CVDMRF was identified, as increased physical activity levels are associated with lower odds of having clustering of CVDMRF. The adjusted odds ratio (95% confidence interval) of having ≥1, ≥2, and ≥ 3 CVRF for moderate physical activity group and high physical activity group was 0.88 (0.79 to 0.98) and 0.88 (0.79 to 0.99), 0.85 (0.78 to 0.92) and 0.85 (0.78 to 0.92), 0.84 (0.76 to 0.91) and 0.81 (0.74 to 0.89), respectively, with low physical activity as reference group.

CONCLUSIONS

Among Chinese adults, physical activity level inversely associates with clustering of CVDMRF, especially in those aged 35-54 years. Health promotion including improve physical activity should be advocated. The potential role of physical activity in the clustering of CVDMRF warrants further validation.

The "hyper-triglyceridemic waist phenotype" is a reliable marker for prediction of accumulation of abdominal visceral fat in Chinese adults

PURPOSE

The "hyper-triglyceridemic waist (HTW) phenotype" is relatively convenient to identify, acquired readily, and is inexpensive. We explored the relationship between the HTW phenotype and abdominal-fat accumulation in Chinese adults.

METHODS

The study cohort comprised 195 adults divided into four groups according to triglyceride (TG) concentration and waist circumference (WC): normal (A), "hyper-TG" (B), "hyper-WC" (C) and the HTW phenotype (D). The abdominal-fat compartment was measured by magnetic resonance imaging. A 75-g oral glucose tolerance test (OGTT) was administered after an overnight fast. Clinical, anthropometric and laboratory data were analyzed.

RESULTS

Individuals with the HTW phenotype had the highest WC, Conicity Index, waist:hip ratio and abdominal visceral fat (AVF) area, and the highest TG and uric-acid concentrations among the four groups. People with the HTW phenotype were older, had higher blood pressure than those with normal WC (groups A and B). In the OGTT, participants with the HTW phenotype had the highest insulin resistance and lowest insulin sensitivity. In binary logistic regression analysis, age, sex, Body Mass Index, high concentrations of density lipoprotein-cholesterol and low-density lipoprotein-cholesterol, and the HTW phenotype were independent risk factors for predicting AVF accumulation with a sensitivity of 81.08% and specificity of 90.91%.

CONCLUSIONS

Chinese adults with the HTW phenotype had the highest AVF area and insulin resistance, and were associated with higher blood pressure than individuals with normal WC. The HTW phenotype is a reliable marker for prediction of AVF accumulation associated with insulin resistance.

LEVEL OF EVIDENCE

IV.

Screening for Metabolic Syndrome Using an Integrated Continuous Index Consisting of Waist Circumference and Triglyceride: A Preliminary Cross-sectional Study

BACKGROUND

It has been suggested that hypertriglyceridemic waist (HW) phenotype is strongly associated with metabolic syndrome (MetS); however, there are very limited studies integrating triglyceride (TG) and waist circumference (WC) into a continuous variable to investigate the predictive power of this phenotype. Inspired from the triglyceride glucose index (TyG), we developed an integrated continuous index termed waist-triglyceride index (WTI) which was calculated as Ln [TG (mg/dl) WC (cm)/2].

OBJECTIVE

We aimed to examine the potential of WTI in screening for MetS by comparing this quantitative index with the qualitative HW phenotype and other frequently used indices.

METHODS

A cross-sectional study was conducted in a total of 3460 non-diabetic adults who participated in an annual health checkup. MetS was defined by the update National Cholesterol Education Program/Adult Treatment Panel ш criteria for Asian Americans. Receiving operating characteristic (ROC) curve and areas under the curve (AUC) were employed to evaluate the performance of the involved indices in screening for MetS. Statistical differences among the AUC values of the indices were compared.

RESULTS

In both genders, the AUC value of WTI, TyG or HW phenotype was markedly larger than that of each anthropometric index alone. In men, there were no statistical differences in the AUC values among WTI, TyG and HW phenotype, whereas in women, the AUC value of WTI was significantly larger than that of HW phenotype [difference between area (DBA): 0.042, 95% CI: 0.0224-0.0617, P < 0.0001] and was nominally and significantly smaller than that of TyG (DBA: 0.00646, 95% CI: 0.000903-0.012, P = 0.0227).

CONCLUSION

Our results suggest that there are discriminatory performance between the WTI and HW phenotype in the detection of MetS in women rather than in men. Appropriate markers for screening MetS in population study should be considered according to the genders.

Superior Role of Waist Circumference to Body-Mass Index in the Prediction of Cardiometabolic Risk in Dyslipidemic Patients

Coronary risk evaluation by conventional factors (age, gender, smoking, blood pressure and cholesterol) may further be specified by facets of the metabolic syndrome, namely insulin resistance, hypertriglyceridemia and obesity. Although obesity is usually defined as elevated body mass index (BMI), recent data indicate a superior role of waist circumference or hypertri-glyceridemic waist (HTGW) over BMI in the assessment of cardiometabolic risk. In dyslipidemic patients, the specific contributions of risky waist, HTGW or BMI have not been evaluated as yet. 686 dyslipidemic subjects (322 males and 364 females) were enrolled into a cross-sectional study. In each subject basic antropometry (i.e. waist circumference, HTGW, BMI) and laboratory parameters of lipid profile and insulin resistance were determined. Cardiometabolic risk was given by fulfilling the criteria (harmonized definition) of metabolic syndrome. The significance of risky waist, HTGW and BMI were assessed by comparing the respective predictive values for the presence of metabolic syndrome. Dyslipidemic patients with risky waist, HTGW or high BMI have a more atherogenic lipid profile and higher insulin resistance compared to those without risky waist, HTGW or high BMI. Risky waist is stronger predictor of metabolic syndrome (PPV 66 %, NPV 90 %) and thus posesa greater cardiometabolic risk than higher BMI per se does (PPV 42 %, NPV 97 %). The contribution of triglycerides (i.e. HTGW) to these predictive values is marginal (PPV 66 %, NPV 92 %). The present results highlight the superior role of waist circumference as a screening tool over BMI for the evaluation of cardiometabolic risk in dyslipidemic subjects. HTGW brings little additional benefit in risk stratification. Lower BMI proved to be optimal for identifying the subjects with inferior risk.

Hypertriglyceridemic-waist is more predictive of abnormal liver and renal function in an Australian population than a Chinese population

OBJECTIVE

We aimed to compare the association of hypertriglyceridemic-waist (HTGW), with glycaemia, liver and renal function between a Chinese and an Australian population using 3 HTGW definitions.

METHODS

1454 Australian and 5824 Chinese adults, from randomly selected households provided clinical history, glucose, lipids, anthropometric, and blood pressure measurements. Liver and renal functions were assessed using alanine aminotransferase and estimated Glomerular Filtration Rate respectively. The impact of interaction between HTGW and glucose on the liver and renal functions were measured by General Linear Model. Logistic regression was used to estimate the association between this interaction and abnormal liver and renal function.

RESULTS

HTGW was associated with abnormal liver and renal function in both Chinese and Australian populations using all 3 HTGW definitions. The highest sensitivity (93 (95% confidence interval: 87, 97) %) and specificity (81 (80, 84) %) were observed for abnormal renal function in the Australian population. The probability of having abnormal liver or renal function increased with glucose in the presence of HTGW phenotype only in the Australian population. Similar findings were revealed in people without type 2 diabetes.

CONCLUSIONS

In both Chinese and Australian populations, HTGW is associated with abnormal liver and renal function using any of the 3 definitions. HTGW is a potential tool to identify high-risk individuals with impaired renal function especially in the Australian population. HTGW interacted with the fasting glucose in its association with impaired liver and renal function only in the Australian population, suggesting different underlying interactions between environmental and genetic backgrounds.

Association between the Hypertriglyceridemic Waist Phenotype and Prediabetes in Chinese Adults Aged 40 Years and Older

OBJECTIVE

To investigate the association between the hypertriglyceridemic waist (HTGW) phenotype and prediabetes in Chinese adults aged 40 years and older.

METHODS

12757 adults (4101 men and 8656 women) without diabetes or cardiovascular and cerebrovascular diseases, free of using lipid-modified agents, were enrolled in this cross-sectional study. The HTGW phenotype was defined as elevated serum triglyceride concentrations and enlarged waist circumference. A two-hour post 75 g oral glucose tolerance test was performed in all participants. Multiple logistic regression analysis was used to evaluate the relationship of the HTGW phenotype with prediabetes.

RESULTS

Individuals with the HTGW phenotype had a higher adjusted odds ratio (OR: 1.70; 95% CI: 1.48-1.95) of prediabetes than those without the phenotype. There existed a strong relationship of the HTGW phenotype with impaired glucose tolerance (IGT) (OR: 1.83; 95% CI: 1.57-2.13), but not with impaired fasting glucose (IFG) (OR: 0.87; 95% CI: 0.65-1.17). Only women with the HTGW phenotype are significantly associated with the combined IFG and IGT (OR: 1.83; 95% CI: 1.28-2.62).

CONCLUSIONS

The HTGW phenotype was a useful risk indicator and a practical screening tool to benefit in the early diagnosis and intervention for prediabetes, particularly for IGT and the combined IFG and IGT.

Association Between the Hypertriglyceridemic Waist Phenotype, Prediabetes, and Diabetes Mellitus Among Adults in Puerto Rico

This study assessed the association of the hypertriglyceridemic waist (HTGW) phenotype with prediabetes and diabetes (DM) in a group of Hispanics. Analysis of a cross-sectional study of 858 adults residing in Puerto Rico that collected data on blood pressure, biochemical, and anthropometric measurements was performed. HTGW phenotype was defined as elevated triglycerides and elevated waist circumference. Prediabetes was defined as a fasting glucose of 100-125 mg/dL and DM as a fasting glucose ≥126 mg/dL or prior diagnosis. Prevalence of HTGW, prediabetes, and DM was 27.9, 38.0, and 21.6 %, respectively. Subjects with the HTGW phenotype had higher adjusted odds of prediabetes (POR 5.55; 95 % CI 3.38-9.13) and DM (POR 7.28; 95 % CI 3.63-14.63) compared to those without the phenotype. The association for prediabetes was stronger for women than among men. HTGW phenotype was strongly associated with prediabetes and DM, reinforcing the need to further assess its performance as a screening tool to identify at-risk individuals for cardiometabolic conditions.

Prevalence of hypertriglyceridemic waist and association with risk of type 2 diabetes mellitus: a meta-analysis

INTRODUCTION

A meta-analysis of studies assessing the prevalence of hypertriglyceridemic waist and an association with risk of type 2 diabetes mellitus (T2DM).

MATERIALS AND METHODS

PubMed, EMBASE, Web of Science, CNKI, CQVIP and Wanfang databases were searched for studies of the prevalence of hypertriglyceridemic waist or association with risk of T2DM. Reference lists of each original article were also searched. A random-effects model was used to synthesize the combined prevalence and odds ratios. Publication bias and substantial heterogeneity were examined.

RESULTS

Twenty-five eligible studies involving 93 194 participants (93 194 for prevalence and 34 199 for odds ratios): 17 articles of prevalence, and 8 of both prevalence and risk of T2DM. Prevalence of hypertriglyceridemic waist ranged from 4% to 47%, with pooled prevalence of 18% (95% CI 13-23%), overall: 18% (95% CI 13-23%) for men and 19% (95% CI 13-24%) for women. Odds ratios ranged from 2.8 to 9.6 for T2MD in overall, with pooled odds ratios of 4.18 (95% CI 3.55-4.92), overall: 3.55 (95% CI 2.93-4.31) for men and 4.18 (95% CI 3.43-5.09) for women.

DISCUSSION/CONCLUSION

The prevalence of hypertriglyceridemic waist has reached an alarming level and is closely associated with increased risk of T2DM in the general population, particularly among women and among brown-skinned men and women.

Utility of hypertriglyceridemic waist phenotype for predicting incident type 2 diabetes: The Isfahan Diabetes Prevention Study

Aim/Introduction

We evaluated the association between hypertriglyceridemic waist (HTW) phenotype and the risks of type 2 diabetes in an Iranian high‐risk population.

Materials and Methods

We analyzed 7‐year follow‐up data (n = 1,865) in non‐diabetic first‐degree relatives of consecutive patients with type 2 diabetes aged 30–70 years. The primary outcome was the diagnosis of type 2 diabetes based on repeated oral glucose tolerance tests. We used multiple logistic regressions to estimate the odds ratio (OR) for incident type 2 diabetes across four groups according to baseline fasting serum triglycerides (TG) level and waist circumference (WC): normal WC and normal TG, normal WC and high TG, enlarged WC and normal TG, and HTW (enlarged WC high TG).

Results

The HTW phenotype at baseline was associated with the incidence of type 2 diabetes. Those with HTW were 2.4‐fold (OR 2.36, 95% confidence interval 1.61–3.44), those with normal WC high TG were 1.9‐fold (OR 1.87, 95% confidence interval 1.29–2.70) and those with enlarged WC but normal TG were 2.8‐fold (OR 2.84, 95% confidence interval 1.96–4.13) more likely to develop type 2 diabetes than those with normal WC and normal TG.

Conclusions

These data provide further evidence that the HTW phenotype is a robust predictor of type 2 diabetes in high‐risk individuals in Iran, and the predictive power is not higher than that of simple enlarged WC and normal TG, emphasizing the importance of enlarged WC to the development of type 2 diabetes.

Association of the hypertriglyceridemic waist phenotype and type 2 diabetes mellitus among adults in China

AIMS/INTRODUCTION

To clarify the association of the hypertriglyceridemic waist phenotype and type 2 diabetes mellitus among adults in China.

MATERIALS AND METHODS

In the present case-control study, we included 1,685 patients with type 2 diabetes mellitus and 7,141 normal glucose-tolerant controls from the Henan Province of China in 2011. Elevated waist circumference (GW) was defined as ≥90 cm for men and ≥80 cm for women. Hypertriglyceridemia (HT) was defined as >1.7 m mol/L triglycerides (TG) level. The association of hypertriglyceridemic waist phenotype and type 2 diabetes mellitus was investigated by sex, body mass index, physical activity, and family history of diabetes.

RESULTS

Cases and controls differed in age, waist circumference (WC), weight, TG level, fasting glucose, body mass index, smoking status, diabetic family history, physical activity and hypertriglyceridemic waist phenotype (P < 0.05), but not alcohol drinking (P = 0.63). In the overall sample, as compared with the phenotype of normal TG level and normal WC (NTNW), normal TG level/enlarged WC (NTGW), elevated TG level/normal WC (HTNW) and elevated TG level/enlarged WC (HTGW) were associated with type 2 diabetes mellitus (odds ratio 4.14, 2.42 and 6.23, respectively). Only HTGW was consistently associated with risk of type 2 diabetes mellitus, with or without adjustment. The strongest relationship between HTGW and type 2 diabetes mellitus was for subjects with body mass index <24.0 kg/m(2) (odds ratio 6.54, 95% confidence interval 4.22-10.14) after adjustment for cofounding variables.

CONCLUSION

HTGW was stably and significantly associated with risk of type 2 diabetes mellitus in adult Chinese.

Predictors of metabolic abnormalities in phenotypes that combined anthropometric indices and triglycerides

BACKGROUND

The hypertriglyceridemic waist (HW) phenotype has been shown to be strongly associated with metabolic abnormalities; however, to date, no study has reported the prediction of metabolic abnormalities using the HW phenotype along with waist circumference (WC) and the triglyceride (TG) level or various phenotypes consisting of an individual anthropometric index combined with the TG level. The objectives of this study were to assess the association of the HW phenotype with metabolic abnormalities in Korean women and to evaluate the predictive powers of various phenotypes with regard to metabolic abnormalities.

METHODS

Total cholesterol (TC), high- and low-density lipoprotein (HDL and LDL) cholesterol, and TG levels, systolic and diastolic blood pressures (SBP and DBP), and anthropometric indices were measured in 7661 women. The Naive Bayes algorithm and logistic regression were used to determine the predictive powers of the models using different phenotypes.

RESULTS

The HW phenotype demonstrated the strongest association with all metabolic components. The best phenotypic predictors were the forehead-to-rib circumference ratio + TG for the HDL level, age + TG for the LDL level, age + TG for SBP, and rib circumference + TG and neck circumference + TG for DBP. The associations between TG and TC or HDL were higher compared with those between WC and TC or HDL, whereas the associations between WC and SBP or DBP were higher compared with those between TG and SBP or DBP. Age was strongly associated with hypercholesterolemia, the HDL and LDL cholesterol levels, and SBP and had good predictive power, but not with respect to DBP.

CONCLUSIONS

We have determined that the HW phenotype is a useful indicator of metabolic abnormalities in Korean women; although HW had the strongest association with metabolic abnormalities, the best phenotype combination consisting of a single anthropometric index and the TG level may differ depending on the metabolic factors in question. Our findings provide insights into the detection of metabolic abnormalities in complementary and alternative medicine.

Body Composition in Asians and Caucasians: Comparative Analyses and Influences on Cardiometabolic Outcomes

Within the last four decades Asia has witnessed major transformation in its population demographics, which gave rise to changes in food availability, food habits and lifestyle. A significant consequence of these changes has been the continuing rise in overweight and obesity across Asia. In parallel, there has been a significant rise in Asians in the incidence of the major chronic diseases, particularly in cardiometabolic disorders such as metabolic syndrome, type 2 diabetes, hypertension, and other cardiovascular diseases. Given that the majority of the evidence, to date, investigating the associations between adiposity and cardiometabolic disorder risk have been obtained from studies undertaken either in European or in North American Caucasians, in this chapter, we have reviewed differences in body fat content and distribution between East Asians, South Asians, and Caucasians. The evidence is consistent that the content and distribution of body fat are markedly different between the various ethnic groups. We found that Asians have a greater predisposition towards adiposity at higher BMI than in Caucasians. Moreover, at any given level of adiposity, Asians have a much greater predisposition to risk of cardiometabolic disorders than Caucasians. We therefore strongly endorse the need for different adiposity cutoffs in Asians as compared to the Caucasians. We have also reviewed the predictive abilities of the various body composition/adiposity measures in determining risk of cardiometabolic disorders in Asians.

Identification of Type 2 Diabetes Risk Factors Using Phenotypes Consisting of Anthropometry and Triglycerides based on Machine Learning

The hypertriglyceridemic waist (HW) phenotype is strongly associated with type 2 diabetes; however, to date, no study has assessed the predictive power of phenotypes based on individual anthropometric measurements and triglyceride (TG) levels. The aims of the present study were to assess the association between the HW phenotype and type 2 diabetes in Korean adults and to evaluate the predictive power of various phenotypes consisting of combinations of individual anthropometric measurements and TG levels. Between November 2006 and August 2013, 11,937 subjects participated in this retrospective cross-sectional study. We measured fasting plasma glucose and TG levels and performed anthropometric measurements. We employed binary logistic regression (LR) to examine statistically significant differences between normal subjects and those with type 2 diabetes using HW and individual anthropometric measurements. For more reliable prediction results, two machine learning algorithms, naive Bayes (NB) and LR, were used to evaluate the predictive power of various phenotypes. All prediction experiments were performed using a tenfold cross validation method. Among all of the variables, the presence of HW was most strongly associated with type 2 diabetes (p < 0.001, adjusted odds ratio (OR) = 2.07 [95% CI, 1.72-2.49] in men; p < 0.001, adjusted OR = 2.09 [1.79-2.45] in women). When comparing waist circumference (WC) and TG levels as components of the HW phenotype, the association between WC and type 2 diabetes was greater than the association between TG and type 2 diabetes. The phenotypes tended to have higher predictive power in women than in men. Among the phenotypes, the best predictors of type 2 diabetes were waist-to-hip ratio + TG in men (AUC by NB = 0.653, AUC by LR = 0.661) and rib-to-hip ratio + TG in women (AUC by NB = 0.73, AUC by LR = 0.735). Although the presence of HW demonstrated the strongest association with type 2 diabetes, the predictive power of the combined measurements of the actual WC and TG values may not be the best manner of predicting type 2 diabetes. Our findings may provide clinical information concerning the development of clinical decision support systems for the initial screening of type 2 diabetes.

Type-2 diabetes and coronary heart disease: common physiopathology, viewed from autoimmunity

Two highly prevalent diseases, Type-2 diabetes mellitus and coronary heart disease (CHD), share risk factors. Excess levels of LDL-cholesterol have been overemphasized to uniformly encompass the development of CHD, and the origin of insulin resistance underlying Type-2 diabetes has not been fully elucidated. Autoimmune response has been recognized to be responsible only of a small minority of diabetes. The increasing trend in the worldwide prevalence of diabetes and the risk factors for both diseases are reviewed, the independent mediation for CHD of (central) adiposity in both diseases and the 'hypertriglyceridemic waist' phenotype are outlined. Evidence is described that serum lipoprotein (Lp)(a) concentrations, not only in excess, but also in apparently 'reduced' levels, as a result of autoimmune response, underlie both disorders and are closely related to insulin resistance.

Hypertriglyceridemic waist and newly-diagnosed diabetes among remote-dwelling Indigenous Australians

AIMS

Hypertriglyceridemic waist (HTgW) is predictive of cardiovascular disease. The HTgW relationship with diabetes is little studied.

METHODS

This study analysed data from diabetes and cardiovascular risk factor screening programmes in remote Indigenous Australian settlements. Elevated waist girth (EW) was defined as ≥90 cm for men (n = 1134) or ≥80 cm for women (n = 1313). Hypertriglyceridemia (ETg) was defined as ≥1.7 mmol/L. Diabetes was defined as fasting plasma glucose ≥7.0 mmol/L. Body mass index (BMI) was categorised as <22, 22-24.9 and >25.0 kg/m(2). Logistic regression was used to analyse the odds of newly-diagnosed diabetes for individuals with either HTgW, ETg or EW, relative to individuals with values below cut-offs.

RESULTS

The prevalence of HTgW was 33.2% for men and 34.8% for women. Accounting for age-group and gender, newly-diagnosed diabetes was associated (odds ratio (OR) (95% confidence interval)) with HTgW: 9.6 (6.6, 13.8). The relationship remained strong after accounting for the covariates BMI and smoking (OR = 4.9 (2.7, 8.8)). In BMI-stratified analyses the strongest odds were observed for the lowest category (<22 kg/m(2): OR = 12.9 (4.0, 41.7)).

CONCLUSIONS

HTgW has a high prevalence and is associated with newly-diagnosed diabetes in Indigenous people, particularly those with BMI <22 kg/m(2), whom clinicians might not normally consider for screening.

Abdominal obesity with hypertriglyceridaemia, lipoprotein(a) and apolipoprotein A-I determine marked cardiometabolic risk

BACKGROUND

Risks for coronary heart disease (CHD) and diabetes (T2DM) of the 'hypertriglyceridemic waist' phenotype (HtgW) warrant further investigation. We studied this issue and whether partial proinflammatory conversion of apolipoprotein (apo) A-I by lipoprotein(a) [Lp(a)] is a codeterminant.

MATERIALS AND METHODS

In a population-based prospective study, 1328 Turkish adults were analysed in four groups by the presence of abdominal obesity and elevated triglycerides (Htg).

RESULTS

LDL-cholesterol levels, significantly elevated in isolated Htg, were lower in HtgW, yet significantly higher apoB and complement C3 values existed in women with HtgW in whom also the lowest Lp(a) values prevailed. Lp(a) was linearly associated, more strongly in HtgW than in the remaining groups, with apoB and, in women inversely, with gamma-glutamyltransferase. Incident HtgW was predicted, not in men, but in women inversely by Lp(a) (OR 0.80 [95%CI 0.65; 0.97]), regardless of adjustment for relevant confounders. After adjustment for conventional risk factors, HtgW (OR 2.84) and high apoA-I/HDL-C ratio (OR 1.50) were significantly and additively associated with combined prevalent and incident CHD risk. High apoA-I and low HDL-cholesterol levels interacted therein in women. Type-2 diabetes was strongly predicted by HtgW, mediated in men by high apoA-I/HDL-C ratio.

CONCLUSION

HtgW is associated with excess inflammatory markers, is predicted in women paradoxically by lower circulating Lp(a) and is associated in both sexes with marked excess cardiometabolic risk to which high apoA-I/HDL-C ratio contributes additively. These findings are consistent in women with apoA-I being oxidized via aggregation to Lp(a).

Hypertriglyceridemic waist might be an alternative to metabolic syndrome for predicting future diabetes mellitus

Background

In some cross-sectional studies, hypertriglyceridemic waist (HTGW) has been recommended as an alternative to metabolic syndrome (MetS) for screening individuals at high risk for diabetes mellitus (DM). However, little information is about the predictive power of HTGW for future DM. The aims of the study were to assess the DM predictive power of HTGW compared with MetS based on the follow-up data over 15 years collected from a general Chinese population.

Methods

And Findings: The data were collected in 1992 and then again in 2007 from the same group of 687 individuals without DM in 1992. For the whole population (n =687), multivariate analysis showed presence of HTGW was associated with a 4.1-fold (95%CI: 2.4-7.0, p < 0.001) increased risk and presence of MetS was associated with a 3.7-fold (95%CI: 2.2-6.2, p < 0.001) increased risk for future DM. For the population without elevated fasting plasma glucose (n = 650), multivariate analysis showed presence of HTGW was associated with a 3.9-fold (95%CI: 2.2-7.0, p < 0.001) increased risk and presence of MetS was associated with a 3.7-fold (95%CI: 2.1-6.6, p < 0.001) increased risk for future DM.

Conclusions

HTGW could predict future DM independently, and the predictive power was similar to MetS. HTGW might be an alternative to MetS for predicting future DM. For simpler and fewer components, HTGW might be more practical than MetS, and it might be recommended in most clinical practices. This finding might be more useful for the individuals who only have elevated WC and TG. Although these individuals are without MetS, they are still at high risk for future DM, similarly to the individuals with MetS.

Hypertriglyceridemic waist and cardiometabolic risk in hypertensive women

OBJECTIVE

To evaluate the association between hypertriglyceridemic waist (HW) and cardiometabolic risk factors in women with hypertension.

METHODS

A cross-sectional study was performed in 218 patients monitored by HiperDia (Enrollment and Monitoring Program for Hypertensive and Diabetic Individuals) in two health units in São Luis, MA, Brazil. The dependent variable was HW and the independent variables were sociodemographics, lifestyle, anthropometrics, and health problems.

RESULTS

HW was present in 33% of the sample and was predominant in women aged > 60 years (56.4%), non-whites (81.7%), those with eight or fewer years of schooling (57.3%), and those belonging to socioeconomic class C (49%). Excess weight (68.8%) and hypercholesterolemia (68.8%) were observed. HW was associated with: smoking (PR: 2.08; p = 0.017), overweight (PR: 2.46; p = 0.010), obesity (PR: 4.13; p < 0.001), hypercholesterolemia (PR: 1.87; p = 0.015), high levels of high-density lipoproteins (HDL) cholesterol (PR: 3.41; p < 0.001), and fasting glycemia > 100 mg/dL or being diabetic (PR: 1.86; p = 0.006). After adjustment, total cholesterol (PR = 1.78; p = 0.012), HDL-cholesterol (PR: 3.03; p < 0.001), body mass index (BMI) > 25 to < 30 kg/m² (PR = 2.60; p = 0.005), and BMI > 30 kg/m² (PR = 3.61; p < 0.001) remained associated.

CONCLUSION

A high prevalence of HW and its association with altered lipid profile and excess body weight was observed. HW showed to be an important diagnostic tool for the monitoring of hypertensive women with metabolic risk, which is low cost, easily accessible, and useful in clinical practice, especially in primary health care in the Brazilian Unified Health System (Sistema Único de Saúde - SUS).

The hypertriglyceridemic waist phenotype in young adults from the Southern Region of Brazil

The present study aimed to assess the prevalence of the hypertriglyceridemic waist phenotype and its associated factors among subjects that have been followed up from birth. In 1982, all maternity hospitals in the city of Pelotas, in the Southern Region of Brazil, were visited and all births were recorded. Babies whose parents lived in the urban area of Pelotas were subsequently followed up on several occasions. A 22 to 23-year follow-up of this birth cohort was carried out in 2004 and 2005. The presence of the hypertriglyceridemic waist phenotype was defined as waist circumference ≥ 90cm and triglyceride levels ≥ 177mg/dL for males, and waist circumference ≥ 85cm and triglyceride levels ≥ 133mg/dL for females. The prevalence of the hypertriglyceridemic waist phenotype was 5.9% and 4.5% among men and women, respectively. Among males, a sedentary lifestyle during leisure time, smoking and obesity were associated with the presence of the hypertriglyceridemic waist phenotype, whereas among females the condition was positively associated with skin color, family income, obesity and dietary fat intake.

Association between three genetic variants of the Perilipin Gene (PLIN) and glucose metabolism: results from a replication study among Chinese adults and a meta-analysis

OBJECTIVE

This study was aimed to replicate the associations between three Perilipin Gene (PLIN) variants (rs894160, rs1052700, and rs2304796) and diabetes risks and to evaluate the overall effects of these variants on diabetes risk and obesity risk.

METHODS

We conducted a cross-sectional study among 993 Chinese Han adults. We also made a meta-analysis to estimate associations between these variants and diabetes risk and obesity risk.

RESULTS

In the sample of all participants, all three single-nucleotide polymorphisms (SNPs) were not significantly associated with diabetes risks. The PLIN polymorphisms significantly interacted with central obesity in relation to diabetes risk (P for interaction = 0.036, 0.033, and 0.042 for rs1052700, rs894160, and rs2304796, respectively). In those with allele T of rs1052700 or allele A of rs894160, fasting glucose concentration and diabetes risk increased significantly with the increment of waist circumference. Only association between rs894160 and obesity risk was available for meta-analysis. The meta-analysis indicated the overall estimation of obesity risk for rs894160 was 0.97 (0.78, 1.16) among participants with allele A versus people with genotype GG and 1.46 (0.99, 1.93) among those with genotype AA versus allele G carriers.

CONCLUSION

Chinese adults with high waist circumference may have a high risk of diabetes, especially among those with allele T in rs1052700 or with allele A in rs894160. People with genotype AA (rs894160) may have a high risk of obesity.

Hypertriglyceridemic-waist phenotype predicts diabetes: a cohort study in Chinese urban adults

BACKGROUND

Hypertriglycedemic-waist (HTGW) phenotype is a simple and inexpensive screening parameter to identify people at increased risk for cardiovascular disease. We evaluated whether the HTGW phenotype predicts prediabetes and diabetes in Chinese urban adults.

METHODS

Two thousand nine hundred and eight (2908) subjects including 1957 men and 951 women, aged 20 years and older, free of prediabetes and diabetes at baseline were enrolled in 2008 and followed for 3 years. Meanwhile, new cases of prediabetes and diabetes were identified via annual physical examination. Cox proportional hazards models were used to assess the association of HTGW phenotype with the incidence of prediabetes and diabetes.

RESULTS

One thousand five hundred and thirty-three (1533) new prediabetes and 90 new diabetes cases were diagnosed during the follow-up period. The accumulated incidence of prediabetes and diabetes was 52.7% and 3.1%, respectively. Compared with the normal waist normal triglyceride (NWNT) group, those in the HTGW group had higher incidence of prediabetes and diabetes for both men and women. The hazard ratio (HR) for developing prediabetes in the presence of HTGW phenotype at baseline was 1.51 (95% confidence interval [CI] =1.04-2.19) in women, not in men (HR=1.01; 95% CI = 0.82-1.24), after adjusting for age, body mass index, systolic blood pressure, total cholesterol and low density lipoprotein-cholesterol. The HR for developing diabetes were 4.46 (95% CI = 1.88-10.60) in men and 4.64 (95% CI = 1.20-17.97) in women for people who were HTGW phenotype at baseline, after adjusting for age, body mass index, systolic blood pressure, total cholesterol and low density lipoprotein-cholesterol.

CONCLUSIONS

The HTGW phenotype can be used as a simple screening approach to predict diabetes. By using this approach, it is possible to identify individuals at high-risk for diabetes, which is of great significance in reducing the incidence of diabetes among Chinese urban adults.

Hypertriglyceridemic-waist phenotype and glucose intolerance among Canadian Inuit: the International Polar Year Inuit Health Survey for Adults 2007-2008

BACKGROUND

Inuit have not experienced an epidemic in type 2 diabetes mellitus, and it has been speculated that they may be protected from obesity's metabolic consequences. We conducted a population-based screening for diabetes among Inuit in the Canadian Arctic and evaluated the association of visceral adiposity with diabetes.

METHODS

A total of 36 communities participated in the International Polar Year Inuit Health Survey. Of the 2796 Inuit households approached, 1901 (68%) participated, with 2595 participants. Households were randomly selected, and adult residents were invited to participate. Assessments included anthropometry and fasting plasma lipids and glucose, and, because of survey logistics, only 32% of participants underwent a 75 g oral glucose tolerance test. We calculated weighted prevalence estimates of metabolic risk factors for all participants.

RESULTS

Participants' mean age was 43.3 years; 35% were obese, 43.8% had an at-risk waist, and 25% had an elevated triglyceride level. Diabetes was identified in 12.2% of participants aged 50 years and older and in 1.9% of those younger than 50 years. A hypertriglyceridemic-waist phenotype was a strong predictor of diabetes (odds ratio [OR] 8.6, 95% confidence interval [CI] 2.1-34.6) in analyses adjusted for age, sex, region, family history of diabetes, education and use of lipid-lowering medications.

INTERPRETATION

Metabolic risk factors were prevalent among Inuit. Our results suggest that Inuit are not protected from the metabolic consequences of obesity, and that their rate of diabetes prevalence is now comparable to that observed in the general Canadian population. Assessment of waist circumference and fasting triglyceride levels could represent an efficient means for identifying Inuit at high risk for diabetes.