Ethnic differences in the ability of triglyceride levels to identify insulin resistance
Ethnic differences in the ability of triglyceride levels to identify insulin resistance
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DOI：
10.1016/j.atherosclerosis.2006.12.018
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发表时间：
2008-02-01
期刊：
影响因子：
5.3
通讯作者：
Cowie, Catherine C.
中科院分区：
文献类型：
--
作者：
Sumner, Anne E.;Cowie, Catherine C.
代谢综合征被用来预测冠状动脉疾病和2型糖尿病的发病。随着代谢综合征的预测价值受到挑战，替代综合征已经开发出来。所有这些综合征都发生在以非西班牙裔白色（NHW）为主的人群中。它们包括腰围增大、甘油三酯升高综合征、超重-血脂综合征和高甘油三酯血症腰围综合征。第一种适用于绝经后妇女，第二种适用于超重个体（BMI >= 25 kg/m2），第三种适用于男性。每种综合征都以高胆固醇血症为标准。然而，高甘油三酯血症的定义因综合征而异，即TG >= 128 mg/dL为腰围增大甘油三酯升高综合征，TG >= 130 mg/dL为超重-脂质综合征，TG >= 150 mg/dL为代谢综合征，TG >= 176 mg/dL为高甘油三酯血症腰围综合征。胰岛素抵抗和高血糖症高度相关。但是，由于胰岛素抵抗的非西班牙裔黑人（NHB）的甘油三酯（TG）水平通常低于这些综合征设定的阈值，因此TG或这些综合征识别高风险NHB的能力尚不清楚。使用1999 - 2002年的国家健康和营养检查调查（NHANES），我们的目标是根据种族确定：（1）这些综合征的患病率;（2）空腹TG浓度在这些综合征确定的截止水平（特别是130、150和176 mg/dL）下识别胰岛素抵抗的能力。参与者是1999 - 2002年NHANES的2804名成年人。将队列分为稳态模型评估的三分位数。胰岛素抵抗定义为上三分位数（>= 2.73）。NHB中每种综合症的患病率均低于NHW或墨西哥裔美国人（MA）（均P < 0.05）。NHB、非西班牙裔白人（NHW）和墨西哥裔美国人（MA）的平均TG水平分别为：99、140和144 mg/dL。TG < 130 mg/dL的胰岛素抵抗NHB、NHW和MA的平均患病率分别为：64、31和36。TG < 150 mg/dL的胰岛素抵抗NHB、NHW和MA的发生率分别为：75、46和47。TG < 176 mg/dL的胰岛素抵抗NHB、NHW和MA的发生率分别为：81、58和59。与NHB的每次比较的显著性为P < 0.001。总之，使用TG作为诊断标准的综合征的患病率在NHB中低于NHW或MA。NHB比NHW或MA更可能是胰岛素抵抗的，并且具有低于阈值的TG水平。由于综合征的制定是为了识别心血管疾病和2型糖尿病等疾病的高风险个体，因此应考虑TG水平的种族差异。出版社：Elsevier爱尔兰Ltd.
The Metabolic Syndrome is used to predict the onset of coronary artery disease and Type 2 diabetes. As the predictive value of the Metabolic Syndrome has been challenged, alternative syndromes have been developed. All of these syndromes were developed in populations that were predominantly non-Hispanic white (NHW). They include the Enlarged Waist Elevated Triglyceride Syndrome, the Overweight-Lipid Syndrome and the Hypertriglyceridemic Waist Syndrome. The first applies to postmenopausal women, the second to overweight individuals (BMI >= 25 kg/m(2)), and the third to men. Each syndrome uses hypertriglyceridemia as a criterion. However, the definition of hypertriglyceridemia varies by syndrome i.e. TG >= 128 mg/dL for the Enlarged Waist Elevated Triglyceride Syndrome, TG >= 130 mg/dL for the Overweight-Lipid Syndrome, >= 150 mg/dL for the Metabolic Syndrome, and TG >= 176 mg/dL for the Hypertriglyceridemic Waist Syndrome. Insulin resistance and hypertriglyceridemia are highly correlated. But as insulin resistant non-Hispanic blacks (NHB) often have triglyceride (TG) levels below the thresholds set by these syndromes, the ability of either TG or these syndromes to identify high risk NHB is unknown. Using the National Health and Nutrition Examination Survey (NHANES) 1999 - 2002, our goals were to determine by ethnicity: (1) the prevalence of each of these syndromes; (2) the ability of fasting TG concentrations to identify insulin resistance at cut-off levels established by these syndromes, specifically 130, 150 and 176 mg/dL. Participants were 2804 adults from NHANES 1999 - 2002. The cohort was divided into tertiles of homeostasis model assessment. Insulin resistance was defined as the upper tertile (>= 2.73). The prevalence of each syndrome was lower in NHB than NHW or Mexican Americans (MA) (all P < 0.05). Mean TG levels in NHB, non-Hispanic Whites (NHW) and Mexican Americans (MA) were: 99, 140 and 144 mg/dL, respectively. The mean percents of insulin-resistant NHB, NHW and MA with TG < 130 mg/dL were: 64, 31 and 36. The percents of insulin-resistant NHB, NHW and MA with TG < 150 mg/dL were: 75, 46 and 47. The percents of insulin-resistant NHB, NHW and MA with TG < 176 mg/dL were: 81, 58 and 59. Significance was P < 0.001 for each comparison to NHB. In conclusion, the prevalence of syndromes that use TG as a diagnostic criterion is lower in NHB than NHW or MA. NHB are more likely than NHW or MA to be insulin-resistant and have TG levels below threshold values. As syndromes are formulated to identify individuals at high risk for conditions such as cardiovascular disease and Type 2 diabetes, ethnic differences in TG levels should be considered. Published by Elsevier Ireland Ltd.