Use of metabolic markers to identify overweight individuals who are insulin resistant
Use of metabolic markers to identify overweight individuals who are insulin resistant
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DOI：
10.7326/0003-4819-139-10-200311180-00007
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发表时间：
2003-11-18
影响因子：
39.2
通讯作者：
Reaven, G
中科院分区：
文献类型：
--
作者：
McLaughlin, T;Abbasi, F;Reaven, G
背景：胰岛素抵抗在超重人群中更为常见，并与2型糖尿病和心血管疾病的风险增加有关。考虑到目前肥胖的流行，以及生活方式的干预，如减肥和运动，可以降低胰岛素抵抗，一种相对简单的方法来识别胰岛素抵抗的超重个体在临床上是有用的。目的：评估与胰岛素抵抗和心血管疾病风险增加相关的代谢标志物识别胰岛素抵抗的超重个体亚群的能力。设计：横断面研究。单位：普通临床研究中心。患者：258名非糖尿病、正常超重的志愿者。测量方法：身体质量指数；空腹血糖、胰岛素、脂质和脂蛋白浓度；胰岛素抑制试验中稳态血浆葡萄糖浓度量化胰岛素介导的葡萄糖处理。超重被定义为体重指数大于等于25kg /m(2)，胰岛素抵抗被定义为处于稳态血浆葡萄糖浓度的前五分之一。采用受体-工作特征曲线分析，确定胰岛素抵抗的最佳标志物；确定并分析了预测能力的最佳切割点。结果：血浆甘油三酯浓度、甘油三酯与高密度脂蛋白胆固醇浓度之比、胰岛素浓度是识别胰岛素抵抗个体最有用的代谢指标。最佳临界值甘油三酯为1.47 mmol/L (130 mg/dL)，甘油三酯-高密度脂蛋白胆固醇比值为1.8（传统单位为3.0），胰岛素为109 pmol/L。这些切点的敏感性和特异性分别为67%、64%和57%，71%、68%和85%。他们识别胰岛素抵抗个体的能力与成人治疗小组III提出的诊断代谢综合征的标准相似（敏感性为52%，特异性为85%）。结论：三个相对简单的代谢指标可以帮助识别胰岛素抵抗程度足够的超重个体，从而增加各种不良后果的风险。在缺乏标准化胰岛素检测的情况下，我们建议，确定胰岛素抵抗的超重个体最实用的方法是使用甘油三酯浓度或甘油三酯-高密度脂蛋白胆固醇浓度比的临界值。
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, normotensive 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/m(2) 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 triglycericle, 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 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%).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 triglycericle concentration or the triglyceride-high-density lipoprotein cholesterol concentration ratio.