Identification of subjects with insulin resistance and β-cell dysfunction using alternative definitions of the metabolic syndrome
Identification of subjects with insulin resistance and β-cell dysfunction using alternative definitions of the metabolic syndrome
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DOI：
10.2337/diabetes.52.11.2740
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发表时间：
2003-11-01
期刊：
影响因子：
7.7
通讯作者：
Haffner, SM
中科院分区：
文献类型：
--
作者：
Hanley, AJG;Wagenknecht, LE;Haffner, SM
近年来，代谢综合征（MetS）作为心血管疾病的危险群引起了广泛关注。尽管人们认为患有MetS的个体具有胰岛素抵抗（IR），但是使用IR的直接测量（例如葡萄糖钳夹或频繁采样的静脉内葡萄糖耐量试验（FSIGTT））的数据很少。在胰岛素抵抗动脉粥样硬化研究中，我们研究了非糖尿病受试者中MetS与FSIGTT衍生的胰岛素敏感性和分泌指标的相关性。两套MetS标准进行了评估：1999年世界卫生组织（WHO）和2001年国家胆固醇教育计划（NCEP）。WHO和NCEP MetS定义均与直接测量的胰岛素敏感性最低四分位数风险显著相关（所有受试者以及种族亚组内P < 0.0001）。然而，在所有受试者合并（WHO：比值比[OR] = 10.2; 95% CI 7.5-13.9; NCEP：OR = 4.6; 3.4-6.2）和非西班牙裔白人、黑人和西班牙裔的单独分析中，与WHO-MetS的相关性更强。WHO和NCEP MetS定义也与胰岛素敏感性调整的急性胰岛素反应（AIR）和处置指数的最低四分位数风险显著相关（DI;所有P < 0.01），尽管这些相关性通常弱于胰岛素敏感性，并且在所有受试者中，两种定义之间没有差异（低AIR，WHO：OR = 1.7，1.2-2.4; NCEP：OR = 1.7，1.2 -2.5）。然而，也有一些种族差异，包括黑人中NCEP-MetS与低AIR的更强关联。WHO-MetS在检测低胰岛素敏感性方面明显高于NCEP-MetS（分别为65.4%和45.6%; P < 0.0001），两种定义之间的特异性无显著差异（84.4 vs. 84.6%; P = 0.91），尽管WHO-MetS的受试者工作特征曲线下面积更大（75% vs. 65%; P < 0.0001）。总之，尽管WHO和NCEP MetS标准都能识别出胰岛素敏感性低的非糖尿病个体，但使用WHO定义时，相关性明显更强。虽然NCEP-MetS似乎可以区分出有胰岛素分泌缺陷的黑人受试者，但这些定义对于识别低AIR或DI的受试者通常不太有用。
Recently, the metabolic syndrome (MetS) has attracted much attention as a risk cluster for cardiovascular disease. Although it is believed that individuals with the MetS have insulin resistance (IR), there are few data using direct measures of IR such as glucose clamps or frequently sampled intravenous glucose tolerance tests (FSIGTTs). We examined associations of MetS with FSIGTT-derived measures of insulin sensitivity and secretion among nondiabetic subjects in the Insulin Resistance Atherosclerosis Study. Two sets of MetS criteria were evaluated: those from the 1999 World Health Organization (WHO) and the 2001 National Cholesterol Education Program (NCEP). Both WHO and NCEP MetS definitions were significantly associated with risk of being in the lowest quartile of directly measured insulin sensitivity (P < 0.0001 for all subjects as well as within ethnic subgroups). However, the associations with WHO-MetS were stronger for all subjects combined (WHO: odds ratio [OR] = 10.2; 95% CI 7.5-13.9; NCEP: OR = 4.6; 3.4-6.2) and in separate analyses of non-Hispanic whites, blacks, and Hispanics. WHO and NCEP MetS definitions were also significantly associated with risk of being in the lowest quartile of insulin sensitivity-adjusted acute insulin response (AIR) and disposition index (DI; all P < 0.01), although the associations were generally weaker than those for insulin sensitivity and there was no difference between the two definitions in all subjects combined (low AIR, WHO: OR = 1.7, 1.2-2.4; NCEP: OR = 1.7,1.2-2.5). There were, however, a number of ethnic differences, including a stronger association of NCEP-MetS with low AIR among blacks. WHO-MetS was significantly more sensitive than NCEP-MetS in detecting low insulin sensitivity (65.4 vs. 45.6%, respectively; P < 0.0001), with no significant differences in specificity between the definitions (84.4 vs. 84.6%; P = 0.91), although WHO-MetS had a larger area under the receiver operating characteristic curve (75% vs. 65%; P < 0.0001). In conclusion, although both the WHO and NCEP MetS criteria identify nondiabetic individuals with low insulin sensitivity, the associations were notably stronger using the WHO definition. The definitions are generally less useful for identifying those with low AIR or DI, although NCEP-MetS seems to differentiate black subjects with insulin secretion defects.