Endocrinol Metab.  2014 Dec;29(4):514-521. 10.3803/EnM.2014.29.4.514.

Increased Risk of Diabetes Development in Subjects with the Hypertriglyceridemic Waist Phenotype: A 4-Year Longitudinal Study

• Han KJ
• Lee SY
• Kim NH
• Chae HB
• Lee TH
• Jang CM
• Yoo KM
• Park HJ
• Lee MK
• Jeon WS
• Park SE
• Park CY
• Lee WY
• Oh KW
• Park SW
• Rhee EJ

• KMID: 2384249
• DOI: http://doi.org/10.3803/EnM.2014.29.4.514

Abstract

BACKGROUND
The hypertriglyceridemic waist (HTGW) phenotype is a simple and inexpensive screening parameter to identify people at increased risk of cardiovascular disease. We evaluated whether the HTGW phenotype predicts diabetes in urban Korean adults.
METHODS
A total of 2,900 nondiabetic subjects (mean age 44.3 years), comprising 2,078 males (71.7%) and 822 females (28.3%) who underwent annual medical check-ups at our center between January 2005 and December 2009, were recruited. The subjects were divided into four groups according to baseline serum triglyceride (TG) level and waist circumference (WC): normal WC-normal TG (NWNT) level, normal WC-high TG level, enlarged WC-normal TG level, and enlarged WC-high TG (EWHT) level. High serum TG level was defined as > or =150 mg/dL and enlarged WC was defined as > or =90 cm for men and > or =85 cm for women. New cases of diabetes were determined according to questionnaires filled in by participants and the diagnostic criteria of the American Diabetes Association. Cox proportional hazards model analysis was used to assess the association of HTGW phenotype with the incidence of diabetes.
RESULTS
A total of 101 (3.5%) new diabetes cases were diagnosed during the study period. The EWHT group had a higher incidence of diabetes (8.3%) compared with the NWNT group (2.2%). The adjusted hazard ratio for diabetes for subjects with the EWHT phenotype at baseline was 4.113 (95% confidence interval [CI], 2.397 to 7.059) after adjustment for age, and 2.429 (95% CI, 1.370 to 4.307) after adjustment for age, sex, total cholesterol, systolic blood pressure, and alcohol drinking history. It was attenuated by inclusion of baseline fasting glucose level in the model.
CONCLUSION
Subjects with the HTGW phenotype showed the highest risk of incident diabetes. This tool could be useful for identifying individuals at high risk of diabetes.

Keyword

Hypertriglyceridemic waist phenotype; Hypertriglyceridemia; Waist circumference; Diabetes; Metabolic syndrome

MeSH Terms

Adult
Alcohol Drinking
Blood Pressure
Cardiovascular Diseases
Cholesterol
Fasting
Female
Glucose
Humans
Hypertriglyceridemia
Hypertriglyceridemic Waist*
Incidence
Longitudinal Studies*
Male
Mass Screening
Phenotype*
Proportional Hazards Models
Triglycerides
Waist Circumference
Surveys and Questionnaires
Cholesterol
Glucose

Figure

• 

  Fig. 1 Cumulative disease-free survival for diabetes in the four groups divided by waist circumference and serum triglyceride level. NWNT, normal waist, normal triglyceride level; NWHT, normal waist, hypertriglyceridemia; EWNT, enlarged waist, normal triglyceride level; EWHT, enlarged waist, hypertriglyceridemia.

Reference

1. Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract. 2011; 94:311–321.

2. Lee KW. Costs of diabetes mellitus in Korea. Diabetes Metab J. 2011; 35:567–570.

3. Centers for Disease Control and Prevention. 2011 National diabetes fact sheet [Internet]. Atlanta: Centers for Disease Control and Prevention;2011. updated 2014 Jul 7. cited 2014 Aug 26. Available from: http://www.cdc.gov/diabetes/pubs/factsheet11.htm.

4. Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes. 1988; 37:1595–1607.

5. Assmann G, Guerra R, Fox G, Cullen P, Schulte H, Willett D, Grundy SM. Harmonizing the definition of the metabolic syndrome: comparison of the criteria of the Adult Treatment Panel III and the International Diabetes Federation in United States American and European populations. Am J Cardiol. 2007; 99:541–548.

6. Alberti KG, Zimmet P, Shaw J. IDF Epidemiology Task Force Consensus Group. The metabolic syndrome: a new worldwide definition. Lancet. 2005; 366:1059–1062.

7. Sam S, Haffner S, Davidson MH, D'Agostino RB Sr, Feinstein S, Kondos G, Perez A, Mazzone T. Hypertriglyceridemic waist phenotype predicts increased visceral fat in subjects with type 2 diabetes. Diabetes Care. 2009; 32:1916–1920.

8. Lemieux I, Pascot A, Couillard C, Lamarche B, Tchernof A, Almeras N, Bergeron J, Gaudet D, Tremblay G, Prud'homme D, Nadeau A, Despres JP. Hypertriglyceridemic waist: A marker of the atherogenic metabolic triad (hyperinsulinemia; hyperapolipoprotein B; small, dense LDL) in men? Circulation. 2000; 102:179–184.

9. Lemieux I, Poirier P, Bergeron J, Almeras N, Lamarche B, Cantin B, Dagenais GR, Despres JP. Hypertriglyceridemic waist: a useful screening phenotype in preventive cardiology? Can J Cardiol. 2007; 23:Suppl B. 23B–31B.

10. Cameron AJ, Boyko EJ, Sicree RA, Zimmet PZ, Söderberg S, Alberti KG, Tuomilehto J, Chitson P, Shaw JE. Central obesity as a precursor to the metabolic syndrome in the AusDiab study and Mauritius. Obesity (Silver Spring). 2008; 16:2707–2716.

11. Bos G, Dekker JM, Heine RJ. Hoom study. Non-HDL cholesterol contributes to the "hypertriglyceridemic waist" as a cardiovascular risk factor: the Hoorn study. Diabetes Care. 2004; 27:283–284.

12. LaMonte MJ, Ainsworth BE, DuBose KD, Grandjean PW, Davis PG, Yanowitz FG, Durstine JL. The hypertriglyceridemic waist phenotype among women. Atherosclerosis. 2003; 171:123–130.

13. Solati M, Ghanbarian A, Rahmani M, Sarbazi N, Allahverdian S, Azizi F. Cardiovascular risk factors in males with hypertriglycemic waist (Tehran Lipid and Glucose Study). Int J Obes Relat Metab Disord. 2004; 28:706–709.

14. Lemieux I, Almeras N, Mauriege P, Blanchet C, Dewailly E, Bergeron J, Despres JP. Prevalence of 'hypertriglyceridemic waist' in men who participated in the Quebec Health Survey: association with atherogenic and diabetogenic metabolic risk factors. Can J Cardiol. 2002; 18:725–732.

15. NGSP. List of NGSP certified methods [Internet]. [place unknown]: NGSP;c2010. cited 2012 Nov 26. Available from: http://www.ngsp.org/docs/methods.pdf.

16. Schwartz KL, Monsur JC, Bartoces MG, West PA, Neale AV. Correlation of same-visit HbA1c test with laboratory-based measurements: a MetroNet study. BMC Fam Pract. 2005; 6:28.

17. American Diabetes Association. Standards of medical care in diabetes: 2013. Diabetes Care. 2013; 36:Suppl 1. S11–S66.

18. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985; 28:412–419.

19. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ. National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003; 289:2560–2572.

20. Lee SY, Park HS, Kim DJ, Han JH, Kim SM, Cho GJ, Kim DY, Kwon HS, Kim SR, Lee CB, Oh SJ, Park CY, Yoo HJ. Appropriate waist circumference cutoff points for central obesity in Korean adults. Diabetes Res Clin Pract. 2007; 75:72–80.

21. Galic S, Oakhill JS, Steinberg GR. Adipose tissue as an endocrine organ. Mol Cell Endocrinol. 2010; 316:129–139.

22. Despres JP, Lemieux I. Abdominal obesity and metabolic syndrome. Nature. 2006; 444:881–887.

23. Samson SL, Garber AJ. Metabolic syndrome. Endocrinol Metab Clin North Am. 2014; 43:1–23.

24. Bluher M. Are there still healthy obese patients? Curr Opin Endocrinol Diabetes Obes. 2012; 19:341–346.

25. Hamer M, Stamatakis E. Metabolically healthy obesity and risk of all-cause and cardiovascular disease mortality. J Clin Endocrinol Metab. 2012; 97:2482–2488.

26. Rhee EJ, Seo MH, Kim JD, Jeon WS, Park SE, Park CY, Oh KW, Park SW, Lee WY. Metabolic health is more closely associated with coronary artery calcification than obesity. PLoS One. 2013; 8:e74564.

27. He S, Zheng Y, Shu Y, He J, Wang Y, Chen X. Hypertriglyceridemic waist might be an alternative to metabolic syndrome for predicting future diabetes mellitus. PLoS One. 2013; 8:e73292.

28. Alqahtani N, Khan WA, Alhumaidi MH, Ahmed YA. Use of glycated hemoglobin in the diagnosis of diabetes mellitus and pre-diabetes and role of fasting plasma glucose, oral glucose tolerance test. Int J Prev Med. 2013; 4:1025–1029.