Elsevier

Metabolism

Volume 58, Issue 8, August 2009, Pages 1123-1130
Metabolism

The hypertriglyceridemic waist phenotype versus the National Cholesterol Education Program–Adult Treatment Panel III and International Diabetes Federation clinical criteria to identify high-risk men with an altered cardiometabolic risk profile

https://doi.org/10.1016/j.metabol.2009.03.012Get rights and content

Abstract

The hypertriglyceridemic waist phenotype, the National Cholesterol Education Program–Adult Treatment Panel III (NCEP-ATP III) criteria, and the International Diabetes Federation (IDF) criteria have been proposed as screening tools to identify subjects with features of the metabolic syndrome and therefore at increased cardiometabolic risk. The aim of the present study was to compare the ability of these 3 clinical approaches to identify individuals at increased cardiometabolic risk as suggested by the presence of deteriorated markers such as hyperinsulinemia, elevated apolipoprotein B levels, small low-density lipoprotein particles, high C-reactive protein concentrations, and low adiponectin levels. For that purpose, physical and cardiometabolic characteristics of a sample of 272 white men recruited for various metabolic investigations were studied. The hypertriglyceridemic waist phenotype was defined as having both a high waist circumference (≥90 cm) and increased fasting triglyceride levels (≥2.0 mmol/L). Having at least 3 of the 5 NCEP-ATP III criteria or waist circumference of at least 94 cm plus any 2 of the 4 additional IDF criteria was also used to identify individuals at increased cardiometabolic risk. A large proportion of men with the hypertriglyceridemic waist phenotype also met the NCEP-ATP III (82.7%) or IDF (89.2%) criteria. Men with the hypertriglyceridemic waist phenotype were characterized by alterations in their lipoprotein-lipid profile that included small low-density lipoprotein particles, increased apolipoprotein B and insulin levels, as well as reduced adiponectin concentrations, which were similar to individuals meeting the NCEP-ATP III or the IDF criteria. Moreover, the Framingham risk score of men meeting any of the 3 screening tools criteria was higher and was similar across the 3 approaches (4.2, 3.8, and 3.7, respectively). These results suggest that hypertriglyceridemic waist may be as discriminant as the NCEP-ATP III or the IDF criteria and could be used as an initial screening approach to identify individuals with deteriorated cardiometabolic risk markers.

Introduction

The metabolic syndrome is recognized as a cluster of cardiometabolic risk factors that includes an atherogenic dyslipidemic state, insulin resistance, elevated blood pressure, impaired fibrinolysis, and a prothrombotic profile and an inflammatory state [1]. The association between these cardiometabolic risk markers and cardiovascular disease (CVD) or cardiovascular mortality is well recognized [2], [3], [4]. However, controversy remains around the underlying pathophysiologic processes leading to the development of the metabolic syndrome (insulin resistance and/or hyperinsulinemia vs abdominal obesity) [5].

Guidelines encouraged identification of patients with features of the metabolic syndrome in clinical practice [6], [7], [8]. In this regard, several clinical criteria to aid detection of individuals characterized by features of the metabolic syndrome have been developed [1], [6], [8], [9], [10], [11], [12]. However, it is very important to point out that clinical criteria are not the definition of the metabolic syndrome per se but that they are proposed as screening tools with the hope that they will help physicians to identify patients with a cluster of atherogenic cardiometabolic risk abnormalities largely resulting from the presence of abdominal obesity [13].

The criteria of the National Cholesterol Education Program–Adult Treatment Panel III (NCEP-ATP III) guidelines are widely used in clinical practice to identify subjects likely to have the metabolic syndrome [1]. With the NCEP-ATP III clinical criteria, a diagnosis of the metabolic syndrome is made when 3 or more of 5 criteria are met: (1) enlarged waist circumference, (2) elevated triglycerides (TG), (3) low high-density lipoprotein (HDL) cholesterol, (4) impaired fasting glucose, and (5) elevated blood pressure [1], [11]. More recently, the International Diabetes Federation (IDF) has attempted to provide a global approach to identify men and women characterized by the metabolic syndrome worldwide [8]. The IDF criteria have been built upon the NCEP-ATP III 5 screening tools but differ in 2 aspects. First, the waist circumference cutoff has been lowered (102 to 94 cm); and the cutoff is also population specific. Second, an elevated waist circumference is a mandatory clinical criterion and must be present along with 2 additional criteria to diagnose the metabolic syndrome [8]. Both the NCEP-ATP III and IDF criteria have been associated with similar relative increase in the risk of CVD [14].

We have also been interested in the development of a simple screening approach to identify men at increased cardiometabolic risk. In 2000, Lemieux et al [12] proposed that the hypertriglyceridemic waist phenotype (waist girth ≥90 cm combined with fasting plasma TG levels ≥2.0 mmol/L) was predictive of a very high probability for men to be characterized by the simultaneous presence of some cardiometabolic risk markers. It has also been suggested that the hypertriglyceridemic waist phenotype could be helpful in the assessment of risk of coronary artery disease and type 2 diabetes mellitus [12], [15].

More recently, Tankó and colleagues [16] have compared the ability of the hypertriglyceridemic waist phenotype and of the NCEP-ATP III clinical criteria to estimate cardiovascular risk in postmenopausal women. They found that the combined presence of an elevated waist circumference (≥88 cm) and increased TG levels (≥1.45 mmol/L) was the best indicator of progression rate of aortic calcification over an 8.5-year follow-up period [16]. However, although many prevalence studies have been published comparing numbers obtained with the NCEP-ATP III and IDF criteria, no study has simultaneously compared the ability of hypertriglyceridemic waist, NCEP-ATP III, and IDF screening tools to identify men characterized by deteriorated cardiometabolic risk markers such as hyperinsulinemia, elevated apolipoprotein B levels, small low-density lipoprotein (LDL) particles, increased C-reactive protein (CRP) concentrations, and low adiponectin levels.

Section snippets

Study sample and measurements

Two hundred seventy-two men, aged 25 to 63 years (mean age ± SD, 44.9 ± 7.6 years), were recruited from the Québec City metropolitan area by solicitation through the media. Participants were selected to cover a wide range of body mass index values (18.7-39.1 kg/m2). Subjects gave their written consent to participate in the study, which was approved by the Medical Ethics Committee of Université Laval. All subjects were sedentary but healthy, nonsmoking, and nondiabetic volunteers; and they were

Results

In the present sample, the prevalence of men with the NCEP-ATP III criteria, IDF criteria, or hypertriglyceridemic waist phenotype was 59.2%, 64.0%, and 51.1%, respectively. A large proportion of men having the hypertriglyceridemic waist phenotype also met the NCEP-ATP III (82.7%) or the IDF (89.2%) criteria. Physical characteristics and fasting cardiometabolic risk profile of men with or without the NCEP-ATP III, the IDF, or the hypertriglyceridemic waist criteria are presented in Table 1.

Discussion

The NCEP-ATP III guidelines have recognized the metabolic syndrome as a cluster of abnormalities increasing the risk of CVD and type 2 diabetes mellitus [1]. Indeed, studies have shown that the risk of CVD is increased by about 2-fold, whereas the risk of type 2 diabetes mellitus could be increased by about 3- to 5-fold among subjects diagnosed with the clinical markers of the metabolic syndrome [2], [30], [31], [32]. Because the metabolic syndrome is a prevalent condition [33], it is important

Acknowledgment

Angelo Tremblay holds a Canada Research Chair in Physical Activity, Nutrition, and Energy Metabolism. Benoît Lamarche holds a Canada Research Chair in Nutrition, Functional Foods, and Cardiovascular Health. Jean-Pierre Després is Scientific Director of the International Chair on Cardiometabolic Risk, which is supported by an unrestricted grant from Sanofi Aventis awarded to Université Laval. We would like to thank the staff of the Physical Activity Sciences Laboratory for the data collection

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