Hypertriglyceridemic Waist Phenotype Indicates Insulin Resistance in Adolescents According to the Clamp Technique in the BRAMS Study

Hypertriglyceridemic waist phenotype, hypertriglyceridemic waist-to-height ratio phenotype and abnormal glucose metabolism in adolescents

OBJECTIVE

The purpose of this study was to evaluate the relationship between hypertriglyceridemic waist (HW) phenotype,hypertriglyceridemic waist-to-height ratio (HWHtR) phenotype and abnormal glucose metabolism in adolescents.

METHODS

A secondary analysis was conducted on 2626 adolescents aged 12-19 years in United States. Abnormal glucose metabolism was defined as fasting plasma glucose ≥ 5.6 mmol/L or oral glucose tolerance test 2-h plasma glucose ≥ 7.8 mmol/L or glycohemoglobin A1c ≥ 5.7% or a previous diagnosis of diabetes. The HW phenotype was defined as triglyceride(TG) concentrations ≥ 1.47 mmol/L and waist circumference (WC) ≥ 90th percentile. The HWHtR phenotype was defined as TG concentrations ≥ 1.47 mmol/L and waist-to-height ratio (WHtR) ≥ 0.5.

RESULTS

621(23.6%) adolescents had abnormal glucose metabolism. The prevalences of abnormal glucose metabolism were 22.7% and 40.6% in adolescents without and with HW phenotype. The prevalences of abnormal glucose metabolism were 22.4% and 38.6% in adolescents without and with HWHtR phenotype. Adolescents with HWHtR phenotype were more likely to have abnormal glucose metabolism (OR = 1.548, P = 0.010). The levels of homeostasis model assessment insulin resistance and β cell fuction index were higher in adolescents with HWHtR phenotype than in adolescents without HWHtR phenotype (P < 0.001).

CONCLUSION

The study demonstrates that HWHtR phenotype was closely associated with an increased risk of abnormal glucose metabolism in adolescents. Adolescents with HWHtR phenotype had worsen insulin resistance and increased insulin secretion as a result of compensation.

IMPACT STATEMENT

The study provided a simple method, HWHtR phenotype, for evaluating the status of glucose metabolism in adolescents.

Hypertriglyceridemic-waist phenotype is strongly associated with cardiovascular risk factor clustering in Chinese adolescents

The early identification of predictors related to cardiovascular risk factor clustering (CVRFC) in adolescents can help prevent Cardiovascular disease. The hypertriglyceridemic-waist circumference (HTW) phenotype is considered a simple and useful indicator to identify cardiovascular disease. However, there is limited research on the relationship between the HTW phenotype and (CVRFC) in adolescents. It is unclear whether the HTW phenotype can identify early the risk of developing CVRFC in adolescents. The study aimed to examine the association of the HTW phenotype with CVRFC in adolescents. A total of 1478 adolescents aged 12–18 years were classified into normal waist circumference (WC) and normal triglyceride (TG) (NWNT, 66.4%), normal WC and high TG (HTG, 5.5%), enlarged WC and normal TG (EW, 22.2%) and enlarged WC and high TG (HTW, 5.8%). High TG was defined as TG ≥ 1.47 mmol/L and enlarged WC ≥ 90th percentile by gender and age. CVRFs in this study included elevated blood pressure (BP), impaired fasting glucose (IFG), high total cholesterol (TC), low high-density lipoprotein cholesterol (HDL-C), and high low-density lipoprotein cholesterol (LDL-C). CVRFC ≥ 2 or CVRFC ≥ 3 were defined as the presence of at least two or three cardiovascular risk factors. After adjustment for BMI, gender and age, the HTW phenotype increased the risk of CVRFC ≥ 2 and CVRFC ≥ 3 compared to the NTNW phenotype, OR and 95%CI were 2.40 (1.23–4.58) and 3.63 (1.49–8.86), respectively. After stratification by gender, similar results were found in boys, however, girls with the EW phenotype had a lower risk of CVRFC ≥ 2 and CVRFC ≥ 3 compared with the NTNW phenotype after adjustment for BMI and age. The area under the ROC curve was 0.698 (0.661–0.736) and 0.782 (0.725–0.840) when TG was combined with WC to detect cardiovascular risk factors clustering, which was better than BMI, WHtR, TG or WC alone. And similar results were obtained for both boys and girls when stratified by gender. These results revealed that different combinations of TG and WC levels are closely associated with cardiovascular risk factors clustering in both boys and girls, and TG combining WC performed better than BMI, WHtR, TG or WC alone in detecting cardiovascular risk factor clustering in adolescents.

Adolescent metabolic syndrome and its components associations with incidence of type 2 diabetes in early adulthood: Tehran lipid and glucose study

AIM

To investigate the association of youth metabolic syndrome (MetS) and its components, individually and in combination with early adulthood incident type 2 diabetes (T2DM).

METHODS

A total of 2798 adolescents aged 11-19 years enrolled in the study. At baseline, MetS, its components including blood pressure (BP), waist circumference (WC), triglycerides (TGs), fasting plasma glucose, and low HDL-C, and different combinations of MetS components were defined. After a mean 11.3 years of follow-up, T2DM was determined. Multivariable Cox proportional hazard regression analysis adjusted for age, sex, family history of T2DM, and adult BMI was used for data analysis. The hazard ratio (HR) and 95% confidence interval (CI) were reported.

RESULTS

During the follow-up, 44 incidents T2DM were developed. Among different individual components, only high WC [HR = 2.63, 95% CI (1.39-4.97)] and high TGs [HR = 1.82, 95% CI (1.00-3.34)] remained as significant predictors only in the age and sex adjusted model. Regarding combinations of MetS components, 'high TGs and high WC' [HR = 2.70, 95% CI (1.27-5.77)], 'high BP and high WC' [HR = 2.52, 95% CI (1.00-6.33)], 'high TGs and high BP' [HR = 2.27, 95% CI (1.02-5.05)] as well as MetS per se [HR = 2.82, 95% CI (1.41-5.64)] had a significant relationship with incident T2DM in the multivariable adjusted model. Among different confounders, being female and having family history of T2DM were consistently associated with higher risk of T2DM, in different combinations of MetS components.

CONCLUSIONS

Adolescence MetS and some combinations of MetS components predicted early adulthood T2DM. Thus, adolescents, particularly female ones, with combinations of MetS components as well as those with family history of T2DM could be targeted for lifestyle intervention.

HYPERTRIGLYCERIDEMIC WAIST AND ASSOCIATED FACTORS IN CHILDREN AND ADOLESCENTS WITH TYPE 1 DIABETES MELLITUS

Objective:

To assess the frequency of the hypertriglyceridemic waist phenotype and its associated factors in children and adolescents with type 1 diabetes mellitus.

Methods:

This is an observational analytical study with individuals with type 1 diabetes mellitus, aged 5 to 18 years, of both genders, followed in a university hospital in the Brazilian Northeast. Weight, height, and waist circumference were measured, and the lipid profile and glycated hemoglobin were analyzed. The hypertriglyceridemic waist phenotype was defined by the simultaneous presence of increased waist circumference (≥90^th percentile for age and gender) and elevated serum triglyceride levels (≥75 mg/dL for children and ≥90 mg/dL for adolescents). We also investigated the family history of cardiovascular diseases and diabetes, as well as sociodemographic and behavioral variables. In the statistical inference tests, the proportions were compared by Pearson’s chi-square test ­and/­or Fisher’s exact test, being significant p<0.05.

Results:

A total of 102 patients were evaluated, most of them females (54.9%) and adolescents (66.7%). The frequency of hypertriglyceridemic waist was 23.5%, which was associated with females (p=0.043), overweight (p=0.023), hypercholesterolemia (p=0.002), high LDL (p=0.001), and borderline VLDL (<0.001).

Conclusions:

The frequency of the hypertriglyceridemic waist phenotype was associated with females, atherogenic lipid profile, and overweight, indicating the importance of the nutritional monitoring of this population, aiming at reducing future cardiovascular diseases.

Superior Role of Waist Circumference to Body-Mass Index in the Prediction of Cardiometabolic Risk in Dyslipidemic Patients

Coronary risk evaluation by conventional factors (age, gender, smoking, blood pressure and cholesterol) may further be specified by facets of the metabolic syndrome, namely insulin resistance, hypertriglyceridemia and obesity. Although obesity is usually defined as elevated body mass index (BMI), recent data indicate a superior role of waist circumference or hypertri-glyceridemic waist (HTGW) over BMI in the assessment of cardiometabolic risk. In dyslipidemic patients, the specific contributions of risky waist, HTGW or BMI have not been evaluated as yet. 686 dyslipidemic subjects (322 males and 364 females) were enrolled into a cross-sectional study. In each subject basic antropometry (i.e. waist circumference, HTGW, BMI) and laboratory parameters of lipid profile and insulin resistance were determined. Cardiometabolic risk was given by fulfilling the criteria (harmonized definition) of metabolic syndrome. The significance of risky waist, HTGW and BMI were assessed by comparing the respective predictive values for the presence of metabolic syndrome. Dyslipidemic patients with risky waist, HTGW or high BMI have a more atherogenic lipid profile and higher insulin resistance compared to those without risky waist, HTGW or high BMI. Risky waist is stronger predictor of metabolic syndrome (PPV 66 %, NPV 90 %) and thus posesa greater cardiometabolic risk than higher BMI per se does (PPV 42 %, NPV 97 %). The contribution of triglycerides (i.e. HTGW) to these predictive values is marginal (PPV 66 %, NPV 92 %). The present results highlight the superior role of waist circumference as a screening tool over BMI for the evaluation of cardiometabolic risk in dyslipidemic subjects. HTGW brings little additional benefit in risk stratification. Lower BMI proved to be optimal for identifying the subjects with inferior risk.

Homeostatic model assessment of adiponectin (HOMA-Adiponectin) as a surrogate measure of insulin resistance in adolescents: Comparison with the hyperglycaemic clamp and homeostatic model assessment of insulin resistance

BACKGROUND

Studies on adults have reported inverse association between the homeostatic model assessment (HOMA) of adiponectin (HOMA-Adiponectin) and the insulin resistance assessed by the glucose clamp technique. To our knowledge, in the pediatric population this association has not been previously investigated.

OBJECTIVES

To evaluate the association between the HOMA-Adiponectin and the insulin resistance assessed by the glucose clamp technique in adolescents, and to compare the accuracy of HOMA-Adiponectin and HOMA-insulin resistance (HOMA-IR) for identifying insulin resistance.

METHODS

This was a cross-sectional study of 56 adolescents (aged 10-18 years). Insulin resistance was assessed using the HOMA-IR, HOMA-Adiponectin and the hyperglycaemic clamp technique. The clamp-derived insulin sensitivity index, HOMA-Adiponectin, and HOMA-IR were log-transformed to get closer to a normal distribution before analysis.

RESULTS

In the multivariable linear regression analysis controlling for sex and Tanner stage, HOMA-Adiponectin was inversely associated with the clamp-derived insulin sensitivity index (unstandardized coefficient [B] = -0.441; P < 0.001). After additional adjustment for waist circumference-to-height ratio, this association remained significant (B = -0.349; P = < 0.001). Similar results were observed when HOMA-IR replaced HOMA-Adiponectin in the model (B = -1.049 and B = -0.968 after additional adjustment for waist circumference-to-height ratio); all P < 0.001. The area under the receiver operating characteristic curve for predicting insulin resistance was 0.712 (P = 0.02) for HOMA-Adiponectin and 0.859 (P < 0.0001) HOMA-IR.

CONCLUSIONS

The HOMA-Adiponectin was independently associated with insulin resistance and exhibited a good discriminatory power for predicting it. However, it did not show superiority over HOMA-IR in the diagnostic accuracy.

Sagittal abdominal diameter resembles waist circumference as a surrogate marker of insulin resistance in adolescents-Brazilian Metabolic Syndrome Study

OBJECTIVE

To evaluate the association of the sagittal abdominal diameter (SAD) with insulin resistance (IR) and metabolic syndrome (MetS) components, and to compare SAD with waist circumference (WC).

SUBJECTS/METHODS

This was a multicenter, cross-sectional study of 520 adolescents (10- to 18-years old). IR was assessed using the homeostasis model assessment of IR (HOMA-IR) and the hyperglycaemic clamp (n = 76).

RESULTS

SAD and WC were positively correlated with HOMA-IR (r = 0.637 and r = 0.653) and inversely correlated with the clamp-derived insulin sensitivity index (ISI) (r = -0.734 and r = -0.731); P < .001. In the multivariable linear regression analysis, SAD was positively associated with HOMA-IR (B = 0.046 ± 0.003) and inversely associated with the clamp-derived ISI (B = -0.084 ± 0.009) after adjusting for sex, age, and Tanner's stages (P < .001). When WC replaced the SAD, it was positively associated with HOMA-IR (B = 0.011 ± 0.001) and inversely associated with the clamp-derived ISI (B = -0.018 ± 0.002); P < .001. The values of the areas under the curves (AUC) were 0.823 and 0.813 for SAD and WC, respectively. In Bland-Altman analysis, there were agreement between both, SAD and WC, with the clamp-derived ISI (mean = 0.00; P > .05). The SAD and WC were positively associated with blood pressure, triglycerides, and uric acid, and inversely associated with high-density lipoprotein (HDL)-cholesterol after adjusting for sex, age, and Tanner's stages.

CONCLUSION

The SAD was associated with IR and MetS components, with a good discriminatory power for detecting IR. When compared to WC, SAD showed equivalent results.