Increased risk of diabetes development in subjects with the hypertriglyceridemic waist phenotype: a 4-year longitudinal study

Association between hypertriglyceridemic-waist phenotype and circadian syndrome risk: a longitudinal cohort study

Recently, circadian syndrome (CircS) has been proposed as a new predictor of cardiometabolic risk. We aimed to investigate the relationship between the hypertriglyceridemic-waist phenotype and its dynamic status with CircS in China. We conducted a two-stage study based on the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015. Multivariate logistic regression models in cross-sectional analysis and Cox proportional hazards regression models in longitudinal analysis were used to estimate the associations of hypertriglyceridemic-waist phenotypes with CircS and its components. We then applied multiple logistic regression analysis to evaluate the odds ratios (ORs) and 95% confidence intervals (CIs) for CircS risk by transformation into the hypertriglyceridemic-waist phenotype. A total of 9863 participants were included in the cross-sectional analysis and 3884 participants in the longitudinal analysis. Compared with normal waist circumference (WC) and normal triglyceride (TG) level (NWNT), CircS risk was increased with enlarged WC and high TG level (EWHT) (hazard ratio (HR) 3.87 [95% CI: 2.38, 5.39]). Similar results were observed in subgroup analyses by sex, age, smoking status, and drinking status. During follow-up, CircS risk was increased in group K (stable EWNT during follow-up) (OR 9.97 [95% CI: 6.41, 15.49]) compared with group A (stable NWNT during follow-up), while group L (baseline enlarged WC and normal TG level transformed to follow-up EWHT) had the highest risk of CircS (OR 116.07 [95% CI: 72.77, 185.14]). In conclusion, the hypertriglyceridemic-waist phenotype and its dynamic status were associated with the risk of developing CircS in Chinese adults.

Characterization of the hypertriglyceridemic waist phenotype in patients with type 2 diabetes mellitus in Spain: an epidemiological study

BACKGROUND AND OBJECTIVES

In patients with type 2 diabetes mellitus (DM2), the presence of increased waist circumference and triglycerides is a reflection of increased visceral fat and insulin resistance. However, information about the prevalence and clinical characteristics of the hypertriglyceridemic waist (HTGW) phenotype in patients with DM2 is scarce. The aim of the present study was to analyze the prevalence and characteristics of DM2 patients with HTGW.

METHODS

We analyzed 4214 patients with DM2 in this epidemiological, cross-sectional study conducted in primary care centers across Spain between 2011 and 2012. The HTGW phenotype was defined as increased waist circumference according to the International Diabetes Federation criteria for Europids (≥ 94 cm for men and ≥ 80 cm for women) with the presence of triglyceride levels ≥ 150 mg/dL. We compared the demographic, clinical and analytical variables according to the presence or absence of the HTGW phenotype.

RESULTS

Thirty-five percent of patients presented the HTGW phenotype. Patients with the HTGW phenotype had a higher body mass index (31.14 ± 4.88 vs. 29.2 ± 4.82 kg/m2; p < .001) and glycated hemoglobin levels (7.38 ± 1.2% vs. 7 ± 1.07%; p < .001). The presence of hypertension, peripheral arterial disease, cardiac insufficiency and microvascular complications were higher when compared with patients without the HTGW phenotype. Patients with the HTGW phenotype were less adherent to prescribed diet (69.8 vs. 81%; p < .001), exercise (44.6 vs. 58.2%; p < .001) and presented greater weight increase within the year prior to the study visit (29.4 vs. 22.5%; p < .001).

CONCLUSIONS

The HTGW phenotype is prevalent in the Spanish DM2 population and identifies a subgroup of patients with higher cardiometabolic risk and prevalence of diabetic complications.

Association between Hypertriglyceridemic-Waist Phenotype and Risk of Type 2 Diabetes Mellitus in Middle-Aged and Older Chinese Population: A Longitudinal Cohort Study

Current evidence remains inconsistent with regard to the association between different triglyceridemic-waist phenotypes and the risks for type 2 diabetes mellitus (T2DM). We aimed to investigate this association among a retrospective cohort analysis of 6918 participants aged ≥ 45 years in the China Health and Retirement Longitudinal Study (CHARLS). Participants were categorized into four triglyceridemic-waist phenotypes consisting of NWNT (normal waist circumference and normal triglycerides), NWHT (normal waist circumference and high triglycerides), EWNT (enlarged waist circumference and normal triglycerides), and EWHT (enlarged waist circumference and high triglycerides) based on participants’ baseline information. Multivariate log-binomial regression was used to assess the T2DM risk in different phenotypes. Subgroup analysis was conducted to test the robustness of the findings. After 4-years of follow-up, participants with EWHT (Relative Risk [RR]: 1.909, 95% Confidence Interval [CI]: 1.499 to 2.447) or EWNT (RR: 1.580, 95%CI: 1.265 to 1.972) phenotypes had significantly higher likelihood of incident T2DM compared to the NWNT phenotype, whereas the association was not significant for the NWHT phenotype (RR: 1.063, 95%CI: 0.793 to 1.425). The subgroup analyses generally revealed similar associations across all subgroups. Among middle-aged and older adults, we suggested a combined use of waist circumference and triglycerides measures in identifying participants who are at high risk of developing T2DM.

Association of "hypertriglyceridemic waist" with increased 5-year risk of subclinical atherosclerosis in a multi-ethnic population: a prospective cohort study

Background

Hypertriglyceridemic waist (HTGW), which incorporates measures of waist circumference and levels of triglyceride in blood, could act as an early-stage predictor to identify the individuals at high-risk for subclinical atherosclerosis. Previous studies have explored the cross-sectional association between HTGW and atherosclerosis; however, understanding how this association might change over time is necessary. This study will assess the association between HTGW with 5-year subclinical carotid atherosclerosis.

Methods

517 participants of Aboriginal, Chinese, European, and South Asian ethnicities were examined for baseline HTGW and 5-year indices of subclinical atherosclerosis (intima media thickness (mm), total area (mm²), and plaque presence). Family history of cardiovascular disease, sociodemographic measures (age, sex, ethnicity, income level, maximum education), and traditional risk factors (systolic blood pressure, smoking status, total cholesterol, high-density lipoprotein cholesterol, body mass index) were incorporated into the models of association. These models used multiple linear regression and logistic regression.

Results

Baseline HTGW phenotype is a statistically significant and clinically meaningful predictor of 5-year intima media thickness (β = 0.08 [0.04, 0.11], p < 0.001), total area (β = 0.20 [0.07, 0.33], p = 0.002), and plaque presence (OR = 2.17 [1.13, 4.19], p = 0.02) compared to the non-HTGW group independent of sociodemographic factors and family history. However, this association is no longer significant after adjusting for the traditional risk factors of atherosclerosis (p = 0.27, p = 0.45, p = 0.66, respectively). Moreover, change in status of HTGW phenotype does not correlate with change in indices of atherosclerosis over 5 years.

Conclusions

Our results suggest that when the traditional risk factors of atherosclerosis are known, HTGW may not offer additional value as a predictor of subclinical atherosclerosis progression over 5 years.

Characterization of the hypertriglyceridemic waist phenotype in patients with type2 diabetes mellitus in Spain: An epidemiological study

BACKGROUND AND OBJECTIVES

In patients with type2 diabetes mellitus (DM2), the presence of increased waist circumference and triglycerides is a reflection of increased visceral fat and insulin resistance. However, information about the prevalence and clinical characteristics of the hypertriglyceridemic waist (HTGW) phenotype in patients with DM2 is scarce. The aim of the present study was to analyze the prevalence and characteristics of DM2 patients with HTGW.

METHODS

We analyzed 4214 patients with DM2 in this epidemiological, cross-sectional study conducted in primary care centers across Spain between 2011 and 2012. The HTGW phenotype was defined as increased waist circumference according to the International Diabetes Federation criteria for Europids (≥94cm for men and ≥80cm for women) with the presence of triglyceride levels ≥150mg/dl. We compared demographic, clinical and analytical variables according to the presence or absence of the HTGW phenotype.

RESULTS

Thirty-five percent of patients presented the HTGW phenotype. Patients with the HTGW phenotype had a higher body mass index (31.14±4.88 vs. 29.2±4.82kg/m2; P<.001) and glycated hemoglobin levels (7.38±1.2% vs. 7±1.07%; P<.001). The presence of hypertension, peripheral arterial disease, cardiac insufficiency and microvascular complications were higher when compared with patients without the HTGW phenotype. Patients with the HTGW phenotype were less adherent to prescribed diet (69.8 vs. 81%; P<.001), exercise (44.6 vs. 58.2%; P<.001) and presented greater weight increase within the year prior to the study visit (29.4 vs. 22.5%; P<.001).

CONCLUSIONS

The HTGW phenotype is prevalent in the Spanish DM2 population and identifies a subgroup of patients with higher cardiometabolic risk and prevalence of diabetic complications.

Hypertriglyceridemic Waist Phenotype and Lipid Accumulation Product: Two Comprehensive Obese Indicators of Waist Circumference and Triglyceride to Predict Type 2 Diabetes Mellitus in Chinese Population

PURPOSE

To determine whether hypertriglyceridemic waist (HTGW) and high lipid accumulation product (LAP) preceded the incidence of type 2 diabetes mellitus (T2DM), and to investigate the interactions of HTGW and LAP with other components of metabolic syndrome on the risk of T2DM.

METHODS

A total of 15,717 eligible participants without baseline T2DM and aged 35 and over were included from a Chinese rural cohort. Cox proportional hazards regression models were used to estimate the association of HTGW and LAP with the incidence of T2DM, and the restricted cubic spline model was used to evaluate the dose-response association.

RESULTS

Overall, 867 new T2DM cases were diagnosed after 7.77 years of follow-up. Participants with HTGW had a higher hazard ratio for T2DM (hazard ratio (HR): 6.249, 95% confidence interval (CI): 5.199-7.511) after adjustment for potential confounders. The risk of incident T2DM was increased with quartiles 3 and 4 versus quartile 1 of LAP, and the adjusted HRs (95% CIs) were 2.903 (2.226-3.784) and 6.298 (4.911-8.077), respectively. There were additive interactions of HTGW (synergy index (SI): 1.678, 95% CI: 1.358-2.072) and high LAP (SI: 1.701, 95% CI: 1.406-2.059) with increased fasting plasma glucose (FPG) on the risk of T2DM. Additionally, a nonlinear (P nonlinear < 0.001) dose-response association was found between LAP and T2DM.

CONCLUSION

The subjects with HTGW and high LAP were at high risk of developing T2DM, and the association between LAP and the risk of T2DM may be nonlinear. Our study further demonstrates additive interactions of HTGW and high LAP with increased FPG on the risk of T2DM.

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.

Hypertriglyceridemic waist phenotype and abnormal glucose metabolism: a system review and meta-analysis

OBJECTIVE

This study was to perform a meta-analysis to assess the relationship between hypertriglyceridemic-waist (HTW) phenotype and abnormal glucose metabolism.

METHODS

The data sources were PubMed and EMBASE up to June 2018. Studies providing the relationship between HTW phenotype and abnormal glucose metabolism were included.

RESULTS

In total, 48 eligible studies that evaluated 2,42,879 subjects were included in the meta-analysis. In the general population, the pooled odds ratios (ORs) for elevated blood glucose and diabetes related to HTW phenotype was 2.32 (95% confidence interval (CI): 1.98-2.71) and 2.69 (95% CI: 2.40-3.01), respectively. In cohort studies, the pooled OR for diabetes related to HTW phenotype was 2.89 (95% CI: 1.97-4.25) in subjects without diabetes. The levels of homeostasis model assessment of insulin resistance (HOMA-IR) in the HTW population were increased with values of mean differences (MD) 1.12 (95% CI: 0.81-1.43. P < 0.00001, I² = 99%) in the general population and 0.89 (95% CI: 0.75-1.04, P < 0.00001, I² = 67%) in subjects without diabetes.

CONCLUSION

HTW phenotype was closely associated with increased risk of abnormal glucose metabolism. There was also a significant correlation between HTW phenotype and insulin resistance.

Prevalence and relationship of hypertriglyceridaemic-waist phenotype and type 2 diabetes mellitus among a rural adult Chinese population

OBJECTIVE

Limited information is available on the prevalence and effect of hypertriglyceridaemic-waist (HTGW) phenotype on the risk of type 2 diabetes mellitus (T2DM) in rural populations.

DESIGN

In the present cross-sectional study, we investigated the prevalence of the HTGW phenotype and T2DM and the strength of their association among rural adults in China.

SETTING

HTGW was defined as TAG &gt;1·7 mmol/l and waist circumference (WC) ≥90 cm for males and ≥80 cm for females. Logistic regression analysis yielded adjusted odds ratios (aOR) relating risk of T2DM with HTGW.ParticipantsAdults (n 12 345) aged 22·83-92·58 years were recruited from July to August of 2013 and July to August of 2014 from a rural area of Henan Province in China.

RESULTS

The prevalence of HTGW and T2DM was 23·71 % (males: 15·35 %; females: 28·88 %) and 11·79 % (males: 11·15 %; females: 12·18 %), respectively. After adjustment for sex, age, smoking, alcohol drinking, blood pressure, physical activity and diabetic family history, the risk of T2DM (aOR; 95 % CI) was increased with HTGW (v. normal TAG and WC: 3·23; CI 2·53, 4·13; males: 3·37; 2·30, 4·92; females: 3·41; 2·39, 4·85). The risk of T2DM with BMI≥28·0 kg/m2, simple enlarged WC and simple disorders of lipid metabolism showed an increasing tendency (aOR=1·31, 1·75 and 2·32).

CONCLUSIONS

The prevalence of HTGW and T2DM has reached an alarming level among rural Chinese people, and HTGW is a significant risk factor for T2DM.

The relationship between hypertriglyceridemic-waist phenotype and vitamin D status in type 2 diabetes

Background: The aim of the study was to explore the relationship between hypertriglyceridemic-waist (HTW) phenotype and vitamin D status in type 2 diabetes. Methods: A cross-sectional study was conducted in subjects with type 2 diabetes. This study enrolled 338 type 2 diabetic (190 males and 148 females). The HTW phenotype was defined as serum triglyceride concentrations ≥1.7 mmol/L and waist circumference ≥90 cm (male) and 85 cm (female). Multiple logistic regression models were used for modeling relationships between HTW phenotype and vitamin D status. Results: The prevalence of HTW phenotype was 36.4%. The prevalence of HTW phenotype was 10.5%, 27.2%, and 41.6% in type 2 diabetes with vitamin D sufficiency, vitamin D insufficiency, and vitamin D deficiency, respectively. In multiple logistic regression analysis, subjects with vitamin D deficiency were more likely to have HTW phenotype (OR=6.222, 95%CI: 1.307-29.620, P=0.022) compared with subjects with vitamin D sufficiency. Conclusions: There was a significant correlation between HTW phenotype and vitamin D status in type 2 diabetes.

Metabolic Syndrome, and Particularly the Hypertriglyceridemic-Waist Phenotype, Increases Breast Cancer Risk, and Adiponectin Is a Potential Mechanism: A Case-Control Study in Chinese Women

Objective: To investigate the association between metabolic syndrome and breast cancer and to elucidate the potential mechanism underlying this association. Patients and Methods: Based on baseline data drawn from 21 hospitals in 11 provinces of China, we performed a case-control study among 1,127 women (595 cases and 532 controls), divided into premenopausal, and postmenopausal subgroups. Student's t test, Pearson's χ² test, and logistic regression analyses were performed to ascertain the association between breast cancer and metabolic syndrome, including all of its components. In addition, we attempted to clarify the potential role of adiponectin in this association. Results: Among the components of metabolic syndrome, abnormal waist circumference was the component that markedly increased breast cancer risk in premenopausal women (OR 1.447, 95% CI 1.043-2.006). Metabolic syndrome with clusters of special risk factors showed an association with breast cancer risk. Among all these components of metabolic syndrome, the hypertriglyceridemic-waist (HW) phenotype significantly increased breast cancer risk (OR 1.56, 95% CI 1.02-2.39), regardless of menopausal status, rendering it a strong predictor of breast cancer. Total adiponectin levels and high-molecular-weight adiponectin were reversely associated with metabolic syndrome. In addition, total adiponectin levels among breast cancer patients were much lower than among controls (6.67 ± 3.05 vs. 8.01 ± 4.18, p = 0.014) only in the HW phenotype subgroup. Furthermore, the HW phenotype was associated with increased risk of estrogen receptor/progesterone receptor-positive (ER+/PR+) and -negative (ER-/PR-) breast cancer, with a 51% (OR 1.51, 95% CI 1.03-2.21) and 69% (OR 1.69, 95% CI 1.05-2.72) increase, respectively. However, there was no significant association between the HW phenotype and the ER+/PR- subtype. These results suggested that low adiponectin levels may be a mechanism that explains the association between the HW phenotype and breast cancer risk. Conclusion: Metabolic syndrome with special cluster factors is related to breast cancer risk; in particular, the HW phenotype can be regarded as a strong predictor of breast cancer. As an important factor involved in fat metabolism, adiponectin may strongly predict metabolic syndrome, especially the HW phenotype and breast cancer. Further research into this mechanism and epidemiological studies are needed. This study provides new evidence for the role of a healthy lifestyle in preventing breast cancer.

Being Metabolically Healthy, the Most Responsible Factor for Vascular Health

The prevalence of obesity is rapidly increasing worldwide. One-thirds of world population is suffering from the deleterious effects of excessive fat and adipose tissue in their body. At the same time, the average life expectancy is becoming higher and higher every decade. Therefore, living healthy and longer is the dream for everyone. Simply being obese is not the primary cause for the consequence of obesity; rather, the depot where the fat is accumulated, is the primary key for the deleterious effects of obesity. Results from historical research suggest that visceral fat increases the risk for cardiovascular and metabolic diseases, such as diabetes, myocardial infarction and ischemic stroke, not subcutaneous fat. Therefore, body mass index (BMI), which reflects body weight relative to height might not reflect the appropriate size of metabolic burden of fat in our body. In contrast, waist circumference, which reflects abdominal obesity, would mirror the metabolic burden of fat better than BMI. Visceral fat is the marker of ectopic fat accumulation. In this review, I will introduce my researches mainly involved in uncovering the clues to the link between metabolic health and cardiovascular disease.

Genetic effects on hypertriglyceridemic waist phenotype: rs780094, rs10830963, rs151290, and rs972283 polymorphisms and the interactions between them and behavior risk factors

BACKGROUNDS

We aimed to evaluate the association of SNPs in GCKR, MTNR1B, KCNQ1, and KLF14 genes confirmed in previous studies and hapertriglyceridemic waist (HTGW) in Han Chinese, and assess the interactions between genes and behavior risk factors.

METHODS

We genotyped the single nucleotide polymorphisms (SNPs) for GCKR, MTNR1B, KCNQ1, and KLF14 gene were genotyped in 373 patients with HTGW and 466 normal healthy subjects. We used logistic regression to investigate the gene-gene, gene-behavior interactions for the risk of HTGW.

RESULTS

Among the 4 SNPs, the AG genotype of rs780094 was protective factor, whereas the recessive model of rs151290 was risk factor after adjusting for confounders. Stratified by sex, only for women, the recessive model of rs151290 was still significance. The significant synergies interactions between SNPs were found between rs780094 in GCKR and rs972283 in KLF14 and rs10830963 in MTNR1B, respectively; meanwhile, the antagonistic interaction was revealed for rs151290 and rs780094 only for women. For male, there were significant synergies interactions between rs780094, smoking and alcohol drinking; and antagonistic interaction was revealed between rs780094 and severe activity both for men and women.

CONCLUSIONS

GCKR and KLF14 genes play a significant role in risk of HTGW in a Han Chinese population.

The Relationship between Hypertriglyceridemic Waist Phenotype and Early Diabetic Nephropathy in Type 2 Diabetes

Background/Aims

The aim of this study was to explore the relationship between hypertriglyceridemic waist (HW) phenotype and early diabetic nephropathy in type 2 diabetes.

Methods

A cross-sectional study was conducted on 538 type 2 diabetes patients in Qinhuangdao. The HW phenotype was defined as serum triglyceride concentrations ≥1.7 mmol/L and waist circumference ≥90 cm (males) and ≥85 cm (females).

Results

The prevalence of the HW phenotype was 34.9%. The prevalence of early diabetic nephropathy was 10.6% in type 2 diabetes patients with normal waist circumference and triglycerides and 24.5% in type 2 diabetes patients with HW phenotype. After adjustment for sex, age, body mass index, hypertension, history of diabetes, and glycosylated hemoglobin A1c, the prevalence of early diabetic nephropathy among type 2 diabetes patients with the HW phenotype was 2.81 (95% confidence interval 1.36-5.80, p = 0.005) times higher than that among type 2 diabetes patients with normal waist circumference and triglycerides.

Conclusion

There was a significant correlation between HW phenotype and early diabetic nephropathy in type 2 diabetes.

The Association of Hypertriglyceridemic Waist Phenotype with Chronic Kidney Disease and Its Sex Difference: A Cross-Sectional Study in an Urban Chinese Elderly Population

Background: The primary objective of this study was to explore the association of hypertriglyceridemic waist (HTGW) phenotype with chronic kidney disease (CKD) and its sex difference in an urban Chinese elderly population. Methods: In a cross-sectional study, a total of 2102 participants aged 60–95 years were recruited and classified into four phenotypes: normal waist-normal triglyceride (NWNT), normal waist-elevated triglycerides (NWET), elevated waist-normal triglycerides (EWNT), and HTGW. Logistic regression analysis was used to estimate the associations of interest. Results: Total prevalence of CKD was 12.6%, and the CKD prevalence in participants with EWNT and HTGW was higher than with NWNT and NWET without regard to sex. Compared to NWNT phenotype, the adjusted OR for CKD was 1.95 (95% CI: 1.32–2.88) in HTGW groups. In contrast with the null findings (OR: 1.66; 95% CI: 0.94–2.94) in women after additional adjustment for diabetes and hypertension, the OR with HTGW remained strong (OR: 1.88; 95% CI: 1.04–3.39) in men. Similar findings appeared with the EWNT phenotype. Conclusions: The HTGW phenotype is positively associated with CKD among Chinese community elderly and may have a greater impact on men. More attention should be paid to the association between triglycerides and waist circumference in clinical practice and to the further identification this uncertain sex-related association.

Hypertriglyceridemic waist - a simple clinical tool to detect cardiometabolic risk: comparison with harmonized definition of metabolic syndrome

With the increasing prevalence of obesity and especially abdominal obesity, a simple clinical tool is needed that identifies the cardiometabolic risk for cardiovascular disease and type 2 diabetes. The aim of our study was to evaluate a broad spectrum of metabolic variables and IMT in subjects with and without hypertriglyceridemic waist (HTGW) and compare it with the harmonized definition of metabolic syndrome (MS) with both a higher (MS-I) and lower waist circumference (MS-II) for Europids. We enrolled 607 asymptomatic dyslipidemic subjects (295 men and 312 women) into our cross-sectional study. The subjects with HTGW had an atherogenic lipid profile (significantly higher triglycerides, AIP, non-HDL-C, lower HDL-C and ApoA-1, and the women also higher TC and ApoB), increased markers of insulin resistance (insulin, HOMA, C-peptide, proinsulin), inflammation (hsCRP), thrombosis (fibrinogen, PAI-1), SBP and DBP, and lower adiponectin (p<0.05-0.001 for all). These risk factors were entirely similar in HTGW, MS-I and MS-II. Age-adjusted IMT was significantly higher only in the women with HTGW but this significance disappeared after further adjustment for TC, SBP, and smoking. Our results support the routine use of HTGW as a simple and inexpensive screening tool to detect subjects at increased cardiometabolic risk in clinical practice.

Prevalence of hypertriglyceridemic waist and association with risk of type 2 diabetes mellitus: a meta-analysis

INTRODUCTION

A meta-analysis of studies assessing the prevalence of hypertriglyceridemic waist and an association with risk of type 2 diabetes mellitus (T2DM).

MATERIALS AND METHODS

PubMed, EMBASE, Web of Science, CNKI, CQVIP and Wanfang databases were searched for studies of the prevalence of hypertriglyceridemic waist or association with risk of T2DM. Reference lists of each original article were also searched. A random-effects model was used to synthesize the combined prevalence and odds ratios. Publication bias and substantial heterogeneity were examined.

RESULTS

Twenty-five eligible studies involving 93 194 participants (93 194 for prevalence and 34 199 for odds ratios): 17 articles of prevalence, and 8 of both prevalence and risk of T2DM. Prevalence of hypertriglyceridemic waist ranged from 4% to 47%, with pooled prevalence of 18% (95% CI 13-23%), overall: 18% (95% CI 13-23%) for men and 19% (95% CI 13-24%) for women. Odds ratios ranged from 2.8 to 9.6 for T2MD in overall, with pooled odds ratios of 4.18 (95% CI 3.55-4.92), overall: 3.55 (95% CI 2.93-4.31) for men and 4.18 (95% CI 3.43-5.09) for women.

DISCUSSION/CONCLUSION

The prevalence of hypertriglyceridemic waist has reached an alarming level and is closely associated with increased risk of T2DM in the general population, particularly among women and among brown-skinned men and women.

Utility of hypertriglyceridemic waist phenotype for predicting incident type 2 diabetes: The Isfahan Diabetes Prevention Study

Aim/Introduction

We evaluated the association between hypertriglyceridemic waist (HTW) phenotype and the risks of type 2 diabetes in an Iranian high‐risk population.

Materials and Methods

We analyzed 7‐year follow‐up data (n = 1,865) in non‐diabetic first‐degree relatives of consecutive patients with type 2 diabetes aged 30–70 years. The primary outcome was the diagnosis of type 2 diabetes based on repeated oral glucose tolerance tests. We used multiple logistic regressions to estimate the odds ratio (OR) for incident type 2 diabetes across four groups according to baseline fasting serum triglycerides (TG) level and waist circumference (WC): normal WC and normal TG, normal WC and high TG, enlarged WC and normal TG, and HTW (enlarged WC high TG).

Results

The HTW phenotype at baseline was associated with the incidence of type 2 diabetes. Those with HTW were 2.4‐fold (OR 2.36, 95% confidence interval 1.61–3.44), those with normal WC high TG were 1.9‐fold (OR 1.87, 95% confidence interval 1.29–2.70) and those with enlarged WC but normal TG were 2.8‐fold (OR 2.84, 95% confidence interval 1.96–4.13) more likely to develop type 2 diabetes than those with normal WC and normal TG.

Conclusions

These data provide further evidence that the HTW phenotype is a robust predictor of type 2 diabetes in high‐risk individuals in Iran, and the predictive power is not higher than that of simple enlarged WC and normal TG, emphasizing the importance of enlarged WC to the development of type 2 diabetes.

βig-h3 Represses T-Cell Activation in Type 1 Diabetes

βig-h3/TGF-βi is a secreted protein capable of binding to both extracellular matrix and cells. Human genetic studies recently revealed that in the tgfbi gene encoding for βig-h3, three single nucleotide polymorphisms were significantly associated with type 1 diabetes (T1D) risk. Pancreatic islets express βig-h3 in physiological conditions, but this expression is reduced in β-cell insult in T1D. Since the integrity of islets is destroyed by autoimmune T lymphocytes, we thought to investigate the impact of βig-h3 on T-cell activation. We show here that βig-h3 inhibits T-cell activation markers as well as cytotoxic molecule production as granzyme B and IFN-γ. Furthermore, βig-h3 inhibits early T-cell receptor signaling by repressing the activation of the early kinase protein Lck. Moreover, βig-h3-treated T cells are unable to induce T1D upon transfer in Rag2 knockout mice. Our study demonstrates for the first time that T-cell activation is modulated by βig-h3, an islet extracellular protein, in order to efficiently avoid autoimmune response.

Changes in Metabolic Health Status Over Time and Risk of Developing Type 2 Diabetes: A Prospective Cohort Study

Metabolic health and obesity are not stable conditions, and changes in the status of these conditions might lead to different clinical outcomes. We aimed to determine whether changes in metabolic health status or obesity over time have any effect on the risk of future diabetes. Nondiabetic individuals (n = 2692) from a population-based prospective cohort study with baseline and 2 follow-up examinations at 4-year intervals were included. Being "metabolically obese" (MO) was defined as being in the highest quartile of the TyG index (ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]), whereas falling into the lower 3 quartiles was regarded as being "metabolically healthy" (MH). Individuals were classified as "obese" (O) or "nonobese" (NO) using a body mass index of 25 kg/m2 as a cut-off. The risk of diabetes at year 8 was assessed according to changes of metabolic health status between year 0 and 4. Multivariate-adjusted relative risks (RRs) (95% confidence interval [CI]) of diabetes were significantly higher in individuals who retained the MONO phenotype (RR 3.72, 95% CI 2.10, 6.60) or who had progressed to MONO from the MHNO phenotype (RR 1.96, 95% CI 1.06, 3.61), whereas it was not significant in individuals who had improved to MHNO from the MONO phenotype (RR 0.67, 95% CI 0.26, 1.74) compared with individuals who retained the MHNO phenotype. In contrast, obese individuals had significantly higher RRs for diabetes, independent of changes in metabolic health status, whereas weight reduction resulted in a decreased risk of diabetes. Sensitivity analysis using the presence or absence of the metabolic syndrome as a definition of metabolic health revealed similar results. Changes in metabolic health status were an independent risk factor for future diabetes in nonobese individuals, whereas general obesity had a greater contribution to the risk of obese individuals developing diabetes. These observations might imply a different intervention strategy for diabetes prevention according to obesity status.