CLUSTERING OF DYSLIPIDEMIA, HYPERURICEMIA, DIABETES, AND HYPERTENSIONAND ITS ASSOCIATION WITH FASTING INSULIN AND CENTRAL AND OVERALL OBESITY IN A GENERAL-POPULATION
Mi. Schmidt et al., CLUSTERING OF DYSLIPIDEMIA, HYPERURICEMIA, DIABETES, AND HYPERTENSIONAND ITS ASSOCIATION WITH FASTING INSULIN AND CENTRAL AND OVERALL OBESITY IN A GENERAL-POPULATION, Metabolism, clinical and experimental, 45(6), 1996, pp. 699-706
Clustering of elevated triglycerides, decreased high-density lipoprote
in cholesterol (HDL-C), hyperuricemia, diabetes, and hypertension has
been related to insulin resistance/high insulin levels and central and
/or overall obesity. The extent to which these abnormalities cluster a
nd whether hyperinsulinemia, central adiposity, and overall obesity ea
ch independently associate with this clustering were evaluated in 14,4
81 US whites and African-Americans 45 to 64 years of age. With the exc
eption of hypertension, abnormalities rarely existed in isolated form.
Clustering greatly exceeded chance association (P <.001). Although th
is clustering was greater in relative terms (ratio of observed to expe
cted cluster frequency) in the lean and less centrally obese, it was g
reater in absolute terms (observed minus expected cluster frequency as
a percent of total population) in the more centrally and more general
ly obese. The greatest excesses were found for clusters that included
both hypertriglyceridemia and low HDL-C. Multiple logistic regression
models showed strong and independent graded relationships of clusters
with quintiles of fasting insulin (fifth quintile odds ratio, 10 to 54
, P <.001) and to a lesser degree with quintiles of the waist to hip r
atio (2.2 to 5.4, P <.001 for most) and of body mass index (1.6 to 4.5
, P <.05 for most). In conclusion, all abnormalities cluster in excess
of that predicted by chance, with clusters showing remarkable and gra
ded independent associations with fasting hyperinsulinemia and to a le
sser extent with central and overall obesity. Thus, a metabolic syndro
me occurs in both lean and obese middle-aged US adults. Copyright (C)
1996 by W.B. Saunders Company.