Impact of the Triglyceride/High-Density Lipoprotein Cholesterol Ratio and the Hypertriglyceremic-Waist Phenotype to Predict the Metabolic Syndrome and Insulin Resistance

Helene von Bibra; Sarama Saha; Alexander Hapfelmeier; Gabriele Müller; Peter E. H. Schwarz

doi:10.1055/s-0043-107782

Hormone and Metabolic Research, Inhaltsverzeichnis

Horm Metab Res 2017; 49(07): 542-549
DOI: 10.1055/s-0043-107782

Endocrine Care

Impact of the Triglyceride/High-Density Lipoprotein Cholesterol Ratio and the Hypertriglyceremic-Waist Phenotype to Predict the Metabolic Syndrome and Insulin Resistance

Helene von Bibra

¹Clinic for Endocrinology, Diabetes and Vascular Medicine, Staedt. Klinikum Bogenhausen, Academic Hospital of the TUM, Munich, Germany

,

Sarama Saha

²Department of Medicine III, University Hospital Carl Gustav Carus, TU Dresden, Germany

,

Alexander Hapfelmeier

³Institute for Statistics and Epidemiology in Medicine of the Technische Universität, Munich, Germany

,

Gabriele Müller

⁴Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus, TU Dresden, Germany

,

Peter E. H. Schwarz

²Department of Medicine III, University Hospital Carl Gustav Carus, TU Dresden, Germany

⁵Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, TU Dresden, Dresden, Germany

⁶German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany

› Institutsangaben

Abstract

Insulin resistance is the underlying mechanism for the metabolic syndrome and associated dyslipidaemia that theoretically implies a practical tool for identifying individuals at risk for cardiovascular disease and type-2-diabetes. Another screening tool is the hypertriglyceremic-waist phenotype (HTW). There is important impact of the ethnic background but a lack of studied European populations for the association of the triglyceride/high-density lipoprotein cholesterol (HDL-C) ratio and insulin resistance. This observational, retrospective study evaluated lipid ratios and the HTW for predicting the metabolic syndrome/insulin resistance in 1932 non-diabetic individuals from Germany in the fasting state and during a glucose tolerance test. The relations of triglyceride/HDL-C, total-cholesterol/HDL-C, and low-density lipoprotein cholesterol/HDL-C with 5 surrogate estimates of insulin resistance/sensitivity and metabolic syndrome were analysed by linear regression analysis and receiver operating characteristics (ROC) in participants with normal (n=1 333) or impaired fasting glucose (n=599), also for the impact of gender. Within the lipid ratios, triglyceride/HDL-C had the strongest associations with insulin resistance/sensitivity markers. In the prediction of metabolic syndrome, diagnostic accuracy was good for triglyceride/HDL-C (area under the ROC curve 0.817) with optimal cut-off points (in mg/dl units) of 2.8 for men (80% sensitivity, 71% specificity) and 1.9 for women (80% sensitivity, 75% specificity) and fair for HTW and HOMA-IR (area under the curve 0.773 and 0.761). These data suggest the triglyceride/HDL-C ratio as a physiologically relevant and practical index for predicting the concomitant presence of metabolic syndrome, insulin resistance and dyslipidaemia for therapeutic and preventive care in apparently healthy European populations.

Key words

metabolic syndrome - insulin resistance - triglycerides - HDL cholesterol - hypertriglyceremic-waist phenotype

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References
1 Expert panel on detection evaluation treatment of high blood cholesterol in adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001; 285: 2486-2497
2 Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet 2005; 365: 1415-1428
3 Schwarz PE, Bornstein SR. Pre-diabetes and metabolic syndrome in Germans. Hormone and metabolic research 2006; 38: 359
4 von Bibra H, Paulus St W, John Sutton M. Cardio-metabolic syndrome and increased risk of heart failure. Curr Heart Fail Rep 2016; 13: 219-229
5 Anstee QM, Targher G, Day CP. Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis. Nat Rev Gastroenterol Hepatol 2013; 10: 330-344
6 Eyre H, Kahn R, Robertson RM. Preventing cancer, cardiovascular disease, and diabetes. Diabetes Care 2004; 27: 1812-1824
7 Scuteri A, Najjar SS, Morrell CH, Lakatta EG. Cardiovascular Health S. The metabolic syndrome in older individuals: Prevalence and prediction of cardiovascular events: the Cardiovascular Health Study. Diabetes Care 2005; 28: 882-887
8 Reaven GM. Role of insulin resistance in human disease. Diabetes Care 1988; 37: 1595-1607
9 Smiley T, Oh P, Shane LG. The relationship of insulin resistance measured by reliable indexes to coronary artery disease risk factors and outcomes–a systematic review. Canad J Cardiol 2001; 17: 797-805
10 Szendrödi J, Phielix E, Roden M. Assessment of insulin sensitivity. In: Byrne CD, Wild SH. (eds) The metabolic syndrome. 2nd ed Oxford: Blackwell Publishing Ltd; 2014: 88-105
11 Eckel RH, Kahn R, Robertson RM, Rizza RA. Preventing cardiovascular disease and diabetes: A call to action from the American Diabetes Association and the American Heart Association. Circulation 2006; 113: 2943-2946
12 Sarwar N, Danesh J, Eiriksdottir G, Sigurdsson G, Wareham N, Bingham C, Matthijs-Boekholdt S, Khaw T-K, Gudnason V. Triglycerides and the risk of coronary heart disease: 10,158 incident cases among 262,525 participants in 29 Western prospective studies. Circulation 2007; 115: 450-458
13 Kinosian B, Glick H, Garland G. Cholesterol and coronary heart disease: Predicting risks by levels and ratios. Ann Intern Med 1994; 121: 641-647
14 Salazar MR, Carbajal HA, Espeche WG, Aizpurúa M, Leiva Sisnieguez CE, Leiva Sisnieguez BC, March CE, Stavile RN, Balbín E, Reaven GM. Identifying cardiovascular disease risk and outcome: Use of the plasma triglyceride/high-density lipoprotein cholesterol concentration ratio vs. metabolic syndrome criteria. J Intern Med 2013; 273: 595-601
15 McLaughlin T, Reaven GM, Abbasi F, Lamendola C, Saad M, Waters D, Simon J, Krauss RM. Is there a simple way to identify insulinresistant individuals at increased risk of cardiovascular disease?. Am J Cardiol 2005; 96: 399-404
16 McLaughlin T, Schweitzer P, Carter S, Yen CG, Lamendola C, Abbasi F, Reaven G. Persistence of improvement in insulin sensitivity following a dietary weight loss programme. Diabetes Obes Metab 2008; 10: 1186-1194
17 Bell DSH, O’Keefe JH. Lowering the triglyceride/high-density lipoprotein cholesterol and its association with the beneficial impact of pioglitazone on coronary arterosclerosis in the PERISCOPE study is likely due to lowering insulin resistance. J Am Coll Cardiol 2011; 58: 778
18 von Bibra H, Ströhle A, St John Sutton M, Worm N. Dietary therapy of heart failure preserved ejection fraction and/or left ventricular diastolic dysfunction in patients with metabolic syndrome. Int J Cardiol 2017; 234: 7-15
19 Accurso A, Bernstein RK, Dahlqvist A, Draznin B, Feinman RD, Fine EJ, Gleed A, Jacobs DB, Larson G, Lustig RH, Manninen AH, McFarlane SI, Morrison K, Vesti Nielsen J, Ravnskov U, Roth KS, Silvestre R, Sowers JR, Sundberg R, Volek JS, Westman EC, Wood RJ, Wortman J, Vernon MC. Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal. Nutr Metab 2008; 5: 9-17
20 Li C, Ford ES, Meng YX, Mokdad AH, Reaven MG. Does the association of the triglyceride to high-density lipoprotein cholesterol ratio with fasting serum insulin differ by race/ethnicity?. Cardiovasc Diabetol 2008; 7: 1-9
21 Salazar MR, Carbajal HA, Espeche WG, Leiva Sisnieguez CE, Balbín E, Dulbecco CA, Aizpurúa M. Relation among the plasma triglyceride/high-density lipoprotein cholesterol concentration ratio, insulin resistance, and associated cardio-metabolic risk factors in men and women. Am J Cardiol 2012; 109: 1749-1753
22 Lemieux I, Poirier P, Bergeron J, Alméras N, Lamarche B, Cantin B, Dagenais GR, Després JP. Hypertriglyceridemic waist: A useful screening phenotype in preventive cardiology. Can J Cardiol 2007; 23 SupplB 23-31
23 Arsenault BJ, Lemieux I, DesprèsJP Wareham NJ, Kastelein JJ, Khaw KT, Boekholdt SM. The hypertriglyceremic-waist phenotype and the risk of coronary artery disease: Results from the EPIC-norfolk prospective population study. Canad Med Assoc J 2010; 182: 1427-1432
24 American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2007; 30: s42-s47
25 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
26 Katz A, Nambi SS, Mather K, Baron AD, Follmann DA, Sullivan G, Quon MJ. Quantitative insulin sensitivity check index: A simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab 2000; 85: 2402-2410
27 Stumvoll M, Mitrakou A, Pimenta W, Jenssen T, Yki-Järvinen H, Van Haeften T, Renn W, Gerich J. Use of the oral glucose tolerance test to assess insulin release and insulin sensitivity. Diabetes Care 2000; 23: 295-301
28 Shah SJ, Kitzman DW, Borlaug BA, van Heerebeek L, Zile MR, Kass DA, Paulus WJ. Phenotype-specific treatment of heart failure with preserved ejection fraction. A multiorgan roadmap. Circulation 2016; 134: 73-90
29 Santos FL, Esteves SS, da Costa Pereira A, Yancy Jr WS, Nunes JP. Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors. Obes Rev 2012; 13: 1048-1066
30 Brehm A, Pfeiler G, Pacini G, Vierhapper H, Roden M. Relationship between serum lipoprotein ratios and insulin resistance in obesity. Clin Chem 2004; 50: 2316-2322
31 Moro E, Gallina P, Pais M, Cazzolato G, Alessandrini P, Bittolo-Bon G. Hypertriglyceridemia is associated with increased insulin resistance in subjects with normal glucose tolerance: Evaluation in a large cohort of subjects assessed with the 1999 World Health Organization criteria for the classification of diabetes. Metabolism 2003; 52: 616-619
32 Laakso M, Pyorala K, Voutilainen E, Marniemi J. Plasma insulin and serum lipids and lipoproteins in middle-aged non- insulindependent diabetic and non-diabetic subjects. Am J Epidemiol 1987; 125: 611-621
33 McLaughlin T, Abbasi F, Cheal K, Chu J, Lamendola C, Reaven G. Use of metabolic markers to identify overweight individuals who are insulin resistant. Ann Intern Med 2003; 139: 802-809
34 Ferrara CM, Goldberg AP. Limited value of the homeostasis model assessment to predict insulin resistance in older men with impaired glucose tolerance. Diabetes Care 2001; 24: 245-249
35 Gayoso-Diz P, Otero-Gonzalez A, Rodriguez-Alvarez MX, Gude F, García F, De Francisco A, Quintela AG. Insulin resistance (HOMA-IR) cut-off values and the metabolic syndrome in a general adult population: Effect of gender and age: EPIRCE cross-sectional study. BMC Endocr Disord 2013; 13: 47-57
36 Kahn R, Buse J, Ferrannini E, Stern M. The metabolic syndrome: time for a critical appraisal. Joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia 2005; 48: 1684-1699
37 von Bibra H, Wulf St G, John Sutton M, Pfützner A, Schuster T, Heilmeyer P. Low-carbohydrate/high-protein diet improves diastolic cardiac function and the metabolic syndrome in overweight-obese patients with type 2 diabetes. IJC Metab Endocr 2014; 2: 11-18
38 Hu G, Qiao Q, Tuomilehto J, Balkau B, Borch-Johnsen K, Pyorala K. DECODE Study Group. Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women. Arch Intern Med 2004; 164: 1066-1076