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Diabetes 53:1195-1200, 2004
© 2004 by the American Diabetes Association, Inc.

Relationship to Insulin Resistance of the Adult Treatment Panel III Diagnostic Criteria for Identification of the Metabolic Syndrome

Karen L. Cheal1, Fahim Abbasi2, Cindy Lamendola2, Tracey McLaughlin2, Gerald M. Reaven2, and Earl S. Ford3

1 Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
2 Department of Medicine, Stanford University School of Medicine, Stanford, California
3 Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia

The Adult Treatment Panel III (ATP III) has published criteria for diagnosing the metabolic syndrome, a cluster of closely related abnormalities related to insulin resistance that increase cardiovascular disease risk. The present analysis was performed to evaluate the ability of these criteria to identify insulin-resistant individuals. The population consisted of 443 healthy volunteers, with measurements of BMI, blood pressure, fasting plasma glucose, triglycerides, HDL cholesterol concentrations, and steady-state plasma glucose (SSPG) concentration. Insulin resistance was defined as being in the top tertile of SSPG concentrations. Of the population, 20% satisfied ATP III criteria for the metabolic syndrome. Although insulin resistance and the presence of the metabolic syndrome were significantly associated (P < 0.001), the sensitivity and positive predictive value equaled 46% (69 of 149) and 76% (69 of 91), respectively. Being overweight, with high triglycerides, low HDL cholesterol, or elevated blood pressure, most often resulted in a diagnosis of the metabolic syndrome. Thus, the ATP III criteria do not provide a sensitive approach to identifying insulin-resistant individuals. The individual components vary both in terms of their utility in making a diagnosis of the metabolic syndrome and their relationship to insulin resistance, with the obesity and lipid criteria being most useful.

Address correspondence and reprint requests to Gerald M. Reaven, MD, Division of Cardiovascular Medicine, Falk CVRC, Stanford Medical Center, 300 Pasteur Drive, Stanford, CA 94305-5406. E-mail: greaven{at}cvmed.stanford.edu


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