Intra-Abdominal Fat Is a Major Determinant of the National Cholesterol Education Program Adult Treatment Panel III Criteria for the Metabolic Syndrome

Darcy B. Carr; Kristina M. Utzschneider; Rebecca L. Hull; Keiichi Kodama; Barbara M. Retzlaff; John D. Brunzell; Jane B. Shofer; Brian E. Fish; Robert H. Knopp; Steven E. Kahn

doi:10.2337/diabetes.53.8.2087

Pathophysiology

Intra-Abdominal Fat Is a Major Determinant of the National Cholesterol Education Program Adult Treatment Panel III Criteria for the Metabolic Syndrome

Darcy B. Carr1,
Kristina M. Utzschneider2,
Rebecca L. Hull2,
Keiichi Kodama2,
Barbara M. Retzlaff2,
John D. Brunzell2,
Jane B. Shofer3,
Brian E. Fish2,
Robert H. Knopp2 and
Steven E. Kahn2

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
²Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, Veterans Affairs Puget Sound Health Care System and Harborview Medical Center, University of Washington, Seattle, Washington
³Department of Rehabilitation Research and Development, University of Washington, Seattle, Washington

Address correspondence and reprint requests to Darcy B. Carr, MD, Assistant Professor, Box 356460, Dept. OB/GYN, University of Washington, Seattle, WA 98195-6460. E-mail: darcarr{at}u.washington.edu

Diabetes 2004 Aug; 53(8): 2087-2094. https://doi.org/10.2337/diabetes.53.8.2087

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FIG. 1.
The frequency of the number of NCEP ATP III metabolic syndrome criteria in the whole study population (n = 218; □), the male subjects (n = 89; □), and the female subjects (n = 129; ▪)
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FIG. 2.
Frequency of the individual NCEP ATP III criteria in the whole study population (n = 218; □), the male subjects (n = 89; □), and the female subjects (n = 129; ▪)
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FIG. 3.
S_i and IAF and SCF areas (mean ± SE) versus the number of NCEP ATP III criteria

Tables

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TABLE 1

Characteristics of the study population

	Total	Male	Female
n	218	89	129
Age (years)	52.5 ± 0.7	52.8 ± 1.1	52.4 ± 0.9
BMI (kg/m²)	26.2 ± 0.3	26.7 ± 0.4	25.9 ± 0.4
Systolic BP (mmHg)	117.4 ± 0.9	119.5 ± 1.2	116.0 ± 1.2
Diastolic BP (mmHg)	72.3 ± 0.6	74.2 ± 0.8	71.0 ± 0.*
Waist circumference (cm)	87.1 ± 1.0	94.7 ± 1.2	81.9 ± 1.1†
HDL (mmol/l)	1.34 ± 0.03	1.13 ± 0.03	1.48 ± 0.03†
TG (mmol/l)	1.38 ± 0.06	1.47 ± 0.11	1.32 ± 0.07
FPG (mmol/l)	5.4 ± 0.03	5.6 ± 0.05	5.3 ± 0.04†

Data are means ± SE.
*
* P < 0.01 and
†
† P < 0.001 for male vs. female subjects, determined by independent samples t or Wilcoxon’s rank-sum test.

TABLE 2

Simple linear regression analyses of the association of S_i, IAF area, or SCF area and the individual NCEP ATP III criteria as continuous dependent variables

	Systolic BP (mmHg)			Diastolic BP (mmHg)			Waist circumference (cm)			HDL (mmol/l)			log(TG [mmol/l])
		Slope	P	Slope	P	Slope	P	Slope	P	Slope	P	Slope	P
S_i [×10⁻⁵ min⁻¹/(pmol/l)]	−1.0 ± 0.2	<0.001	−0.55 ± 0.13	<0.001	−1.6 ± 0.18	<0.001	0.028 ± 0.006	<0.001	−0.022 ± 0.004	<0.001	−0.04 ± 0.007	<0.001
IAF (cm²)	0.08 ± 0.01	<0.001	0.045 ± 0.007	<0.001	0.15 ± 0.008	<0.001	−0.086 ± 0.013	<0.001	0.0014 ± 0.0002	<0.001	0.039 ± 0.008	<0.001
SCF (cm²)	0.025 ± 0.007	0.001	0.018 ± 0.004	<0.001	0.064 ± 0.006	<0.001	−0.019 ± 0.008	0.01	0.0006 ± 0.0001	<0.001	0.015 ± 0.004	0.001

Data are means ± SE, unless otherwise noted.

TABLE 3

Multiple linear regression analyses of the association of S_i, IAF and SCF areas and the individual NCEP ATP III criteria as continuous dependent variables

	Systolic BP (mmHg)			Diastolic BP (mmHg)			Waist circumference (cm)			HDL (mmol/l)			log(TG [mmol/l])
		Slope	P	Slope	P	Slope	P	Slope	P	Slope	P	Slope	P
S_i[×10⁻⁵ min⁻¹(pmol/l)]	−0.39 ± 0.23	0.1	−0.15 ± 0.15	0.3	−0.06 ± 0.15	0.7	0.54 ± 0.26	0.04	−0.011 ± 0.004	0.02	−0.47 ± 0.15	0.002
IAF (cm²)	0.06 ± 0.01	<0.001	0.03 ± 0.009	<0.001	0.122 ± 0.009	<0.001	−0.07 ± 0.02	<0.001	0.0009 ± 0.0003	0.001	0.021 ± 0.009	0.02
SCF (cm²)	0.002 ± 0.008	0.8	0.007 ± 0.005	0.2	0.032 ± 0.005	<0.001	0.009 ± 0.008	0.3	0.0003 ± 0.0001	0.07	0.002 ± 0.005	0.7

Data are means ± SE, unless otherwise noted.

TABLE 4

Multivariate logistic regression determining the independent predictors of the metabolic syndrome

Independent variables	OR (95% CI)	P
Model 1
S_i [×10⁻⁵ min⁻¹/(pmol/l)]	0.30 (0.09–0.96)	0.04
IAF (cm²)	2.40 (1.41–4.10)	0.001
SCF (cm²)	2.12 (1.30–3.46)	0.003
Model 2
S_i [×10⁻⁵ min⁻¹/(pmol/l)]	0.30 (0.09–0.96)	0.04
IAF (cm²)	2.43 (1.33–4.47)	0.004
SCF (cm²)	2.09 (1.18–3.70)	0.012
Age (years)	1.008 (0.96–1.06)	0.7
Sex	1.13 (0.34–3.69)	0.8

All ORs are presented as the odds of the metabolic syndrome for a 1 SD increase in the independent variable.

TABLE 5

Multiple regression models including all of the NCEP ATP III criteria as independent continuous variables to assess their association to S_i and IAF and SCF areas as dependent variables

	log{S_i[min⁻¹/(pmol/l)]}			sqrt(IAF [cm²])			sqrt(SCF [cm²])
	Independent variables	Slope	P	Slope	P	Slope	P
Systolic BP (mmHg)	−0.003 ± 0.001	0.02	0.035 ± 0.014	0.02	−0.026 ± 0.024	0.3
Diastolic BP (mmHg)	−0.001 ± 0.002	0.6	−0.024 ± 0.023	0.3	0.014 ± 0.039	0.7
Waist circumference (cm)	−0.009 ± 0.001	<0.001	0.179 ± 0.014	<0.001	0.215 ± 0.023	<0.001
HDL (mmol/l)	0.001 ± 0.001	0.3	0.005 ± 0.011	0.6	0.063 ± 0.019	0.001
TG (mmol/l)	−0.0007 ± 0.0002	<0.001	0.007 ± 0.002	<0.001	0.009 ± 0.003	0.003
FPG (mmol/l)	−0.006 ± 0.002	0.004	0.002 ± 0.018	0.9	−0.017 ± 0.03	0.6