Analysis of obesity and Hyperinsulinemia in the development of metabolic syndrome: San Antonio Heart Study

HAN, THANG S., KEN WILLIAMS, NAVEED SATTAR, KELLY J. HUNT, MICHAEL E.J. LEAN, AND STEVEN M. HAFFNER. Analysis of obesity and hyperinsulinemia in the development of metabolic syndrome: San Antonio Heart Study. Obes Res. 2002; 10:923-931. Objective: To use standardized cut-offs of body mass index (BMI), waist circumference, waist-to-hip ratio, and fasting insulin levels to predict the development of metabolic disorders and metabolic syndrome. Research Methods and Procedures: We performed an 8-year follow-up study of 628 non-Hispanic whites and 1340 Mexican Americans, ages 25 to 64 years, from the second cohort of the San Antonio Heart Study. We defined metabolic disorders as dyslipidemia (triglycerides greater than or equal to2.26 mM or high-density lipoprotein <0.91 mM in men and < 1. 17 ITIM in women), hypertension (blood pressure greater than or equal to140/ greater than or equal to90 mm Hg, or receiving antihypertensive medications), and type 2 diabetes (fasting glucose greater than or equal to7.0 mM, 2-hour test glucose greater than or equal to11. 1 mM, or receiving anti-diabetic medications). People with at least two metabolic disorders were defined as having metabolic syndrome. Results: High waist-to-hip ratio and fasting insulin levels were significant predictors of developing metabolic syndrome. High anthropometric indices remained significant predictors of metabolic syndrome after adjusting for fasting insulin. Waist circumference, BMI, and insulin had similar areas under the receiver operating characteristic curves (0.74 to 0.76). Further multivariate analyses combining these indices showed minimal increase in prediction. Of subjects who had a combination of high BMI (greater than or equal to 30 kg/m(2)) and high waist circumference (above "Action Level 2"), 32% developed metabolic syndrome, compared with 10% of subjects with both low BMI and low waist circumference. Discussion: These findings support the National Institutes of Health recommendations for reducing the risk of metabolic syndrome. Adjustment for baseline fasting insulin levels had only a small effect on the ability of anthropometric indices to predict the metabolic syndrome.