Document Detail

Critical evaluation of adult treatment panel III criteria in identifying insulin resistance with dyslipidemia.
MedLine Citation:
PMID:  15047659     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The goal of this study was to evaluate the efficacy of the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) in identifying insulin resistance. RESEARCH DESIGN AND METHODS: This study included 74 nondiabetic Caucasians who were evaluated for insulin resistance and risk factors associated with the metabolic syndrome. Glucose disposal rate (GDR) was measured by hyperinsulinemic-euglycemic clamp and was used to quantify insulin resistance. Sensitivity and specificity of ATP III criteria in detecting insulin resistance were calculated for various cutoffs of GDR. RESULTS: Insulin resistance was associated with increased waist circumference, fasting glucose, blood pressure, triglycerides, and decreased levels of HDL cholesterol. Only 12.2% of study subjects met ATP III criteria for metabolic syndrome, and ATP III criteria exhibited low sensitivity for detecting insulin resistance. Although high in specificities (>90%), the sensitivities of ATP III criteria ranged only between 20 and 50% when insulin resistance was defined as various GDR cutoff values below 10 to 12 The larger number of subjects who were insulin resistant but did not meet ATP III criteria were found to have an adverse cardiovascular disease risk profile, including higher BMI, waist circumference, fasting glucose, triglycerides, and an unfavorable lipoprotein subclass profile determined by nuclear magnetic resonance compared with insulin-sensitive individuals (i.e., increased large VLDL, increased small LDL, and decreased large HDL particle concentrations). CONCLUSIONS: ATP III criteria have low sensitivity for identifying insulin resistance with dyslipidemia in nondiabetic individuals who are at increased risk for cardiovascular disease and diabetes. More sensitive criteria should be developed for clinical assessment of metabolic and cardiovascular disease risk relevant to the metabolic syndrome.
Youlian Liao; Soonho Kwon; Sara Shaughnessy; Penny Wallace; Amy Hutto; Alicia J Jenkins; Richard L Klein; W Timothy Garvey
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Diabetes care     Volume:  27     ISSN:  0149-5992     ISO Abbreviation:  Diabetes Care     Publication Date:  2004 Apr 
Date Detail:
Created Date:  2004-03-29     Completed Date:  2004-10-14     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7805975     Medline TA:  Diabetes Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  978-83     Citation Subset:  IM    
Department of Biometry and Epidemiology, Medical University of South Carolina, Charleston, South Carolina, USA.
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MeSH Terms
Blood Glucose / metabolism
Body Mass Index
Cardiovascular Diseases / etiology
Glucose Clamp Technique
Hyperlipidemias / complications*,  diagnosis*
Insulin Resistance*
Lipids / blood
Metabolic Syndrome X / etiology*
Middle Aged
Practice Guidelines as Topic / standards*
Risk Factors
Sensitivity and Specificity
Grant Support
Reg. No./Substance:
0/Blood Glucose; 0/Lipids
Comment In:
Diabetes Care. 2004 Apr;27(4):1011-2   [PMID:  15047666 ]

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