title: Development of the multiple metabolic syndrome in the ARIC cohort: joint contribution of insulin, BMI, and WHR. Atherosclerosis risk in communities.
abstract: OBJECTIVE
  The natural history of the multiple metabolic syndrome (MMS) and its predictors has rarely been addressed in population samples. This study evaluated the predictive role of fasting serum insulin, body mass index (BMI), and waist-to-hip ratio (WHR) on the development of incident MMS components (diabetes, hypertension, and dyslipidemias) over the course of three years.
  
  
  METHODS
  The study population comprised the cohort of middle-aged African American and European American men and women of the Atherosclerosis Risk in Communities Study (1987-1992).
  
  
  RESULTS
  Among 6113 individuals free of MMS components at baseline, high insulin (> 14 microU/ ml) was independently predictive of the development of one or more MMS components (OR:1.5, 95% CI:1.2-1.8), as was a BMI > or = 30 (OR:1.7, 95% CI:1.4-2.0), and a high WHR (> 0.98) (OR:1.5, 95% CI:1.3-1.8) adjusting statistically for age, gender, and ethnicity/center. These associations were markedly stronger for combinations of MMS components (two or more) than for isolated components.
  
  
  CONCLUSIONS
  The findings confirm earlier reports on the predictive role of insulin, BMI, and WHR, and suggest that these antecedent factors may be integral to the development of combinations of disorders, i.e., the particular clustering identified as the MMS.
authors.affiliation: Institute of Epidemiology and Social Medicine, University of Münster, Germany.
authors.forename: A D
authors.initials: AD
authors.lastname: Liese
authors.forename: E J
authors.initials: EJ
authors.lastname: Mayer-Davis
authors.forename: H A
authors.initials: HA
authors.lastname: Tyroler
authors.forename: C E
authors.initials: CE
authors.lastname: Davis
authors.forename: U
authors.initials: U
authors.lastname: Keil
authors.forename: B B
authors.initials: BB
authors.lastname: Duncan
authors.forename: G
authors.initials: G
authors.lastname: Heiss
mesh_terms: D000704:Analysis of Variance; D000886:Anthropometry; D044383:Black People; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D007328:Insulin / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008659:Metabolic Diseases / Q000453:epidemiology*; D008875:Middle Aged; D009765:Obesity; D011237:Predictive Value of Tests; D013577:Syndrome; D014481:United States / Q000453:epidemiology; D044465:White People; D001741:Black or African American
chemical_list: D007328:Insulin