Critical evaluation of adult treatment panel III criteria in identifying insulin resistance with dyslipidemia.
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.


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 mg.kg(-1).min(-1). 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.
Liao
Youlian
Y
Department of Biometry and Epidemiology, Medical University of South Carolina, Charleston, South Carolina, USA.
Kwon
Soonho
S
Shaughnessy
Sara
S
Wallace
Penny
P
Hutto
Amy
A
Jenkins
Alicia J
AJ
Klein
Richard L
RL
Garvey
W Timothy
WT
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology; D005260:Female; D015309:Glucose Clamp Technique; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications* / Q000175:diagnosis*; D007333:Insulin Resistance; D008055:Lipids / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000209:etiology*; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D012307:Risk Factors; D012680:Sensitivity and Specificity
D001786:Blood Glucose; D008055:Lipids