title: Insulin resistance, beta cell dysfunction and visceral adiposity as predictors of incident diabetes: the Insulin Resistance Atherosclerosis Study (IRAS) Family study.
abstract: OBJECTIVE
  Central obesity, insulin resistance and beta cell dysfunction are independent risk factors for incident type 2 diabetes, although few studies have used detailed measures of these disorders. Our objective was to study the association of directly measured visceral and subcutaneous adipose tissue (VAT, SAT), insulin sensitivity (S (I)) and the acute insulin response (AIR) with incident type 2 diabetes.
  
  
  METHODS
  Participants were 1,230 Hispanic-Americans and African-Americans in the Insulin Resistance Atherosclerosis Study (IRAS) Family Study who were free of type 2 diabetes at baseline (2000-2002). S (I) and AIR were determined from frequently sampled IVGTTs with minimal model analysis. VAT and SAT were determined by computed tomography. Impaired fasting glucose and type 2 diabetes were defined according to American Diabetes Association criteria.
  
  
  RESULTS
  Incident type 2 diabetes was diagnosed in 90 participants after 5 years. After adjustment for age, sex, ethnicity, centre, impaired fasting glucose, triacylglycerol, HDL-cholesterol and systolic BP, both S(I) and AIR were inversely associated with type 2 diabetes (S (I), OR 0.53, 95% CI 0.39-0.73; AIR, OR 0.22, 95% CI 0.14-0.34 per SD; both p < 0.001), while both VAT and SAT were positively associated with type 2 diabetes (VAT, OR 1.68, 95% CI 1.22-2.33; SAT, OR 1.49, 95% CI 1.13-1.99; both p < 0.01). In a model including all four factors, S (I) and AIR (S (I), OR 0.55, 95% CI 0.37-0.80; AIR, OR 0.21, 95% CI 0.13-0.33; both p < 0.01) were significant predictors of type 2 diabetes, although associations with VAT and SAT were no longer significant. A significant sex x VAT interaction indicated a stronger association of VAT with type 2 diabetes in women than in men.
  
  
  CONCLUSIONS
  Insulin resistance, beta cell dysfunction and VAT predicted incident type 2 diabetes, with evidence of a stronger association of VAT with type 2 diabetes among women.
authors.affiliation: Department of Nutritional Sciences, University of Toronto, ON, Canada. anthony.hanley@utoronto.ca
authors.forename: A J G
authors.initials: AJ
authors.lastname: Hanley
authors.forename: L E
authors.initials: LE
authors.lastname: Wagenknecht
authors.forename: J M
authors.initials: JM
authors.lastname: Norris
authors.forename: M
authors.initials: M
authors.lastname: Bryer-Ash
authors.forename: Y I
authors.initials: YI
authors.lastname: Chen
authors.forename: A M
authors.initials: AM
authors.lastname: Anderson
authors.forename: R
authors.initials: R
authors.lastname: Bergman
authors.forename: S M
authors.initials: SM
authors.lastname: Haffner
mesh_terms: D050154:Adiposity / Q000502:physiology*; D000328:Adult; D001741:Black or African American; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D007328:Insulin / Q000378:metabolism / Q000502:physiology; D007333:Insulin Resistance / Q000502:physiology*; D050417:Insulin-Secreting Cells / Q000378:metabolism / Q000473:pathology*; D050152:Intra-Abdominal Fat / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012737:Sex Factors
chemical_list: D007328:Insulin