Predictors of insulin resistance in the obese with metabolic syndrome.
BACKGROUND
In the obese, the metabolic syndrome (MetS) is assumed to reflect insulin resistance.


OBJECTIVE
To determine the predictors of insulin resistance in obese subjects with MetS.


METHODS
We used the 90th percentile of the homeostasis model assessment (HOMA) to define insulin resistance in 4958 nondiabetic adults evaluated in the National Health and Nutrition Examination Surveys, 1999-2004, and compared the 373 obese subjects who were insulin-resistant (HOMA 9.52+/-5.73) to a control group of 373 obese who had the highest sensitivity to insulin (HOMA 1.79+/-0.44).


METHODS
MetS was present in 312 (83.6%) obese with insulin resistance and in 156 (41.8%) obese from the insulin-sensitive control group. Demographic, metabolic, and lifestyle variables were analyzed with logistic regression.


RESULTS
In a logistic model of insulin resistance given the presence of MetS, the significant predictors were triglycerides (P=0.0021), body mass index (P=0.0096), HDL-cholesterol (P=0.0098), age (P=0.0242) and smoking (P=0.0366).


CONCLUSIONS
Cross-sectional design prevents elucidation of causality for the association between insulin resistance and MetS.


CONCLUSIONS
Insulin resistance is not an obligatory correlate of MetS in the obese. Its likelihood can be predicted by cigarette smoking and by the severity of obesity and dyslipidemia.
Manu
Peter
P
The Zucker Hillside Hospital, 59-75 263rd Street, Glen Oaks, NY 11004, USA. pmanu@lij.edu
Tsang
James
J
Napolitano
Barbara A
BA
Lesser
Martin L
ML
Correll
Christoph U
CU
D000328:Adult; D015992:Body Mass Index; D008076:Cholesterol, HDL / Q000097:blood; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000378:metabolism; D050171:Dyslipidemias / Q000453:epidemiology / Q000378:metabolism; D005260:Female; D006706:Homeostasis / Q000502:physiology; D006801:Humans; D007249:Inflammation / Q000453:epidemiology / Q000378:metabolism; D007333:Insulin Resistance / Q000502:physiology*; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology* / Q000378:metabolism*; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology* / Q000378:metabolism*; D011237:Predictive Value of Tests; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology / Q000378:metabolism; D014280:Triglycerides / Q000097:blood
D008076:Cholesterol, HDL; D014280:Triglycerides