title: Baseline levels, and changes over time in body mass index and fasting insulin, and their relationship to change in metabolic trait clustering.
abstract: BACKGROUND
  Multiple abnormal metabolic traits are found together or "cluster" within individuals more often than is predicted by chance. The individual and combined role of adiposity and insulin resistance (IR) on metabolic trait clustering is uncertain. We tested the hypothesis that change in trait clustering is a function of both baseline level and change in these measures.
  
  
  METHODS
  In 2616 nondiabetic Framingham Offspring Study participants, body mass index (BMI) and fasting insulin were related to a within-person 7-year change in a trait score of 0-4 Adult Treatment Panel III metabolic syndrome traits (hypertension, high triglycerides, low high-density lipoprotein cholesterol, hyperglycemia).
  
  
  RESULTS
  At baseline assessment, mean trait score was 1.4 traits, and 7-year mean (SEM) change in trait score was +0.25 (0.02) traits, P<0.0001. In models with BMI predictors only, for every quintile difference in baseline BMI, the 7-year trait score increase was 0.14 traits, and for every quintile increase in BMI during 7-year follow-up, the trait score increased by 0.3 traits. Baseline level and change in fasting insulin were similarly related to trait score change. In models adjusted for age-sex-baseline cluster score, 7-year change in trait score was significantly related to both a 1-quintile difference in baseline BMI (0.07 traits) and fasting insulin (0.18 traits), and to both a 1-quintile 7-year increase in BMI (0.21 traits) and fasting insulin (0.18 traits).
  
  
  CONCLUSIONS
  Change in metabolic trait clustering was significantly associated with baseline levels and changes in both BMI and fasting insulin, highlighting the importance of both obesity and IR in the clustering of metabolic traits.
authors.affiliation: 1 The Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester , and Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom .
authors.forename: Martin K
authors.initials: MK
authors.lastname: Rutter
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Sullivan
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Fox
authors.forename: Peter W F
authors.initials: PW
authors.lastname: Wilson
authors.forename: David M
authors.initials: DM
authors.lastname: Nathan
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
authors.forename: Ralph B
authors.initials: RB
authors.lastname: D'Agostino
authors.forename: James B
authors.initials: JB
authors.lastname: Meigs
mesh_terms: D050154:Adiposity / Q000502:physiology; D000328:Adult; D015992:Body Mass Index; D016000:Cluster Analysis; D005215:Fasting / Q000097:blood*; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000150:complications / Q000453:epidemiology; D012307:Risk Factors; D013997:Time Factors
chemical_list: D007328:Insulin