Lipoprotein heterogeneity may help to detect individuals with insulin resistance.
OBJECTIVE
The triacylglycerol (TG)-to-HDL-cholesterol ratio has been shown to detect insulin resistance. However, the added predictive value of a more comprehensive assessment of lipoprotein composition is unknown.


METHODS
We analysed cross-sectional data from 882 non-diabetic participants in the Insulin Resistance Atherosclerosis Study (IRAS). Lipoproteins were measured by nuclear magnetic resonance (NMR) spectroscopy. Determined by the frequently sampled intravenous glucose tolerance test, insulin resistance was defined as the lowest sex-specific quartile of insulin sensitivity.


RESULTS
The AUC of the receiver operating characteristic curve of HDL-cholesterol and TG levels for detecting insulin resistance was similar to that of the TG-to-HDL-cholesterol ratio (0.676 vs 0.673; p = 0.685), but smaller than the AUC of NMR-detected lipoproteins (0.676 vs 0.745; p < 0.001). NMR lipoproteins added discriminative value to HDL-cholesterol and TG levels (net reclassification improvement of 40.0%; p < 0.001; and integrated discrimination improvement of 9.5%; p < 0.001), with net benefit within predicted probabilities of between 10% and 50% by Vickers' decision-curve analysis. We also demonstrated additive value to demographic variables, BMI and levels of fasting glucose, TG, and HDL-cholesterol (net reclassification improvement of 14.0%; p < 0.001; and integrated discrimination improvement of 4.5%; p < 0.001).


CONCLUSIONS
NMR lipoproteins, which can be measured in the fasting state, add information to the TG and HDL-cholesterol ratio across a broad range on insulin resistance. Depending on the other risk factors of insulin resistance that are incorporated, NMR lipoproteins permit the correct reclassification of an additional 14-40% of individuals.
Department of Medicine, Division of Clinical Epidemiology, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA. lorenzo@uthscsa.edu.
Carlos
C
Lorenzo
Department of Nutritional Sciences, and the Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.|Department of Medicine, and the Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Anthony J
AJ
Hanley
Barbara Davis Center for Childhood Diabetes, University Colorado School of Medicine, Aurora, CO, USA.
Marian J
MJ
Rewers
Elli Lilly and Co., Vienna, Austria.
Andreas
A
Festa
Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA.
Steven M
SM
Haffner
D019540:Area Under Curve; D015415:Biomarkers / Q000032:analysis; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D008076:Cholesterol, HDL / Q000032:analysis; D003430:Cross-Sectional Studies; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007333:Insulin Resistance; D008074:Lipoproteins / Q000737:chemistry* / Q000235:genetics; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood; D012727:Sex Characteristics; D014280:Triglycerides / Q000032:analysis
D015415:Biomarkers; D001786:Blood Glucose; D008076:Cholesterol, HDL; D008074:Lipoproteins; D014280:Triglycerides
Clinical science; Epidemiology; Human; Insulin sensitivity; Lipids; Lipoproteins