This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (30)  • Contact me when this article is cited  Related Content  • Related letters  • Similar articles in this journal  Topic Collections  • Lipids and Lipid Disorders  • Metabolic Diseases  • Nutritional and Metabolic Disorders, Other  • Randomized Controlled Trial  • Alert me on articles by topic  Social Bookmarking   What's this?

Anne E. Sumner, MD; Karl B. Finley, MD; David J. Genovese, RN; Michael H. Criqui, MD, MPH; Raymond C. Boston, PhD

Arch Intern Med. 2005;165:1395-1400.

Background  The "lipid criteria" consist of a triglyceride (TG) level of 130 mg/dL (1.47 mmol/L) or greater and a ratio of TG to high-density lipoprotein cholesterol (HDL-C) of 3 or greater. In Caucasians, the lipid criteria predict insulin resistance in individuals with a body mass index (BMI) of 25 kg/m² or greater. Our goal was to determine whether TG levels or TG–HDL-C ratio predicted insulin resistance in African Americans with a BMI of 25 kg/m² or more.

Methods  Of 125 African Americans, the 98 with a BMI of 25 kg/m² or more participated. All subjects had frequently sampled intravenous glucose tolerance tests with insulin resistance determined by the insulin sensitivity index. Subjects were divided into the following tertiles by insulin sensitivity: 12.8 to 4.3, 4.2 to 2.3, and 2.2 to 0.2 mU/L per minute. Insulin resistance was defined as being in the third tertile. Across tertiles, the distribution of variables was compared by 1-way analysis of variance. Areas under the receiver operating characteristic curve were determined to identify variables that predicted insulin resistance.

Results  Fasting insulin level, BMI, and waist circumference increased across tertiles (all P<.01), but TG levels and TG–HDL-C ratio did not (all P.3). The mean ± SE areas under the curves for fasting insulin, BMI, and waist circumference were 0.85 ± 0.04, 0.72 ± 0.05, and 0.71 ± 0.05, respectively. For TG level and TG–HDL-C ratio, the areas under the curves were 0.55 ± 0.06 and 0.56 ± 0.06, respectively, meaning that the true-positive rate was nearly equal to the false-positive rate. Therefore, they could not be used as markers of insulin resistance. Furthermore, 17 subjects met the lipid criteria but only 7 were in the insulin-resistant tertile, making the sensitivity of these criteria to identify insulin resistance only 17%.

Conclusion  In African Americans, TG levels and TG–HDL-C ratio are not reliable markers of insulin resistance.

Author Affiliations: Clincial Endocrinology Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Md (Drs Sumner and Finley and Mr Genovese); Department of Family and Preventive Medicine, University of California at San Diego (Dr Criqui); and Center for Biostatistics, University of Pennsylvania, Philadelphia (Dr Boston).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTERS

Why the Plasma TG/HDL-C Concentration Ratio Does Not Predict Insulin Resistance in African Americans
Gerald Reaven and Traceu McLaughlin
Arch Intern Med. 2006;166(2):249.
EXTRACT | FULL TEXT  

Why the Plasma TG/HDL-C Concentration Ratio Does Not Predict Insulin Resistance in African Americans—Reply
Anne E. Sumner
Arch Intern Med. 2006;166(2):249-250.
EXTRACT | FULL TEXT  

The Prediction of Insulin Resistance With Serum Triglyceride and High-Density Lipoprotein Cholesterol Levels in an East African Population
Pascal Bovet, David Faeh, Anne Gabriel, and Luc Tappy
Arch Intern Med. 2006;166(11):1236-1237.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

In Vivo Insulin Sensitivity and Lipoprotein Particle Size and Concentration in Black and White Children
Burns et al.
Diabetes Care 2009;32:2087-2093.
ABSTRACT | FULL TEXT  

Evaluation of quantitative models of the effect of insulin on lipolysis and glucose disposal
Periwal et al.
Am. J. Physiol. Regul. Integr. Comp. Physiol. 2008;295:R1089-R1096.
ABSTRACT | FULL TEXT  

Effect of Low-Dose Oral Contraceptives on Metabolic Risk Factors in African-American Women
Frempong et al.
J. Clin. Endocrinol. Metab. 2008;93:2097-2103.
ABSTRACT | FULL TEXT  

Association of serum lipid indices with large artery atherosclerotic stroke
Bang et al.
Neurology 2008;70:841-847.
ABSTRACT | FULL TEXT  

The prediction of insulin resistance with serum triglyceride and high-density lipoprotein cholesterol levels in an East african population.
Bovet et al.
Arch Intern Med 2006;166:1236-1237.
FULL TEXT  

Increased Fasting Triglyceride Levels Are Associated With Hepatic Insulin Resistance in Caucasian but Not African-American Adolescents.
Hoffman
Diabetes Care 2006;29:1402-1404.
FULL TEXT  

Why the Plasma TG/HDL-C Concentration Ratio Does Not Predict Insulin Resistance in African Americans
Reaven and McLaughlin
Arch Intern Med 2006;166:249-249.
FULL TEXT  

Why the Plasma TG/HDL-C Concentration Ratio Does Not Predict Insulin Resistance in African Americans--Reply
Sumner
Arch Intern Med 2006;166:249-250.
FULL TEXT