Relationship to Insulin Resistance of the Adult Treatment Panel III Diagnostic Criteria for Identification of the Metabolic Syndrome

• Published in: Diabetes (New York, N.Y.) Vol. 53; no. 5; pp. 1195 - 1200
• Main Authors: CHEAL, Karen L, ABBASI, Fahim, LAMENDOLA, Cindy, MCLAUGHLIN, Tracey, HEAVEN, Gerald M, FORD, Earl S
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01-05-2004
• Subjects: Adult; Aged; Associated diseases and complications; Biological and medical sciences; Blood Glucose - analysis; Blood Pressure; Body Weight; Cardiovascular diseases; Care and treatment; Cholesterol, HDL - blood; Diabetes; Diabetes mellitus; Diabetes. Impaired glucose tolerance; Diagnostic Tests, Routine - standards; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Homeostasis; Humans; Insulin Resistance; Male; Medical sciences; Metabolic Syndrome - diagnosis; Metabolic Syndrome - physiopathology; Metabolic syndrome X; Middle Aged; Osmolar Concentration; Predictive Value of Tests; Sensitivity and Specificity; Triglycerides - blood; United States; Endocrinopathy; Target tissue resistance; Treatment; X Syndrome; Diabetes mellitus; Cardiovascular disease; Metabolic diseases
• ISSN: 0012-1797; 1939-327X
• DOI: 10.2337/diabetes.53.5.1195

Relationship to Insulin Resistance of the Adult Treatment Panel III Diagnostic Criteria for Identification of the Metabolic
Syndrome
Karen L. Cheal 1 ,
Fahim Abbasi 2 ,
Cindy Lamendola 2 ,
Tracey McLaughlin 2 ,
Gerald M. Reaven 2 and
Earl S. Ford 3
1 Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
2 Department of Medicine, Stanford University School of Medicine, Stanford, California
3 Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease
Control and Prevention, Atlanta, Georgia
Address correspondence and reprint requests to Gerald M. Reaven, MD, Division of Cardiovascular Medicine, Falk CVRC, Stanford
Medical Center, 300 Pasteur Drive, Stanford, CA 94305-5406. E-mail: greaven{at}cvmed.stanford.edu
Abstract
The Adult Treatment Panel III (ATP III) has published criteria for diagnosing the metabolic syndrome, a cluster of closely
related abnormalities related to insulin resistance that increase cardiovascular disease risk. The present analysis was performed
to evaluate the ability of these criteria to identify insulin-resistant individuals. The population consisted of 443 healthy
volunteers, with measurements of BMI, blood pressure, fasting plasma glucose, triglycerides, HDL cholesterol concentrations,
and steady-state plasma glucose (SSPG) concentration. Insulin resistance was defined as being in the top tertile of SSPG concentrations.
Of the population, 20% satisfied ATP III criteria for the metabolic syndrome. Although insulin resistance and the presence
of the metabolic syndrome were significantly associated ( P < 0.001), the sensitivity and positive predictive value equaled 46% (69 of 149) and 76% (69 of 91), respectively. Being overweight,
with high triglycerides, low HDL cholesterol, or elevated blood pressure, most often resulted in a diagnosis of the metabolic
syndrome. Thus, the ATP III criteria do not provide a sensitive approach to identifying insulin-resistant individuals. The
individual components vary both in terms of their utility in making a diagnosis of the metabolic syndrome and their relationship
to insulin resistance, with the obesity and lipid criteria being most useful.
ADA, American Diabetes Association
ATP III, Adult Treatment Panel III
CVD, cardiovascular disease
NHANES III, Third National Health and Nutrition Examination Survey
SSPG, steady-state plasma glucose
SSPI, steady-state plasma insulin
WOSCOPS, West of Scotland Coronary Prevention Study
Footnotes
Accepted February 4, 2004.
Received December 1, 2003.
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