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Published online June 22, 2007
Diabetes Care 30:2529-2535, 2007
DOI: 10.2337/dc07-0817
© 2007 by the American Diabetes Association
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Epidemiology/Health Services Research
Original Article

Association of Oxidative Stress, Insulin Resistance, and Diabetes Risk Phenotypes

The Framingham Offspring Study

James B. Meigs, MD, MPH1, Martin G. Larson, SD2, Caroline S. Fox, MD, MPH3,4, John F. Keaney, Jr., MD5, Ramachandran S. Vasan, MD3,6,7 and Emelia J. Benjamin, MD, SCM3,6,7

1 General Medicine Division and Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
2 Department of Mathematics and Statistics, Boston University, Boston, Massachusetts
3 National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts
4 Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
5 Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
6 Evans Department of Medicine, Whitaker Cardiovascular Institute, Boston, Massachusetts
7 Preventive Medicine Section, Boston University School of Medicine, Boston, Massachusetts

Address correspondence and reprint requests to James B. Meigs, MD, General Medicine Division, Massachusetts General Hospital, 50 Staniford St., 9th Floor, Boston, MA 02114. E-mail: jmeigs{at}partners.org

OBJECTIVE—Systemic oxidative stress causes insulin resistance in rodents. We tested the hypothesis that oxidative stress and insulin resistance are associated in humans.

RESEARCH DESIGN AND METHODS—We used cross-sectional data from 2,002 nondiabetic subjects of the community-based Framingham Offspring Study. We measured insulin resistance with the homeostasis model and defined categorical insulin resistance as homeostasis model assessment of insulin resistance (HOMA-IR) >75th percentile. We measured oxidative stress using the ratio of urine 8-epi-prostaglandin F2{alpha} (8-epi-PGF2{alpha}) to creatinine and used age- and sex-adjusted regression models to test the association of oxidative stress with insulin resistance in individuals without diabetes and among subgroups at elevated risk of diabetes.

RESULTS—Across 8-epi-PGF2{alpha}/creatinine tertiles, the prevalence of insulin resistance increased (18.0, 27.5, and 29.4% for the first, second, and third tertiles, respectively; P < 0.0001), as did mean levels of HOMA-IR (3.28, 3.83, and 4.06 units; P < 0.0001). The insulin resistance–oxidative stress association was attenuated by additional adjustment for BMI (P = 0.06 across tertiles for insulin resistance prevalence; P = 0.004 for mean HOMA-IR). Twenty-six percent of participants were obese (BMI ≥30 kg/m2), 39% had metabolic syndrome (according to the Adult Treatment Panel III definition), and 37% had impaired fasting glucose (IFG) (fasting glucose 5.6–6.9 mmol/l). Among 528 obese participants, respectively, insulin resistance prevalence was 41.3, 60.6, and 54.2% across 8-epi-PGF2{alpha}/creatinine tertiles (P = 0.005); among 781 subjects with metabolic syndrome, insulin resistance prevalence was 41.3, 56.7, and 51.7% (P = 0.0025); and among 749 subjects with IFG, insulin resistance prevalence was 39.6, 47.2, and 51.6% (P = 0.04).

CONCLUSIONS—Systemic oxidative stress is associated with insulin resistance in individuals at average or elevated risk of diabetes even after accounting for BMI.

Abbreviations: 8-epi-PGF2{alpha}, 8-epi-prostaglandin F2{alpha} • CVD, cardiovascular disease • FPG, fasting plasma glucose • HOMA-IR, homeostasis model assessment of insulin resistance • IFG, impaired fasting glucose • NF-{kappa}B, nuclear factor-{kappa}B • NOS, nitric oxide synthase


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