American Association of Clinical Endocrinologists (AACE) Consensus Conference on the Insulin Resistance Syndrome

25–26 August 2002, Washington, DC

• ADA, American Diabetes Association
• AII, angiotensin II
• AACE, American Association of Clinical Endocrinologists
• ADMA, asymmetric dimethyl arginine
• AP, activator protein
• ATP, Adult Treatment Panel
• CHD, congestive heart disease
• CRP, C-reactive protein
• CVD, cardiovascular disease
• Egr, early growth factor
• eNOS, endothelial NO synthase
• FFA, free fatty acid
• G6P, glucose-6-phosphate
• ICAM, intercellular adhesion molecule
• IGT, impaired glucose tolerance
• IκB, inhibitor of NF-κB
• IRS, insulin resistance syndrome
• IRS-1, insulin receptor substrate-1
• MCP, monocyte chemoattractant protein
• MMP, matrix metalloproteinase
• NASH, nonalcoholic steatohepatitis
• NE, norepinephrine
• NHANES III, third National Health and Nutrition Evaluation Survey
• NMR, nuclear magnetic resonance
• NO, nitric oxide
• PC-1, plasma cell membrane glycoprotein-1
• PCOS, polycystic ovary syndrome
• PDGF, platelet-derived growth factor
• PDK1, phosphoinositide-dependent kinase 1
• PI3K, phosphatidylinositol 3 kinase
• ROS, reactive oxygen species
• SNS, sympathetic nervous system
• SSPG, steady-state plasma glucose
• TF, tissue factor
• VCAM, vascular cell adhesion molecule

This is the first of two articles on the American Association of Clinical Endocrinologists (AACE) consensus conference on the insulin resistance syndrome (IRS), which was held in Washington, DC, on 25–26 August 2002. (See http://www.aace.com/pub/irscc/findings.php for summary.)

Woody Kessel (Washington, DC), the Deputy Surgeon General, introduced the conference, by discussing “leading health indicators,” including physical activity, reduction of overeating, drug abuse, attention to sexual health, mental health, environmental health, injury prevention, and provision of access to care. The lifestyle factors underlying the metabolic syndrome are, he pointed out, highly prominent factors on this list.

Earl S. Ford (Atlanta, GA) discussed public health aspects of the IRS. He characterized “public health” as engaging not only in the assessment and in monitoring of the health of communities, but also in the formulation of public policies and the assurance of access to health care. Addressing the question of whether the IRS is a public health problem, he pointed to its high prevalence and its association with increased morbidity and mortality. Persons with the IRS show higher all-cause mortality, cardiovascular disease (CVD), diabetes, polycystic ovary syndrome (PCOS), and nonalcoholic steatohepatitis (NASH). The syndrome is likely to be very costly, with estimates that the related condition, obesity, leads to health costs in the U.S. of $100 billion yearly. Ford cited proposed AACE criteria defining persons as having the IRS if they do not have diabetes and if they meet two or more of the criteria of triglyceride ≥150 mg/dl, HDL <40 or 50 in men or women, respectively, blood pressure ≥130/85 mmHg or current use of antihypertensive medications, and 2-h glucose 140–199 mg/dl (with postload rather than fasting glucose chosen as being of greater sensitivity). He applied these criteria to data from the third National Health and Nutrition Evaluation Survey (NHANES III) carried out in …