Second World Congress on the Insulin Resistance Syndrome
Insulin resistance syndrome and nonalcoholic fatty liver disease
- ALT, alanine transaminase
- AST, aspartate transaminase
- FFA, free fatty acid
- HCV, hepatitis C virus
- MMP, matrix metalloproteinase
- NAFLD, nonalcoholic fatty liver disease
- NASH, nonalcoholic steatohepatitis
- PCOS, polycystic ovary syndrome
- PPAR, peroxisome proliferator–activated receptor
- PUFA, polyunsaturated fatty acid
- SSPG, steady-state plasma glucose
- TGF, transforming growth factor
- TLR, toll-like receptor
- TNF, tumor necrosis factor
- TZD, thiazolidinedione
This is the first in a series of articles on the Second World Congress on the Insulin Resistance Syndrome, Universal City, California, 18–20 November 2004.
Yehuda Handelsman (Tarzana, CA) introduced the Second World Congress on the Insulin Resistance Syndrome, noting the importance of ICD-9 diagnostic code 277.7, which allows one to use insulin resistance syndrome as a specific medical diagnosis, although the nomenclature of the syndrome is complex (1). There is a continuous relationship between the number of risk factors and associated conditions and the severity of insulin resistance, so that it may be incorrect to suggest that a specific number of components is needed to determine the presence of this condition, a potential advantage of the American Association of Clinical Endocrinologists diagnostic criteria, which appears to be more strongly associated with diabetes than other criteria for the insulin resistance syndrome.
Gerald M. Reaven (Stanford, CA) discussed the relationship between obesity and the insulin resistance syndrome, noting that mean fat and energy intake increased between 1990 and 2000 from 81 to 86 g and from 1,969 to 2,200 calories daily, respectively, so that “we’re getting heavier because we’re eating more.” Obesity is associated with increased mortality, with insulin resistance the link between obesity and coronary heart disease. Reaven used 3-h somatostatin, insulin, and glucose infusion to measure the steady-state plasma glucose (SSPG), which is inversely related to insulin sensitivity. There is tremendous variability in healthy individuals, with SSPG in 490 people with normal glucose tolerance <50 mg in the 1st and >300 mg/dl in the 10th decile. The lowest quartile of insulin sensitivity is strongly predictive of development of diabetes and of coronary artery disease. Both BMI and waist circumference correlate with SSPG, but “with enormous variation,” as some obese individuals have normal and some lean individuals have high …
