The Lipid Accumulation Product Is Better Than BMI for Identifying Diabetes
A population-based comparison
- Henry S. Kahn, MD
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Address correspondence and reprint requests to Henry S. Kahn, MD, CDC, Mail Stop K-10, 4770 Buford Highway, Atlanta, GA 30341-3717. E-mail: hkahn{at}cdc.gov
Gaining weight is associated with diabetes risk (1–3). It may be, however, that gaining lipid is associated more specifically with the development of insulin resistance, pancreatic exhaustion, and diabetes. According to a current pathophysiological model, when available fuels exceed the adipose tissue’s capacity for buffering and safe storage, lipid will be ectopically deposited in nonadipose tissues such as liver, skeletal muscle, and the pancreatic β-cell (4–6). These ectopic lipid deposits are associated with lipotoxicities that in turn lead to insulin resistance and the eventual decline of β-cell function (7, 8). To simplify the recognition of lipid overaccumulation, researchers have devised dichotomous risk markers based on waist circumference and fasting triglyceride concentration (9–11). However, lipid accumulation, like body weight, may not be adequately described by a dichotomous index. This report explores whether a continuous “lipid accumulation product” (LAP) performs better than the continuous BMI (in kilograms divided by the square of height in meters) for identifying adults with insulin resistance, elevated glucose, and diabetes.
RESEARCH DESIGN AND METHODS
The LAP was developed from population-based frequency plots of adult waist circumferences and circulating triglyceride concentrations (10, 12). With aging, the waist circumference increasingly moves away from its minimal adult value (empirically 65 cm for men and 58 cm for women) …
