Abstract

Objective: Greater accumulation of visceral fat is strongly linked to risk of cardiovascular disease. However, elevated waist circumference by itself does not always identify individuals with increased visceral fat.

Research Design and Methods: We examined 375 subjects with type 2 diabetes from the CHICAGO cohort for presence of hypertriglyceridemic waist phenotype (waist circumference >90 cm in men or >85 cm in women, in conjunction with a plasma triglyceride concentration of ≥177 mg/dl) to determine its usefulness for identifying subjects with increased amount of visceral fat. We divided subjects into three groups: Group 1 ( low waist and low triglyceride; waist ≤90 cm in men or ≤85 cm in women and triglyceride<177 mg/dl, n=18), Group 2 (high waist and low triglyceride; waist >90 cm in men or >85 cm in women and triglyceride<177 mg/dl, n=230) and Group 3 (high waist and high triglyceride; waist >90 cm in men or >85 cm in women and triglyceride≥177 mg/dl, n=127).

Results: Subjects in Group 3 had significantly higher visceral fat (P<0.0001), hemoglobin A1c (P<0.01) and coronary artery calcium (P<0.05) compared to Group 2 despite similar age, BMI and waist circumference. The relationship of the phenotype to atherosclerosis, however, was attenuated by adjustment for HDL, triglyceride-rich lipoprotein cholesterol, Apo B or LDL particle number.

Conclusions: The presence of hypertriglyceridemic waist phenotype in subjects with type 2 diabetes identifies a subset with greater degree of visceral adiposity. This subset also has greater degree of subclinical atherosclerosis that may be related to the pro-atherogenic lipoprotein changes.