Two-Hour Insulin Determination Improves the Ability of Abdominal Fat Measurement to Identify Risk for the Metabolic Syndrome

Fernando F. Ribeiro-Filho; Alessandra N. Faria; Narcia E.B. Kohlmann; Maria-Teresa Zanella; Sandra R.G. Ferreira

doi:10.2337/diacare.26.6.1725

Clinical Care/Education/Nutrition

Two-Hour Insulin Determination Improves the Ability of Abdominal Fat Measurement to Identify Risk for the Metabolic Syndrome

Fernando F. Ribeiro-Filho, MD, PHD1,
Alessandra N. Faria, MD, PHD1,
Narcia E.B. Kohlmann, RN2,
Maria-Teresa Zanella, MD, PHD1 and
Sandra R.G. Ferreira, MD, PHD3

¹Endocrinology Division, the Department of Internal Medicine, Federal University of São Paulo, São Paulo, Brazil
²Nephrology Division, Department of Internal Medicine, Federal University of São Paulo, São Paulo, Brazil
³Department of Preventive Medicine, Federal University of São Paulo, São Paulo, Brazil

Diabetes Care 2003 Jun; 26(6): 1725-1730. https://doi.org/10.2337/diacare.26.6.1725

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Figure 1—
Glycemic curves and insulin values obtained for subjects with matched VFA (A) and for those with matched BMI (B). P < 0.05 vs. lower VFA group.

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Table 1—

Correlation coefficients of BMI, SFA, and VFA with anthropometric, metabolic, and hormonal parameters and percent body fat

	BMI			SFA			VFA
		r	P	r	P	r	P
Waist circumference	0.78	<0.01	0.55	<0.01	0.56	<0.01
Hip circumference	0.76	<0.01	0.60	<0.01	0.10	>0.10
WHR	0.34	<0.01	0.18	>0.10	0.58	<0.01
Fat mass	0.71	<0.01	0.48	<0.01	0.27	0.02
Subcutaneous fat by CT	0.66	<0.01	—	—	0.16	>0.10
Visceral fat by CT	0.33	<0.01	0.16	>0.10	—	—
Fasting plasma glucose	0.29	0.01	−0.01	>0.10	0.22	0.05
2-h plasma glucose	0.13	>0.10	−0.08	>0.10	0.32	<0.01
Glucose area under curve	0.15	>0.10	−0.08	>0.10	0.35	<0.01
Fasting insulin	0.16	>0.10	0.15	>0.10	0.30	<0.01
2-h insulin	0.12	>0.10	0.12	>0.10	0.35	<0.01
HOMA index	0.18	>0.10	0.12	>0.10	0.30	<0.01
Total cholesterol	−0.10	>0.10	−0.09	>0.10	0.09	>0.10
HDL cholesterol	−0.24	0.03	−0.07	>0.10	−0.34	<0.01
LDL cholesterol	−0.04	>0.10	−0.05	>0.10	0.09	>0.10
Apolipoprotein B	−0.02	>0.10	−0.10	>0.10	0.21	>0.10
Triglyceride	0.05	>0.10	−0.07	>0.10	0.33	<0.01
Uric acid	0.25	0.03	0.20	0.08	0.24	0.04
Leptin	0.38	<0.01	0.27	0.02	−0.03	>0.10
MS*	0.33	<0.01	0.14	>0.10	0.36	<0.01

*
↵* Presence of abdominal obesity and at least two of the following components: hypertension, dyslipidemia, and glucose intolerance and/or hyperinsulinemia.

Table 2—

Anthropometric, hemodynamic, and metabolic parameters of groups of patients with matched BMI or VFA

	Matched BMI			Matched VFA
		Less centralized (n = 38)	More centralized (n = 38)	Less generalized (n = 38)	More generalized (n = 38)
Age (years)	45.1 ± 10.7	50.7 ± 6.3*	48.0 ± 9.6	47.8 ± 8.9
BMI (kg/m²)	38.4 ± 5.9	39.1 ± 4.9	36.8 ± 4.0	40.7 ± 5.9*
Waist circumference (cm)	105.5 ± 13.5	114.9 ± 11.3*	107.0 ± 12.0	113.6 ± 13.8*
WHR	0.90 ± 0.09	0.99 ± 0.07*	0.95 ± 0.09	0.95 ± 0.10
Fat mass (%)	42.5 ± 5.4	44.0 ± 4.4	41.7 ± 4.8	44.8 ± 4.7*
Visceral fat by CT (cm²)	101.0 ± 34.2	182.9 ± 47.0*	143.3 ± 60.5	140.6 ± 56.1
Subcutaneous fat by CT (cm²)	374.0 ± 124.7	383.3 ± 128.7	332.3 ± 110.8	424.9 ± 124.3*
Systolic blood pressure (mmHg)	147.0 ± 21.2	152.5 ± 19.5	151.4 ± 23.4	148.0 ± 17.0
Diastolic blood pressure (mmHg)	93.6 ± 10.6	96.0 ± 10.0	93.9 ± 10.8	95.7 ± 9.9
Heart rate (bpm)	79.0 ± 6.4	77.7 ± 8.0	78.3 ± 7.7	78.4 ± 6.8
Fasting plasma glucose (mmol/l)	5.2 ± 0.7	5.4 ± 0.6	5.2 ± 0.5	5.4 ± 0.7
2-h plasma glucose (mmol/l)	6.8 ± 2.2	7.8 ± 2.4*	7.2 ± 2.4	7.3 ± 2.3
Glucose area under curve (mg · h⁻¹ · dl⁻¹)	557.8 ± 129.3	621.1 ± 126.6*	583.1 ± 118.3	595.8 ± 144.0
Fasting insulin (pmol/l)	113.7 ± 64.3	132.1 ± 65.9	120.3 ± 57.4	125.6 ± 73.2
2-h insulin (pmol/l)	578.7 ± 346.7	804.2 ± 599.1*	757.8 ± 609.6	620.3 ± 341.8
HOMA index	3.7 ± 2.4	4.4 ± 2.2	3.9 ± 2.0	4.2 ± 2.6
Total cholesterol (mmol/l)	5.3 ± 1.0	5.3 ± 1.0	5.3 ± 1.0	5.3 ± 1.0
HDL cholesterol (mmol/l)	1.1 ± 0.3	1.0 ± 0.2*	1.0 ± 0.3	1.1 ± 0.3
LDL cholesterol (mmol/l)	3.4 ± 0.9	3.5 ± 0.9	3.5 ± 0.9	3.4 ± 0.9
Apolipoprotein B (g/l)	1.22 ± 0.27	1.36 ± 0.29†	1.30 ± 0.28	1.31 ± 0.30
Triglyceride (mmol/l)	1.4 ± 0.6	2.0 ± 0.8*	1.7 ± 0.8	1.7 ± 0.7
Uric acid (mmol/l)	0.29 ± 0.06	0.33 ± 0.07*	0.30 ± 0.50	0.31 ± 0.11
Leptin (ng/ml)	26.3 ± 19.3	26.3 ± 13.3	20.9 ± 13.0	31.3 ± 14.0*

Data are means ± SD.
*
↵* P < 0.05 vs. group less centralized or generalized;
†
↵† P = 0.07 vs. group less centralized or generalized.

Table 3—

Anthropometric and hormonal characteristics according to the presence of MS

	Without MS (n = 32)	With MS (n = 44)
Age (years)	47.2 ± 10.6	48.4 ± 8.1
BMI (kg/m²)	36.9 ± 5.0	40.1 ± 5.4*
Waist circumference (cm)	103.4 ± 13.5	115.1 ± 10.8*
WHR	0.91 ± 0.09	0.97 ± 0.09*
Fat mass (%)	42.6 ± 5.1	43.7 ± 4.9
Fasting insulin (pmol/l)	88.3 ± 32.3	147.9 ± 71.8*
2-h insulin (pmol/l)	450.2 ± 251.7	868.1 ± 558.6*
HOMA index	2.8 ± 1.0	5.0 ± 2.5*
Leptin (ng/ml)	25.0 ± 19.6	27.2 ± 13.8
Subcutaneous fat by CT (cm²)	357.2 ± 136.6	394.2 ± 116.7
Visceral fat by CT (cm²)	119.7 ± 56.0	158.1 ± 54.5*

Data are means ± SD.
*
↵* P < 0.01 vs. without MS. MS was defined by presence of abdominal obesity and at least two of the following components: hypertension, dyslipidemia, and glucose intolerance and/or hyperinsulinemia.