Cited by 937Diabetes, Cardiovascular Risks, and LipoproteinsLipoproteins and Cardiovascular HealthLipid metabolism and disorders

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Hypertriglyceridemic Waist: A Marker of the Atherogenic Metabolic Triad (Hyperinsulinemia; Hyperapolipoprotein B; Small, Dense LDL) in Men?

Lemieux, Isabelle, Pascot, Agnès, Couillard, Charles, Lamarche, Benoı̂t, Tchernof, André, Alméras, Natalie, Bergeron, Jean, Gaudet, Daniel, Tremblay, Gérald, Prud’homme, Denis, Nadeau, André, Després, Jean-Pierre·2000·Circulation

DOI 10.1161/01.cir.102.2.179

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Abstract

Background —The present study tested the hypothesis that simple variables, such as waist circumference and fasting plasma triglyceride (TG) concentrations, could be used as screening tools for the identification of men characterized by a metabolic triad of nontraditional risk factors (elevated insulin and apolipoprotein [apo] B and small, dense LDL particles). Methods and Results —Results of the metabolic study (study 1) conducted on 185 healthy men indicate that a large proportion (>80%) of men with waist circumference values ≥90 cm and with elevated TG levels (≥2.0 mmol/L) were characterized by the atherogenic metabolic triad. Validation of the model in an angiographic study (study 2) on a sample of 287 men with and without coronary artery disease (CAD) revealed that only men with both elevated waist and TG levels were at increased risk of CAD (odds ratio of 3.6, P <0.03) compared with men with low waist and TG levels. Conclusions —It is suggested that the simultaneous measurement and interpretation of waist circumference and fasting TG could be used as inexpensive screening tools to identify men characterized by the atherogenic metabolic triad (hyperinsulinemia, elevated apo B, small, dense LDL) and at high risk for CAD.

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Health Canada's new guidelines for body weight classification in adults: challenges and concerns
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“The data do not support this assertion: many studies have shown that people who are in the overweight range while showing low levels of abdominal adipose tissue generally display a risk profile similar to that of nonobese subjects.(13,14) Using a more “severe” criterion to identify overweight people could facilitate t…”
Result
Predictive performance of lipid accumulation product and visceral adiposity index for renal function decline in non-diabetic adults, an 8.6-year follow-up
Mousapour, P., Barzin, M., Valizadeh, M., Mahdavi, M., Azizi, F., & Hosseinpanah, F. (2019) · Clinical and Experimental Nephrology · doi:10.1007/s10157-019-01813-7 · Cited by 23
The Relationship between Hypertriglyceridemic Waist Phenotype and Early Diabetic Nephropathy in Type 2 Diabetes
Ma, C.-M., Wang, R., Liu, X.-L., Lu, N., Lu, Q., & Yin, F.-Z. (2017) · CardioRenal Medicine · doi:10.1159/000477828 · Cited by 23
Lipid Accumulation Product and Hypertension Related to Stroke: a 9.2-Year Prospective Study Among Mongolians in China
Zhong, C., Xia, W., Zhong, X., Xu, T., Li, H., Zhang, M., Wang, A., Xu, T., Sun, Y., & Zhang, Y. (2016) · Journal of Atherosclerosis and Thrombosis · doi:10.5551/jat.33514 · Cited by 31
Visceral adiposity index, hypertriglyceridemic waist phenotype and chronic kidney disease in a southern Chinese population: a cross-sectional study
Huang, J., Zhou, C.-M., Li, Y.-Q., Zhu, S.-S., Liu, A.-Q., Shao, X., Liu, X.-Y., Holthfer, H., & Zou, H. (2015) · International Urology and Nephrology · doi:10.1007/s11255-015-1040-y · Cited by 23
Hypertriglyceridemic waist, cytokines and hyperglycaemia in Chinese
Yu, Z., Sun, L., Qi, Q., Wu, H.-Y., Lu, L., Liu, C., Li, H.-X., & Lin, X. (2012) · European Journal of Clinical Investigation · doi:10.1111/j.1365-2362.2012.02702.x · Cited by 23
Characterization of the Human Insulin-induced Gene 2 (INSIG2) Promoter
Fernández-Álvarez, A. J., Álvarez, M. S., Cucarella, C., & Casado, M. (2010) · Journal of Biological Chemistry · doi:10.1074/jbc.m109.067447 · Cited by 23
Is Central Obesity a Good Predictor of Carotid Atherosclerosis in Japanese Type 2 Diabetes with Metabolic Syndrome?
Yasuda, T., Matsuhisa, M., Fujiki, N., Sakamoto, F., Tsuji, M., FUJISAWA, N., Kimura, M., Ishibashi, R., Kaneto, H., Yamasaki, Y., et al. (2007) · Endocrine Journal · doi:10.1507/endocrj.k06-210 · Cited by 21
Lipid Metabolism and Health
Moffatt, R. J., & STAMFORD, B. A. (2005) · CRC Press eBooks · doi:10.1201/9781420038422 · Cited by 25
Zespół metaboliczny u dzieci i młodzieży
Sielużycka, A. (2011) · doi:10.1016/s0031-3939(11)70001-4 · Cited by 23
Metabolic syndrome: do clinical criteria identify similar individuals among overweight premenopausal women?
Alhassan, S., Kiazand, A., Balise, R. R., King, A. C., Reaven, G. M., & Gardner, C. D. (2007) · Metabolism · doi:10.1016/j.metabol.2007.08.006 · Cited by 17
“The TG/ HDL-C concentration ratio and the combination of EW and ET (EWET) are good surrogate estimates of insulin resistance, as is fasting plasma insulin concentration, and are as effective as the ATP III MetSyn criteria in identifying insulin-resistant individuals [12,14-16].”
Overweight and Obesity as Determinants of Cardiovascular Risk: The Framingham Experience
Wilson, P. W. F., D'Agostino, R. B., Sullivan, L., Parise, H., & Kannel, W. B. (2002) · Archives of Internal Medicine · doi:10.1001/archinte.162.16.1867 · Cited by 22
Hypertriglyceridemic Waist Phenotype and Lipid Accumulation Product: Two Comprehensive Obese Indicators of Waist Circumference and Triglyceride to Predict Type 2 Diabetes Mellitus in Chinese Population
Xu, M., Huang, M., Qiang, D., Jian-xin, G., Li, Y., Pan, Y., Yao, X., Xu, W., Tao, Y., Zhou, Y., et al. (2020) · Journal of Diabetes Research · doi:10.1155/2020/9157430 · Cited by 22
Association between the Hypertriglyceridemic Waist Phenotype and Prediabetes in Chinese Adults Aged 40 Years and Older
Zhao, K., Yang, S., Wang, H., Chen, K., Lu, Z.-H., & Mu, Y. (2018) · Journal of Diabetes Research · doi:10.1155/2018/1031939 · Cited by 21
“[8] first verified that the HTGW phenotype could be used as an inexpensive screening tool to identify men characterized by the Hindawi Journal of Diabetes Research Volume 2018, Article ID 1031939, 9 pages https://doi.”
Method
Low "quotient" Lp(a) concentration mediates autoimmune activation and independently predicts cardiometabolic risk.
Onat, A., Coban, N., Can, G., Yüksel, M., Karagöz, A., Yüksel, H., Ademoglu, E., & Erginel-Unaltuna, N. (2014) · Experimental and clinical endocrinology & diabetes · doi:10.1055/s-0034-1385922 · Cited by 22
Impact of Walking on Adipose Tissue Lipoprotein Lipase Activity and Expression in Pre- and Postmenopausal Women
Tessier, S., Riesco, É., Lacaille, M., Pérusse, F., Weisnagel, J., Doré, J., & Mauriège, P. (2010) · Obesity Facts · doi:10.1159/000314611 · Cited by 23
Waist circumference, atherogenic lipoproteins, and vascular smooth muscle biomarkers in children.
Burns, S., & Arslanian, S. (2009) · Journal of Clinical Endocrinology and Metabolism · doi:10.1210/jc.2009-1301 · Cited by 22
“Indeed, a combination of a high WC along with high fasting TG referred to as the “hypertriglyceridemic waist” is predictive of an atherogenic metabolic triad where individuals are characterized by the simultaneous occurrence of hyperinsulinemia, hyperapolipoprotein B, and small LDL particles (20).”
Background
Thematic review series: Patient-Oriented Research. What have we learned about HDL metabolism from kinetics studies in humans?
Rashid, S., Patterson, B. W., & Lewis, G. F. (2006) · Journal of Lipid Research · doi:10.1194/jlr.r600008-jlr200 · Cited by 28
Clinical Significance of Body Fat Distribution in Coronary Artery Calcification Progression in Korean Population
Lee, H., Park, H., Yoon, J., & Choi, S.-Y. (2020) · Diabetes & Metabolism Journal · doi:10.4093/dmj.2019.0161 · Cited by 21
“These findings in the present study coincide with prior reports that Asians have lower BMI but higher body fat percentage than Caucasians [35,36] and support the legitimacy of the WHO’s Asia-Pacific region-specific classification of obesity [20].”
ResultInfluential
Metabolomics: a search for biomarkers of visceral fat and liver fat content
Boone, S. C., Mook-Kanamori, D. O., Rosendaal, F. R., den Heijer, M., Lamb, H. J., Roos, A., le Cessie, S., van Dijk, K. W., & de Mutsert, R. (2019) · Metabolomics · doi:10.1007/s11306-019-1599-x · Cited by 35
Association of the hypertriglyceridemic waist phenotype and severity of acute pancreatitis
Ding, Y.-B., Zhang, M., Wang, L., Yin, T., Wang, N., Wu, J., Zhi, J.-H., Chen, W.-W., Wu, K.-Y., Gong, W.-J., et al. (2019) · Lipids in Health and Disease · doi:10.1186/s12944-019-1019-2 · Cited by 21
“Lemieux first introduced the HTGW phenotype in the Quebec Cardiovascular Study and suggested that this phenotype may be an inexpensive tool for identifying asymptomatic patients at elevated risk of coronary heart disease [14].”
BackgroundMethodInfluential
Utility of hypertriglyceridemic waist phenotype for predicting incident type 2 diabetes: The Isfahan Diabetes Prevention Study
Janghorbani, M., & Amini, M. (2016) · Journal of Diabetes Investigation · doi:10.1111/jdi.12520 · Cited by 21
FTO Is a Relevant Factor for the Development of the Metabolic Syndrome in Mice
Ikels, K., Kuschel, S., Fischer, J., Kaisers, W., Eberhard, D., & Rüther, U. (2014) · PLoS ONE · doi:10.1371/journal.pone.0105349 · Cited by 20
Metabolic syndrome and associated chronic kidney diseases: Nutritional interventions
Pasupulati, A. K., Chitra, P. S., & Reddy, G. B. (2013) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-013-9268-2 · Cited by 22
Cintura hipertrigliceridêmica e risco cardiometabólico em mulheres hipertensas
Cabral, N. A. L., Ribeiro, V. S., França, A. K. T. D. C., Salgado, J., dos Santos, A. D., Salgado, N., & da Sílva, A. A. M. (2012) · Revista da Associação Médica Brasileira · doi:10.1590/s0104-42302012000500014 · Cited by 21
Comparison of anthropometric parameters as predictors of serum lipids in premenopausal women
Moreira-Andrés, M., del Cañizo-Gómez, F. J., Losa, M., Ferrando, P., de la Cámara, A. G., & Hawkins, F. (2004) · Journal of Endocrinological Investigation · doi:10.1007/bf03351059 · Cited by 21
Evaluation of the Value of Waist Circumference and Metabolomics in the Estimation of Visceral Adipose Tissue
Boone, S. C., van Smeden, M., Rosendaal, F. R., le Cessie, S., Groenwold, R. H. H., Jukema, J. W., van Dijk, K. W., Lamb, H. J., Greenland, P., Neeland, I. J., et al. (2022) · American Journal of Epidemiology · doi:10.1093/aje/kwab298 · Cited by 19
Effective, disease-modifying, clinical approaches to patients with mild-to-moderate hypertriglyceridaemia
Lewis, G. F., & Hegele, R. A. (2021) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(21)00284-9 · Cited by 25
Automatic measurement of anthropometric dimensions using frontal and lateral silhouettes
Aslam, M., Rajbdad, F., Khattak, S., & Azmat, S. (2017) · IET Computer Vision · doi:10.1049/iet-cvi.2016.0406 · Cited by 20

Authors: Lemieux, I., Pascot, A., Couillard, C., Lamarche, B., Tchernof, A., Alméras, N., Bergeron, J., Gaudet, D., Tremblay, G., Prud’homme, D., Nadeau, A., & Després, J.-P.
Affiliations: Centre hospitalier de l'Université Laval (CA)
From the Quebec Heart Institute, Laval Hospital Research Center; the Lipid Research Center, CHUL Research Center; the Physical Activity Sciences Laboratory, Laval University; the Diabetes Research Unit, CHUL Research Center, Ste-Foy; and the Lipid Clinic, Chicoutimi Hospital, Chicoutimi, Québec, Canada.
ORCID: Lemieux, Isabelle
Couillard, Charles
Lamarche, Benoı̂t
Bergeron, Jean
Gaudet, Daniel
Prud’homme, Denis
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2000-07-11
Volume: 102
Issue: 2
Pages: 179-184
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/01.cir.102.2.179
OpenAlex: W1991251155
Cited by: 937
References: 0
Citations by year: 2026: 10 · 2025: 19 · 2024: 23 · 2023: 28 · 2022: 31 · 2021: 29 · 2020: 30 · 2019: 26 · 2018: 35 · 2017: 29 · 2016: 38 · 2015: 38 · 2014: 42 · 2013: 42 · 2012: 49
FWCI: 18.34
Type: journal article
Language: en
Open access: closed
Locations: Circulation (publishedVersion)
PubMed (publishedVersion)
Funders: American Heart Association
Heart and Stroke Foundation of Canada
Medical Research Council Canada
Medical Research Council
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
Keywords: hypertriglyceridemic waist phenotype, waist circumference, fasting plasma triglycerides, hyperinsulinemia, apolipoprotein B, small dense LDL, coronary artery disease risk, cardiovascular screening, men
MeSH terms: Abdomen, Adult, Apolipoproteins B, Body Composition, Coronary Artery Disease, Coronary Disease, Humans, Hyperinsulinism, Lipoproteins, LDL, Male, Mass Screening, Middle Aged, Predictive Value of Tests, Risk Factors, Triglycerides, Hypertriglyceridemia, Biomarkers, Coronary Angiography

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Hypertriglyceridemic Waist: A Marker of the Atherogenic Metabolic Triad (Hyperinsulinemia; Hyperapolipoprotein B; Small, Dense LDL) in Men?

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