Components of the “Metabolic Syndrome” and Incidence of Type 2 Diabetes
Abstract
The combination of insulin resistance, dyslipidemia, hypertension, and obesity has been described as a “metabolic syndrome” that is a strong determinant of type 2 diabetes. Factor analysis was used to identify components of this syndrome in 1,918 Pima Indians. Prospective analyses were conducted to evaluate associations of identified factors with incidence of diabetes. Factor analysis identified 4 factors that accounted for 79% of the variance in the original 10 variables. Each of these factors reflected a proposed component of the metabolic syndrome: insulinemia, body size, blood pressure, and lipid metabolism. Among 890 originally nondiabetic participants with follow-up data, 144 developed diabetes in a median follow-up of 4.1 years. The insulinemia factor was strongly associated with diabetes incidence (incidence rate ratio [IRR] for a 1-SD difference in factor scores = 1.81, P < 0.01). The body size and lipids factors also significantly predicted diabetes (IRR 1.52 and 1.37, respectively, P < 0.01 for both), whereas the blood pressure factor did not (IRR 1.11, P = 0.20). Identification of four unique factors with different associations with incidence of diabetes suggests that the correlations among these variables reflect distinct metabolic processes, about which substantial information may be lost in the attempt to combine them into a single entity.
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People with the metabolic syndrome are at increased risk of developing type 2 diabetes mellitus.
“Patients with the metabolic syndrome also are at increased risk for developing type 2 diabetes mellitus.”
From Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement (2005) · cites this paper as [59]
Cites
Regression Models and Life-Tables
Cox, D. R. (1972) · Journal of the Royal Statistical Society Series B: Statistical Methodology · doi:10.1111/j.2517-6161.1972.tb00899.x · Cited by 39,793 · see citing works
Grundy, S. M., Bilheimer, D. W., Chait, A., Clark, L. T., Denke, M. A., Havel, R. J., Hazzard, W. R., Hulley, S. B., Hunninghake, D. B., Kreisberg, R. A., et al. (1993) · JAMA · doi:10.1001/jama.269.23.3015 · Cited by 27,944 · see citing works
Regression Models and Life-Tables
Cox, D. R. (1992) · Springer Series in Statistics · doi:10.1007/978-1-4612-4380-9_37 · Cited by 26,297 · see citing works
Expert Panel on Detection, E. (2001) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.285.19.2486 · Cited by 26,011 · see citing works
The meaning and use of the area under a receiver operating characteristic (ROC) curve.
Hanley, J. A., & McNeil, B. J. (1982) · Radiology · doi:10.1148/radiology.143.1.7063747 · Cited by 21,856 · see citing works
Role of Insulin Resistance in Human Disease
Reaven, G. M. (1988) · Diabetes · doi:10.2337/diab.37.12.1595 · Cited by 12,154 · see citing works
The Statistical Analysis of Failure Time Data.
Aitkin, M. A., Kalbfleisch, J. D., & Prentice, R. L. (1981) · Biometrics · doi:10.2307/2530581 · Cited by 9,875 · see citing works
Hanley, J. A., & McNeil, B. J. (1983) · Radiology · doi:10.1148/radiology.148.3.6878708 · Cited by 7,016 · see citing works
DeFronzo, R. A., & Ferrannini, E. (1991) · Diabetes Care · doi:10.2337/diacare.14.3.173 · Cited by 4,555 · see citing works
Epidemiology of coronary heart disease: the Framingham study.
Castelli, W. (1984) · American Journal of Medicine · doi:10.1016/0002-9343(84)90952-5 · Cited by 1,106 · see citing works
Hyperinsulinaemia: the key feature of a cardiovascular and metabolic syndrome
Ferrannini, E., Haffner, S. M., Mitchell, B. D., & Stern, M. P. (1991) · Diabetologia · doi:10.1007/bf00403180 · Cited by 898 · see citing works
Diabetes and Cardiovascular Disease: The “Common Soil” Hypothesis
Stern, M. P. (1995) · Diabetes · doi:10.2337/diab.44.4.369 · Cited by 739 · see citing works
Knowler, W. C., Bennett, P. H., Hamman, R. F., & Miller, M. (1978) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a112648 · Cited by 601 · see citing works
Self-citationRisk Variable Clustering in the Insulin Resistance Syndrome: The Framingham Offspring Study
Meigs, J. B., D’Agostino, R. B., Wilson, P. W. F., Cupples, L. A., Nathan, D. M., & Singer, D. E. (1997) · Diabetes · doi:10.2337/diacare.46.10.1594 · Cited by 525 · see citing works
Hanson, R. L., Pratley, R. E., Bogardus, C., Narayan, K. M. V., Roumain, J. M. L., Imperatore, G., Fagot-Campagna, A., Pettitt, D. J., Bennett, P. H., & Knowler, W. C. (2000) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a010187 · Cited by 463 · see citing works
Self-citationSakkinen, P. A., WAHL, P. W., Cushman, M., Lewis, M. R., & Tracy, R. P. (2000) · American Journal of Epidemiology · doi:10.1093/aje/152.10.897 · Cited by 420 · see citing works
Meigs, J. B. (2000) · American Journal of Epidemiology · doi:10.1093/aje/152.10.908 · Cited by 397 · see citing works
Pyörälä, M., Miettinen, H., Halonen, P. M., Laakso, M., & Pyörälà, K. (2000) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/01.atv.20.2.538 · Cited by 349 · see citing works
DIABETES MELLITUS IN AMERICAN (PIMA) INDIANS
Bennett, P., Burch, T., & Miller, M. (1971) · The Lancet · doi:10.1016/s0140-6736(71)92303-8 · Cited by 338 · see citing works
Self-citationInsulin Resistance Syndrome Predicts Coronary Heart Disease Events in Elderly Nondiabetic Men
Lempiäinen, P., Mykkänen, L., Pyörälä, K., Laakso, M., & Kuusisto, J. (1999) · Circulation · doi:10.1161/01.cir.100.2.123 · Cited by 293 · see citing works
Chen, W., Srinivasan, S. R., Elkasabany, A., & Berenson, G. S. (1999) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a010069 · Cited by 266 · see citing works
Genetic and environmental determinants of non‐insulin‐dependent diabetes mellitus (NIDDM)
Hamman, R. F. (1992) · Diabetes/Metabolism Reviews · doi:10.1002/dmr.5610080402 · Cited by 256 · see citing works
Factor analysis of the metabolic syndrome: obesity vs insulin resistance as the central abnormality
Anderson, P., Critchley, J. A. J. H., Chan, J., Cockram, C., Lee, Z. S. K., Thomas, G. N., & Tomlinson, B. (2001) · International Journal of Obesity · doi:10.1038/sj.ijo.0801837 · Cited by 232 · see citing works
Carmelli, D., Cardon, L. R., & Fabsitz, R. R. (1994) · PubMed Central · Cited by 216 · see citing works
Diabetes and cardiovascular disease. The "common soil" hypothesis
Stern, M. P. (1995) · Diabetes · doi:10.2337/diabetes.44.4.369 · Cited by 203 · see citing works
Mitchell, B. D., Kammerer, C. M., Mahaney, M. C., Blangero, J., Comuzzie, A. G., Atwood, L. D., Haffner, S. M., Stern, M. P., & MacCluer, J. W. (1996) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/01.atv.16.2.281 · Cited by 202 · see citing works
Arya, R., Blangero, J., Williams, K., Almasy, L. A., Dyer, T. D., Leach, R. J., O'Connell, P., D, M. P. S. M., & Duggirala, R. (2002) · Diabetes · doi:10.2337/diabetes.51.3.841 · Cited by 199 · see citing works
Risk Factor Clustering in the Insulin Resistance Syndrome: The Strong Heart Study
Gray, R. S., Fabsitz, R. R., Cowan, L. D., Lee, E. T., Howard, B. V., & Savage, P. J. (1998) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a009712 · Cited by 166 · see citing works
Multivariate analysis of the insulin resistance syndrome in women.
Edwards, K. L., Austin, M. A., Newman, B. M., Mayer, E. J., Krauss, R. M., & Selby, J. V. (1994) · Arteriosclerosis and Thrombosis A Journal of Vascular Biology · doi:10.1161/01.atv.14.12.1940 · Cited by 159 · see citing works
Hyperleptinemia as a Component of a Metabolic Syndrome of Cardiovascular Risk
Leyva, F., Godsland, I., Ghatei, M., Proudler, A., Aldis, S., Walton, C., Bloom, S., & Stevenson, J. (1998) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/01.atv.18.6.928 · Cited by 139 · see citing works
Anderson, R. L., Hamman, R. F., Savage, P. J., Saad, M. F., Laws, A., Kades, W. W., Sands, R., & Cefalu, W. T. (1995) · American Journal of Epidemiology · doi:10.1093/aje/142.7.724 · Cited by 138 · see citing works
Insulin Resistance Syndrome Predicts Coronary Heart Disease Events in Elderly Type 2 Diabetic Men
Kuusisto, J., Lempiäinen, P. A., Mykkänen, L. M., & Laakso, M. (2001) · Diabetes Care · doi:10.2337/diacare.24.9.1629 · Cited by 109 · see citing works
Metabolic Syndrome and Ischemic Heart Disease in Elderly Men and Women
Lindblad, U., Langer, R. D., Wingard, D. L., Thomas, R. G., & Barrett-Connor, E. L. (2001) · American Journal of Epidemiology · doi:10.1093/aje/153.5.481 · Cited by 91 · see citing works
Kekäläinen, P., Sarlund, H., Pyörälà, K., & Laakso, M. (1999) · Diabetes Care · doi:10.2337/diacare.22.1.86 · Cited by 89 · see citing works
Factors of the Insulin Resistance Syndrome in Nondiabetic and Diabetic Elderly Japanese-American Men
Edwards, K. L., Burchfiel, C. M., Sharp, D. S., Curb, J. D., Rodríguez, B. L., Fujimoto, W. Y., LaCroix, A. Z., Vitiello, M. V., & Austin, M. A. (1998) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a009469 · Cited by 83 · see citing works
Leptin and other components of the Metabolic Syndrome in Mauritius—a factor analysis
Hodge, A., Boyko, E., de Courten, M., Zimmet, P., Chitson, P., Tuomilehto, J., & Alberti, K. (2001) · International Journal of Obesity · doi:10.1038/sj.ijo.0801522 · Cited by 80 · see citing works
Shmulewitz, D., Auerbach, S. B., Lehner, T., Blundell, M. L., Winick, J. D., Youngman, L. D., Skilling, V. A., Heath, S. C., Ott, J., Stoffel, M., et al. (2000) · Human Heredity · doi:10.1159/000022953 · Cited by 80 · see citing works
The Choice of Variables in Observational Studies
Cox, D. R., & Snell, E. J. (1974) · Journal of the Royal Statistical Society Series C (Applied Statistics) · doi:10.2307/2347053 · Cited by 78 · see citing works
Chen, C., Lin, K., Tsai, S.-T., & Chou, P. (2000) · American Journal of Hypertension · doi:10.1016/s0895-7061(00)00255-7 · Cited by 68 · see citing works
Does Insulin Resistance Unite the Separate Components of the Insulin Resistance Syndrome?
Donahue, R. P., Bean, J. A., Donahue, R. A. D., Goldberg, R. B., & Prineas, R. J. (1997) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/01.atv.17.11.2413 · Cited by 68 · see citing works
Factors of the Metabolic Syndrome
Leyva, F., Godsland, I. F., Worthington, M., Walton, C., & Stevenson, J. C. (1998) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/01.atv.18.2.208 · Cited by 55 · see citing works
Snehalatha, C., Sivasankari, S., Satyavani, K., Viswanathan, V., & Ramachandran, A. (2000) · Diabetic Medicine · doi:10.1046/j.1464-5491.2000.00239.x · Cited by 50 · see citing works
Neel, J. V., Julius, S., Weder, A. B., Yamada, M., Kardia, S. L. R., & Haviland, M. B. (1998) · Genetic Epidemiology · doi:10.1002/(sici)1098-2272(1998)15:1 · Cited by 30 · see citing works
Alberti (1998) · doi:10.1002/(sici)1096-9136(199807)15:7
Flagged first, then by citations
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Sorted by citations
Grundy, S. M., Cleeman, J. I., Daniels, S. R., Donato, K. A., Eckel, R. H., Franklin, B. A., Gordon, D. J., Krauss, R. M., Savage, P. J., Smith, S. C., et al. (2005) · Circulation · doi:10.1161/circulationaha.105.169404 · Cited by 11,961 · see citing works
Follow-up report on the diagnosis of diabetes mellitus
The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus* (2003) · Diabetes Care · doi:10.2337/diacare.26.11.3160 · Cited by 3,784 · see citing works
DE HERT, M., CORRELL, C. U., BOBES, J., CETKOVICH‐BAKMAS, M., COHEN, D., ASAI, I., DETRAUX, J., GAUTAM, S., MÖLLER, H., NDETEI, D. M., et al. (2011) · World Psychiatry · doi:10.1002/j.2051-5545.2011.tb00014.x · Cited by 2,488 · see citing works
Cornier, M.-A., Dabelea, D., Hernandez, T. L., Lindstrom, R. C., Steig, A. J., Stob, N. R., Van Pelt, R. E., Wang, H., & Eckel, R. H. (2008) · Endocrine Reviews · doi:10.1210/er.2008-0024 · Cited by 2,162 · see citing works
Metabolic syndrome: definitions and controversies
Kassi, E., Pervanidou, P., Kaltsas, G., & Chrousos, G. (2011) · BMC Medicine · doi:10.1186/1741-7015-9-48 · Cited by 1,565 · see citing works
Stern, M. P., Williams, K., González-Villalpando, C., Hunt, K. J., & Haffner, S. M. (2004) · Diabetes Care · doi:10.2337/diacare.27.11.2676 · Cited by 735 · see citing works
Insulin resistance and cancer risk: An overview of the pathogenetic mechanisms
Arcidiacono, B., Iiritano, S., Nocera, A., Possidente, K., Nevolo, M. T., Ventura, V., Foti, D., Chiefari, E., & Brunetti, A. (2012) · Experimental Diabetes Research · doi:10.1155/2012/789174 · Cited by 606 · see citing works
Self-Reported Sleep Duration is Associated with the Metabolic Syndrome in Midlife Adults
Hall, M. H., Muldoon, M. F., Jennings, J. R., Buysse, D. J., Flory, J. D., & Manuck, S. B. (2008) · Sleep · doi:10.1093/sleep/31.5.635 · Cited by 447 · see citing works
Association of Oxidative Stress, Insulin Resistance, and Diabetes Risk Phenotypes
Meigs, J. B., Larson, M. G., Fox, C. S., Keaney, J. F., Vasan, R. S., & Benjamin, E. J. (2007) · Diabetes Care · doi:10.2337/dc07-0817 · Cited by 220 · see citing works
Goodman, E., Dolan, L. M., Morrison, J. A., & Daniels, S. R. (2005) · Circulation · doi:10.1161/01.cir.0000161957.34198.2b · Cited by 213 · see citing works
Metabolic and Inflammation Variable Clusters and Prediction of Type 2 Diabetes
Hanley, A. J. G., Festa, A., D’Agostino, R. B., Wagenknecht, L. E., Savage, P. J., Tracy, R. P., Saad, M. F., & Haffner, S. M. (2004) · Diabetes · doi:10.2337/diabetes.53.7.1773 · Cited by 198 · see citing works
Chen, W., Srinivasan, S. R., Li, S., Xu, J., & Berenson, G. S. (2005) · Diabetes Care · doi:10.2337/diacare.28.1.126 · Cited by 167 · see citing works
Insulin signaling and glucose transport in insulin resistant human skeletal muscle
Karlsson, H. K. R., & Zierath, J. R. (2007) · Cell Biochemistry and Biophysics · doi:10.1007/s12013-007-0030-9 · Cited by 159 · see citing works
Tinahones, F. J., Coín-Aragüez, L., Mayas, M. D., Garcia-Fuentes, E., Hurtado-del-Pozo, C., Vendrell, J., Cardona, F., Calvo, R.-M., Obregon, M.-J., & El Bekay, R. (2012) · BMC Physiology · doi:10.1186/1472-6793-12-4 · Cited by 95 · see citing works
Shimazaki, T., Kadowaki, T., Ohyama, Y., Ohe, K., & Kubota, K. (2007) · Translational research · doi:10.1016/j.trsl.2006.09.008 · Cited by 42 · see citing works
Girman, C. J., Dekker, J. M., Rhodes, T., Nijpels, G., Stehouwer, C. D. A., Bouter, L. M., & Heine, R. J. (2005) · American Journal of Epidemiology · doi:10.1093/aje/kwi229 · Cited by 41 · see citing works
- Authors
- Hanson, R. L., Imperatore, G., Bennett, P. H., & Knowler, W. C.
- Affiliations
- National Institute of Diabetes and Digestive and Kidney Diseases (US)
- Venue
- Diabetes
- Publisher
- American Diabetes Association
- Published
- 2002-10-01
- Volume
- 51
- Issue
- 10
- Pages
- 3120-3127
- ISSN
- 0012-1797 (ISSN-L)
- 1939-327X
- OpenAlex
- W2114319968
- Cited by
- 590
- References
- 44
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 5 · 2023: 12 · 2022: 7 · 2021: 19 · 2020: 20 · 2019: 17 · 2018: 15 · 2017: 23 · 2016: 23 · 2015: 27 · 2014: 21 · 2013: 27 · 2012: 32
- FWCI
- 20.90
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Diabetes Association
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Keywords
- metabolic syndrome, type 2 diabetes incidence, insulin resistance, insulin levels, dyslipidemia, hypertension, obesity, Pima Indians, factor analysis, body size, lipid metabolism, blood pressure
- MeSH terms
- Adult, Blood Pressure, Body Constitution, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Humans, Hyperglycemia, Hyperinsulinism, Indians, North American, Insulin Resistance, Male, Risk Factors, Incidence, Metabolic Syndrome, Lipid Metabolism
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