Cited by 198Diabetes, Cardiovascular Risks, and LipoproteinsAdipokines, Inflammation, and Metabolic DiseasesDiet, Metabolism, and Disease

Metabolic and Inflammation Variable Clusters and Prediction of Type 2 Diabetes

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Hanley, Anthony J.G., Festa, Andreas, D’Agostino, Ralph B., Wagenknecht, Lynne E., Savage, Peter J., Tracy, Russell P., Saad, Mohammed F., Haffner, Steven M.·2004·Diabetes

Abstract

Factor analysis, a multivariate correlation technique, has been used to provide insight into the underlying structure of the metabolic syndrome. The majority of previous factor analyses, however, have used only surrogate measures of insulin sensitivity; very few have included nontraditional cardiovascular disease (CVD) risk factors such as plasminogen activator inhibitor (PAI)-1, fibrinogen, and C-reactive protein (CRP); and only a limited number have assessed the ability of factors to predict type 2 diabetes. The objective of this study was to investigate, using factor analysis, the clustering of metabolic and inflammation variables using data from 1,087 nondiabetic participants in the Insulin Resistance Atherosclerosis Study (IRAS) and to determine the association of these clusters with risk of type 2 diabetes at follow-up. This study includes information on directly measured insulin sensitivity (Si) from the frequently sampled intravenous glucose tolerance test among African-American, Hispanic, and non-Hispanic white subjects aged 40–69 years. Principal factor analysis of data from nondiabetic subjects at baseline (1992–1994) identified three factors, which explained 28.4, 7.4, and 6% of the total variance in the dataset, respectively. Based on factor loadings of ≥ 0.40, these factors were interpreted as 1) a “metabolic” factor, with positive loadings of BMI, waist circumference, 2-h glucose, log triglyceride, and log PAI-1 and inverse loadings of log Si + 1 and HDL; 2) an “inflammation” factor, with positive loadings of BMI, waist circumference, fibrinogen, and log CRP and an inverse loading of log Si + 1; and 3) a “blood pressure” factor, with positive loadings of systolic and diastolic blood pressure. The results were similar within strata of ethnicity, and there were only subtle differences in sex-specific analyses. In a prospective analysis, each of the factors was a significant predictor of diabetes after a median follow-up period of 5.2 years, and each factor remained significant in a multivariate model that included all three factors, although this three-factor model was not significantly more predictive than models using either impaired glucose tolerance or conventional CVD risk factors. Factor analysis identified three underlying factors among a group of inflammation and metabolic syndrome variables, with insulin sensitivity loading on both the metabolic and inflammation variable clusters. Each factor significantly predicted diabetes in multivariate analysis. The findings support the emerging hypothesis that chronic subclinical inflammation is associated with insulin resistance and comprises a component of the metabolic syndrome.

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Authors
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.
Affiliations
  • Mount Sinai Hospital (CA)
  • The University of Texas at San Antonio Health Science Center (US)
  • Department of Public Health Sciences, Wake Forest University School of Medicine, Winston Salem, North Carolina
  • Wake Forest University Health Sciences (US)
  • National Heart, Lung, and Blood Institute (US)
  • University of Vermont (US)
  • University of California, Los Angeles (US)
Venue
Diabetes
Published
2004-07-01
Volume
53
Issue
7
Pages
1773-1781
ISSN
  • 0012-1797 (ISSN-L)
  • 1939-327X
OpenAlex
W2132823438
Cited by
198
References
76
Citations by year
2026: 1 · 2025: 5 · 2024: 1 · 2023: 1 · 2022: 4 · 2021: 2 · 2020: 3 · 2019: 5 · 2018: 5 · 2017: 6 · 2016: 5 · 2015: 9 · 2014: 7 · 2013: 4 · 2012: 9
FWCI
15.91
Type
journal article
Language
en
Open access
Locations
  • Diabetes (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Canadian Diabetes Association
  • National Institutes of Health (5u01hl047887-09, M01-RR-43, 5u01hl047889-09)
  • U.S. Public Health Service (R01-58329)
  • National Heart, Lung, and Blood Institute (U01HL047902, U01-HL 47889, U01 HL 47892, U01-HL 47887, U01 HL 47902, U01HL047892, DK-29867)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK029867, DK29867)
  • National Center for Research Resources (M01 RR-43)
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, inflammation, insulin sensitivity, plasminogen activator inhibitor-1, fibrinogen, C-reactive protein, blood pressure, diabetes risk prediction, impaired glucose tolerance, cardiovascular risk factors, Insulin Resistance Atherosclerosis Study, ethnic differences, sex differences, African Americans, Hispanic Americans, middle-aged adults
MeSH terms
Adult, Aged, Black or African American, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Factor Analysis, Statistical, Glucose Tolerance Test, Hispanic or Latino, Humans, Inflammation, Insulin Resistance, Middle Aged, Prospective Studies, Risk Factors, Multivariate Analysis, Risk Assessment, White People

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