Intra-Abdominal Fat Is a Major Determinant of the National Cholesterol Education Program Adult Treatment Panel III Criteria for the Metabolic Syndrome

Carr, Darcy B.; Utzschneider, Kristina M.; Hull, Rebecca L.; Kodama, Keiichi; Retzlaff, Barbara M.; Brunzell, John D.; Shofer, Jane B.; Fish, Brian E.; Knopp, Robert H.; Kahn, Steven E.

doi:10.2337/diabetes.53.8.2087

Cited by 993Diabetes, Cardiovascular Risks, and LipoproteinsAdipokines, Inflammation, and Metabolic DiseasesCardiovascular Disease and Adiposity

Intra-Abdominal Fat Is a Major Determinant of the National Cholesterol Education Program Adult Treatment Panel III Criteria for the Metabolic Syndrome

Carr, Darcy B., Utzschneider, Kristina M., Hull, Rebecca L., Kodama, Keiichi, Retzlaff, Barbara M., Brunzell, John D., Shofer, Jane B., Fish, Brian E. +2 more·2004·Diabetes

DOI 10.2337/diabetes.53.8.2087

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Abstract

The underlying pathophysiology of the metabolic syndrome is the subject of debate, with both insulin resistance and obesity considered as important factors. We evaluated the differential effects of insulin resistance and central body fat distribution in determining the metabolic syndrome as defined by the National Cholesterol Education Program (NCEP) Adult Treatment Panel III. In addition, we determined which NCEP criteria were associated with insulin resistance and central adiposity. The subjects, 218 healthy men (n = 89) and women (n = 129) with a broad range of age (26–75 years) and BMI (18.4–46.8 kg/m2), underwent quantification of the insulin sensitivity index (Si) and intra-abdominal fat (IAF) and subcutaneous fat (SCF) areas. The metabolic syndrome was present in 34 (15.6%) of subjects who had a lower Si [median: 3.13 vs. 6.09 × 10−5 min−1/(pmol/l)] and higher IAF (166.3 vs. 79.1 cm2) and SCF (285.1 vs. 179.8 cm2) areas compared with subjects without the syndrome (P < 0.001). Multivariate models including Si, IAF, and SCF demonstrated that each parameter was associated with the syndrome. However, IAF was independently associated with all five of the metabolic syndrome criteria. In multivariable models containing the criteria as covariates, waist circumference and triglyceride levels were independently associated with Si and IAF and SCF areas (P < 0.001). Although insulin resistance and central body fat are both associated with the metabolic syndrome, IAF is independently associated with all of the criteria, suggesting that it may have a pathophysiological role. Of the NCEP criteria, waist circumference and triglycerides may best identify insulin resistance and visceral adiposity in individuals with a fasting plasma glucose <6.4 mmol/l.

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Abdominal obesity develops later in the course of the metabolic syndrome along with NAFLD and is likely more a consequence of insulin resistance in skeletal muscle rather than a primary cause of insulin resistance and atherogenic dyslipidemia.
“These data suggest that abdominal obesity develops later in the course of the metabolic syndrome along with NAFLD and that it is likely more a consequence of insulin resistance in skeletal muscle rather than a primary cause of insulin resistance and atherogenic dyslipidemia (5–7).”
From The role of skeletal muscle insulin resistance in the pathogenesis of the metabolic syndrome (2007) · cites this paper as [7]

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Authors: Carr, D. B., Utzschneider, K. M., Hull, R. L., Kodama, K., Retzlaff, B. M., Brunzell, J. D., Shofer, J. B., Fish, B. E., Knopp, R. H., & Kahn, S. E.
Affiliations: University of Washington (US)
ORCID: Utzschneider, Kristina M.
Hull, Rebecca L.
Kodama, Keiichi
Brunzell, John D.
Shofer, Jane B.
Kahn, Steven E.
Venue: Diabetes
Publisher: American Diabetes Association
Published: 2004-08-01
Volume: 53
Issue: 8
Pages: 2087-2094
ISSN: 0012-1797 (ISSN-L)
1939-327X
DOI: 10.2337/diabetes.53.8.2087
OpenAlex: W2102009612
Cited by: 993
References: 57
Citations by year: 2026: 2 · 2025: 15 · 2024: 21 · 2023: 26 · 2022: 28 · 2021: 45 · 2020: 30 · 2019: 37 · 2018: 38 · 2017: 41 · 2016: 43 · 2015: 54 · 2014: 56 · 2013: 54 · 2012: 58
FWCI: 41.54
Type: journal article
Language: en
Open access: closed
Locations: Diabetes (publishedVersion)
PubMed (publishedVersion)
Funders: National Heart, Lung, and Blood Institute (P01HL030086, HL3-0086)
National Institute of Diabetes and Digestive and Kidney Diseases (DK-35816, DK 02456, K24DK002654, DK 50129, DK -35747, DK 02654, DK-17047, R01DK050129, P30DK035816, P30DK017047, P30DK035747)
National Center for Research Resources (K23RR016066, RR 16066, RR 37)
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 › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
Keywords: metabolic syndrome, intra-abdominal fat, visceral fat, insulin resistance, subcutaneous adipose tissue, insulin sensitivity index, NCEP ATP III criteria, waist circumference, triglycerides, obesity, abdominal obesity
MeSH terms: Abdomen, Adipose Tissue, Adult, Blood Glucose, Blood Pressure, Cholesterol, Humans, Lipoproteins, HDL, Middle Aged, Patient Education as Topic, Reference Values, Triglycerides, Washington, Patient Selection, Metabolic Syndrome

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Intra-Abdominal Fat Is a Major Determinant of the National Cholesterol Education Program Adult Treatment Panel III Criteria for the Metabolic Syndrome

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