Original article
Abdominal obesity, insulin resistance, and metabolic syndrome in a southern European population

https://doi.org/10.1016/S0953-6205(03)00022-0Get rights and content

Abstract

Background: Our objective was to investigate the relationship between abdominal obesity (AO), as measured by waist circumference (WC), insulin resistance (IR), and components of the metabolic syndrome (MS). Methods: A cross-sectional study was carried out with 283 subjects (130 males and 153 females aged 25–65 years) from a primary care outpatient clinic in Valencia (Spain) over a period of 1 year. Body mass index (BMI), waist circumference (WC), blood pressure (BP), total cholesterol, triglycerides, HDL-C, glucose, and insulin were measured by standard methods. IR was defined as HOMA-IR equal to or greater than 3.8. Results: The prevalence of IR was 39.6%. Subjects were divided into groups according to WC. A ‘normal’ WC was defined as below 88 cm in women and below 102 cm in men; ‘AO’ was defined as a WC equal to or above 88 cm in women and equal to or above 102 cm in men. The prevalence of IR was 31.7% in the group with normal WC and 54.6% in the AO group (P<0.001). The percentage of subjects with the MS (high BP, dyslipemia or abnormal glucose tolerance) significantly increased (P<0.001) in subjects with AO (48.4 vs. 18.8% in normal WC subjects). AO is an indicator of IR with an odds ratio of 2.59 (95% CI 1.55–4.29). Conclusions: AO, expressed as WC, appears to be a good indicator of risk for IR and the MS, particularly in non-obese subjects (BMI<30). The main independent parameters of risk for IR are WC and TG, whereas those for the MS are IR, WC, and age.

Introduction

Obesity is the most prevalent metabolic disease in developed countries [1] and carries an important cardiovascular and global mortality rate, be it directly or through its association with numerous cardiovascular risk factors [2]. For this reason, it constitutes an important cause for concern from the point of view of public health.

In a recent national survey [3], the prevalence of obesity (BMI≥30 kg/m2) in the Spanish population between 25 and 60 years of age is 13.4% (11.5% in men and 15.2% in women). In the Valencia region, the prevalence in the population under 65 years of age is 14.7% in men and 17.8% in women [4].

Abdominal or visceral obesity, clinically defined by the waist/hip ratio (≥1 in men or ≥0.90 in women) or by waist circumference (≥88 cm in women and ≥102 cm in men) [5], [6], is related to the metabolic and cardiovascular changes that form part of metabolic syndrome (MS) [7]. The MS is characterized by abdominal obesity, dyslipemia, glucose intolerance or type 2 diabetes, high blood pressure, hyperuricemia or gout, hypercoagulability and fibrinolysis defects, and a high incidence of coronary heart disease (CHD). These characteristics coexist with an increase in the prevalence of non-alcoholic fatty liver, gallstones, hyperandrogenism, and osteoporosis [8].

Obesity, and particularly abdominal obesity (AO), is an important coronary risk factor, both directly and through its association with other risk factors. The goal of the present study was to assess the relationship between AO, measured by waist circumference (WC), insulin resistance (IR), and the main components of the metabolic syndrome (MS) in a southern European population with a low CHD prevalence.

Section snippets

Subjects

A cross-sectional study was carried out on men and women 25–65 years of age who, for various reasons, visited a primary care outpatient clinic in the metropolitan area of Valencia over a period of 1 year. An opportunistic search method, with sample selection, was carried out using a simple, random sampling method [9]. A total of 283 subjects (130 males and 153 females) were studied.

Inclusion criteria were: voluntary participation in the study, normal hepatic and renal function, a complete blood

Results

The study population included 283 subjects (130 men and 153 women) aged 25–65 years. There were no differences in the gender distribution in the study group.

Table 1 shows the general characteristics of the subjects studied, divided according to their WC (normal<88 cm in women and <102 cm in men and abnormal or AO≥88 cm in women or ≥102 cm in men) and gender.

Table 2 shows the prevalence of IR (HOMA-IR≥3.8) and of the MS, characterized by the presence of at least two of the following changes:

Discussion

Obesity, particularly AO [19], [20], is related to various cardiovascular risk factors that form part of the MS or IR syndrome [21]. The IR syndrome is clinically characterized by the association of two or more of the following components: changes in glycemia, dyslipemia, hypertension, hyperuricemia, and other metabolic disturbances, together with a high cardiovascular mortality [22]. Recently, other inflammatory components have also been related to obesity and IR [23], [24]. However, the

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