Abstract
To assess the independent and joint effects of the components of the metabolic syndrome, including leptin, which is a recently proposed addition to this syndrome, in predicting the cumulative incidence of impaired glucose tolerance (IGT) and diabetes among individuals with normal glucose tolerance. This prospective study involved 2,605 residents of Mauritius with normal glucose tolerance who were followed for 5 years for IGT or diabetes onset in relation to total and regional adiposity (BMI, waist-to-hip ratio [WHR]), fasting and 2-h 75-g oral glucose load glucose and insulin, total and HDL cholesterol, blood pressure, serum uric acid, triglyceride, and leptin levels. A multivariate logistic regression model adjusted for age, sex, ethnicity, and diabetes family history showed a significantly higher linear increase in risk of IGT and diabetes in association with the following variables only: fasting glucose (odds ratio 1.89 [95% CI 1.51-2.34]), 2-h glucose (1.68 [1.50-1.88]), WHR (1.30 [1.10-1.52]), BMI (1.04 [1.00-1.08]), and serum uric acid (1.37 [1.20-1.57]). However, a nonlinear increase was seen with serum triglyceride and plasma leptin concentrations. No risk factors resulted in joint effects that were greater than expected from combining individual effects. Metabolic syndrome features independently predict a higher risk of diabetes or IGT in normoglycemic subjects but in combination confer no higher-than-expected risk of these outcomes. At higher concentrations of triglycerides and leptin, risk plateaus and even declines slightly.
Highlights
Background and subjectsMauritius is a subtropical island located in the southwestern Indian Ocean about 800 km east of Madagascar
This analysis focuses on the development of diabetes and impaired glucose tolerance (IGT) among individuals who were initially normoglycemic in 1987 (n = 3,467), of whom 2,605 (75.1%) had longitudinal information available from both surveys
Multivariate models were fit with loge transformations of these variables in addition to the linear term (Table 1). Because both the linear and loge transformations of these variables were significant in these models at P Ͻ 0.05, this finding rejects the hypothesis that a linear association exists between diabetes or IGT odds and leptin or triglyceride levels
Summary
Background and subjects Mauritius is a subtropical island located in the southwestern Indian Ocean about 800 km east of Madagascar. Longitudinal 1987–1992 data were available for 3,793 subjects (74.6%) This analysis focuses on the development of diabetes and IGT among individuals who were initially normoglycemic (as defined below) in 1987 (n = 3,467), of whom 2,605 (75.1%) had longitudinal information available from both surveys. Diabetes was diagnosed if subjects reported a history of diabetes and were taking oral hypoglycemic medication or insulin or if the fasting plasma glucose level was Ն7.0 mmol/l or the 2-h value was Ն11.1 mmol/l [16]. Subjects included 48.9% men and 51.1% women Among these individuals, 356 (13.7%) developed IGT and 159 (6.1%) developed diabetes during the 5-year follow-up, which gave annual incidence rates of 2.9 and 1.3%, respectively. Regarding features of DIABETES CARE, VOLUME 23, NUMBER 9, SEPTEMBER 2000
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