Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Hypertriglyceridemic waist: an alternative to the metabolic syndrome? Results of the IMAP Study (multidisciplinary intervention in primary care)

International Journal of Obesity volume 35, pages 292–299 (2011)Cite this article

Subjects

Abstract

Aim:

To study the prevalence of hypertriglyceridemic waist (HTGW) in an urban adult Spanish population and its association with type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD).

Methods:

We undertook a cross-sectional analysis in a random sample of 2270 individuals (18–80 years of age). All participants provided a clinical history and underwent a physical examination. Blood and urine analyses were conducted. HTGW was diagnosed using anthropometric criteria for the European population (waist circumference: for men, ⩾94 cm; for women, ⩾80 cm) and fasting plasma triglycerides (TGs) ⩾1.71 mmol l−1 (⩾150 mg per 100 ml).

Results:

The prevalence of HTGW was 14.5% (men: 18.2%, women: 10.8%) and was significantly greater in men <59 years (P<0.001). HTGW was associated with older individuals, a low educational level and, in men, with a sedentary lifestyle (P<0.001). Subjects with HTGW had higher levels of total cholesterol, low-density lipoprotein-cholesterol (LDL-c) and uric acid, lower levels of high-density lipoprotein-cholesterol, a higher blood pressure, a greater degree of obesity and a higher prevalence of T2DM (20.00 vs 6.4%, P<0.001) (odds ratio (OR) 3.61; 95% confidence interval (95% CI), 2.60–5.01) and CVD (8.5 vs 3.4%, P<0.001) (OR 2.63; 95% CI, 1.66–4.16). The association of HTGW with T2DM and CVD disappeared after adjusting for age. The degree of concordance between HTGW and the metabolic syndrome (MS) was moderate, with both the Adult Treatment Panel III Report (ATP-III) and the International Diabetes Federation criteria (κ=0.51 and κ=0.58, respectively). Subjects with isolated HTGW as compared with those with isolated MS (ATP-III) were younger, had greater levels of total cholesterol, LDL-c and TGs and a lower prevalence of obesity, high blood pressure and dysglycemia.

Conclusion:

HTGW is a phenotype of cardiometabolic risk prevalent in the adult population in our environment. HTGW may be an alternative to MS to detect the population at risk for T2DM and CVD, especially in young individuals who do not fulfill the criteria for MS.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Després JP, Lemieux I, Bergeron J, Pibarot P, Mathieu P, Larose E et al. Abdominal obesity and the metabolic syndrome: contribution to global cardiometabolic risk. Arterioscler Thromb Vasc Biol 2008; 28: 1039–1049.

    Article  Google Scholar 

  2. Couillard C, Bergeron N, Prud’homme D, Bergeron J, Tremblay A, Bouchard C et al. Postprandial triglyceride response in visceral obesity in men. Diabetes 1998; 47: 953–960.

    Article  CAS  Google Scholar 

  3. Pouliot MC, Despres JP, Lemieux S, Moorjani S, Bouchard C, Tremblay A et al. Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol 1994; 73: 460–468.

    Article  CAS  Google Scholar 

  4. Wang J, Thornton JC, Bari S, Williamson B, Gallagher D, Heymsfield SB et al. Comparisons of waist circumferences measured at 4 sites. Am J Clin Nutr 2003; 77: 379–384.

    Article  Google Scholar 

  5. Wang J . Waist circumference: a simple, inexpensive, and reliable tool that should be included as part of physical examinations in the doctor's office. Am J Clin Nutr 2003; 78: 902–903.

    Article  CAS  Google Scholar 

  6. Cheal KL, Abbasi F, Lamendola C, McLaughlin T, Reaven GM, Ford ES . Relationship to insulin resistance of the Adult Treatment Panel III diagnostic criteria for identification of the metabolic syndrome. Diabetes 2004; 53: 1195–1200.

    Article  CAS  Google Scholar 

  7. Liao Y, Kwon S, Shaughnessy S, Wallace P, Hutto A, Jenkins AJ et al. Critical evaluation of Adult Treatment Panel III criteria in identifying insulin resistance with dyslipidemia. Diabetes Care 2004; 27: 978–983.

    Article  Google Scholar 

  8. Carr DB, Utzschneider KM, Hull RL, Kodama K, Retzlaff BM, Brunzell JD et al. Intra-abdominal fat is a major determinant of the National Cholesterol Education Program Adult Treatment Panel III criteria for the metabolic syndrome. Diabetes 2004; 53: 2087–2094.

    Article  CAS  Google Scholar 

  9. Hanley AJ, Williams K, Stern MP, Haffner SM . Homeostasis model assessment of insulin resistance in relation to the incidence of cardiovascular disease: the San Antonio heart study. Diabetes Care 2002; 25: 1177–1184.

    Article  Google Scholar 

  10. Tankó LB, Bruun JM, Alexandersen P, Bagger YZ, Richelsen B, Christiansen C et al. Novel associations between bioavailable estradiol and adipokines in elderly women with different phenotypes of obesity: implications for atherogenesis. Circulation 2004; 110: 2246–2252.

    Article  Google Scholar 

  11. Kahn HS, Valdez R . Metabolic risks identified by the combination of enlarged waist and elevated triacylglycerol concentration. Am J Clin Nutr 2003; 78: 928–934.

    Article  CAS  Google Scholar 

  12. Grundy SM, Brewer HB, Cleeman JI, Smith SC, Lenfant C, For the Conference Participants. Definition of metabolic syndrome. Report of the National Heart, Lung, and Blood Institute/American Heart Association Conference on Scientific Issues Related to Definition. Circulation 2004; 109: 433–438.

    Article  Google Scholar 

  13. Alberti KG, Zimmet P, Shaw J, IDF Epidemiology Task Force Consensus Group. The metabolic syndrome—a new worldwide definition. Lancet 2005; 366: 1059–1062.

    Article  Google Scholar 

  14. The International Expert Committee. International Expert Committee Report on the Role of the A1C Assay in the Diagnosis of Diabetes. Diabetes Care 2009; 32: 1–8.

    Article  Google Scholar 

  15. World Health Organization. Obesity: Preventing and Managing the Global Epidemic: Report on a WHO Consultation (WHO Technical Report Series 894). World Health Organization: Geneva, Switzerland, 2000.

  16. Lemieux I, Alméras N, Mauriége P, Blanchet C, Dewailly E, Bergeron J et al. Prevalence of ‘hypertriglyceridemic waist’ in men who participated in the Quebec Health Survey: association with atherogenic and diabetogenic metabolic risk factors. Can J Cardiol 2002; 18: 725–732.

    PubMed  Google Scholar 

  17. LaMonte MJ, Ainsworth BE, DuBose KD, Grandjean PW, Davis PG, Yanowitz FG et al. The hypertriglyceridemic waist phenotype among women. Atherosclerosis 2003; 171: 123–130.

    Article  CAS  Google Scholar 

  18. Bos G, Dekker JM, Heine RJ . Non-HDL cholesterol contributes to the ‘hypertriglyceridemic waist’ as a cardiovascular risk factor. The Hoorn Study. Diabetes Care 2004; 27: 283–284.

    Article  Google Scholar 

  19. Solati M, Ghanbarian A, Rahmani M, Sarbazi N, Allahverdian S, Azizi F . Cardiovascular risk factors in males with hypertriglycemic waist (Tehran Lipid and Glucose Study). Int J Obes Relat Metab Disord 2004; 28: 706–709.

    Article  CAS  Google Scholar 

  20. Tankó LB, Bagger YZ, Qin G, Alexandersen P, Larsen PJ, Christiansen C . Enlarged waist combined with elevated triglycerides is a strong predictor of accelerated atherogenesis and related cardiovascular mortality in postmenopausal women. Circulation 2005; 111: 1883–1890.

    Article  Google Scholar 

  21. Czernichow S, Bruckert E, Bertrais S, Galan P, Hercberg S, Oppert JM . Hypertriglyceridemic waist and 7.5-year prospective risk of cardiovascular disease in asymptomatic middle-aged men. Int J Obes (Lond) 2007; 31: 791–796.

    Article  CAS  Google Scholar 

  22. Lemieux I, Pascot A, Couillard C, Lamarche B, Tchernof A, Almeras N et al. Hypertriglyceridemic waist: a marker of the atherogenic metabolic triad (hyperinsulinemia; hyperapolipoprotein B; small, dense LDL) in men? Circulation 2000; 102: 179–184.

    Article  CAS  Google Scholar 

  23. Lamarche B, Tchernof A, Moorjani S, Cantin B, Dagenais GR, Lupien PJ et al. Small, dense low-density lipoprotein particles as a predictor of the risk of ischemic heart disease in men: prospective results from the Québec Cardiovascular Study. Circulation 1997; 95: 69–75.

    Article  CAS  Google Scholar 

  24. St-Pierre J, Lemieux I, Perron P, Brisson D, Santuré M, Vohl MC et al. Relation of the ‘hypertriglyceridemic waist’ phenotype to earlier manifestations of coronary artery disease in patients with glucose intolerance and type 2 diabetes mellitus. Am J Cardiol 2007; 99: 369–373.

    Article  CAS  Google Scholar 

  25. Onat A, Ayhan E, Hergenç G, Can G, Barlan MM . Smoking inhibits visceral fat accumulation in Turkish women: relation of visceral fat and body fat mass to atherogenic dyslipidemia, inflammatory markers, insulin resistance, and blood pressure. Metabolism 2009; 58: 963–970.

    Article  CAS  Google Scholar 

  26. Lamarche B, Tchernof A, Mauriége P, Cantin B, Dagenais GR, Lupien PJ et al. Fasting insulin and apolipoprotein B levels and low-density lipoprotein particle size as risk factors for ischemic heart disease. JAMA 1998; 279: 1955–1961.

    Article  CAS  Google Scholar 

  27. Blackburn P, Lamarche B, Couillard C, Pascot A, Bergeron N, Prud’homme D et al. Postprandial hyperlipidemia: another correlate of the ‘hypertriglyceridemic waist’ phenotype in men. Atherosclerosis 2003; 171: 327–336.

    Article  CAS  Google Scholar 

  28. St-Pierre J, Lemieux I, Vohl MC, Perron P, Tremblay G, Despres JP et al. Contribution of abdominal obesity and hypertriglyceridemia to impaired fasting glucose and coronary artery disease. Am J Cardiol 2002; 90: 15–18.

    Article  CAS  Google Scholar 

  29. Sam S, Haffner S, Davidson MH, D Agostino RB, Feinstein S, Kondos G et al. Hypertriglyceridemic waist phenotype predicts increased visceral fat in subjects with type 2 diabetes. Diabetes Care 2009; 32: 1916–1920.

    Article  CAS  Google Scholar 

  30. Gazi IF, Filippatos TD, Tsimihodimos V, Saougos VG, Liberopoulos EN, Mikhailidis DP et al. The hypertriglyceridemic waist phenotype is a predictor of elevated levels of small, dense LDL cholesterol. Lipids 2006; 41: 647–654.

    Article  CAS  Google Scholar 

  31. World Health Organization. WHO Statistical Information System (WHOSIS). [Consulted in August 2009]. http://www3.who.int/whosis/.

  32. Instituto Nacional de Estadística. INEbase [consulted in August 2009]. Available at: http://www.ine.es/inebase/.

  33. Basterra-Gortari FJ, Bes-Rastrollo M, Seguí-Gómez M, Forga L, Alfredo-Martínez J, Martínez-González MA . Tendencias de la obesidad, diabetes mellitus, hipertensión e hipercolesterolemia en España (1997–2003). Med Clin (Barc) 2007; 129: 405–408.

    Article  Google Scholar 

Download references

Acknowledgements

We thank Rita Perez González (Imabis Foundation) for her collaboration, and the doctors and nurses of ‘Ciudad Jardin’ Health Center who participated in the IMAP study: Antón Cortés M, Fernández Tapia ML, Ginel Mendoza L, Kuhn González M, Linares Castro L, Martos Cerezuela I, Mestre Reoyo G, Muñoz Villalba JC, Paniagua Gómez F, Pérez Juncosa F, Reyes Alcázar P, Rodríguez Lago JA, Rodríguez Rivera MR, Sánchez Pérez R, Sacristán Visquert E, Taboada González F. CIBER de Obesidad y Nutrición and CIBER de Diabetes y Enfermedades Metabólicas Asociadas are ISCIII projects. This study was undertaken with finance from the Consejería de Salud de la Junta de Andalucía (no. exp.283/06), Consejería de Innovación de la Junta de Andalucía (CTS 04369) and Fondo de Investigación Sanitaria (PS09/00997).

Author information

Authors and Affiliations

  1. Internal Medicine Department, Carlos Haya Hospital, Malaga, Spain

    R Gomez-Huelgas, A Villalobos, S Jansen, R Guijarro & F Salgado

  2. Endocrinology Department, Biomedical Research Laboratory, Virgen de la Victoria Hospital, CIBER Fisiopatología de la Obesidad y la Nutrición (CB06/003), Malaga, Spain

    M R Bernal-López & F J Tinahones

  3. Health Center ‘Ciudad Jardin’, Malaga, Spain

    J Mancera-Romero & A J Baca-Osorio

  4. Department of Internal Medicine, CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Hospital Clinico San Carlos, Madrid, Spain,

    M Serrano-Ríos

Authors
  1. R Gomez-Huelgas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M R Bernal-López
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A Villalobos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J Mancera-Romero
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A J Baca-Osorio
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S Jansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R Guijarro
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. F Salgado
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. F J Tinahones
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. M Serrano-Ríos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M R Bernal-López.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gomez-Huelgas, R., Bernal-López, M., Villalobos, A. et al. Hypertriglyceridemic waist: an alternative to the metabolic syndrome? Results of the IMAP Study (multidisciplinary intervention in primary care). Int J Obes 35, 292–299 (2011). https://doi.org/10.1038/ijo.2010.127

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijo.2010.127

Keywords

This article is cited by

Search

Advanced search

Quick links