Metabolic Risks Identified by the Combination of Enlarged Waist and Elevated Triacylglycerol Concentration

Background: Abdominal fat and circulating triacylglycerols increase with age, which indicates lipid overaccumulation. Enlarged waist (EW) with elevated triacylglycerols (ET) could identify adults at metabolic risk.

Objective: Using thresholds for EW and ET observed among the youngest adults, we estimated for all adults the prevalence of combined EW and ET (EWET) and described the metabolic risks associated with EWET.

Design: In a cross-sectional, weighted sample of 9183 adults, we used two-dimensional displays to provide thresholds for EW (men: > or = 95 cm; women: > or = 88 cm) and fasting ET (> or = 1.45 mmol/L) and estimated the characteristics of EWET among adults of all ages.

Results: The population prevalence of EWET in 18-24-y-olds was 6%; it rose with age until age 55-74 y (prevalence: 43%) and then was lower among the elderly. Persons with EWET were more likely (P < 0.0001) to have adverse mean (+/- SEE) concentrations of risk variables in adjusted analyses (fasting insulin: 43 +/- 3 pmol/L; HDL cholesterol: -0.27 +/- 0.02 mmol/L; apolipoprotein B: 0.20 +/- 0.01 g/L; fasting glucose: 0.71 +/- 0.07 mmol/L; uric acid: 50 +/- 2 micromol/L) and to have diabetes (relative risk: 3.2) than were persons without EWET. Compared with a similar-size subpopulation with high body mass index, persons with EWET were older and had more dyslipidemia, hyperglycemia, and hyperuricemia. Compared with "metabolic syndrome," EWET identified more persons who were younger and had greater LDL-cholesterol and apolipoprotein B concentrations. Compared with "prediabetes," EWET identified more persons with hyperinsulinemia, dyslipidemia, and hyperuricemia.

Conclusions: EWET identifies a syndrome of lipid overaccumulation associated with metabolic risk and accelerated mortality after middle age. Prospective studies should evaluate this simple indicator.