Youth/Child Cardiovascular Risk and Environmental (YCARE) Research Group, School of Medicine, University of São Paulo, São Paulo, Brazil; Growth, Exercise, Nutrition and Development (GENUD) Research Group, Faculty of Health Sciences, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Universidad de Zaragoza, Zaragoza, Spain; Metabolic Diseases, Exercise and Nutrition (DOMEN) Research Group, Federal University of Piauí, Teresina, Brazil.
Youth/Child Cardiovascular Risk and Environmental (YCARE) Research Group, School of Medicine, University of São Paulo, São Paulo, Brazil; Growth, Exercise, Nutrition and Development (GENUD) Research Group, Faculty of Health Sciences, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Universidad de Zaragoza, Zaragoza, Spain.
Clin Nutr. 2017 Dec;36(6):1693-1700. doi: 10.1016/j.clnu.2016.12.020. Epub 2016 Dec 28.
BACKGROUND & AIMS: Lipid accumulation product (LAP) is emergent predictor of central lipid accumulation linked to diabetes risk and cardiovascular disease. In this study, our aims were (i) to assess the accuracy of the LAP for predicting metabolic syndrome (MS) in subjects without diagnosis of cardiovascular disease (CVD) and type 2 diabetes mellitus compared with other classical anthropometric parameters and (ii) to estimate the optimal LAP cut-off point to predict MS in this population.
SUBJECTS/METHODS: We conducted a cross-sectional study with representative undiagnosed subjects aged 20-79 years (n = 201; 37.8% men), selected by simple random sampling. In this study, subjects without previous diagnosis of CVD and type 2 diabetes mellitus, and those who did not make use of continuous medication were included. The independent variables were body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR) and LAP. MS was defined by American Heart Association and the National Heart, Lung, and Blood Institute (AHA/NHLBI); International Diabetes Federation (IDF); and a harmonized criteria between AHA/NHLBI and IDF.
The prevalence of MS was 78.9% and 69.6% for men and women, respectively. LAP showed better area under the curve (AUC) for MS in three different criteria than those indexes based on body mass index, waist circumference, waist-to-height ratio and waist-to-hip ratio, even after adjusting for age and sex. In the harmonized criteria, the cut-off point of 34.2 cm.mmol/L for LAP showed the highest accuracy for MS (sensitivity 0.90, specificity 0.61, positive likelihood ratio of 2.31 and negative likelihood ratio of 0.17).
LAP is a simple and accurate predictor tool for MS in undiagnosed adults. Moreover, it has significantly higher predictability than other screening tools commonly used to find subjects at risk of CVD and type 2 diabetes mellitus development, with the best performance at the 34.2 cm.mmol/L cut-off point.
脂联素水平（LAP）是与糖尿病风险和心血管疾病相关的中心性脂质蓄积的新兴预测因子。本研究旨在：（i）评估 LAP 在预测无心血管疾病（CVD）和 2 型糖尿病诊断的受试者中代谢综合征（MS）的准确性，与其他经典人体测量参数相比；（ii）评估该人群中预测 MS 的最佳 LAP 截断值。
受试者/方法：我们进行了一项横断面研究，纳入了 201 名年龄在 20-79 岁的未诊断受试者（37.8%为男性），通过简单随机抽样选择。本研究纳入了既往无 CVD 和 2 型糖尿病诊断且未使用连续药物治疗的受试者。自变量为体重指数（BMI）、腰围（WC）、腰高比（WHtR）和腰臀比（WHR）和 LAP。MS 采用美国心脏协会和美国国立心肺血液研究所（AHA/NHLBI）、国际糖尿病联合会（IDF）和 AHA/NHLBI 和 IDF 之间的协调标准进行定义。
男性和女性 MS 的患病率分别为 78.9%和 69.6%。与 BMI、腰围、腰高比和腰臀比相关的指数相比，LAP 在三种不同标准下对 MS 的曲线下面积（AUC）更好，即使在调整了年龄和性别后也是如此。在协调标准中，LAP 为 34.2cm.mmol/L 的截断点对 MS 具有最高的准确性（敏感性 0.90，特异性 0.61，阳性似然比为 2.31，阴性似然比为 0.17）。
LAP 是未诊断成年人 MS 的一种简单且准确的预测工具。此外，与常用于发现 CVD 和 2 型糖尿病发病风险的其他筛查工具相比，它具有更高的预测性，在 34.2cm.mmol/L 的截断点具有最佳性能。
