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Factor analysis of the metabolic syndrome: obesity vs insulin resistance as the central abnormality

International Journal of Obesity volume 25, pages 1782–1788 (2001)Cite this article

Abstract

OBJECTIVES: To evaluate whether there is one central abnormality contributing to the conditions associated with the metabolic syndrome (MES), or whether one abnormality is contributing on multiple levels.

METHODS: We recruited 145 Chinese subjects aged 17–68 y with varying degrees of insulin-sensitivity (IS): 33 healthy, 59 with type 2 diabetes mellitus, 32 essential hypertensives and 21 dyslipidaemics. IS was evaluated by the short insulin sensitivity test using a 0.1 U/kg intravenous bolus dose of insulin. Blood pressure, anthropometric measures and biochemical parameters associated with IS were also measured. Exploratory factor analyses (EFA) were performed in the entire group of 145 subjects and in the 76 with normal glucose tolerance.

RESULTS: EFA in all 145 subjects defined three distinct, independent factors. Factor 1 was interpreted as general and central adiposity, impaired IS and glucose intolerance, Factor 2 was associated with hypertension and general and central obesity, whilst Factor 3 was strongly related to low HDL-cholesterol and high triglyceride concentrations and weakly to waist circumference. In patients with impaired glucose tolerance, only two factors were identified; factor 1 related to reduced IS, impaired glucose tolerance, dyslipidaemia and general and central adiposity, and factor 2 which was related to blood pressure and general and central adiposity.

CONCLUSIONS: These models suggest that the clustering of variables in MES is a result of multiple factors linked by adiposity and not a single aetiology. Furthermore, increases in blood pressure are related to obesity in these Chinese subjects rather than decreased IS per se.

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References

  1. Reaven GM . Banting Lecture 1988: Role of insulin resistance in human disease Diabetes 1988 37: 1595–1607.

    Article  CAS  Google Scholar 

  2. Defronzo RA, Ferrannini E . Insulin resistance: a multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease Diabetes Care 1991 14: 173–194.

    Article  CAS  Google Scholar 

  3. Després JP, Marette A . Relation of components of insulin resistance syndrome to coronary disease risk Curr Opin Lipidol 1994 5: 274–289.

    Article  Google Scholar 

  4. Donahue RP, Bean JA, Donahue RD, Goldberg RB, Prineas RJ . Does insulin resistance unite the separate components of the insulin resistance syndrome? Evidence from the Miami Community Health Study Arterioscler Thromb Vasc Biol 1997 17: 2413–2417.

    Article  CAS  Google Scholar 

  5. Koyama K, Chen G, Lee Y, Unger R . Tissue triglycerides, insulin resistance, and insulin production: implications for hyperinsulinaemia of obesity Am J Physiol 1997 273: E708–E713.

    CAS  PubMed  Google Scholar 

  6. Larson B . Obesity, fat distribution and cardiovascular disease Int J Obes 1991 15: 53–57.

    Google Scholar 

  7. Arauz-Pacheco C, Ramirez LC, Schnurr-Breen L, Raskin P . Relationship between insulin sensitivity and degree of obesity in mild hypertension Am J Med Sci 1992 304: 225–230.

    Article  CAS  Google Scholar 

  8. Björntorp P . Abdominal obesity and the development of non-insulin-dependent diabetes mellitus Diabetes Metab Rev 1988 4: 615–622.

    Article  Google Scholar 

  9. Després JP . Obesity and lipid metabolism: relevance of body fat distribution Curr Opin Lipidol 1991 2: 5–15.

    Article  Google Scholar 

  10. Edwards KL, Austin MA, Newman B, Mayer E, Krauss RM, Selby JV . Multivariate analysis of the insulin resistance syndrome Arterioscler Thromb 1994 14: 1940–1945.

    Article  CAS  Google Scholar 

  11. Meigs JB, D'Agostino RB Sr, Wilson PW, Cupples LA, Nathan DM, Singer DE . Risk variable clustering in the insulin resistance syndrome Diabetes 1997 46: 1594–1600.

    Article  CAS  Google Scholar 

  12. Wingard D, Von Muhlen D, Barrett-Connor E, Kritz-Silverstein D . Factor analysis of proposed components of the insulin resistance syndrome Diabetes 1996 45: 137A.

    Google Scholar 

  13. MacDonald IA . Advances in our understanding of the role of the sympathetic nervous system in obesity Int J Obes Relat Metab Disord 1995 19 (Suppl 7): S2–S7.

    PubMed  Google Scholar 

  14. Modan M, Halkin H, Fuchs Z, Lusky A, Chetrit A, Segal P, Eshkol A, Almog S, Shefi M . Hyperinsulinemia: a link between glucose intolerance, obesity, hypertension, dyslipoproteinemia, elevated serum uric acid and internal cation imbalance Diabetes Metab 1987 13: 375–380.

    CAS  Google Scholar 

  15. Chan JCN, Cheung JCK, Lau EMC, Woo J, Swaminathan R, Cockram CS . The metabolic syndrome in Hong Kong Chinese—the inter-relationships amongst its components analysed by structural equation modeling Diabetes Care 1996 19: 953–959.

    Article  CAS  Google Scholar 

  16. Cockram CS, Woo J, Lau E, Chan JC, Chan AY, Lau J, Swaminathan R, Donnan SP . The prevalence of diabetes mellitus and impaired glucose tolerance among Hong Kong Chinese adults of working age Diabetes Res Clin Pract 1993 21: 67–73.

    Article  CAS  Google Scholar 

  17. Janus ED, Cockram CS, Lam KSL, Lam TH . The prevalence of diabetes mellitus and impaired glucose tolerance in the Hong Kong population 3rd International Diabetes Federation-Western Pacific Regional Congress Hong Kong 1996 90.

    Google Scholar 

  18. World Health Organization . Diabetes mellitus Report of a WHO study group. Technical reports series no. 727 WHO: Geneva 1985

    Google Scholar 

  19. National Diabetes Data Group . Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance Diabetes 1979 28: 1039–1057.

    Article  Google Scholar 

  20. Taskinen M-R . Strategies for the diagnosis of metabolic syndrome Curr Opin Lipidol 1993 4: 434–443.

    Article  CAS  Google Scholar 

  21. Young RP, Critchley JAJH, Anderson PJ, Lau MSW, Lee KKC, Chan JCN . The short insulin tolerance test: feasibility using venous sampling Diabetic Med 1996 13: 429–433.

    Article  CAS  Google Scholar 

  22. Friedewald WT, Levy RI, Fredrickson DS . Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge Clin Chem 1972 18: 499–502.

    CAS  Google Scholar 

  23. McClendon MJ . Multiple regression and causal analysis F.E. Peacock: Itasca, IL 1994

    Google Scholar 

  24. Bernstein IH, Garbin CP, Teng GK . Applied multivariate analysis Springer: New York 1988

    Book  Google Scholar 

  25. Flury B, Riedwyl H . Multivariate statistics. A practical approach Chapman and Hall: London 1988

    Book  Google Scholar 

  26. Hopkins PN, Hunt SC, Wu LL, Williams GH, Williams RR . Hypertension, dyslipidaemia, and insulin resistance: links in a chain or spokes on a wheel? Curr Opin Lipidol 1996 7: 241–253.

    Article  CAS  Google Scholar 

  27. Randle PJ, Hales CN, Garland PB, Newsholme EA . The glucose fatty-acid cycle: its role in insulin sensitivity and the metabolic disturbances of diabetes mellitus Lancet 1963 ii: 785–789.

    Article  Google Scholar 

  28. Chen YDI, Golay A, Swislocki ALM, Reaven GM . Resistance to insulin suppression of plasma free fatty acids concentrations and insulin stimulation of glucose uptake in NIDDM J Clin Endocrinol Metab 1987 64: 17–21.

    Article  CAS  Google Scholar 

  29. Warnotte C, Gilon P, Nenquin M, Henquin J-C . Mechanisms of the stimulation of insulin release by saturated fatty acids Diabetes 1994 43: 703–711.

    Article  CAS  Google Scholar 

  30. Bevilacqua S, Bonadonna R, Buzzigoli G, Boni C, Ciociaro D, Maccari F, Giorico MA, Ferrannini E . Acute elevation of free fatty acid levels leads to hepatic insulin resistance in obese subjects Metabolism 1987 36: 502–506.

    Article  CAS  Google Scholar 

  31. Ferrannini E, Barrett EJ, Bevilacqua S, Defronzo RA . Effect of fatty acids on glucose production and utilization in man J Clin Invest 1983 72: 1737–1747.

    Article  CAS  Google Scholar 

  32. Saloranta C, Franssila-Kallunki A, Ekstrand A, Taskinen M-R, Groop L . Modulation of hepatic glucose production by non-esterified fatty in acids in type 2 (non-insulin-dependent) diabetes mellitus Diabetologia 1991 34: 409–415.

    Article  CAS  Google Scholar 

  33. Unger RH . Lipotoxicity in the pathogenesis of obesity-dependent NIDDM Diabetes 1995 44: 863–870.

    Article  CAS  Google Scholar 

  34. Després JP, Moorjani S, Lupien PJ, Tremblay A, Nadeau A, Bouchard C . Regional distribution of body fat, plasma lipoproteins, and cardiovascular disease Arteriosclerosis 1990 10: 497–511.

    Article  Google Scholar 

  35. Mayer EJ, Newman B, Austin MA, Zhang D, Quesenberry CP Jr, Edwards K, Selby JV . Genetic and environmental influences on insulin levels and the insulin resistance syndrome: an analysis of women twins Am J Epidemiol 1996 143: 323–332.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Clinical Pharmacology, The Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, New Territories, Hong Kong SAR

    PJ Anderson, JAJH Critchley, JCN Chan, ZSK Lee, GN Thomas & B Tomlinson

  2. Division of Endocrinology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, New Territories, Hong Kong SAR

    JCN Chan & CS Cockram

Authors
  1. PJ Anderson
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  2. JAJH Critchley
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Correspondence to PJ Anderson.

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Anderson, P., Critchley, J., Chan, J. et al. Factor analysis of the metabolic syndrome: obesity vs insulin resistance as the central abnormality. Int J Obes 25, 1782–1788 (2001). https://doi.org/10.1038/sj.ijo.0801837

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