In this paper, Lemieux et al. provide an extensive review of the literature on the relationship of “hypertriglyceridemic waist” to co-morbidities that predict type 2 diabetes and cardiovascular disease (CVD) risk. The authors present new evidence that some middle-aged men without classical risk factors might be misclassified by risk assessment algorithms based on traditional risk factors such as the Framingham risk score. Under the model proposed, the simultaneous presence of an elevated waist circumference and elevated triglyceride concentration is highly predictive of excess visceral and ectopic fat in individuals who are characterized by insulin resistance and the constellation of athero-thrombotic inflammatory abnormalities of the metabolic syndrome. This paper emphasizes once again the importance of paying attention to plasma triglyceride concentrations and measuring waist circumference in clinical practice in order to identify a sub-group of viscerally obese individuals for whom current risk assessment algorithms might underestimate global CVD risk.
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