J Endocrinol Metab

Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc

Journal website http://www.jofem.org

Original Article

Volume 2, Number 2, April 2012, pages 51-65

Paradoxical Hyperadiponectinemia is Associated With the Metabolically Healthy Obese (MHO) Phenotype in African Americans

Figure 1. Box-plots of log adiponectin in lean individuals. ( + ) denotes the geometric mean; * Cut-off used to define paradoxical hyperadiponectinemia in Men; ** Cut-off used to define paradoxical hyperadiponectinemia in Women.

Figure 2. Association between circulating adiponectin levels and obesity markers by gender in 822 African Americans.

Figure 3. Association between circulating adiponectin levels and glycolytic indexes by gender in 822 African Americans.

Figure 4. Association between circulating adiponectin levels and serum lipids by gender in 822 African Americans.

**Table 1.** Anthropometric and Metabolic Characteristics of the 822 African American Participants Included in this Study
Variable	Men (n = 364)	Women (n = 458 )	P-value
Data is presented as mean ± standard deviation; values in parenthesis ( ) are geometric means when variables were not normally distributed; t-student test was used to assess difference between men and women.
Age (years)	43.9 ± 10.9	42.8 ± 10.7	0.13
BMI (kg/m²)	27.9 ± 6.8	31.3 ± 8.8	6.5 × 10^-10
PFM	27.9 ± 9.2	41.1 ± 9.3	8.7 × 10^-73
WC (cm)	93.3 ± 15.9	94.35 ± 16.87	0.35
WHR	0.89 ± 0.07	0.84 ± 0.07	2.5 × 10^-26
Glucose (mg/dL)	86.3 ± 12.3	83.7 ± 10.2	0.001
Insulin (µU/mL)
Mean	10.7 ± 13.2	12.3 ± 18.2	0.16
Geometric mean	6.6	8.1
Median (IQR)	7.4 (9.5)	7.8 (9.2)
HOMA-IR
Mean	2.5 ± 3.6	2.7 ± 4.7	0.46
Geometric mean	1.4	1.7
Median (IQR)	1.6 (2.1)	1.6 (2.1)
HDL-C (mg/dL)	52.9 ± 19.2	54.7 ± 16.8	0.15
LDL-C (mg/dL)	111.6 ± 40.8	116.8 ± 38.1	0.06
TG (mg/dL)
Mean	111.3 ± 69.6	100.72 ± 68.5	0.03
Geometric mean	97.7	87.1
Median (IQR)	95 (62)	83 (54)
Total cholesterol (mg/dL)	187.0 ± 44.9	192.4 ± 42.6	0.08
Adiponectin (ng/mL)
Mean	7855.2 ± 4704.0	9186.3 ± 5551.8	0.0002
Geometric mean	6760.8	7762.4
Median (IQR)	6527.9 (5853)	7734.7 (6983)
Hypertension (%)	36.8	32.5
SBP (mmHg)	130.1 ± 19.4	82.0 ± 13.6	0.003
DBP (mmHg)	126.1 ± 18.3	79.8 ± 11.8	0.016

Table 1. Anthropometric and Metabolic Characteristics of the 822 African American Participants Included in this Study

Variable

Men (n = 364)

Women (n = 458 )

P-value

Data is presented as mean ± standard deviation; values in parenthesis ( ) are geometric means when variables were not normally distributed; t-student test was used to assess difference between men and women.

Age (years)

43.9 ± 10.9

42.8 ± 10.7

0.13

BMI (kg/m²)

27.9 ± 6.8

31.3 ± 8.8

6.5 × 10^-10

PFM

27.9 ± 9.2

41.1 ± 9.3

8.7 × 10^-73

WC (cm)

93.3 ± 15.9

94.35 ± 16.87

0.35

WHR

0.89 ± 0.07

0.84 ± 0.07

2.5 × 10^-26

Glucose (mg/dL)

86.3 ± 12.3

83.7 ± 10.2

0.001

Insulin (µU/mL)

Mean

10.7 ± 13.2

12.3 ± 18.2

0.16

Geometric mean

6.6

8.1

Median (IQR)

7.4 (9.5)

7.8 (9.2)

HOMA-IR

Mean

2.5 ± 3.6

2.7 ± 4.7

0.46

Geometric mean

1.4

1.7

Median (IQR)

1.6 (2.1)

HDL-C (mg/dL)

52.9 ± 19.2

54.7 ± 16.8

0.15

LDL-C (mg/dL)

111.6 ± 40.8

116.8 ± 38.1

0.06

TG (mg/dL)

Mean

111.3 ± 69.6

100.72 ± 68.5

0.03

Geometric mean

97.7

87.1

Median (IQR)

95 (62)

83 (54)

Total cholesterol (mg/dL)

187.0 ± 44.9

192.4 ± 42.6

0.08

Adiponectin (ng/mL)

Mean

7855.2 ± 4704.0

9186.3 ± 5551.8

0.0002

Geometric mean

6760.8

7762.4

Median (IQR)

6527.9 (5853)

7734.7 (6983)

Hypertension (%)

36.8

32.5

SBP (mmHg)

130.1 ± 19.4

82.0 ± 13.6

0.003

DBP (mmHg)

126.1 ± 18.3

79.8 ± 11.8

0.016

**Table 2.** Clinical Characteristics of the Obese African American Subjects Included in this Study
Variables	Men (n = 110)	Females (n =233)	P-value
Data is presented as mean ± standard deviation; values in parenthesis ( ) are geometric means when variables were not normally distributed; Student's t-test was used to assess difference between men and women.
Age (years)	42.9 ± 10.5	42.8 ± 9.8	0.95
BMI (kg/m ² )	35.7 ± 6.5	38.0 ± 7.0	0.004
PFM	36.0 ± 7.5	46.6 ± 6.4	0.000
WC (cm)	110.9 ± 14.4	106.0 ± 13.4	0.002
WHR	0.94 ± 0.06	0.85 ± 0.07	< 0.0001
SBP (mmHg)	131.8 ± 17.4	129.4 ± 18.5	0.26
DBP (mmHg)	83.4 ± 11.0	81.0 ± 11.6	0.08
Glucose (mg/dL)	90.9 ± 12.3	86.0 ± 9.8	< 0.0001
Insulin (µU/mL)	16.8 ± 18.9 (12.6)	16.4 ± 23.7 (11.5)	0.87
HOMA-IR	4.01 ± 5.4 (2.7)	3.7 ± 6.3 (2.4)	0.61
HDL-C (mg/dL)	43.8 ± 11.3	51 ± 15.3	< 0.0001
LDL-C (mg/dL)	126.7 ± 44.4	120.3 ± 39.5	0.18
TG (mg/dL)	128.2 ± 77.9 (109.6)	105.1 ± 63.8 (93.3)	0.007
Total cholesterol (mg/dL)	196.1 ± 47.7	192.3 ± 43.8	0.46
Adiponectin (ng/mL)	6023.8 ±3227.1 (5248.1)	7541.2 ±4759.0 (6309.6)	0.001

Table 2. Clinical Characteristics of the Obese African American Subjects Included in this Study

Variables

Men (n = 110)

Females (n =233)

P-value

Data is presented as mean ± standard deviation; values in parenthesis ( ) are geometric means when variables were not normally distributed; Student's t-test was used to assess difference between men and women.

Age (years)

42.9 ± 10.5

42.8 ± 9.8

0.95

BMI (kg/m ² )

35.7 ± 6.5

38.0 ± 7.0

0.004

PFM

36.0 ± 7.5

46.6 ± 6.4

0.000

WC (cm)

110.9 ± 14.4

106.0 ± 13.4

0.002

WHR

0.94 ± 0.06

0.85 ± 0.07

< 0.0001

SBP (mmHg)

131.8 ± 17.4

129.4 ± 18.5

0.26

DBP (mmHg)

83.4 ± 11.0

81.0 ± 11.6

0.08

Glucose (mg/dL)

90.9 ± 12.3

86.0 ± 9.8

< 0.0001

Insulin (µU/mL)

16.8 ± 18.9 (12.6)

16.4 ± 23.7 (11.5)

0.87

HOMA-IR

4.01 ± 5.4 (2.7)

3.7 ± 6.3 (2.4)

0.61

HDL-C (mg/dL)

43.8 ± 11.3

51 ± 15.3

< 0.0001

LDL-C (mg/dL)

126.7 ± 44.4

120.3 ± 39.5

0.18

TG (mg/dL)

128.2 ± 77.9 (109.6)

105.1 ± 63.8 (93.3)

0.007

Total cholesterol (mg/dL)

196.1 ± 47.7

192.3 ± 43.8

0.46

Adiponectin (ng/mL)

6023.8 ±3227.1 (5248.1)

7541.2 ±4759.0 (6309.6)

0.001

**Table 3.** Clinical Characteristics of 343 Obese African American Individuals With or Without Paradoxical Hyperadiponectinemia
Variable	Men	Women
Data is presented as mean ± standard deviation; values in parenthesis ( ) are geometric means when variables were not normally distributed. In females: “obese without PHA” was defined as adiponectin level below 11050.9 ng/mL and obese with PHA was defined as adiponectin level above 11050.9 ng/mL; In males: “Obese without PHA” was defined as adiponectin level below 8377.2 ng/mL and “Obese with PHA” was defined as adiponectin level above 8377.2 ng/mL; Student -t tests were used to compare means between “obese without PHA” and “obese with PHA” within gender.
Age (years)	42.3 ± 10.6	45.3 ± 10.2	0.25	41.9 ± 9.8	46.7 ± 8.9	0.003
BMI (kg/m²)	35.9 ± 6.6	34.8 ± 6.7	0.48	38.5 ± 7.3	35.9 ± 5.4	0.007
PFM	36.0 ± 7.0	36.3 ± 9.7	0.86	46.7 ± 6.5	46.2 ± 6.3	0.67
WC (cm)	111.7 ± 14.2	107.5 ± 15.3	0.23	107.5 ± 13.4	99.8 ± 11.8	0.0005
WHR	0.94 ± 0.06	0.92 ± 0.06	0.10	0.86 ± 0.07	0.84 ± 0.08	0.08
SBP (mmHg)	131.4 ± 16.9	133.2 ± 19.7	0.68	129.1 ± 18.8	130.6 ± 17.4	0.62
DBP (mmHg)	83.1 ± 10.5	84.5 ± 13.3	0.60	80.7 ± 11.7	82.2 ± 11.4	0.45
Glucose (mg/dL)	91.8 ± 12.4	87.2 ± 11.3	0.13	86.9 ± 10.0	82.23 ± 8.11	0.004
Insulin (µU/mL)	17.9 ± 20.6 (13.2)	12.3 ± 7.5 (10.2)	0.04	18.4 ± 26.0 (12.9)	8.3 ± 4.5 (6.9)	1.2 × 10^-06
HOMA-IR	4.3 ± 5.9 (3.0)	2.7 ± 1.8 (2.2)	0.03	4.14 ± 6.89 (2.8)	1.68 ± 0.9 (1.4)	4.8 × 10^-06
HDL (mg/dL)	41.8 ± 9.8	52.2 ± 13.4	0.002	48.1 ± 14.4	62.8 ± 13.4	2.13 × 10^-09
LDL-C (mg/dL)	125.7 ± 43.9	130.9 ± 50.7	0.63	120.7 ± 38.5	118.5 ± 43.7	0.74
TG (mg/dL)	131.5 ± 79.0 (114.8)	114.2 ± 73.0 (97.7)	0.36	109.8 ± 68.2 (97.7)	85.4 ± 34.2 (79.4)	0.0008
Total Cholesterol (mg/dL)	193.8 ± 45.7	206.0 ± 55.82	0.30	190.8 ± 42.9	198.4 ± 47.3	0.30
Adiponectin (ng/mL)	4772.7 ± 1746.7 (4466.8)	11352.1 ± 2561.0 (11220.2)	4.0 × 10^-11	5648.4 ± 2283.0 (5128.6)	15449.2 ± 4242.3 (14791.1)	3.5 × 10^-20

Table 3. Clinical Characteristics of 343 Obese African American Individuals With or Without Paradoxical Hyperadiponectinemia

Variable

Men

Women

Obese without PHA n = 89

Obese with PHA n = 21

P-value

Obese without PHA (n = 188)

Obese with PHA (n = 45)

P-value

Data is presented as mean ± standard deviation; values in parenthesis ( ) are geometric means when variables were not normally distributed. In females: “obese without PHA” was defined as adiponectin level below 11050.9 ng/mL and obese with PHA was defined as adiponectin level above 11050.9 ng/mL; In males: “Obese without PHA” was defined as adiponectin level below 8377.2 ng/mL and “Obese with PHA” was defined as adiponectin level above 8377.2 ng/mL; Student -t tests were used to compare means between “obese without PHA” and “obese with PHA” within gender.

Age (years)

42.3 ± 10.6

45.3 ± 10.2

0.25

41.9 ± 9.8

46.7 ± 8.9

0.003

BMI (kg/m²)

35.9 ± 6.6

34.8 ± 6.7

0.48

38.5 ± 7.3

35.9 ± 5.4

0.007

PFM

36.0 ± 7.0

36.3 ± 9.7

0.86

46.7 ± 6.5

46.2 ± 6.3

0.67

WC (cm)

111.7 ± 14.2

107.5 ± 15.3

0.23

107.5 ± 13.4

99.8 ± 11.8

0.0005

WHR

0.94 ± 0.06

0.92 ± 0.06

0.10

0.86 ± 0.07

0.84 ± 0.08

0.08

SBP (mmHg)

131.4 ± 16.9

133.2 ± 19.7

0.68

129.1 ± 18.8

130.6 ± 17.4

0.62

DBP (mmHg)

83.1 ± 10.5

84.5 ± 13.3

0.60

80.7 ± 11.7

82.2 ± 11.4

0.45

Glucose (mg/dL)

91.8 ± 12.4

87.2 ± 11.3

0.13

86.9 ± 10.0

82.23 ± 8.11

0.004

Insulin (µU/mL)

17.9 ± 20.6 (13.2)

12.3 ± 7.5 (10.2)

0.04

18.4 ± 26.0 (12.9)

8.3 ± 4.5 (6.9)

1.2 × 10^-06

HOMA-IR

4.3 ± 5.9 (3.0)

2.7 ± 1.8 (2.2)

0.03

4.14 ± 6.89 (2.8)

1.68 ± 0.9 (1.4)

4.8 × 10^-06

HDL (mg/dL)

41.8 ± 9.8

52.2 ± 13.4

0.002

48.1 ± 14.4

62.8 ± 13.4

2.13 × 10^-09

LDL-C (mg/dL)

125.7 ± 43.9

130.9 ± 50.7

0.63

120.7 ± 38.5

118.5 ± 43.7

0.74

TG (mg/dL)

131.5 ± 79.0 (114.8)

114.2 ± 73.0 (97.7)

0.36

109.8 ± 68.2 (97.7)

85.4 ± 34.2 (79.4)

0.0008

Total Cholesterol (mg/dL)

193.8 ± 45.7

206.0 ± 55.82

0.30

190.8 ± 42.9

198.4 ± 47.3

0.30

Adiponectin (ng/mL)

4772.7 ± 1746.7 (4466.8)

11352.1 ± 2561.0 (11220.2)

4.0 × 10^-11

5648.4 ± 2283.0 (5128.6)

15449.2 ± 4242.3 (14791.1)

3.5 × 10^-20

**Table 4.** Clinical Characteristics of MHO and Non MHO African American Individuals in This Study
Variable	Men	Women
Data is presented as mean ± standard deviation; values in parenthesis ( ) are geometric means when variables were not normally distributed. Student-t tests were used to compare means between “metabolically healthy obese” and “non metabolically healthy obese” within gender.
AGE (years)	43.1 ± 9.7	42.3 ± 12.5	0.70	43.1 ± 9.6	42.2 ± 10.5	0.55
BMI (kg/m²)	36.3 ± 7.3	34.2 ± 3.7	0.05	38.4 ± 7.2	37.0 ± 6.4	0.18
PFM	36.3 ± 7.9	35.2 ± 6.6	0.49	46.6 ± 6.4	46.6 ± 6.6	0.99
WC (cm)	112.1 ± 15.5	107.9 ± 10.9	0.11	107.4 ± 13.7	102.3 ± 12.2	0.01
WHR	0.94 ± 0.06	0.94 ± 0.06	0.60	0.87 ± 0.07	0.83 ± 0.08	< 0.0001
SBP (mmHg)	137.2 ± 17.4	118.4 ± 7.1	< 0.0001	134.0 ± 19.5	117.2 ± 6.9	< 0.0001
DBP(mmHg)	87.1 ± 10.2	74.2 ± 7.0	< 0.0001	83.4 ± 12.6	74.8 ± 5.0	< 0.0001
GLUCOSE (mg/dL)	91.3 ± 12.6	90.1 ± 11.7	0.65	86.2 ± 10.1	85.4 ± 9.04	0.55
Insulin (µU/mL)	18.8 ± 21.7 (13.5)	11.8 ± 6.4 (10)	0.01	17.4 ± 26.3 (11.7)	13.8 ± 15.04 (10.2)	0.19
HOMA-IR	4.6 ± 6.3 (3.0)	2.7 ± 1.5 (2.2)	0.01	3.9 ± 7.0 (2.4)	3.0 ± 3.9 (2.1)	0.23
HDL-C (mg/dL)	41 ± 11.1	50.4 ± 9.0	< 0.0001	47.1 ± 15.5	61.3 ± 8.5	< 0.0001
LDL-C (mg/dL)	123.8 ± 42.3	133.9 ± 49.0	0.28	121.9 ± 38.9	116 ± 40.9	0.30
TG (mg/dL)	135.6 ± 85.4 (117.5)	110.2 ± 52.3 (97.7)	0.06	113.3 ± 70.0 (100)	83.2 ± 34.9 (77.6)	< 0.0001
Total cholesterol (mg/dl)	191.9 ± 44.34	206.3 ± 54.6	0.15	191.7 ± 43.5	193.9 ± 44.9	0.73
Adiponectin (ng/mL)	5508.2 ± 2646.6 (4897.8)	7297.7 ± 4108.0 (6309.6)	0.03	6974.7 ± 4193.6 (5888.5)	9037.2 ± 5776.8 (7585.8)	0.01

Table 4. Clinical Characteristics of MHO and Non MHO African American Individuals in This Study

Variable

Men

Women

Non MHO (n = 78)

MHO (n = 32)

P-value

Non MHO (n = 169)

MHO (n = 64)

P-value

Data is presented as mean ± standard deviation; values in parenthesis ( ) are geometric means when variables were not normally distributed. Student-t tests were used to compare means between “metabolically healthy obese” and “non metabolically healthy obese” within gender.

AGE (years)

43.1 ± 9.7

42.3 ± 12.5

0.70

43.1 ± 9.6

42.2 ± 10.5

0.55

BMI (kg/m²)

36.3 ± 7.3

34.2 ± 3.7

0.05

38.4 ± 7.2

37.0 ± 6.4

0.18

PFM

36.3 ± 7.9

35.2 ± 6.6

0.49

46.6 ± 6.4

46.6 ± 6.6

0.99

WC (cm)

112.1 ± 15.5

107.9 ± 10.9

0.11

107.4 ± 13.7

102.3 ± 12.2

0.01

WHR

0.94 ± 0.06

0.60

0.87 ± 0.07

0.83 ± 0.08

< 0.0001

SBP (mmHg)

137.2 ± 17.4

118.4 ± 7.1

< 0.0001

134.0 ± 19.5

117.2 ± 6.9

< 0.0001

DBP(mmHg)

87.1 ± 10.2

74.2 ± 7.0

< 0.0001

83.4 ± 12.6

74.8 ± 5.0

< 0.0001

GLUCOSE (mg/dL)

91.3 ± 12.6

90.1 ± 11.7

0.65

86.2 ± 10.1

85.4 ± 9.04

0.55

Insulin (µU/mL)

18.8 ± 21.7 (13.5)

11.8 ± 6.4 (10)

0.01

17.4 ± 26.3 (11.7)

13.8 ± 15.04 (10.2)

0.19

HOMA-IR

4.6 ± 6.3 (3.0)

2.7 ± 1.5 (2.2)

0.01

3.9 ± 7.0 (2.4)

3.0 ± 3.9 (2.1)

0.23

HDL-C (mg/dL)

41 ± 11.1

50.4 ± 9.0

< 0.0001

47.1 ± 15.5

61.3 ± 8.5

< 0.0001

LDL-C (mg/dL)

123.8 ± 42.3

133.9 ± 49.0

0.28

121.9 ± 38.9

116 ± 40.9

0.30

TG (mg/dL)

135.6 ± 85.4 (117.5)

110.2 ± 52.3 (97.7)

0.06

113.3 ± 70.0 (100)

83.2 ± 34.9 (77.6)

< 0.0001

Total cholesterol (mg/dl)

191.9 ± 44.34

206.3 ± 54.6

0.15

191.7 ± 43.5

193.9 ± 44.9

0.73

Adiponectin (ng/mL)

5508.2 ± 2646.6 (4897.8)

7297.7 ± 4108.0 (6309.6)

0.03

6974.7 ± 4193.6 (5888.5)

9037.2 ± 5776.8 (7585.8)

0.01

**Table 5.** Association Between MHO Phenotype and Adiponectin Levels Among African Americans in Logistic Regression Models With Adjustment for Relevant Covariates
Dependant variable: MHO (yes = 1; no = 0)
B: coefficient, S.E. standard error of B, OR: estimated odds ratio, CI: confidence interval of OR; HTN: hypertension (0 = no hypertension, 1 = hypertension), WC = waist circumference, INS =log - insulin; ¥ PHA status was coded 1, if adiponectin level is above 8377.2 ng / mL and 11050.9 ng / mL for men and women respectively; or 0, if adiponectin level is below 8377.2 ng / mL and 11050.9 ng / mL for men and women respectively. * Denote significant P-value (P < 0.05)
Men	PHA ^¥	1.01 ± 0.50	2.8 (1.03 - 7.40)	0.04*
	PHA ^¥ ( age)	1.10 ± 0.51	2.9 (1.1 - 7.80)	0.04*
	PHA ^¥ (age, HTN)	1.30 ± 0.56	3.5 (1.2 - 10.55)	0.03*
	PHA ^¥ (age, HTN, WC)	1.20 ± 0.57	3.3 (1.1 - 10.02)	0.04*
	PHA ^¥ (age, HTN, WC, INS)	1.30 ± 0.59	3.6 (1.1 - 11.5)	0.03*
Women	PHA ^¥	0.72 ± 0.35	2.1 (1.04 - 4.10)	0.04*
	PHA ^¥ (age)	0.80 ± 0.4	2.2 (1.10 - 4.51)	0.03*
	PHA ^¥ (age, HTN)	0.90 ± 0.39	2.4 (1.10 - 5.03)	0.03*
	PHA ^¥ (age, HTN, WC)	0.65 ± 0.40	1.9 (0.90 - 4.20)	0.10
	PHA ^¥ (age, HTN, WC, INS)	0.61 ± 0.41	1.8 (0.80 - 4.12)	0.14

Table 5. Association Between MHO Phenotype and Adiponectin Levels Among African Americans in Logistic Regression Models With Adjustment for Relevant Covariates

Dependant variable: MHO (yes = 1; no = 0)

Gender

PHA: yes/no (covariates)

B ± S.E.

OR (95% CI)

P-value

B: coefficient, S.E. standard error of B, OR: estimated odds ratio, CI: confidence interval of OR; HTN: hypertension (0 = no hypertension, 1 = hypertension), WC = waist circumference, INS =log - insulin; ¥ PHA status was coded 1, if adiponectin level is above 8377.2 ng / mL and 11050.9 ng / mL for men and women respectively; or 0, if adiponectin level is below 8377.2 ng / mL and 11050.9 ng / mL for men and women respectively. * Denote significant P-value (P < 0.05)

Men

PHA ^¥

1.01 ± 0.50

2.8 (1.03 - 7.40)

0.04*

PHA ^¥ ( age)

1.10 ± 0.51

2.9 (1.1 - 7.80)

0.04*

PHA ^¥ (age, HTN)

1.30 ± 0.56

3.5 (1.2 - 10.55)

0.03*

PHA ^¥ (age, HTN, WC)

1.20 ± 0.57

3.3 (1.1 - 10.02)

0.04*

PHA ^¥ (age, HTN, WC, INS)

1.30 ± 0.59

3.6 (1.1 - 11.5)

0.03*

Women

PHA ^¥

0.72 ± 0.35

2.1 (1.04 - 4.10)

0.04*

PHA ^¥ (age)

0.80 ± 0.4

2.2 (1.10 - 4.51)

0.03*

PHA ^¥ (age, HTN)

0.90 ± 0.39

2.4 (1.10 - 5.03)

0.03*

PHA ^¥ (age, HTN, WC)

0.65 ± 0.40

1.9 (0.90 - 4.20)

0.10

PHA ^¥ (age, HTN, WC, INS)

0.61 ± 0.41

1.8 (0.80 - 4.12)

0.14