Temporal Changes in Concentrations of Lipids and Apolipoprotein B Among Adults With Diagnosed and Undiagnosed Diabetes, Prediabetes, and Normoglycemia

Findings From the National Health and Nutrition Examination Survey 1988-1991 to 2005-2008

Earl S Ford; Chaoyang Li; Allan Sniderman

Cardiovasc Diabetol. 2013;12(26)

Abstract

Background Diabetes is characterized by profound lipid abnormalities. The objective of this study was to examine changes in concentrations of lipids and apolipoprotein B among participants stratified by glycemic status (diabetes, undiagnosed diabetes, prediabetes, and normoglycemia) in the United States from 1988–1991 to 2005–2008.

Methods We used data from 3202 participants aged ≥20 years from the National Health and Nutrition Examination Survey (NHANES) III (1988–1991) and 3949 participants aged ≥20 years from NHANES 2005–2008.

Results Among participants of all four groups, unadjusted and adjusted mean concentrations of total cholesterol, low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein B, but not triglycerides, decreased significantly. Among participants with prediabetes and normoglycemia, unadjusted and adjusted mean concentrations of high-density lipoprotein cholesterol increased significantly. Adjusted mean log-transformed concentrations of triglycerides decreased in adults with undiagnosed diabetes and prediabetes. During 2005–2008, unadjusted concentrations of apolipoprotein B ≥80 mg/dl were observed in 72.8% of participants with diagnosed diabetes, 87.9% of participants with undiagnosed diabetes, 86.6% of participants with prediabetes, and 77.2% of participants with normoglycemia. The unadjusted use of cholesterol-lowering medications rose rapidly, especially among participants with diabetes (from ~1% to ~49%, P <0.001). The use of fenofibrate, gemfibrozil, and niacin rose significantly only among adults with diagnosed diabetes (from ~2% to ~8%, P = 0.011).

Conclusion Lipid profiles of adults with diabetes improved during the approximately 16-year study period. Nevertheless, large percentages of adults continue to have elevated concentrations of apolipoprotein B.

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Table 1. Unadjusted percentages, medians, or means (standard error) of selected sociodemographic and anthropometric characteristics among adults aged > =20 years, National Health and Nutrition Examination Survey 1988–1991 and 2005–2008
	Diagnosed diabetes			Undiagnosed diabetes			Prediabetes			Normal
	1988–1991	2005–2008	P*	1988–1991	2005–2008	P*	1988–1991	2005–2008	P*	1988–1991	2005–2008	P*
N	207	457		92	103		566	850		2337	2539
Age (years) - median	59.9 (1.6)	59.8 (1.1)	—	58.6 (2.1)	61.6 (3.0)	—	56.9 (2.2)	56.5 (0.9)	—	38.0 (0.8)	40.9 (0.8)	—
Age (%)			0.783			0.531			0.257			0.001
20–39 years	13.3 (4.3)	10.8 (1.7)		13.2 (4.8)	6.7 (3.0)		18.0 (2.7)	14.7 (1.4)		51.5 (1.6)	46.2 (1.4)
40–59 years	33.6 (4.8)	37.3 (2.6)		38.1 (6.5)	40.8 (6.2)		36.2 (3.3)	41.2 (1.9)		30.6 (1.5)	38.8 (1.4)
≥60 years	53.1 (3.8)	51.9 (2.9)		48.7 (6.6)	52.5 (6.5)		45.9 (4.3)	44.1 (2.1)		17.9 (1.5)	15.0 (1.4)
Men (%)	36.4 (5.7)	44.4 (3.0)	0.221	49.5 (7.9)	56.6 (6.1)	0.482	53.3 (3.1)	47.9 (2.3)	0.170	47.9 (1.3)	48.8 (1.0)	0.567
Race or ethnicity (%)			0.268			0.932			0.020			0.004
White	73.4 (4.3)	65.3 (4.3)		53.3 (6.3)	55.3 (6.9)		63.9 (5.0)	66.7 (3.4)		81.1 (2.2)	73.7 (2.0)
African American	15.1 (3.6)	17.3 (2.9)		29.8 (4.9)	28.3 (4.0)		24.0 (3.1)	17.4 (2.5)		7.7 (1.0)	8.3 (1.1)
Mexican American	8.4 (1.4)	8.2 (1.4)		8.1 (2.6)	9.9 (2.7)		4.8 (0.5)	7.3 (1.3)		4.7 (0.6)	8.0 (0.9)
Other	3.1 (2.2)	9.2 (2.3)		8.8 (5.9)	6.6 (3.1)		7.3 (2.4)	8.6 (1.9)		6.5 (1.7)	9.9 (1.1)
≥High school graduates (%)	57.4 (5.5)	70.4 (2.2)	0.030	50.2 (5.4)	71.7 (4.8)	0.013	60.3 (2.8)	77.7 (1.7)	<0.001	79.4 (1.9)	84.4 (1.2)	0.034
Body mass index ≥30 kg/m² (%)	38.2 (5.8)	61.7 (2.8)	0.001	60.3 (7.1)	68.4 (6.2)	0.378	28.2 (2.5)	43.0 (2.0)	<0.001	17.4 (1.3)	27.5 (1.3)	<0.001
Body mass index (kg/m²)	29.6 (0.7)	32.8 (0.5)	0.001	32.6 (1.8)	34.8 (1.3)	0.343	27.6 (0.3)	30.2 (0.3)	<0.001	25.7 (0.2)	27.5 (0.2)	<0.001
HbA1c (%)	6.8 (0.2)	7.2 (0.1)	0.060	7.8 (0.3)	7.5 (0.2)	0.345	5.9 (<0.1)	5.9 (<0.1)	0.024	5.0 (<0.1)	5.2 (<0.1)	<0.001

*P-value from chi-square test for categorical variables and from t-test for means.

Table 2. Unadjusted and least-square adjusted mean concentrations (standard error) of lipids and apolipoprotein B among adults aged ≥20 years, by glycemic status and survey, National Health and Nutrition Examination Surveys 1988–1991 and 2005–2006
	Diagnosed diabetes			Undiagnosed diabetes			Prediabetes			Normal
	1988–1991	2005–2008	P*	1988–1991	2005–2008	P*	1988–1991	2005–2008	P*	1988–1991	2005–2008	P*
N	207	457		92	103		566	850		2337	2539
Unadjusted
Total cholesterol (mg/dl)	215.0 (3.6)	181.0 (2.3)	<0.001	223.0 (5.0)	200.4 (4.8)	0.002	218.0 (1.7)	202.9 (1.8)	<0.001	200.5 (1.4)	195.0 (0.9)	0.002
High-density lipoprotein cholesterol (mg/dl)	49.1 (1.6)	50.7 (1.0)	0.390	44.9 (1.8)	47.7 (1.6)	0.234	48.0 (0.7)	53.6 (0.7)	<0.001	51.8 (0.7)	55.7 (0.4)	<0.001
Low-density lipoprotein cholesterol (mg/dl)	135.4 (2.9)	100.5 (1.8)	<0.001	143.3 (3.8)	121.7 (4.3)	<0.001	142.6 (1.8)	122.3 (1.4)	<0.001	124.8 (1.3)	115.4 (0.9)	<0.001
Non-high-density lipoprotein cholesterol (mg/dl)	166.0 (4.4)	130.3 (2.0)	<0.001	178.1 (4.6)	152.7 (4.4)	<0.001	170.0 (1.8)	149.3 (1.8)	<0.001	148.8 (1.5)	139.3 (1.0)	<0.001
Triglycerides (mg/dl)†	153.1 (9.8)	148.9 (4.0)	0.687	173.6 (10.1)	155.4 (10.1)	0.207	137.0 (4.2)	136.9 (3.6)	0.985	119.6 (3.6)	119.5 (1.7)	0.974
Triglycerides (mg/dl)‡	137.8 (9.7)	133.0 (3.6)	0.634	158.4 (9.2)	135.0 (9.4)	0.084	122.0 (3.5)	122.1 (2.9)	0.970	104.3 (3.2)	104.6 (1.6)	0.933
Apolipoprotein B (mg/dl)	114.2 (2.7)	96.3 (1.5)	<0.001	120.3 (3.4)	110.4 (3.1)	0.035	115.6 (1.3)	106.2 (1.2)	<0.001	102.0 (0.9)	98.6 (0.8)	0.011
Age-adjusted
Total cholesterol (mg/dl)	206.7 (3.5)	172.3 (2.5)	<0.001	215.2 (4.5)	191.3 (4.7)	0.001	211.0 (1.7)	195.9 (1.8)	<0.001	202.9 (1.4)	197.0 (0.8)	<0.001
High-density lipoprotein cholesterol (mg/dl)	47.5 (1.6)	49.1 (1.0)	0.418	43.4 (1.7)	46.0 (1.6)	0.265	46.7 (0.7)	52.3 (0.7)	<0.001	52.2 (0.7)	56.0 (0.4)	<0.001
Low-density lipoprotein cholesterol (mg/dl)	130.2 (2.8)	95.1 (2.0)	<0.001	138.5 (3.7)	116.0 (4.3)	<0.001	138.3 (1.8)	118.0 (1.5)	<0.001	126.3 (1.3)	116.7 (0.8)	<0.001
Non-high-density lipoprotein cholesterol (mg/dl)	159.2 (4.3)	123.3 (2.2)	<0.001	171.8 (4.3)	145.2 (4.3)	<0.001	164.3 (1.9)	143.7 (1.8)	<0.001	150.7 (1.5)	141.0 (0.9)	<0.001
Triglycerides (mg/dl)†	145.1 (9.6)	140.5 (4.2)	0.662	166.1 (9.8)	146.6 (9.7)	0.160	130.2 (4.4)	130.1 (3.5)	0.993	121.9 (3.6)	121.5 (1.6)	0.912
Triglycerides (mg/dl)‡	127.9 (8.9)	123.0 (3.6)	0.601	147.7 (8.3)	124.3 (8.3)	0.052	114.5 (3.3)	114.7 (2.5)	0.957	106.5 (3.2)	106.5 (1.5)	1.000
Apolipoprotein B (mg/dl)	109.9 (2.7)	91.9 (1.6)	<0.001	116.3 (3.2)	105.7 (3.1)	0.024	112.0 (1.3)	102.6 (1.2)	<0.001	103.2 (0.9)	99.7 (0.7)	0.006
Adjusted for age, gender, race or ethnicity, education, and body mass index
Total cholesterol (mg/dl)	205.6 (3.3)	169.6 (2.5)	<0.001	213.0 (4.7)	187.6 (4.3)	<0.001	211.5 (1.8)	194.7 (1.9)	<0.001	203.7 (1.3)	197.0 (0.8)	<0.001
High-density lipoprotein cholesterol (mg/dl)	48.1 (1.2)	52.2 (1.0)	0.010	46.6 (2.0)	51.1 (2.1)	0.128	46.9 (0.7)	53.7 (0.7)	<0.001	51.2 (0.6)	56.0 (0.3)	<0.001
Low-density lipoprotein cholesterol (mg/dl)	129.2 (2.6)	91.8 (1.9)	<0.001	135.1 (4.2)	110.6 (3.8)	<0.001	138.0 (1.9)	116.3 (1.5)	<0.001	127.4 (1.3)	116.8 (0.7)	<0.001
Non-high-density lipoprotein cholesterol (mg/dl)	157.5 (3.9)	117.4 (2.2)	<0.001	166.4 (5.3)	136.4 (3.7)	<0.001	164.6 (1.9)	141.0 (1.9)	<0.001	152.6 (1.3)	141.0 (0.8)	<0.001
Triglycerides (mg/dl)†	141.7 (8.2)	128.2 (4.3)	0.153	156.3 (11.5)	129.6 (11.4)	0.100	133.0 (3.8)	125.2 (3.5)	0.137	125.9 (3.2)	120.9 (1.6)	0.161
Triglycerides (mg/dl)‡	124.4 (7.2)	111.0 (3.3)	0.078	136.3 (10.0)	108.0 (8.6)	0.032	117.5 (2.7)	110.1 (2.3)	0.041	110.2 (2.9)	105.9 (1.4)	0.179
Apolipoprotein B (mg/dl)	108.7 (2.5)	88.0 (1.5)	<0.001	112.5 (3.4)	99.7 (2.8)	0.005	111.8 (1.5)	100.8 (1.2)	<0.001	104.4 (0.9)	99.8 (0.6)	<0.001

*P-values from linear regression analyses.
†Untransformed mean.
†Geometric mean.

Table 3. Unadjusted and least-square adjusted mean concentrations (standard error) of lipids and apolipoprotein B among adults aged ≥20 years, by glycemic status and survey, National Health and Nutrition Examination Survey 1988–1991 and 2005–2006
	Diagnosed diabetes			Undiagnosed diabetes			Prediabetes			Normal
	1988–1991	2005–2008	P*	1988–1991	2005–2008	P*	1988–1991	2005–2008	P*	1988–1991	2005–2008	P*
N	200	211		91	67		545	634		2302	2290
Unadjusted
Total cholesterol (mg/dl)	214.4 (3.7)	194.6 (3.2)	<0.001	224.5 (5.0)	208.8 (6.0)	0.051	217.5 (1.7)	209.9 (2.2)	0.008	199.9 (1.3)	196.0 (1.2)	0.034
High-density lipoprotein cholesterol (mg/dl)	48.8 (1.6)	51.2 (1.5)	0.287	44.8 (1.8)	46.3 (2.0)	0.580	48.1 (0.7)	53.5 (0.9)	<0.001	51.8 (0.7)	55.9 (0.5)	<0.001
Low-density lipoprotein cholesterol (mg/dl)	134.7 (3.0)	113.8 (2.6)	<0.001	144.8 (3.9)	130.0 (5.3)	0.028	142.2 (1.8)	129.8 (1.6)	<0.001	124.3 (1.3)	116.7 (1.1)	<0.001
Non-high-density lipoprotein cholesterol (mg/dl)	165.6 (4.6)	143.5 (3.2)	<0.001	179.7 (4.5)	162.5 (5.5)	0.019	169.4 (1.8)	156.4 (2.1)	<0.001	148.1 (1.5)	140.1 (1.2)	<0.001
Triglycerides (mg/dl)†	154.5 (9.8)	148.1 (7.4)	0.604	174.0 (10.4)	163.2 (11.9)	0.496	135.9 (4.3)	135.8 (3.7)	0.987	118.8 (3.6)	116.9 (1.7)	0.639
Triglycerides (mg/dl)‡	139.1 (9.9)	131.2 (7.1)	0.513	158.3 (9.6)	140.6 (12.1)	0.263	120.9 (3.7)	120.5 (3.0)	0.936	103.8 (3.2)	102.3 (1.6)	0.674
Apolipoprotein B (mg/dl)	113.8 (2.8)	103.2 (2.4)	0.005	121.7 (3.1)	116.9 (3.6)	0.321	115.1 (1.2)	109.6 (1.3)	0.003	101.6 (0.9)	98.7 (1.0)	0.041
Age-adjusted
Total cholesterol (mg/dl)	202.5 (3.7)	185.8 (3.6)	0.002	212.9 (4.4)	198.4 (6.3)	0.070	207.4 (1.8)	202.1 (2.0)	0.048	201.6 (1.2)	198.5 (1.1)	0.062
High-density lipoprotein cholesterol (mg/dl)	46.9 (1.6)	49.7 (1.5)	0.202	42.9 (1.8)	44.6 (2.0)	0.528	46.5 (0.7)	52.2 (0.9)	<0.001	52.1 (0.7)	56.3 (0.4)	<0.001
Low-density lipoprotein cholesterol (mg/dl)	126.6 (2.9)	107.8 (2.9)	<0.001	137.0 (3.7)	122.9 (5.7)	0.046	135.3 (1.9)	124.5 (1.5)	<0.001	125.5 (1.3)	118.4 (1.1)	<0.001
Non-high-density lipoprotein cholesterol (mg/dl)	155.6 (4.5)	136.1 (3.6)	0.001	170.0 (4.1)	153.8 (5.7)	0.028	160.9 (2.0)	149.9 (2.0)	<0.001	149.5 (1.4)	142.2 (1.2)	<0.001
Triglycerides (mg/dl)†	145.2 (9.6)	141.2 (7.6)	0.743	164.9 (10.0)	155.0 (11.5)	0.518	127.9 (4.4)	129.7 (3.6)	0.755	120.2 (3.6)	118.9 (1.7)	0.750
Triglycerides (mg/dl)‡	127.6 (9.0)	123.1 (6.9)	0.683	145.6 (8.5)	130.4 (11.0)	0.283	112.3 (3.4)	113.9 (2.6)	0.713	105.1 (3.2)	104.2 (1.6)	0.797
Apolipoprotein B (mg/dl)	107.8 (2.7)	98.7 (2.6)	0.019	115.8 (2.9)	111.6 (3.8)	0.388	109.9 (1.4)	105.7 (1.2)	0.018	102.4 (0.9)	100.0 (0.9)	0.066
Adjusted for age, gender, race or ethnicity, education, and body mass index
Total cholesterol (mg/dl)	201.7 (3.5)	183.7 (3.4)	<0.001	211.3 (4.7)	193.9 (6.2)	0.029	208.0 (1.9)	200.7 (2.1)	0.010	202.2 (1.2)	198.4 (1.0)	0.018
High-density lipoprotein cholesterol (mg/dl)	48.0 (1.2)	52.9 (1.4)	0.009	46.8 (2.1)	51.0 (2.5)	0.213	47.0 (0.7)	53.9 (0.8)	<0.001	51.2 (0.6)	56.3 (0.4)	<0.001
Low-density lipoprotein cholesterol (mg/dl)	125.6 (2.7)	104.8 (2.8)	<0.001	133.7 (4.3)	116.3 (5.6)	0.016	135.0 (2.0)	122.5 (1.5)	<0.001	126.2 (1.2)	118.5 (0.9)	<0.001
Non-high-density lipoprotein cholesterol (mg/dl)	153.7 (4.0)	130.8 (3.4)	<0.001	164.5 (5.3)	143.0 (5.9)	0.009	160.9 (2.0)	146.9 (2.0)	<0.001	150.9 (1.2)	142.1 (0.9)	<0.001
Triglycerides (mg/dl)†	140.6 (8.2)	129.7 (7.4)	0.324	154.1 (11.9)	134.0 (13.2)	0.258	129.6 (3.7)	124.4 (3.8)	0.319	123.4 (3.2)	118.1 (1.6)	0.141
Triglycerides (mg/dl)‡	122.9 (7.3)	111.7 (6.0)	0.224	133.2 (10.3)	109.4 (10.4)	0.107	114.3 (2.7)	109.0 (2.5)	0.148	108.0 (2.8)	103.4 (1.4)	0.146
Apolipoprotein B (mg/dl)	106.4 (2.6)	95.0 (2.5)	0.002	111.8 (3.2)	104.2 (4.0)	0.148	109.6 (1.5)	103.5 (1.2)	0.002	103.4 (0.9)	100.0 (0.7)	0.006

Participants who reported using cholesterol-lowering medications, fenofibrate, gemfibrozil, and niacin were excluded.
*P-values from linear regression analyses.
†Untransformed mean.
‡Geometric mean.

Table 4. Unadjusted and adjusted percentages (standard error) of lipids and apolipoprotein B among adults aged ≥20 years, by glycemic status and survey, National Health and Nutrition Examination Surveys 1988–1991 and 2005–2006
	Diagnosed diabetes			Undiagnosed diabetes			Prediabetes			Normal
	1988–1991	2005–2008	P*	1988–1991	2005–2008	P*	1988–1991	2005–2008	P*	1988–1991	2005–2008	P*
N	207	457		92	103		566	850		2337	2539
Unadjusted
High-density lipoprotein cholesterol <40 mg/dl in men, <50 mg/dl in women	46.4 (5.8)	37.2 (3.0)	0.165	57.5 (8.7)	34.4 (6.4)	0.037	41.8 (2.8)	24.9 (1.7)	<0.001	33.3 (1.7)	22.4 (1.1)	<0.001
High-density lipoprotein cholesterol <40 mg/dl in men, <50 mg/dl in women or medication use^†	47.9 (5.8)	40.7 (3.0)	0.275	57.5 (8.7)	37.5 (6.5)	0.071	43.4 (3.1)	26.4 (1.6)	<0.001	33.6 (1.6)	23.0 (1.0)	<0.001
Low-density lipoprotein cholesterol ≥100 mg/dl	86.1 (4.7)	42.9 (2.6)	<0.001	91.5 (3.3)	70.3 (4.9)	0.001	90.0 (1.4)	75.0 (1.7)	<0.001	74.4 (1.8)	66.0 (1.2)	<0.001
Low-density lipoprotein cholesterol ≥100 mg/dl or medication use	86.1 (4.7)	79.1 (2.4)	0.183	94.4 (2.4)	87.0 (4.9)	0.180	90.1 (1.4)	88.4 (1.3)	0.365	74.4 (1.8)	70.6 (1.2)	0.085
Non-high-density lipoprotein cholesterol ≥130 mg/dl	81.9 (5.5)	43.6 (2.8)	<0.001	91.7 (3.4)	67.5 (5.4)	<0.001	85.0 (1.5)	67.9 (1.9)	<0.001	65.2 (1.7)	57.8 (0.8)	<0.001
Triglycerides ≥150 mg/dl	44.7 (7.0)	43.9 (2.7)	0.909	54.3 (5.8)	43.0 (6.9)	0.215	33.9 (1.9)	33.2 (2.1)	0.797	24.7 (2.3)	24.7 (1.1)	0.997
Triglycerides ≥150 mg/dl or medication use^†	46.9 (6.9)	47.8 (3.0)	0.905	54.3 (5.8)	44.1 (7.1)	0.271	35.9 (1.9)	34.6 (2.0)	0.625	24.9 (2.3)	25.1 (1.0)	0.936
Triglycerides ≥150 mg/dl or use of TG-lowering or cholesterol-lowering medications^‡	47.6 (6.7)	73.5 (2.9)	0.001	54.3 (5.8)	67.4 (5.9)	0.121	36.9 (2.0)	50.2 (2.1)	<0.001	25.3 (2.4)	30.3 (1.3)	0.070
Apolipoprotein B ≥80 mg/dl	91.1 (3.6)	72.8 (2.1)	<0.001	95.8 (2.8)	87.9 (4.2)	0.123	92.8 (1.3)	86.6 (1.4)	0.002	81.7 (1.3)	77.2 (1.0)	0.007
Lipid triad: definition 1^Â§	31.4 (6.5)	21.6 (2.8)	0.172	35.7 (7.7)	23.4 (5.2)	0.190	20.7 (1.7)	13.8 (1.2)	0.002	13.1 (1.5)	9.8 (0.7)	0.050
Lipid triad: definition 2^∥	33.3 (6.4)	24.8 (2.7)	0.228	35.7 (7.7)	24.0 (5.3)	0.212	23.3 (1.9)	15.2 (1.1)	0.001	13.5 (1.4)	10.4 (0.7)	0.056
Lipid triad: definition 3^Â¶	33.3 (6.4)	26.6 (2.8)	0.342	35.7 (7.7)	25.4 (5.8)	0.287	23.8 (2.1)	16.1 (1.1)	0.002	13.7 (1.5)	10.9 (0.7)	0.102
Age-adjusted
High-density lipoprotein cholesterol <40 mg/dl in men, <50 mg/dl in women	51.5 (6.8)	41.5 (3.3)	0.180	63.4 (9.5)	38.7 (7.4)	0.042	45.6 (3.0)	27.2 (1.9)	<0.001	32.4 (1.6)	21.9 (1.0)	<0.001
High-density lipoprotein cholesterol <40 mg/dl in men, <50 mg/dl in women or medication use^†	52.1 (6.7)	44.5 (3.3)	0.293	62.2 (9.3)	41.2 (7.3)	0.078	46.6 (3.4)	28.3 (1.8)	<0.001	32.8 (1.6)	22.5 (1.0)	<0.001
Low-density lipoprotein cholesterol ≥100 mg/dl	80.9 (4.4)	40.2 (2.4)	<0.001	86.2 (3.3)	65.5 (4.6)	0.001	85.2 (1.4)	71.1 (1.7)	<0.001	75.8 (1.7)	67.1 (1.2)	<0.001
Low-density lipoprotein cholesterol ≥100 mg/dl or medication use	78.1 (4.2)	71.4 (2.2)	0.154	86.1 (2.7)	78.1 (4.3)	0.127	82.8 (1.3)	81.4 (1.4)	0.386	76.6 (1.7)	72.5 (1.2)	0.062
Non-high-density lipoprotein cholesterol ≥130 mg/dl	74.2 (5.1)	39.3 (2.6)	<0.001	83.6 (3.7)	60.5 (4.8)	<0.001	78.0 (1.6)	62.5 (1.9)	<0.001	67.1 (1.6)	59.4 (0.8)	<0.001
Triglycerides ≥150 mg/dl	38.6 (6.1)	37.7 (2.6)	0.882	47.4 (4.7)	36.6 (5.8)	0.155	29.8 (2.0)	29.3 (1.9)	0.832	25.8 (2.4)	25.7 (1.1)	0.970
Triglycerides ≥150 mg/dl or medication use^†	40.1 (5.9)	40.6 (2.8)	0.936	46.9 (4.7)	37.2 (5.9)	0.198	31.4 (1.8)	30.3 (1.8)	0.649	26.2 (2.3)	26.3 (1.0)	0.970
Triglycerides ≥150 mg/dl or use of TG-lowering or cholesterol-lowering medications^‡	38.1 (5.4)	58.4 (2.7)	0.001	44.2 (4.4)	52.9 (4.5)	0.160	30.3 (1.9)	41.6 (1.8)	<0.001	27.2 (2.4)	32.3 (1.3)	0.075
Apolipoprotein B ≥80 mg/dl	85.4 (3.2)	68.1 (2.1)	<0.001	90.2 (2.9)	81.9 (4.0)	0.096	87.8 (1.3)	82.0 (1.4)	0.001	83.3 (1.3)	78.5 (0.9)	0.005
Lipid triad: definition 1^Â§	30.0 (6.4)	20.6 (2.8)	0.174	34.3 (7.2)	22.3 (5.1)	0.179	20.0 (1.8)	13.3 (1.1)	0.002	13.3 (1.5)	9.9 (0.7)	0.048
Lipid triad: definition 2^∥	30.9 (6.2)	22.9 (2.6)	0.226	33.3 (6.9)	22.0 (4.9)	0.194	21.8 (1.8)	14.2 (1.1)	<0.001	13.8 (1.4)	10.6 (0.7)	0.053
Lipid triad: definition 3^Â¶	30.5 (6.1)	24.2 (2.7)	0.336	32.9 (6.9)	23.0 (5.3)	0.262	22.0 (2.0)	14.9 (1.1)	0.002	14.0 (1.5)	11.2 (0.7)	0.098
Adjusted for age, gender, race or ethnicity, education, and body mass index
High-density lipoprotein cholesterol <40 mg/dl in men, <50 mg/dl in women	45.8 (5.7)	34.8 (3.0)	0.073	50.6 (10.4)	31.0 (7.0)	0.111	47.6 (2.9)	25.6 (1.8)	<0.001	34.0 (1.8)	21.9 (1.1)	<0.001
High-density lipoprotein cholesterol <40 mg/dl in men, <50 mg/dl in women or medication use^†	46.7 (5.6)	37.6 (3.1)	0.131	50.3 (10.0)	33.3 (7.1)	0.157	48.6 (3.2)	26.7 (1.7)	<0.001	34.4 (1.7)	22.5 (1.0)	<0.001
Low-density lipoprotein cholesterol ≥100 mg/dl	79.8 (4.1)	38.1 (2.3)	<0.001	82.2 (3.1)	60.3 (3.8)	<0.001	85.6 (1.7)	69.2 (1.9)	<0.001	77.4 (1.8)	67.0 (1.2)	<0.001
Low-density lipoprotein cholesterol ≥100 mg/dl or medication use	77.6 (3.9)	67.8 (2.2)	0.024	82.8 (2.6)	71.8 (4.0)	0.018	83.6 (1.6)	79.3 (1.6)	0.018	78.1 (1.8)	72.4 (1.2)	0.012
Non-high-density lipoprotein cholesterol ≥130 mg/dl	72.1 (4.5)	35.6 (2.4)	<0.001	76.6 (4.0)	51.9 (3.9)	<0.001	79.2 (1.9)	59.7 (2.0)	<0.001	69.8 (1.6)	59.3 (0.8)	<0.001
Triglycerides ≥150 mg/dl	36.9 (5.3)	32.6 (2.4)	0.444	41.5 (7.2)	29.2 (6.0)	0.183	31.8 (1.9)	27.7 (1.9)	0.090	27.6 (2.4)	25.3 (1.0)	0.376
Triglycerides ≥150 mg/dl or medication use^†	38.4 (5.1)	35.3 (2.6)	0.558	41.3 (7.1)	29.8 (6.1)	0.209	33.4 (1.6)	28.7 (1.7)	0.025	28.0 (2.4)	25.8 (0.9)	0.399
Triglycerides ≥150 mg/dl or use of TG-lowering or cholesterol-lowering medications^‡	37.0 (4.9)	51.2 (2.8)	0.009	40.1 (5.7)	42.9 (5.2)	0.707	32.0 (1.8)	39.4 (1.8)	0.001	28.9 (2.5)	32.0 (1.2)	0.255
Apolipoprotein B ≥80 mg/dl	84.1 (3.1)	64.5 (2.0)	<0.001	85.8 (3.1)	75.5 (3.4)	0.017	88.2 (1.6)	80.0 (1.5)	<0.001	84.9 (1.2)	78.5 (0.9)	<0.001
Lipid triad: definition 1^Â§	27.6 (5.6)	17.7 (2.5)	0.099	28.4 (8.0)	17.6 (5.0)	0.240	21.7 (1.8)	12.7 (1.1)	<0.001	14.1 (1.5)	9.8 (0.7)	0.013
Lipid triad: definition 2^∥	28.7 (5.5)	19.7 (2.4)	0.117	28.2 (7.6)	17.5 (4.9)	0.227	23.7 (1.8)	13.6 (1.0)	<0.001	14.7 (1.5)	10.4 (0.7)	0.012
Lipid triad: definition 3	28.3 (5.4)	20.8 (2.4)	0.186	27.9 (7.3)	18.1 (5.0)	0.260	23.7 (1.9)	14.1 (1.0)	<0.001	14.9 (1.5)	11.1 (0.7)	0.028

*P-values for difference of predicted marginal from log-linear regressions.
†Use of fenofibrate, gemfibrozil, and niacin.
‡Use of cholesterol-lowering medications as well as fenofibrate, gemfibrozil, and niacin.
§Definition 1 was based on measured values of concentrations of high-density lipoprotein cholesterol, triglycerides, and apolipoprotein B.
∥Definition 2: use of fenofibrate, gemfibrozil, and niacin was counted as having elevated concentrations of triglycerides and decreased concentrations of high-density lipoprotein cholesterol.
¶Definition 3: use of cholesterol-lowering medications, fenofibrate, gemfibrozil, and niacin was counted as having elevated concentrations of triglycerides and use of fenofibrate, gemfibrozil, and niacin was counted as having decreased concentrations of high-density lipoprotein cholesterol.

Table 5. Unadjusted Pearson correlation coefficients among triglycerides, non-high-density lipoprotein cholesterol, and apolipoprotein B among adults aged ≥20 years, National Health and Nutrition Examination Survey 2005–2008
Glycemic status	Ln(TG) and non-HDLC	Ln(TG) and apo B	non-HDLC and apo B
Diagnosed diabetes	0.40	0.40	0.96
Undiagnosed diabetes	0.45	0.37	0.95
Prediabetes	0.51	0.45	0.90
Normal	0.51	0.49	0.95

apo B = apolipoprotein B; non-HDLC = non-high-density lipoprotein cholesterol; TG = triglycerides.

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Temporal Changes in Concentrations of Lipids and Apolipoprotein B Among Adults With Diagnosed and Undiagnosed Diabetes, Prediabetes, and Normoglycemia

Findings From the National Health and Nutrition Examination Survey 1988-1991 to 2005-2008

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