Prevalence of hypertriglyceridemic-waist phenotype and its association with type 2 diabetes mellitus among middle-aged and older adults of Amerindian ancestry

BACKGROUND: The hypertriglyceridemic-waist phenotype (HTWP), defined by concurrent hypertriglyceridemia and increased waist circumference, is a recognized marker of metabolic and cardiovascular risk. While extensively studied across populations, data on Amerindian communities remain scarce. This study examines HTWP prevalence and its association with type 2 diabetes mellitus in middle-aged and older adults of Amerindian ancestry in rural Ecuador. METHODS: This population-based cross-sectional study was conducted in 3 ethnically homogeneous villages. Participants aged ≥40 years underwent standardized assessments, including structured interviews and fasting blood tests. HTWP was defined using serum triglyceride levels ≥150 mg/dL together with increased waist circumference determined by 2 criteria: Amerindian-specific (men ≥ 89 cm, women ≥83 cm) and NCEP-ATP III (men ≥102 cm, women ≥88 cm). Logistic regression models assessed associations between HTWP and diabetes indicators, adjusting for demographics and cardiovascular risk factors. RESULTS: Among 1354 participants, HTWP prevalence was 47% by Amerindian-specific, and 30% using NCEP-ATP III criteria. Hypertriglyceridemia was frequent (55%), particularly in men. In multivariate models, HTWP was associated with fasting glucose ≥126 mg/dL under both Amerindian-specific (OR 1.32, 95% CI 1.02-1.71) and NCEP-ATP III (OR 1.50, 95% CI 1.12-2.01) criteria. When HTWP components were separately included in the models, only hypertriglyceridemia remained significantly associated with diabetes risk. No significant association was observed between HTWP and HbA1c levels. CONCLUSION: HTWP prevalence is high in this population. Hypertriglyceridemia drives diabetes risk more than waist circumference. Findings underscore the need for ethnicity-specific cardiovascular risk assessments and targeted health interventions for indigenous communities.