Even though insulin resistance, cardiovascular disease (CVD), and type 2 diabetes (T2D) are associated with hypertriglyceridemia, blacks with these conditions usually have normal triglyceride (TG) levels. This is often called a lipid paradox. More precisely, it is a "TG paradox." The pathways that lead to hypertriglyceridemia have been intensively explored. Yet, the pathways that allow TG levels to be normal in the presence of insulin resistance have received little attention and this is problematic. Tests designed for the early detection of insulin-resistant conditions often use elevated TG levels as a diagnostic criterion. However, insulin resistance, CVD, and T2D are not usually associated with hypertriglyceridemia in people of African descent; therefore, the widespread use of TG levels to predict these conditions needs re-evaluation. This review focuses on black-white differences in: (1) the lipid profile across North America, Europe, and Africa; (2) the efficacy of TG-based screening tests, specifically the metabolic syndrome and its two abbreviated versions, the hypertriglycerdemic waist and TG/high-density lipoprotein cholesterol (HDL-C) ratio; and (3) the mechanisms that allow TG to be normal even in the presence of insulin resistance. Overall, a broader understanding of how TG physiology varies by race could lead to better diagnostic tests and improved health outcomes.

Food insecurity is defined as limited or uncertain ability to acquire nutritionally adequate and safe foods in socially acceptable ways. The United States Department of Agriculture (USDA) has divided food insecurity into two categories: low food security and very low food security. Low food security is characterized by irregular access to food, binge eating when food is available, overconsumption of energy-dense foods, obesity, and even type 2 diabetes. This type of food insecurity occurs in impoverished urban areas of high-income countries such as the United States. In contrast, very low food security is distinctly different from low food security and can lead to undernutrition and frank starvation. Very low food security is found in developing countries in both rural areas and urban slums. In these countries, food insecurity is often exacerbated by natural disasters and climate changes that compromise food availability. With a focus on the social, economic, and behavioral factors that promote obesity and cardiometabolic disease in food insecure households in the United States, this review will first define the key terms and concepts associated with food insecurity. Then, the characteristics of food insecure households and the relationship to cardiometabolic disease will be discussed. Finally, the cardiac consequences of food insecurity in developing countries will be briefly described.

OBJECTIVEMetabolic risk and metabolic syndrome (MetSyn) prevalence were compared in Africans who immigrated to the U.S. and African Americans. If MetSyn were an effective predictor of cardiometabolic risk, then the group with a worse metabolic risk profile would have a higher rate of MetSyn.RESEARCH DESIGN AND METHODSCross-sectional analyses were performed on 95 men (39 Africans, 56 African Americans, age 38 ± 6 years [mean ± SD]). Glucose tolerance was determined by oral glucose tolerance test, visceral adipose tissue (VAT) was determined by computerized tomography, and MetSyn was determined by the presence of three of five factors: central obesity, hypertriglyceridemia, low levels of HDL cholesterol, hypertension, and fasting hyperglycemia.RESULTSMetSyn prevalence was similar in Africans and African Americans (10 vs. 13%, P = 0.74), but hypertension, glycemia (fasting and 2-h glucose), and VAT were higher in Africans.CONCLUSIONSAfrican immigrants have a worse metabolic profile than African Americans but a similar prevalence of MetSyn. Therefore, MetSyn may underpredict metabolic risk in Africans.

Background: The prevalence of cardiometabolic disease in Africa now rivals that of Western nations. Therefore, screening programs that lead to effective prevention of cardiometabolic disease in Africans is imperative. Most screening tests for cardiometabolic disease use triglyceride (TG) levels as a criterion. However, the failure rate of TG-based screening tests in African Americans is high. In Africans, the efficacy of TG-based screening tests is unknown. Our goal was to determine the association between hypertriglyceridemia (TG ‡ 150 mg/dL) and cardiometabolic disease in African and African-American men. Research Design and Methods: This was a cross-sectional study of 155 men (80 African immigrants, 75 African Americans) [age, 35 -9 years, mean -standard deviation (SD), body mass index (BMI) 28.5 -5.2 kg/m 2 ] who self-identified as healthy. Lipid profiles were performed. Glucose tolerance and insulin resistance was determined by oral glucose tolerance tests (OGTT) and the insulin sensitivity index (S I ), respectively. Cardiometabolic disease was defined by four possible subtypes-prediabetes, diabetes, insulin resistance, or metabolic triad [hyperinsulinemia, hyperapolipoprotein B, small low-density lipoprotein (LDL) particles]. Results: TG levels were higher in men with cardiometabolic disease than without (88 -43 versus 61 -26 mg/dL, P < 0.01). However, < 10% of men with cardiometabolic disease had TG ‡ 150 mg/dL. Even within each cardiometabolic disease subtype, the prevalence of TG ‡ 150 mg/dL was < 10%. Furthermore, TG levels in the 5% of men identified by OGTT as diabetic were £ 100 mg/dL (mean 71 -24, range 45-100 mg/dL). Conclusions: Hypertriglyceridemia is a poor marker of cardiometabolic disease in men of African descent. Therefore TG-based screening tests fail to identify both African immigrants and African-American men with cardiometabolic disease. As a consequence, the opportunity for early intervention and prevention is lost.

Muniyappa R, Sachdev V, Sidenko S, Ricks M, Castillo DC, Courville AB, Sumner AE. Postprandial endothelial function does not differ in women by race: an insulin resistance paradox? Am J Physiol Endocrinol Metab 302: E218 -E225, 2012. First published November 1, 2011; doi:10.1152/ajpendo.00434.2011.-Insulin resistance is associated with endothelial dysfunction. Because AfricanAmerican women are more insulin-resistant than white women, it is assumed that African-American women have impaired endothelial function. However, racial differences in postprandial endothelial function have not been examined. In this study, we test the hypothesis that African-American women have impaired postprandial endothelial function compared with white women. Postprandial endothelial function following a breakfast (20% protein, 40% fat, and 40% carbohydrate) was evaluated in 36 (18 AfricanAmerican women, 18 white women) age-and body mass index (BMI)-matched (age: 37 Ϯ 11 yr; BMI: 30 Ϯ 6 kg/m 2 ) women. Endothelial function, defined by percent change in brachial artery flow-mediated dilation (FMD), was measured at 0, 2, 4, and 6 h following a meal. There were no significant differences between the groups in baseline FMD, total body fat, abdominal visceral fat, and fasting levels of glucose, insulin, total cholesterol, low-density lipoprotein cholesterol, or serum estradiol. Although AfricanAmerican women were less insulin-sensitive [insulin sensitivity index (mean Ϯ SD): 3.6 Ϯ 1.5 vs. 5.2 Ϯ 2.6, P ϭ 0.02], both fasting triglyceride (TG: 56 Ϯ 37 vs. 97 Ϯ 49 mg/dl, P ϭ 0.007) and incremental TG area under the curve (AUC0 -6hr: 279 Ϯ 190 vs. 492 Ϯ 255 mg·dl Ϫ1 ·min Ϫ1 ·10 Ϫ2 , P ϭ 0.008) were lower in African-American than white women. Breakfast was associated with a significant increase in FMD in whites and African-Americans, and there was no significant difference in postprandial FMD between the groups (P Ͼ 0.1 for group ϫ time interactions). Despite being insulin-resistant, postprandial endothelial function in African-American women was comparable to white women. These results imply that insulin sensitivity may not be an important determinant of racial differences in endothelial function.African Americans; endothelial function AFRICAN-AMERICAN WOMEN SUFFER disproportionately from greater cardiovascular (CV) morbidity and mortality when compared with white women (15). In addition to differences in cultural issues, socioeconomic status, and access to health care, traditional cardiometabolic risk factors such as hypertension, diabetes, obesity, smoking, and physical inactivity disproportionately affecting African-American women contribute to the increased cardiovascular disease (CVD) risk (1, 15). Insulin resistance is independently related to cardiac and vascular function and augments CVD risk in African Americans with hypertension (13). Because African-American women are insulin-resistant compared with white women, they are highly susceptible to develop CVD.Endothelial dysfunction characterized by reduced nitric oxide (NO)-dependent vasc...