Ethnic differences in hepatic steatosis: an insulin resistance paradox?
Ethnic differences in hepatic steatosis: an insulin resistance paradox?
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DOI：
10.1002/hep.22726
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发表时间：
2009-03
期刊：
影响因子：
13.5
通讯作者：
Browning, Jeffrey D.
中科院分区：
文献类型：
--
作者：
Guerrero, Richard;Vega, Gloria L.;Grundy, Scott M.;Browning, Jeffrey D.
非酒精性脂肪性肝病(NAFLD)是一个新兴问题。我们之前已经表明，尽管拉美裔和非裔美国人之间存在相似的风险因素，但他们患NAFLD的风险比非裔美国人更大。我们进行了迄今为止最大的基于人群的研究(n=2,170)，利用质子磁共振(MR)波谱、双能X射线吸收测量仪和多层腹部MR成像来确定体脂分布对美国三大民族(非裔美国人、西班牙裔、高加索人)肝脏脂肪变性不同患病率的影响。尽管控制了年龄和总肥胖度，非裔美国人的腹膜内(IP)脂肪比西班牙裔和高加索人的腹膜内脂肪(IP)少，而下肢(LE)脂肪多。在控制了总脂肪、腹部皮下脂肪和脂肪后，这些组之间的肝脏甘油三酯含量(HTGC)的差异仍然存在；然而，控制IP脂肪几乎消除了HTGC的差异，这表明IP与肝脏脂肪之间存在密切的联系，而不考虑种族。尽管非裔美国人的IP和肝脏脂肪水平较低，但他们的胰岛素抵抗患病率与西班牙裔相似，后者的IP和肝脏脂肪水平最高。此外，在控制IP脂肪后，非裔美国人的胰岛素水平和HOMAIR值最高，而血清甘油三酯水平最低。总而言之，IP脂肪与HTGC有关，与种族无关。这些组之间肝脏脂肪变性的不同患病率与内脏肥胖症的相似差异有关。非洲裔美国人对肥胖和胰岛素抵抗的代谢反应与西班牙裔或高加索人不同：非洲裔美国人似乎更耐受腹部内脏隔室(脂肪组织和肝脏)中甘油三酯的积累，以及与胰岛素抵抗相关的高甘油三酯血症。
Non-alcoholic fatty liver disease (NAFLD) is a burgeoning problem. We have previously shown that Hispanics were at greater risk for NAFLD than African-Americans despite a similar prevalence of risk factors between these groups. We have performed the largest, population-based study to date (n=2,170) utilizing proton magnetic resonance (MR) spectroscopy, dual-energy x-ray absorptiometry, and multi-slice abdominal MR imaging to determine the contribution of body fat distribution to the differing prevalence of hepatic steatosis in the three major U.S. ethnic groups (African-American, Hispanic, Caucasian). Despite controlling for age and total adiposity, African-Americans had less intraperitoneal (IP) fat and more lower extremity (LE) fat than their Hispanic and Caucasian counterparts. The differences in hepatic triglyceride content (HTGC) between these groups remained after controlling for total, abdominal subcutaneous, and LE adiposity; however, controlling for IP fat nearly abolished the differences in HTGC, indicating a close association between IP and liver fat regardless of ethnicity. Despite the lower levels of IP and liver fat in African-Americans, their prevalence of insulin resistance was similar to Hispanics, who had the highest levels of IP and liver fat. Furthermore, insulin levels and HOMAIR values were highest and serum triglyceride levels were lowest among African-Americans after controlling for IP fat. In conclusion, IP fat is linked to HTGC, irrespective of ethnicity. The differing prevalence of hepatic steatosis between these groups was associated with similar differences in visceral adiposity. The metabolic response to obesity and insulin resistance differs in African-Americans when compared to either Hispanics or Caucasians: African-Americans appear to be more resistant to both the accretion of triglyceride in the abdominal visceral compartment (adipose tissue and liver) and hypertriglyceridemia associated with insulin resistance.
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