Metabolic effects of visceral fat accumulation in type 2 diabetes
Metabolic effects of visceral fat accumulation in type 2 diabetes
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DOI：
10.1210/jc.2002-020696
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发表时间：
2002-11-01
影响因子：
5.8
通讯作者：
Ferrannini, E
中科院分区：
文献类型：
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作者：
Gastaldelli, A;Miyazaki, Y;Ferrannini, E
内脏脂肪（VF）过量与外周胰岛素敏感性降低有关，并被认为有助于肝脏胰岛素抵抗。然而，VF影响肝脏糖代谢的机制以及VF在血糖控制中的定量作用尚未得到研究。本研究对63例2型糖尿病患者（年龄55 +/- 1岁，空腹血糖5.5-14.4 mmol/ l，血红蛋白A…6.1-11.7%）进行了1)无脂质量（011.0技术），2)se和内脏腹部脂肪面积（磁共振成像），3)胰岛素敏感性（正糖胰岛素钳），4)内源性葡萄糖输出（[[3H]葡萄糖输注技术），5)糖异生(（2)H(2)O法）的测量。在调整性别、年龄、体重指数、糖尿病病程、种族和sc脂肪面积后，VF面积与空腹高血糖呈正相关（部分r = 0.46, P = 0.001），与血红蛋白A呈正相关（部分r = 0.50, P = 0.0003）。胰岛素敏感性与VF呈负相关，与体重指数无关（部分r = 0,33; P = 0.01）。相比之下，基础内源性葡萄糖输出量与VF的关系无统计学意义。这种缺乏相关性的原因是，VF与糖异生通量呈正相关（经混杂因素调整，部分r = 0.45; P = 0.003），但与糖原溶解呈负相关（部分r = 0.31; P < 0.05）。我们得出结论，在2型糖尿病患者中，VF积累通过降低外周胰岛素敏感性和增强糖异生对血糖控制有显著的负面影响。
Visceral fat VF) excess has been associated with decreased peripheral insulin sensitivity and has been suggested to contribute to hepatic insulin resistance. However, the mechanisms by which VF impacts on hepatic glucose metabolism and the quantitative role of VF in glycemic control have not been investigated. In the present study 63 type 2 diabetic subjects (age, 55 +/- 1 yr; fasting plasma glucose, 5.5-14.4 mmol/ liter; hemoglobin A,,, 6.1-11.7%) underwent measurement of 1) fat-free mass 011.0 technique), 2) se and visceral abdominal fat area (magnetic resonance imaging), 3) insulin sensitivity (euglycemic insulin clamp), 4) endogenous glucose output ([[3H]glucose infusion technique), and 5) gluconeogenesis ((2) H(2)O method). After adjustment for sex, age, body mass index, diabetes duration, ethnicity, and sc fat area, VF area was positively related to fasting hyperglycemia (partial r = 0.46; P = 0.001) as well as to hemoglobin A,, (partial r = 0.50; P = 0.0003). Insulin sensitivity was reciprocally related to VF independently of body mass index (partial r = 0,33; P = 0.01). In contrast, the relation of basal endogenous glucose output to VF was not statistically significant. This lack of association was explained by the fact that VF was positively associated with gluconeogenesis flux (confounder-adjusted, partial r = 0.45; P = 0.003), but was reciprocally associated with glycogenolysis (partial r = 0.31; P < 0.05). We conclude that in patients with established type 2 diabetes, VF accumulation has a significant negative impact on glycemic control through a decrease in peripheral insulin sensitivity and an enhancement of gluconeogenesis.