What are the physical characteristics associated with a normal metabolic profile despite a high level of obesity in postmenopausal women?
What are the physical characteristics associated with a normal metabolic profile despite a high level of obesity in postmenopausal women?
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DOI：
10.1210/jc.86.3.1020
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发表时间：
2001-03-01
影响因子：
5.8
通讯作者：
Poehlman, ET
中科院分区：
文献类型：
--
作者：
Brochu, M;Tchernof, A;Poehlman, ET
虽然肥胖通常与胰岛素抵抗和一组代谢紊乱有关，但已经假设存在健康但肥胖的个体亚组。目前尚不清楚为什么一些肥胖个体尽管有非常高的体脂积累，但没有显示出与胰岛素抵抗综合征相关的传统风险因素。为了解决这个问题，我们确定并研究了一个代谢正常但肥胖（MNO）的绝经后妇女亚组，以了解潜在的生理因素，可能会保护他们免受肥胖相关的comorbidity.We发展仔细检查43肥胖，久坐的绝经后妇女（平均+/- so，58.0 +/- 6.0年）的代谢特征。根据公认的胰岛素敏感性临界点（通过高胰岛素/正葡萄糖钳夹技术测量），将受试者分类为MNO或代谢异常肥胖（MAO）。此后，我们确定了1）身体成分（脂肪量和瘦体重），2）体脂分布（腹部内脏和皮下脂肪组织面积，大腿中部皮下脂肪组织和肌肉衰减），3）血浆脂质-脂蛋白水平，4）血浆葡萄糖和胰岛素浓度，5）静息血压，6）峰值耗氧量，7）体力活动能量消耗，我们确定了17名MNO受试者显示出高胰岛素敏感性（11.2 +/- 2.6 mg/min/kg瘦体重），26名MAO受试者显示出较低胰岛素敏感性（5.7 +/- 1.1 mg/min/kg瘦体重）。尽管两组之间的总体肥胖率相当（45.2 +/- 5.3% vs. 44.8 +/- 6.6%; P = NS），但MNO个体的内脏脂肪组织比MAO个体少49%（141 +/- 53 vs. 211 +/- 85 cm（2）; P < 0.01）。腹部皮下脂肪组织组间无差异（453 +/- 126 vs. 442 +/- 144 cm（2）; P = NS），总脂肪量（38.1 +/- 10.6 vs. 40.0 +/- 11.8 kg），肌肉衰减（42.2 +/- 2.6 vs. 43.6 +/- 4.8 Houndsfield单位）和体力活动能量消耗（1060 +/- 323 vs. 1045 +/- 331 Cal/天）。MNO受试者空腹血糖和胰岛素浓度较低，口服葡萄糖耐量试验期间胰岛素水平较低（P值范围为0.01-0.001）。在口服葡萄糖耐量试验期间，两组之间的2小时葡萄糖水平和葡萄糖面积无差异。MNO患者的血浆甘油三酯浓度低于MAO患者，高密度脂蛋白胆固醇浓度高于MAO患者（P < 0.01）。调查问卷的结果表明，48%的MNO妇女出现早发性肥胖（
Although obesity is often associated with insulin resistance and a cluster of metabolic disturbances, the existence of a subgroup of healthy but obese individuals has been postulated. It is unclear why some obese individuals fail to show traditional risk factors associated with the insulin resistance syndrome despite having a very high accumulation of body fat. To address this issue, we identified and studied a subgroup of metabolically normal but obese (MNO) postmenopausal women to gain insight into potential physiological factors that may protect them against the development of obesity-related comorbidities.We carefully examined the metabolic characteristics of 43 obese, sedentary postmenopausal women (mean +/- so, 58.0 +/- 6.0 yr). Subjects were classified as MNO or as metabolically abnormal obese (MAO) based on an accepted cut-point for insulin sensitivity (measured by the hyperinsulinemic/euglycemic clamp technique). Thereafter, we determined 1) body composition (fat mass and lean body mass), 2) body fat distribution (abdominal visceral and sc adipose tissue areas, midthigh sc adipose tissue and muscle attenuation), 3) plasma lipid-lipoprotein levels, 4) plasma glucose and insulin concentrations, 5) resting blood pressure, 6) peak oxygen consumption, 7) physical activity energy expenditure, and 8) age-related onset of obesity with a questionnaire as potential modulators of differences in the risk profile.We identified 17 MNO subjects who displayed high insulin sensitivity (11.2 +/- 2.6 mg/min kg lean body mass) and 26 MAO subjects with lower insulin sensitivity (5.7 +/- 1.1 mg/min kg lean body mass). Despite comparable total body fatness between groups (45.2 +/- 5.3% vs. 44.8 +/- 6.6%; P = NS), MNO individuals had 49% less visceral adipose tissue than MAO subjects (141 +/- 53 vs. 211 +/- 85 cm(2); P < 0.01). No difference was noted between groups for abdominal sc adipose tissue (453 +/- 126 vs. 442 +/- 144 cm(2); P = NS), total fat mass (38.1 +/- 10.6 vs. 40.0 +/- 11.8 kg), muscle attenuation (42.2 +/- 2.6 vs. 43.6 +/- 4.8 Houndsfield units), and physical activity energy expenditure (1060 +/- 323 vs. 1045 +/- 331 Cal/day). MNO subjects had lower fasting plasma glucose and insulin concentrations and lower insulin levels during the oral glucose tolerance test (P values ranging between 0.01-0.001). No difference was observed between groups for 2-h glucose levels and glucose area during the oral glucose tolerance test. MNO subjects showed lower plasma triglycerides and higher high density lipoprotein cholesterol concentrations than MAO individuals (P < 0.01 in both cases). Results from the questionnaire indicated that 48% of the MNO women presented an early onset of obesity (