Abdominal fat distribution and peripheral and hepatic insulin resistance in type 2 diabetes mellitus
Abdominal fat distribution and peripheral and hepatic insulin resistance in type 2 diabetes mellitus
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DOI：
10.1152/ajpendo.0327.2001
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发表时间：
2002-12-01
影响因子：
5.1
通讯作者：
DeFronzo, RA
中科院分区：
文献类型：
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作者：
Miyazaki, Y;Glass, L;DeFronzo, RA
我们研究了 2 型糖尿病 (T2DM) 患者的外周/肝脏胰岛素敏感性与腹部浅层/深层皮下脂肪 (SSF/DSF) 和腹内内脏脂肪 (VF) 之间的关系。 62 名 T2DM 患者（36 名男性和 26 名女性，年龄 = 55 +/- 3 岁，体重指数 = 30 +/- 1 kg/m(2)）接受了两步正常血糖胰岛素钳夹（40 和 160 mU.m(-2).min(-1)）和 [3-H-3] 葡萄糖。通过磁共振成像在 L4-5 水平对 SSF、DSF 和 VF 面积进行定量。男性和女性受试者在第一次和第二次胰岛素钳夹步骤期间的基础内源性葡萄糖产生 (EGP)、肝脏胰岛素抵抗指数 (基础 EGP x FPI) 和总葡萄糖处理 (TGD) 相似。男性和女性受试者的 VF（159 +/- 9 与 143 +/- 9 cm(2)）和 DSF（199 +/- 14 与 200 +/- 15 cm(2)）没有差异。尽管体重指数（31 +/- 1 对比 30 +/- 1 kg/m(2)）和全身脂肪量（31 +/- 2 对比 33 +/- 2 kg）相似，但女性受试者的 SSF（104 +/- 8 对比 223 +/- 15 cm(2)）更大（P < 0.0001）。在男性 T2DM 中，第一个胰岛素钳夹步骤 (1st TGD) 期间的 TGD 与 VF (r = -0.45，P < 0.01)、DSF (r = -0.46，P < 0.01) 和 SSF (r = -0.39，P < 0.05) 呈负相关。在男性中，VF（r = 0.37，P < 0.05）、DSF（r = 0.49，P < 0.01）和SSF（r = 0.33，P < 0.05）与肝脏胰岛素抵抗呈正相关。在女性中，首次 TGD（r = -0.45，P < 0.05）和肝脏胰岛素抵抗（r = 0.49，P < 0.05）与 VF 相关，但与 DSF、SSF 或总皮下脂肪面积无关。我们得出的结论是，在 T2DM 中，内脏肥胖与外周和肝脏胰岛素抵抗相关，与性别无关。在男性而非女性 T2DM 中，深层皮下脂肪组织也与外周和肝脏胰岛素抵抗相关。
We examined the relationship between peripheral/hepatic insulin sensitivity and abdominal superficial/deep subcutaneous fat (SSF/DSF) and intra-abdominal visceral fat (VF) in patients with type 2 diabetes mellitus (T2DM). Sixty-two T2DM patients (36 males and 26 females, age = 55 +/- 3 yr, body mass index = 30 +/- 1 kg/m(2)) underwent a two-step euglycemic insulin clamp (40 and 160 mU.m(-2).min(-1)) with [3-H-3] glucose. SSF, DSF, and VF areas were quantitated with magnetic resonance imaging at the L4-5 level. Basal endogenous glucose production (EGP), hepatic insulin resistance index (basal EGP x FPI), and total glucose disposal (TGD) during the first and second insulin clamp steps were similar in male and female subjects. VF (159 +/- 9 vs. 143 +/- 9 cm(2)) and DSF (199 +/- 14 vs. 200 +/- 15 cm(2)) were not different in male and female subjects. SSF (104 +/- 8 vs. 223 +/- 15 cm(2)) was greater (P < 0.0001) in female vs. male subjects despite similar body mass index (31 +/- 1 vs. 30 +/- 1 kg/m(2)) and total body fat mass (31 +/- 2 vs. 33 +/- 2 kg). In male T2DM, TGD during the first insulin clamp step (1st TGD) correlated inversely with VF (r = -0.45, P < 0.01), DSF (r = -0.46, P < 0.01), and SSF (r = -0.39, P < 0.05). In males, VF (r = 0.37, P < 0.05), DSF (r = 0.49, P < 0.01), and SSF (r = 0.33, P < 0.05) were correlated positively with hepatic insulin resistance. In females, the first TGD (r = -0.45, P < 0.05) and hepatic insulin resistance (r = 0.49, P < 0.05) correlated with VF but not with DSF, SSF, or total subcutaneous fat area. We conclude that visceral adiposity is associated with both peripheral and hepatic insulin resistance, independent of gender, in T2DM. In male but not female T2DM, deep subcutaneous adipose tissue also is associated with peripheral and hepatic insulin resistance.