Insulin Resistance in the Control of Body Fat Distribution: A New Hypothesis
Insulin Resistance in the Control of Body Fat Distribution: A New Hypothesis
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DOI：
10.1055/s-0030-1269851
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发表时间：
2011-02-01
影响因子：
2.2
通讯作者：
Crowther, N. J.
中科院分区：
文献类型：
--
作者：
Ali, A. T.;Ferris, W. F.;Crowther, N. J.
肥胖导致胰岛素抵抗，胰岛素抵抗是2型糖尿病、血脂异常和心血管疾病的主要病因。然而，胰岛素抵抗可能是对肥胖的正常生理反应，其限制了进一步的脂肪沉积，并且仅在高水平时具有病理作用。目前的假设表明，在肥胖症中，甘油三酯的初始沉积发生在皮下脂肪组织中，并且随着其尺寸的增加，胰岛素抵抗将上升并限制进一步的皮下脂质积聚。然后甘油三酯将转移到内脏脂肪库以及异位部位。这导致胰岛素抵抗及其相关疾病的患病率大幅上升。支持这一假设的证据包括研究表明，在瘦的受试者中，胰岛素抵抗的主要决定因素是BMI，即皮下脂肪，而在超重和肥胖的受试者中，它是腰围和内脏肥胖。它也已被证明，代谢综合征的发病率突然增加，在高水平的胰岛素抵抗，我们认为，这是由于转移的脂质从皮下到内脏仓库。这个系统可能在我们进化的过去发挥作用，通过在对胰岛素抵抗有最大影响但体重增加最小的部位引起脂质沉积来限制过度肥胖。
Obesity causes insulin resistance, which is a prime etiological factor for type 2 diabetes, dyslipidemia, and cardiovascular disease. However, insulin resistance may be a normal physiological response to obesity that limits further fat deposition and which only has pathological effects at high levels. The current hypothesis suggests that in obesity the initial deposition of triglycerides occurs in subcutaneous adipose tissue and as this increases in size insulin resistance will rise and limit further subcutaneous lipid accumulation. Triglycerides will then be diverted to the visceral fat depot as well as to ectopic sites. This leads to a substantial rise in insulin resistance and the prevalence of its associated disorders. Evidence supporting this hypothesis includes studies showing that in lean subjects the prime determinant of insulin resistance is BMI, that is, subcutaneous fat whilst in overweight and obese subjects it is waist circumference and visceral adiposity. It has also been shown that the metabolic syndrome suddenly increases in prevalence at high levels of insulin resistance and we suggest that this is due to the diversion of lipids from the subcutaneous to the visceral depot. This system may have functioned in our evolutionary past to limit excessive adiposity by causing lipid deposition to occur at a site that has maximal effects on insulin resistance but involves minimal weight gain.