Effects of pioglitazone versus diet and exercise on metabolic health and fat distribution in upper body obesity
Effects of pioglitazone versus diet and exercise on metabolic health and fat distribution in upper body obesity
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DOI：
10.2337/diacare.26.11.3148
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发表时间：
2003-11-01
期刊：
影响因子：
16.2
通讯作者：
Jensen, MD
中科院分区：
文献类型：
--
作者：
Shadid, S;Jensen, MD
目的-胰岛素抵抗与内脏肥胖有关，减少这种储存的干预措施，例如，饮食和运动，改善胰岛素抵抗。噻唑烷二酮类（TZD）也能改善胰岛素作用，但矛盾的是增加总脂肪量，这可能是通过重塑（募集较小的脂肪细胞）和脂肪组织的重新分布。我们评估了吡格列酮与饮食和运动对脂肪分布和脂肪分布和胰岛素敏感性之间的关系，在上身obesity.RESEARCH设计和方法-三十九上身肥胖，胰岛素抵抗，非糖尿病男性和绝经前女性的影响，随机分配到接受30毫克/天吡格列酮或饮食和运动计划20周。干预前后，胰岛素敏感性，身体成分，体脂分布（腰臀比[WHR]，腹部计算机断层扫描和双能X射线吸收测定法），腹部和股骨脂肪细胞大小进行了评估。结果-饮食和运动导致体重减轻11.8 +/- 1.1 kg。饮食、运动和吡格列酮都可以改善胰岛素敏感性，但只有前者与腹腔内脂肪的减少有关。吡格列酮增加了全身脂肪，男性和女性的脂肪都优先积聚在下半身。两组WHR均下降。腹部脂肪。饮食和运动后细胞大小减少（P = 0.06）。脂肪细胞大小无统计学显着变化，观察吡格列酮治疗volunteers.CONCLUSIONS -在非糖尿病上半身肥胖受试者，通过饮食和运动增加胰岛素敏感性伴随着内脏脂肪减少。吡格列酮治疗也能改善胰岛素敏感性和降低腰臀比，但这是由于选择性增加下半身脂肪。这证实了脂肪组织对TZD的部位特异性反应，并表明吡格列酮对胰岛素敏感性的改善与腹内脂肪的变化无关。
OBJECTIVE - insulin resistance is associated with visceral adiposity, and interventions that reduce this depot, e.g., diet and exercise, improve insulin resistance. Thiazolidinediones (TZDs) also improve insulin action but paradoxically increase total fat mass, perhaps through remodeling (recruitment of smaller fat cells) and redistribution of adipose tissue. We assessed the effects of pioglitazone versus diet and exercise on fat distribution and the relationship between fat distribution and insulin sensitivity in upper body obesity.RESEARCH DESIGN AND METHODS - Thirty-nine upper body obese, insulin-resistant, nondiabetic men and premenopausal women were randomly assigned to receive either 30 mg/day pioglitazone or a diet and exercise program for 20 weeks. Before and after the intervention, insulin sensitivity, body composition, body fat distribution (waist-to-hip ratio [WHR], computed tomography abdomen, and dual-energy X-ray absorptiometry), and abdominal and femoral fat cell size were assessed.RESULTS - Diet and exercise resulted in an 11.8 +/- 1.1 kg weight loss. Both diet and exercise and pioglitazone improved insulin sensitivity, but only the former was associated with loss of intra-abdominal fat. Pioglitazone increased total body fat, which preferentially accumulated in the lower body depot in both men and women. WHRs decreased in both groups. Abdominal fat,. cell size decreased (P = 0.06) after diet and exercise. No statistically significant changes in fat cell size were observed in pioglitazone-treated volunteers.CONCLUSIONS - in nondiabetic upper body obese subjects, increasing insulin sensitivity via diet and exercise accompanies reductions in visceral fat. Pioglitazone treatment also improves insulin sensitivity and lowers WHR, but this is due to a selective increase in lower body fat. This confirms a site-specific responsiveness of adipose tissue to TZD and suggests that improvements in insulin sensitivity by pioglitazone are achieved independent of changes in intra-abdominal fat.