Visceral Fat Resection in Humans: Effect on Insulin Sensitivity, Beta-Cell Function, Adipokines, and Inflammatory Markers
Visceral Fat Resection in Humans: Effect on Insulin Sensitivity, Beta-Cell Function, Adipokines, and Inflammatory Markers
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DOI：
10.1002/oby.20030
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发表时间：
2013-03-01
期刊：
影响因子：
6.9
通讯作者：
Geloneze, Bruno
中科院分区：
文献类型：
--
作者：
Lima, Marcelo M. O.;Pareja, Jose C.;Geloneze, Bruno
目的：内脏脂肪与胰岛素抵抗、代谢综合征、2 型糖尿病和心血管风险增加有关，但尚不清楚它是否具有致病作用。设计和方法：手术切除该脂肪库是解决这一问题的研究模型。 20 名患有代谢综合征和 III 级肥胖的绝经前女性被随机接受单独或联合大网膜切除术的 Roux-en-Y 胃绕道术 (RYGBP)。评估胰岛素敏感性（IS；正常血糖-高胰岛素钳夹）、对葡萄糖的急性胰岛素反应（AIR；静脉内葡萄糖耐量试验）、处置指数（DI = AIR x IS 通过钳夹测量）、血脂谱、脂肪因子谱（瘦素、脂联素、抵抗素、visfatin、白介素-6、TNF-α、MCP-1）、超灵敏 C 反应蛋白（CRP）、身体成分和腹部脂肪回波描记术手术前以及手术后 1、6 和 12 个月。结果：大网膜切除术在所有时间点都与更大的体重减轻相关。两组的 IS 改善情况相似。大网膜切除术与 12 个月后 CRP 降低相关，但不影响脂肪因子和其他代谢参数。在非糖尿病受试者中，大网膜切除术与 12 个月后基线 AIR 的保留（与对照组的恶化相反）以及 6 和 12 个月后更大的 DI 相关。 结论：虽然大网膜切除术没有增强 RYGBP 对胰岛素敏感性和脂肪因子的影响，但它与胰岛素分泌的保留、更大的体重减轻和更低的 CRP 相关。
Objective: The visceral fat is linked to insulin resistance, the metabolic syndrome, type 2 diabetes and an increased cardiovascular risk, but it is not clear whether it has a causative role.Design and Methods: Surgical resection of this fat depot is a research model to address this issue. Twenty premenopausal women with metabolic syndrome and grade III obesity were randomized to undergo Roux-en-Y gastric bypass (RYGBP) either alone or combined with omentectomy. Insulin sensitivity (IS; euglycemic-hyperinsulinemic clamp), acute insulin response to glucose (AIR; intravenous glucose tolerance test), disposition index (DI = AIR x IS measured by clamp), lipid profile, adipokine profile (leptin, adiponectin, resistin, visfatin, interleukin-6, TNF-alpha, MCP-1), ultra-sensitive C-reactive protein (CRP), body composition, and abdominal fat echography were assessed prior to surgery and 1, 6, and 12 months post-surgery.Results: Omentectomy was associated with greater weight loss at all time points. IS improved similarly in both groups. Omentectomy was associated to lower CRP after 12 months, but it did not influence adipokines and other metabolic parameters. Among non-diabetic subjects, omentectomy was associated with a preservation of baseline AIR after 12 months (as opposed to deterioration in the control group) and a greater DI after 6 and 12 months.Conclusion: Although omentectomy did not enhance the effect of RYGBP on insulin sensitivity and adipokines, it was associated with a preservation of insulin secretion, a greater weight loss, and lower CRP.