Insulin sensitivity, lipids, and body composition in childhood: Is ''syndrome X'' present?
Insulin sensitivity, lipids, and body composition in childhood: Is ''syndrome X'' present?
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DOI：
10.1210/jc.81.3.1058
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发表时间：
1996-03-01
影响因子：
5.8
通讯作者：
Suprasongsin, C
中科院分区：
文献类型：
--
作者：
Arslanian, S;Suprasongsin, C
X综合征，或胰岛素抵抗综合征，是一组相关的代谢异常，包括高胰岛素血症、葡萄糖耐受不良、极低密度脂蛋白（VLDL）升高、高密度脂蛋白（HDL）降低以及非肥胖成年人的高血压，并且在心血管疾病的发生中起重要作用。本研究的目的是检查儿童年龄组中胰岛素敏感性、血脂水平和身体成分之间的关系，以确定这些关联在儿童时期是否存在。研究了20名健康的白人坦纳I期（TI）儿童（年龄，10.7±0.3岁；体重指数，18.9±0.8 kg/m²）和22名青春期坦纳II - IV期（TII - IV）青少年（年龄，14.0±0.3岁；体重指数，20.0±0.4 kg/m²）。在40 μU/m²·min的高胰岛素 - 正常血糖钳夹试验中评估体内胰岛素介导的葡萄糖处置（Rd）。通过¹⁸O - H₂O稀释原理用同位素法评估身体成分。采集空腹血用于胆固醇、甘油三酯（TG）、VLDL、低密度脂蛋白（LDL）和HDL的测定。
在两组中，Rd与体脂百分比（%BF）的相关性最强（TI：r = -0.82；P < 0.001；TII - IV：r = -0.73；P < 0.001）。此外，在TI组中，Rd与TG（r = 0.64；P = 0.001）、VLDL（r = 0.64；P = 0.001）和舒张压（r = -0.50；P = 0.01）相关。在TII - IV组中没有这些相关性。在TI组中，%BF与LDL正相关，与TG和VLDL负相关。在TII - IV组中，%BF与胆固醇和LDL正相关。在校正%BF后，偏相关分析显示两组中Rd与血脂水平之间均无关系。这表明胰岛素敏感性与血脂水平的关系是身体成分对血脂水平影响的次要结果。然而，无论身体成分如何，在TII - IV受试者中，基础胰岛素水平与TG（r = 0.38；P = 0.04）和VLDL（r = 0.40；P = 0.04）相关。
我们得出结论：1）在青春期前和青春期受试者中，胰岛素敏感性的主要相关因素是%BF，与血脂无关；2）在青春期前儿童中，舒张压与胰岛素敏感性呈负相关，与胰岛素水平呈正相关，与肥胖无关；3）青春期开始后，无论肥胖程度如何，基础胰岛素水平与VLDL和TG呈正相关。这一观察结果可能是儿童时期X综合征发生的极早期表现。
Syndrome X, or the syndrome of insulin resistance, is a cluster of related metabolic abnormalities of hyperinsulinemia, glucose intolerance, increased very low density lipoprotein (VLDL), decreased high density lipoprotein (HDL), and hypertension in nonobese adults and plays an important role in the genesis of cardiovascular disease. The aim of the present study was to examine the relationships among insulin sensitivity, plasma lipid levels, and body composition in the pediatric age group to determine whether these associations are present in childhood.Twenty healthy Caucasian Tanner stage I (TI) children (age, 10.7 +/- 0.3 yr; body mass index, 18.9 +/- 0.8 kg/m(2)) and 22 pubertal Tanner stage II-IV (TII-IV) adolescents (age, 14.0 +/- 0.3 yr; body mass index, 20.0 +/- 0.4 kg/m(2)) were studied. In vivo insulin-mediated glucose disposal (Rd) was evaluated during a 40 mu/m(2) . min hyperinsulinemic-euglycemic clamp. Body composition was assessed isotopically by the (H2O)-O-18 dilution principle. Fasting blood was obtained for cholesterol, triglyceride (TG), VLDL, low density lipoprotein (LDL, and HDL determinations.In both groups, the strongest correlation of Rd was with percent body fat (%BF) (TI: r = -0.82; P < 0.001; TII-IV: r = -0.73; P < 0.001). In addition, in TI, Rd was correlated with TG (r = 0.64; P = 0.001), VLDL (r = 0.64; P = 0.001), and diastolic blood pressure (r = -0.50; P = 0.01). There were no such correlations in TII-IV. In TI, %BF correlated positively with LDL and negatively with TG and VLDL. In TII-IV, %BF correlated positively with cholesterol and LDL. After correcting for %BF, partial correlation analysis revealed no relationship between Rd and lipid levels in either group. This suggests that the relationship of insulin sensitivity to lipid levels was secondary to the effect of body composition on lipid levels. However, regardless of body composition, the basal insulin level was correlated with TG (r = 0.38; P = 0.04) and VLDL (r = 0.40; P = 0.04) in TII-IV subjects.We conclude that 1) the primary correlate of insulin sensitivity is %BF in both prepubertal and pubertal subjects, with no relationship to plasma lipids; 2) in prepubertal children, diastolic blood pressure is negatively correlated with insulin sensitivity and positively with insulin levels, independent of adiposity; and 3) after the onset of puberty, basal insulin levels are positively correlated with VLDL and TG regardless of the degree of adiposity. This observation could be a very early manifestation of the genesis of syndrome X in childhood.