Association of upper trunk and visceral adipose tissue volume with insulin resistance in control and HIV-Infected subjects in the FRAM study
Association of upper trunk and visceral adipose tissue volume with insulin resistance in control and HIV-Infected subjects in the FRAM study
复制标题
DOI：
10.1097/qai.0b013e31814b94e2
复制
发表时间：
2007-11-01
影响因子：
3.6
通讯作者：
Heymsfield, Steven B.
中科院分区：
文献类型：
--
作者：
Grunfeld, Carl;Rimland, David;Heymsfield, Steven B.
内脏性肥胖与胰岛素抵抗相关，但其他区域性脂肪沉积与胰岛素抵抗的关系尚不清楚。在HIV感染中，布法罗驼峰（上躯干脂肪）与此相关，但上躯干脂肪与胰岛素抵抗的相关性尚未在对照组中进行研究。为了确定内脏以外的脂肪沉积与胰岛素抵抗的独立关联，我们对HIV感染中的脂肪再分布和代谢变化（弗拉姆）研究中的对照和HIV感染受试者进行了横断面分析，这些受试者通过全身磁共振成像测量了葡萄糖、胰岛素和脂肪组织体积。我们研究了来自16个学术医疗中心诊所和试验单位的926名HIV阳性者，这些HIV阳性者具有代表美国HIV感染患者的人口统计学特征，并研究了来自基于人群的年轻人冠状动脉风险发展研究的258名弗拉姆对照。我们测量了腿部、手臂、下躯干（背部和腹部）和上躯干（背部和胸部）的内脏脂肪组织（VAT）和皮下脂肪组织（SAT）体积，并通过逐步多变量分析评估其与稳态评估模型（HOMA）和HOMA >4的相关性。HOMA >4作为胰岛素抵抗标志物的患病率在对照组中为28%，而在HIV感染者中为37%（P = 0.005）。在对照组中，上躯干SAT体积最高三分位数的患者的优势比（OR）为9.0（95%置信区间[CI]：2.4 ~ 34; P = 0.001），而在HIV阳性受试者中，（OR = 2.09，95%CI：1.36 ~ 3.19; P = 0.001）。在对照组中，VAT体积最高的三分位数与HOMA >4的OR值为12.1（95%CI：3.2 ~ 46; P = 0.0002），而在HIV阳性受试者中，OR值为3.12（95%CI：2.0 ~ 4.8; P < 0.0001）。在调整VAT和上干SAT后，其他SAT仓库与HOMA >4的相关性未达到统计学显著性。因此，VAT和上躯干SAT是独立相关的控制和HIV感染者的胰岛素抵抗。
Visceral obesity is associated with insulin resistance, but the association of other regional adipose depots with insulin resistance is not understood. In HIV infection, buffalo hump (upper trunk fat) is associated, but the association of upper trunk fat with insulin resistance has not been examined in controls. To determine the independent association of adipose depots other than visceral with insulin resistance, we performed a cross-sectional analysis of controls and HIV-infected subjects in the Fat Redistribution and Metabolic Change in HIV Infection (FRAM) study, who had measurements of glucose, insulin, and adipose tissue volumes by whole-body magnetic resonance imaging. We studied 926 HIV-positive persons from 16 academic medical center clinics and trials units with demographic characteristics representative of US patients with HIV infection and 258 FRAM controls from the population-based Coronary Artery Risk Development in Young Adults study. We measured visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) volume in the legs, arms, lower trunk (back and abdomen), and upper trunk (back and chest) and assessed their association with the homeostasis model of assessment (HOMA) and HOMA >4 by stepwise multivariable analysis. The prevalence of HOMA >4 as a marker of insulin resistance was 28% among controls compared with 37% among HIV-infected subjects (P = 0.005). Among controls, those in the highest tertile of upper trunk SAT volume had an odds ratio (OR) of 9.0 (95% confidence interval [Cl]: 2.4 to 34; P = 0.001) for having HOMA >4 compared with the lowest tertile, whereas in HIV-positive subjects, the OR was lower (OR = 2.09, 95% Cl: 1.36 to 3.19; P = 0.001). Among controls, the highest tertile of VAT volume bad an OR of 12.1 (95% Cl: 3.2 to 46; P = 0.0002) of having HOMA >4 compared with the lowest tertile, whereas in HIV-positive subjects, the OR was 3.12 (95% Cl: 2.0 to 4.8; P < 0.0001). After adjusting for VAT and upper trunk SAT, the association of other SAT depots with HOMA >4 did not reach statistical significance. Thus, VAT and upper trunk SAT are independently associated with insulin resistance in controls and in HIV-infected persons.