Enlarged subcutaneous abdominal adipocyte size, but not obesity itself, predicts Type II diabetes independent of insulin resistance
Enlarged subcutaneous abdominal adipocyte size, but not obesity itself, predicts Type II diabetes independent of insulin resistance
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DOI：
10.1007/s001250051560
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发表时间：
2000-12-01
期刊：
影响因子：
8.2
通讯作者：
Pratley, RE
中科院分区：
文献类型：
--
作者：
Weyer, C;Foley, JE;Pratley, RE
目的/假设。横断面研究表明，腹部皮下脂肪细胞增大与高胰岛素血症、胰岛素抵抗和葡萄糖耐受不良有关。为了进一步探讨这些关联的病理生理学意义，我们前瞻性地研究了腹部皮下脂肪细胞增大是否预示着II型（非胰岛素依赖型）糖尿病。在280名正常（NGT）、受损（IGT）或糖尿病葡萄糖耐量（75 g OGTT）的皮马印第安人中评估了身体成分（水密度测定法）、平均皮下腹部脂肪细胞大小（脂肪活检）、胰岛素敏感性（高胰岛素钳夹）和急性胰岛素分泌反应（25 g静脉注射GTT）。然后对NGT受试者进行前瞻性随访。结果。校正年龄、性别和体脂百分比后，糖尿病和IGT受试者的平均皮下腹部脂肪细胞大小比NGT受试者高19%和11%（p < 0.001）。胰岛素敏感性与平均皮下腹部脂肪细胞大小呈负相关（r =-0.53，p < 0.0001），即使调整了体脂百分比（r =-0.31，p < 0.001）。在108例NGT受试者中，随访时间为9.3 +/- 4.1年（其中33例发生糖尿病），平均皮下腹部脂肪细胞大小增大，但体脂百分比不高，是糖尿病的独立预测因子，此外还有低胰岛素敏感性和急性胰岛素分泌反应[相对危险度10（th）vs 90（th）百分位数（95% CI）：5.8（1.7-19.6），p < 0.005]。在28名NGT受试者中，2.7 +/- 1.3年内体重增加9%，胰岛素敏感性的变化与平均皮下腹部脂肪细胞大小和体脂百分比的变化呈负相关和独立相关。虽然扩大的平均皮下腹部脂肪细胞大小与胰岛素抵抗的横截面，前瞻性，这两个异常是独立的和添加剂的预测II型糖尿病。
Aims/hypothesis. Cross-sectional studies indicate that enlarged subcutaneous abdominal adipocyte size is associated with hyperinsulinaemia, insulin resistance and glucose intolerance. To further explore the pathophysiological significance of these associations, we examined prospectively whether enlarged subcutaneous abdominal adipocyte size predicts Type II (non-insulin-dependent) diabetes mellitus.Methods. Body composition (hydrodensitometry), mean subcutaneous abdominal adipocyte size (fat biopsy), insulin sensitivity (hyperinsulinaemic clamp) and the acute insulin secretory response (25-g i.v. GTT) were assessed in 280 Pima Indians with either normal (NGT), impaired (IGT) or diabetic glucose tolerance (75-g OGTT). Subjects with NGT were then followed prospectively.Results. After adjusting for age, sex and per cent body fat, mean subcutaneous abdominal adipocyte size was 19% and 11% higher in subjects with diabetes and IGT, compared with those with NGT (p < 0.001). Insulin sensitivity was inversely correlated with mean subcutaneous abdominal adipocyte size (r = -0.53, p < 0.0001), even after adjusting for per cent body fat (r = -0.31, p < 0.001). In 108 NGT subjects followed over 9.3 +/- 4.1 years (33 of whom developed diabetes), enlarged mean subcutaneous abdominal adipocyte size but not high per cent body fat, was an independent predictor of diabetes, in addition to a low insulin sensitivity and acute insulin secretory response [relative hazard 10(th) vs 90(th) centile (95% CI): 5.8 (1.7-19.6), p < 0.005]. In 28 NGT subjects with a 9% weight gain over 2.7 +/- 1.3 years, changes in insulin sensitivity were inversely and independently related to changes in mean subcutaneous abdominal adipocyte size and per cent body fat.Conclusion/interpretation. Although enlarged mean subcutaneous abdominal adipocyte size is associated with insulin resistance cross-sectionally, prospectively, both abnormalities are independent and additive predictors of Type II diabetes.