Rosenfalck A M, Hendel H, Rasmussen M H, Almdal T, Anderson T, Hilsted J, Madsbad S
Department of Endocrinolgy, Hvidovere University Hospital, Copenhagen, Denmark.
Diabetes Obes Metab. 2002 Jan;4(1):19-28. doi: 10.1046/j.1463-1326.2002.00161.x.
To evaluate the long-term effect of changes in body composition induced by weight loss on insulin sensitivity (SI), non-insulin mediated glucose disposal, glucose effectiveness (SG)and beta-cell function.
Glucose metabolism was evaluated before and after participation in a two-year weight loss trial of Orlistat vs. placebo, combined with an energy and fat restricted diet.
Twelve obese patients (11 women, 1 man), age 45.8 +/- 10.5 years, body weight (BW) 99.7 +/- 13.3 kg, BMI 35.3 +/- 2.8 kg/m(2).
At inclusion and 2 years later an oral glucose tolerance test (OGTT) and a frequently sampled intravenous glucose tolerance test (FSIGT) were performed. Body composition was estimated by a dual-energy X-ray absorptiometry (DXA) whole body scanning.
The patients obtained varying changes in BW ranging from a weight loss of 17.8 kg to a weight gain of 6.0 kg. Corresponding changes in fat mass (FM) varied from a 40% reduction to a19% increase. A significant decrease in both fasting (p = 0.038) and 2 h (p = 0.047) blood glucose at OGTT was found. The improvement in insulin sensitivity (SI) estimated by means of Bergmans Minimal Model, was significantly and linearly correlated to change in total FM (r = - 0.83,p = 0.0026). A multiple regression analysis showed that changes in truncal FM was the strongest predictor of change in S(I) explaining 67% of the variation. First phase insulin response (AIRg)remained unchanged whereas insulin disposition index increased significantly (p = 0.044). At inclusion five patients had impaired glucose tolerance of which four, who lost weight, were normalized at the retest 2 years later.
In obese subjects long-term minimal or moderate changes in weight were found to be linearly associated with changes in insulin sensitivity. In obese subjects with impaired glucose tolerance even a minor weight loss was able to normalize glucose tolerance.
评估体重减轻引起的身体成分变化对胰岛素敏感性（SI）、非胰岛素介导的葡萄糖处置、葡萄糖效能（SG）和β细胞功能的长期影响。
在参与一项为期两年的奥利司他与安慰剂对比试验并结合能量和脂肪限制饮食之前和之后，对葡萄糖代谢进行评估。
12名肥胖患者（11名女性，1名男性），年龄45.8±10.5岁，体重（BW）99.7±13.3kg，体重指数（BMI）35.3±2.8kg/m²。
在入组时和2年后进行口服葡萄糖耐量试验（OGTT）和频繁采样静脉葡萄糖耐量试验（FSIGT）。通过双能X线吸收法（DXA）全身扫描估计身体成分。
患者体重变化各异，从体重减轻17.8kg到体重增加6.0kg。相应的脂肪量（FM）变化从减少40%到增加19%不等。在OGTT中，空腹血糖（p = 0.038）和2小时血糖（p = 0.047）均显著降低。通过伯格曼最小模型估计的胰岛素敏感性（SI）改善与总FM变化显著线性相关（r = -0.83，p = 0.0026）。多元回归分析表明，躯干FM变化是SI变化的最强预测因子，解释了67%的变异。第一相胰岛素反应（AIRg）保持不变，而胰岛素处置指数显著增加（p = 0.044）。入组时5名患者葡萄糖耐量受损，其中4名体重减轻的患者在2年后复查时葡萄糖耐量恢复正常。
在肥胖受试者中，发现长期的微小或中度体重变化与胰岛素敏感性变化呈线性相关。在葡萄糖耐量受损的肥胖受试者中，即使轻微体重减轻也能使葡萄糖耐量恢复正常。
