Lim S-C, Tan B-Y, Chew S-K, Tan C-E
Department of Endocrinology, Singapore General Hospital, Outram Road, Singapore.
Int J Obes Relat Metab Disord. 2002 Nov;26(11):1511-6. doi: 10.1038/sj.ijo.0802140.
Insulin resistance (IR) is associated with cardiovascular risk factors including hypertension, dyslipidemia, glucose intolerance and hyperuricemia. The relationship between IR and these cardiovascular risk factors in obese non-diabetic individuals is not well studied. We explore this relationship by comparing the cardiovascular risk factors among insulin-sensitive and insulin-resistant overweight/obese non-diabetic Asian adults in the 1992 National Health Survey of Singapore.
A total of 3568 subjects were examined in the survey, which involved a combination of disproportionate stratified sampling and systematic sampling. Anthropometric measurements, level of physical activity, blood pressure, insulin, lipid profile, uric acid and standard 75 g oral glucose tolerance test were performed after a 10 h overnight fast. Subjects with diabetes were excluded from the analysis. Homeostasis model assessment (HOMA) was used to assess insulin sensitivity. Relative LDL size was derived from the formula LDL/ApoB. We defined insulin-sensitive individuals as having a HOMA value <1.479 (below median in individuals without diabetes; n=3226) and overweight/obesity as body mass index (BMI) >or=25.0 kg/m(2).
There were 156 insulin-sensitive (S) and 679 insulin-resistant (R) overweight/obese individuals, respectively. The groups did not differ in terms of gender and ethnic distribution and level of physical activity. However, subjects in group S were younger than those in group R (mean+/-s.d.; 40.1+/-12.1 vs 42.4+/-12.7 y; P<0.05). Group R individuals were also slightly more obese globally and centrally than group S (BMI=28.2+/-3.2 vs 27.1+/-2.8 kg/m(2); waist circumference (WC)=86.7+/-9.3 vs 82.5+/-8.3 cm; P<0.01). There were more subjects with impaired glucose tolerance (IGT) in group R than in group S (29.7 vs 16.0%; P<0.01). After adjustment for age and indices of global and regional obesity (ie BMI and WC), insulin-resistant individuals showed higher apolipoprotein B, triglyceride, fasting (FPG) and 2 h post-load plasma glucose (2hPG) but lower HDL and LDL size. Further adjustment for FPG, 2hPG and level of physical activity had minimal impact on the results.
Insulin-resistant overweight/obese non-diabetic Asian adults had greater burden of the cardiovascular dysmetabolic syndrome than insulin-sensitive overweight/obese individuals. This could not be fully explained by differences in global and regional obesity, glucose tolerance and level of physical activity.
胰岛素抵抗（IR）与包括高血压、血脂异常、糖耐量异常和高尿酸血症在内的心血管危险因素相关。肥胖非糖尿病个体中IR与这些心血管危险因素之间的关系尚未得到充分研究。我们通过比较1992年新加坡全国健康调查中胰岛素敏感和胰岛素抵抗的超重/肥胖非糖尿病亚洲成年人的心血管危险因素来探讨这种关系。
该调查共检查了3568名受试者，采用了不成比例分层抽样和系统抽样相结合的方法。在禁食10小时过夜后，进行人体测量、身体活动水平、血压、胰岛素、血脂谱、尿酸和标准75克口服葡萄糖耐量试验。糖尿病患者被排除在分析之外。采用稳态模型评估（HOMA）来评估胰岛素敏感性。相对低密度脂蛋白（LDL）大小由公式LDL/ApoB得出。我们将胰岛素敏感个体定义为HOMA值<1.479（无糖尿病个体中的中位数以下；n = 3226），超重/肥胖定义为体重指数（BMI）≥25.0 kg/m²。
分别有156名胰岛素敏感（S）和679名胰岛素抵抗（R）的超重/肥胖个体。两组在性别、种族分布和身体活动水平方面没有差异。然而，S组受试者比R组受试者年轻（均值±标准差；40.1±12.1岁对42.4±12.7岁；P<0.05）。R组个体在整体和中心部位也比S组个体略胖（BMI = 28.2±3.2对27.1±2.8 kg/m²；腰围（WC）= 86.7±9.3对82.5±8.3 cm；P<0.01）。R组中糖耐量受损（IGT）的受试者比S组更多（29.7%对16.0%；P<0.01）。在调整年龄以及整体和局部肥胖指标（即BMI和WC）后，胰岛素抵抗个体的载脂蛋白B、甘油三酯、空腹血糖（FPG）和负荷后2小时血浆葡萄糖（2hPG）较高，但高密度脂蛋白（HDL）和LDL大小较低。进一步调整FPG、2hPG和身体活动水平对结果影响极小。
胰岛素抵抗的超重/肥胖非糖尿病亚洲成年人比胰岛素敏感的超重/肥胖个体有更大的心血管代谢综合征负担。这不能完全用整体和局部肥胖、糖耐量和身体活动水平的差异来解释。
