Faria Alessandra Nunes, Ribeiro Filho Fernando Flexa, Gouveia Ferreira Sandra Roberta, Zanella Maria Teresa
Department of Endocrinology, University of São Paulo, School of Medicine, Hospital do Rim e da Hipertensão, Brazil.
Obes Res. 2002 Dec;10(12):1203-6. doi: 10.1038/oby.2002.164.
The relationship among body fat distribution, blood pressure, serum leptin levels, and insulin resistance was investigated in hypertensive obese women with central distribution of fat.
We studied 74 hypertensive women (age, 49.8 +/- 7.5 years; body mass index, 39.1 +/- 5.5 kg/m(2); waist-to-hip ratio, 0.96 +/- 0.08). All patients were submitted to 24-hour blood pressure ambulatory monitoring (24h-ABPM). Abdominal ultrasonography was used to estimate the amount of visceral fat (VF). Fasting blood samples were obtained for serum leptin and insulin determinations. Insulin resistance was estimated by homeostasis model assessment insulin resistance index (HOMA-r index).
Sixty-four percent of the women were postmenopausal, and all patients showed central distribution of fat (waist-to-hip ratio > 0.85). The VF correlated with systolic 24h-ABPM values (r = 0.28, p = 0.01) and with HOMA-r index (r = 0.27; p = 0.01). VF measurement (7.5 +/- 2.3 vs. 5.9 +/- 2.2 cm, p < 0.001) and the systolic 24h-ABPM (133 +/- 14.5 vs. 126 +/- 9.8 mm Hg, p = 0.04), but not HOMA-r index, were significantly higher in the postmenopausal group (n = 48) than in the premenopausal group (n = 26). No correlations were observed between blood pressure levels and HOMA-r index, leptin, or insulin levels. In the multiple regression analysis, visceral fat, but not age, body fat mass, or HOMA-r index, correlated with the 24h-ABPM (p = 0.003).
In centrally obese hypertensive women, the accumulation of VF, more often after menopause, is associated with higher levels of blood pressure and insulin resistance. The mechanism through which VF contributes to higher blood pressure levels seems to be independent of leptin or insulin levels.
研究脂肪中心分布型高血压肥胖女性的体脂分布、血压、血清瘦素水平和胰岛素抵抗之间的关系。
我们研究了74名高血压女性（年龄49.8±7.5岁；体重指数39.1±5.5kg/m²；腰臀比0.96±0.08）。所有患者均接受24小时动态血压监测（24h-ABPM）。采用腹部超声估计内脏脂肪（VF）量。采集空腹血样测定血清瘦素和胰岛素。通过稳态模型评估胰岛素抵抗指数（HOMA-r指数）评估胰岛素抵抗。
64%的女性为绝经后女性，所有患者均表现为脂肪中心分布（腰臀比>0.85）。VF与24小时动态收缩压值（r = 0.28，p = 0.01）以及HOMA-r指数（r = 0.27；p = 0.01）相关。绝经后组（n = 48）的VF测量值（7.5±2.3 vs. 5.9±2.2cm，p < 0.001）和24小时动态收缩压（133±14.5 vs. 126±9.8mmHg，p = 0.04）显著高于绝经前组（n = 26），但HOMA-r指数无显著差异。未观察到血压水平与HOMA-r指数、瘦素或胰岛素水平之间存在相关性。在多元回归分析中，与24小时动态血压相关的是内脏脂肪，而非年龄、体脂肪量或HOMA-r指数（p = 0.003）。
在中心性肥胖的高血压女性中，VF的积累（更常见于绝经后）与更高的血压水平和胰岛素抵抗相关。VF导致血压升高的机制似乎独立于瘦素或胰岛素水平。
