Snijder Marieke B, Dekker Jacqueline M, Visser Marjolein, Bouter Lex M, Stehouwer Coen D A, Yudkin John S, Heine Robert J, Nijpels Giel, Seidell Jacob C
Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Diabetes Care. 2004 Feb;27(2):372-7. doi: 10.2337/diacare.27.2.372.
Waist and hip circumferences have been shown to have independent and opposite associations with glucose levels. Waist circumference is positively associated with glucose levels, whereas hip circumference is negatively associated. It is unclear which tissues are involved in the pathophysiological mechanism causing these associations. The main goal was to determine which tissue in the trunk and legs, fat or lean tissue, is associated with measures of glucose metabolism.
In 623 participants of the third examination of the Hoorn Study, whole-body dual-energy X-ray absorptiometry was performed to determine fat and lean soft-tissue mass in the trunk and legs. Fasting and 2-h postload glucose levels after 75-g oral glucose tolerance test (OGTT) were determined. After exclusion of known diabetic patients, cross-sectional analyses were performed in 275 men aged 60-87 years (140 with normal glucose metabolism, 92 with impaired glucose metabolism; and 43 with diabetes) and in 281 women (148 with normal glucose metabolism, 90 with impaired glucose metabolism, and 43 with diabetes).
Greater trunk fat mass was associated with higher glucose levels after adjustment for age, trunk lean mass, leg lean mass, and leg fat mass. Standardized beta (95% CI) in men were 0.44 (0.25-0.64) for fasting and 0.41 (0.22-0.60) for postload glucose. For women, these values were 0.49 (0.35-0.63) and 0.47 (0.33-0.61), respectively. In contrast, in the same regression models, a larger leg fat mass was associated with lower glucose levels. Standardized beta in men were -0.24 (-0.43 to -0.05) and -0.12 (-0.31 to 0.07) and in women -0.24 (-0.37 to -0.10) and -0.27 (-0.40 to -0.13) for fasting and postload glucose, respectively. In these models, larger leg lean mass was also associated with lower glucose levels but was only statistically significant in men.
If trunk fat is taken into account, accumulation of fat in the legs seems to be protective against a disturbed glucose metabolism, particularly in women. Further research is needed to unravel underlying pathophysiological mechanisms.
腰围和臀围已被证明与血糖水平存在独立且相反的关联。腰围与血糖水平呈正相关，而臀围与血糖水平呈负相关。目前尚不清楚哪些组织参与了导致这些关联的病理生理机制。主要目标是确定躯干和腿部的脂肪组织或瘦组织中，哪些与葡萄糖代谢指标相关。
在Hoorn研究的第三次检查的623名参与者中，进行了全身双能X线吸收测定，以确定躯干和腿部的脂肪和瘦软组织质量。测定了75克口服葡萄糖耐量试验（OGTT）后的空腹和餐后2小时血糖水平。在排除已知糖尿病患者后，对275名年龄在60 - 87岁的男性（140名葡萄糖代谢正常，92名葡萄糖代谢受损，43名患有糖尿病）和281名女性（148名葡萄糖代谢正常，90名葡萄糖代谢受损，43名患有糖尿病）进行了横断面分析。
在调整年龄、躯干瘦体重、腿部瘦体重和腿部脂肪量后，更大的躯干脂肪量与更高的血糖水平相关。男性空腹血糖的标准化β值（95%CI）为0.44（0.25 - 0.64），餐后血糖为0.41（0.22 - 0.60）。女性的这些值分别为0.49（0.35 - 0.63）和0.47（0.33 - 0.61）。相反，在相同的回归模型中，更大的腿部脂肪量与更低的血糖水平相关。男性空腹和餐后血糖的标准化β值分别为-0.24（-0.43至-0.05）和-0.12（-0.31至0.07），女性分别为-0.24（-0.37至-0.10）和-0.27（-0.40至-0.13）。在这些模型中，更大的腿部瘦体重也与更低的血糖水平相关，但仅在男性中具有统计学意义。
如果考虑躯干脂肪，腿部脂肪的积累似乎对葡萄糖代谢紊乱具有保护作用，尤其是在女性中。需要进一步研究以阐明潜在的病理生理机制。
