Mori Yutaka, Hoshino Kyouko, Yokota Kuninobu, Itoh Yohta, Tajima Naoko
Department of Internal Medicine, National Hospital Organization, Utsunomiya National Hospital, Kawachi, Tochigi, Japan.
Endocrine. 2006 Feb;29(1):149-53. doi: 10.1385/endo:29:1:149.
To elucidate the role of visceral fat accumulation in the metabolic syndrome, differences in the pathology of the metabolic syndrome with or without visceral fat accumulation were investigated. A total of 472 prediabetic Japanese men (mean age, 47.5 +/- 7.2 yr) with impaired fasting glycemia (IFG) levels of 110-125 mg/dL were eligible for participation in the study. The study subjects were divided into the following four groups, and intergroup comparisons were made: group I without visceral fat area [VFA] > or = 100 cm2 but presenting with fewer than two other risk factors (i.e., TG > or =150 mg/dL, HDL-C < 40 mg/dL, BP > or = 130/ > or = 85 mmHg, or FPG > or = 110 mg/dL) (n = 231); group II without VFA of > or = 100 cm2 but presenting with three or more other risk factors (n = 57); group III with VFA of > or = 100 cm2 accompanied by FPG 110 mg/dL alone (n = 27); and group IV with VFA > or =100 cm2 and two or more other risk factors (n = 157). The prevalence of patients who had three or more risk factors with or without VFA > or = 100 cm2 was 45.3% (214 out of 472 patients), while that of those with VFA > or = 100 cm2 who had two or more other risk factors was 33% (157 out of 472 patients). Group II had significantly higher VFA values than group I (p < 0.05), and group IV had significantly higher VFA values than group II (p < 0.001). While no significant differences in HOMA-R values were seen between groups I and II, these values were significantly higher in group IV compared to groups I and II (p < 0.001 and p < 0.05, respectively). Furthermore, group IV showed significantly higher 2-h insulin levels after glucose loading compared to group I (p < 0.001). While no significant differences were seen between groups II and IV, insulin levels tended to be higher in group IV. Adiponectin levels showed an incremental fall in VFA from group I through groups II and III to group IV. Groups III and IV showed significantly lower adiponectin levels compared to group I (p < 0.05, p < 0.001, respectively); and group IV showed significantly lower adiponectin levels than group II (p < 0.05). A logistic regression analysis using VFA, TG and HDL-C, and BP as explanatory variables showed that the relative risk for high HOMAR values were 2.65 (p < 0.001) for patients with VFA > or =100 cm2; 1.64 (p < 0.05) for those with TG > or = 150 mg/dL and HDL < 40 mg/dL; and 1.79 (p < 0.01) for those with BP > or = 130/ > or = 85 mmHg. These findings demonstrate that the degree of insulin resistance and the risk of arteriosclerosis vary depending on whether or not the metabolic syndrome accompanied by a clustering of risk factors has visceral fat accumulation as an underlying pathology, strongly suggesting a crucial role for visceral fat accumulation in the metabolic syndrome.
为阐明内脏脂肪堆积在代谢综合征中的作用，我们研究了伴有或不伴有内脏脂肪堆积的代谢综合征的病理差异。共有472名空腹血糖受损（IFG）水平为110 - 125mg/dL的日本男性糖尿病前期患者（平均年龄47.5±7.2岁）符合参与本研究的条件。研究对象被分为以下四组，并进行组间比较：第一组，内脏脂肪面积（VFA）<100cm²且伴有少于两个其他危险因素（即TG≥150mg/dL、HDL - C<40mg/dL、血压≥130/≥85mmHg或空腹血糖≥110mg/dL）（n = 231）；第二组，VFA<100cm²但伴有三个或更多其他危险因素（n = 57）；第三组，VFA≥100cm²且仅伴有空腹血糖≥110mg/dL（n = 27）；第四组，VFA≥100cm²且伴有两个或更多其他危险因素（n = 157）。伴有或不伴有VFA≥100cm²且有三个或更多危险因素的患者患病率为45.3%（472名患者中的214名），而VFA≥100cm²且伴有两个或更多其他危险因素的患者患病率为33%（472名患者中的157名）。第二组的VFA值显著高于第一组（p<0.05），第四组的VFA值显著高于第二组（p<0.001）。虽然第一组和第二组之间的HOMA - R值没有显著差异，但与第一组和第二组相比，第四组的这些值显著更高（分别为p<0.001和p<0.05）。此外，与第一组相比，第四组在葡萄糖负荷后2小时胰岛素水平显著更高（p<0.001）。虽然第二组和第四组之间没有显著差异，但第四组的胰岛素水平往往更高。脂联素水平显示从第一组到第二组、第三组再到第四组，随着VFA增加而逐渐下降。与第一组相比，第三组和第四组的脂联素水平显著更低（分别为p<0.05，p<0.001）；与第二组相比，第四组的脂联素水平显著更低（p<0.05）。以VFA、TG、HDL - C和血压作为解释变量的逻辑回归分析表明，VFA≥100cm²的患者高HOMAR值的相对风险为2.65（p<0.001）；TG≥150mg/dL且HDL<40mg/dL的患者为1.64（p<0.05）；血压≥130/≥85mmHg的患者为1.79（p<0.01）。这些发现表明，胰岛素抵抗程度和动脉硬化风险因伴有危险因素聚集的代谢综合征是否以内脏脂肪堆积为潜在病理而有所不同，强烈提示内脏脂肪堆积在代谢综合征中起关键作用。
