Grunfeld Carl, Rimland David, Gibert Cynthia L, Powderly William G, Sidney Stephen, Shlipak Michael G, Bacchetti Peter, Scherzer Rebecca, Haffner Steven, Heymsfield Steven B
Department of Medicine, University of California, San Francisco, CA, USA.
J Acquir Immune Defic Syndr. 2007 Nov 1;46(3):283-90. doi: 10.1097/qai.0b013e31814b94e2.
Visceral obesity is associated with insulin resistance, but the association of other regional adipose depots with insulin resistance is not understood. In HIV infection, buffalo hump (upper trunk fat) is associated, but the association of upper trunk fat with insulin resistance has not been examined in controls. To determine the independent association of adipose depots other than visceral with insulin resistance, we performed a cross-sectional analysis of controls and HIV-infected subjects in the Fat Redistribution and Metabolic Change in HIV Infection (FRAM) study, who had measurements of glucose, insulin, and adipose tissue volumes by whole-body magnetic resonance imaging. We studied 926 HIV-positive persons from 16 academic medical center clinics and trials units with demographic characteristics representative of US patients with HIV infection and 258 FRAM controls from the population-based Coronary Artery Risk Development in Young Adults study. We measured visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) volume in the legs, arms, lower trunk (back and abdomen), and upper trunk (back and chest) and assessed their association with the homeostasis model of assessment (HOMA) and HOMA >4 by stepwise multivariable analysis. The prevalence of HOMA >4 as a marker of insulin resistance was 28% among controls compared with 37% among HIV-infected subjects (P = 0.005). Among controls, those in the highest tertile of upper trunk SAT volume had an odds ratio (OR) of 9.0 (95% confidence interval [CI]: 2.4 to 34; P = 0.001) for having HOMA >4 compared with the lowest tertile, whereas in HIV-positive subjects, the OR was lower (OR = 2.09, 95% CI: 1.36 to 3.19; P = 0.001). Among controls, the highest tertile of VAT volume had an OR of 12.1 (95% CI: 3.2 to 46; P = 0.0002) of having HOMA >4 compared with the lowest tertile, whereas in HIV-positive subjects, the OR was 3.12 (95% CI: 2.0 to 4.8; P < 0.0001). After adjusting for VAT and upper trunk SAT, the association of other SAT depots with HOMA >4 did not reach statistical significance. Thus, VAT and upper trunk SAT are independently associated with insulin resistance in controls and in HIV-infected persons.
内脏肥胖与胰岛素抵抗相关，但其他局部脂肪堆积与胰岛素抵抗之间的关联尚不清楚。在HIV感染中，背部脂肪垫（上半身躯干脂肪）与之相关，但上半身躯干脂肪与胰岛素抵抗之间的关联在对照组中尚未得到研究。为了确定除内脏脂肪外的其他脂肪堆积与胰岛素抵抗的独立关联，我们在“HIV感染中的脂肪重新分布和代谢变化”（FRAM）研究中对对照组和HIV感染受试者进行了横断面分析，这些受试者通过全身磁共振成像测量了血糖、胰岛素和脂肪组织体积。我们研究了来自16个学术医学中心诊所和试验单位的926名HIV阳性患者，其人口统计学特征代表了美国HIV感染患者，以及来自基于人群的“青年成人冠状动脉风险发展”研究的258名FRAM对照组。我们测量了腿部、手臂、下半身躯干（背部和腹部）和上半身躯干（背部和胸部）的内脏脂肪组织（VAT）和皮下脂肪组织（SAT）体积，并通过逐步多变量分析评估它们与稳态模型评估（HOMA）以及HOMA>4之间的关联。作为胰岛素抵抗标志物，HOMA>4在对照组中的患病率为28%，而在HIV感染受试者中为37%（P = 0.005）。在对照组中，上半身躯干SAT体积处于最高三分位数的人群与最低三分位数相比，HOMA>4的比值比（OR）为9.0（95%置信区间[CI]：2.4至34；P = 0.001），而在HIV阳性受试者中，OR较低（OR = 2.09，95% CI：1.36至3.19；P = 0.001）。在对照组中，VAT体积处于最高三分位数的人群与最低三分位数相比，HOMA>4的OR为12.1（95% CI：3.2至46；P = 0.0002），而在HIV阳性受试者中，OR为3.12（95% CI：2.0至4.8；P < 0.0001）。在对VAT和上半身躯干SAT进行调整后，其他SAT堆积部位与HOMA>4之间的关联未达到统计学显著性。因此，VAT和上半身躯干SAT在对照组和HIV感染人群中均与胰岛素抵抗独立相关。
