Phillips Gerald B, Jing Tianyi, Heymsfield Steven B
Department of Medicine, Columbia University College of Physicians and Surgeons, St Luke's-Roosevelt Hospital Center, New York, NY 10019, USA.
Metabolism. 2008 Jun;57(6):838-44. doi: 10.1016/j.metabol.2008.01.029.
Insulin resistance, obesity, and a sex hormone alteration have each been suggested as the underlying link for the constellation of risk factors for myocardial infarction (MI) commonly referred to as the metabolic syndrome or the insulin resistance syndrome. In an attempt to identify in women which of these variables is the most likely link, insulin, adiposity variables, sex hormones, and risk factors for MI were measured and their relationships analyzed statistically in 58 premenopausal and 20 postmenopausal healthy women. On controlling for age, visceral adipose tissue (VAT) correlated more strongly with risk factors for MI, insulin, and free testosterone (FT) than did total adipose tissue or subcutaneous adipose tissue. VAT, therefore, was used as the adiposity variable for further data analysis. Waist circumference was a better surrogate of VAT than was waist-hip ratio, which was a poor surrogate of VAT. VAT correlated positively with insulin, FT, triglyceride, and glucose, and negatively with high-density lipoprotein and sex hormone-binding globulin. On controlling for age, FT and insulin correlated with risk factors for MI and with each other, but on controlling for age and VAT, all of their correlations lost statistical significance except for FT-triglyceride and FT-insulin in the postmenopausal women. In conclusion, VAT accumulation in women, independently of other measures of adiposity, may largely explain the correlations of insulin, obesity, and sex hormones with risk factors for MI and may be the immediate underlying factor that links risk factors for MI to form the metabolic syndrome. Insulin resistance, which has been generally accepted to be the underlying factor, may be a component of the syndrome rather than its underlying link. We hypothesize that in women FT may effect preferential VAT accumulation and induce insulin resistance directly, as well as via VAT accumulation, so that a sex hormone alteration may underlie VAT accumulation and thus ultimately underlie the metabolic syndrome (with insulin resistance as a component).
胰岛素抵抗、肥胖和性激素改变均被认为是心肌梗死（MI）危险因素群的潜在关联因素，这些危险因素群通常被称为代谢综合征或胰岛素抵抗综合征。为了确定在女性中这些变量中哪一个最有可能是关联因素，对58名绝经前和20名绝经后健康女性测量了胰岛素、肥胖变量、性激素和MI危险因素，并对它们之间的关系进行了统计学分析。在控制年龄后，内脏脂肪组织（VAT）与MI危险因素、胰岛素和游离睾酮（FT）的相关性比总脂肪组织或皮下脂肪组织更强。因此，VAT被用作肥胖变量进行进一步的数据分析。腰围比腰臀比是VAT更好的替代指标，腰臀比是VAT较差的替代指标。VAT与胰岛素、FT、甘油三酯和葡萄糖呈正相关，与高密度脂蛋白和性激素结合球蛋白呈负相关。在控制年龄后，FT和胰岛素与MI危险因素以及它们彼此之间相关，但在控制年龄和VAT后，除了绝经后女性中FT-甘油三酯和FT-胰岛素的相关性外，它们所有的相关性均失去统计学意义。总之，女性体内VAT的积累，独立于其他肥胖指标，可能在很大程度上解释了胰岛素、肥胖和性激素与MI危险因素之间的相关性，并且可能是将MI危险因素联系起来形成代谢综合征的直接潜在因素。胰岛素抵抗通常被认为是潜在因素，可能是该综合征的一个组成部分而非潜在关联因素。我们假设在女性中，FT可能优先影响VAT积累，并直接以及通过VAT积累诱导胰岛素抵抗，因此性激素改变可能是VAT积累的基础，从而最终是代谢综合征（胰岛素抵抗作为一个组成部分）的基础。
