非肥胖女性在绝经初期报告体重适度增加时的高胰岛素血症：胰岛素抵抗易感性的有用早期指标。

Hyperinsulinemia in nonobese women reporting a moderate weight gain at the beginning of menopause: a useful early measure of susceptibility to insulin resistance.

机构信息

Centre d'Endocrinologie de la Reproduction, d'Infertilité et de Ménopause, Hôpital St.-François d'Assise (CHUQ), Québec City, QC, Canada.

出版信息

Menopause. 2010 Mar;17(2):321-5. doi: 10.1097/gme.0b013e3181b7c521.

DOI:10.1097/gme.0b013e3181b7c521

PMID:19745772

Abstract

OBJECTIVE

At menopause, the frequent weight gain excess could be related to insulin resistance. This study evaluated the prevalence of hyperinsulinemia in nonobese women reporting a moderate increase in weight at the beginning of menopause.

METHODS

Women who were postmenopausal for 1 to 5 years and reporting a weight gain of 5 to 15 kg were evaluated for weight, eating habits, physical activity, body circumferences, fasting blood glucose level, insulin level, and lipid profile. An oral glucose tolerance test was performed in subgroups of 21 hyperinsulinemic women and 21 normoinsulinemic women matched for age, weight, height, body mass index, and hysterectomy.

RESULTS

Among 279 postmenopausal women reporting a weight gain of 8.7 +/- 4.4 kg, insulin level was increased in 49 (17.6%) women as compared with normoinsulinemic women (108.53 +/- 31.35 vs 58.96 +/- 14.52 pmol/L, respectively; P < 0.001). Differences were also found for glucose (5.24 +/- 0.37 vs 5.05 +/- 0.42 mmol/L, respectively; P = 0.003), insulin resistance as estimated by homeostasis model assessment HOMA-2-IR (2.01 +/- 0.53 vs 1.10 +/- 0.27, respectively; P < 0.001), weight (72.6 +/- 8.0 vs 69.9 +/- 7.1 kg, respectively; P = 0.023), body mass index (28.3 +/- 2.3 vs 27.2 +/- 2.3 kg/m2, respectively; P = 0.003), and waist circumference (89.8 +/- 5.8 vs 86.0 +/- 6.5 cm, respectively; P < 0.001). Triglyceride levels were higher (1.47 +/- 0.66 vs 1.17 +/- 0.61 mmol/L, respectively; P = 0.002) and high-density lipoprotein cholesterol level was lower (1.54 +/- 0.35 vs 1.72 +/- 0.42 mmol/L, respectively; P = 0.007) in the hyperinsulinemic and normoinsulinemic groups. Although insulin levels were higher in 21 hyperinsulinemic women at all times that oral glucose tolerance tests were performed, levels of glucose were also above those of 21 matched normoinsulinemic women at 1 and 2 hours and remained greater than 6.0 mmol/L at 2 hours.

CONCLUSIONS

Because insulin resistance is frequently associated with weight gain in nonobese women at menopause, the measurement of fasting insulin, along with glucose, lipids, and waist circumference, may help to identify those who are at higher risk of developing glucose intolerance, metabolic syndrome, diabetes, and cardiovascular diseases and to implement early preventive measures.

摘要

目的

绝经后，体重频繁增加可能与胰岛素抵抗有关。本研究评估了报告绝经初期体重增加 5 至 15 公斤的非肥胖女性中高胰岛素血症的患病率。

方法

绝经 1 至 5 年且报告体重增加 5 至 15 公斤的女性接受体重、饮食习惯、身体活动、体围、空腹血糖水平、胰岛素水平和血脂检查。对 21 名高胰岛素血症和 21 名正常胰岛素血症女性进行亚组口服葡萄糖耐量试验，亚组匹配年龄、体重、身高、体重指数和子宫切除术。

结果

在报告体重增加 8.7 ± 4.4 公斤的 279 名绝经后女性中，49 名（17.6%）女性的胰岛素水平升高，与正常胰岛素血症女性相比（分别为 108.53 ± 31.35 与 58.96 ± 14.52 pmol/L；P < 0.001）。葡萄糖（分别为 5.24 ± 0.37 与 5.05 ± 0.42 mmol/L；P = 0.003）、稳态模型评估 HOMA-2-IR 评估的胰岛素抵抗（分别为 2.01 ± 0.53 与 1.10 ± 0.27；P < 0.001）、体重（分别为 72.6 ± 8.0 与 69.9 ± 7.1 kg；P = 0.023）、体重指数（分别为 28.3 ± 2.3 与 27.2 ± 2.3 kg/m2；P = 0.003）和腰围（分别为 89.8 ± 5.8 与 86.0 ± 6.5 cm；P < 0.001）也存在差异。高胰岛素血症组的甘油三酯水平较高（分别为 1.47 ± 0.66 与 1.17 ± 0.61 mmol/L；P = 0.002），高密度脂蛋白胆固醇水平较低（分别为 1.54 ± 0.35 与 1.72 ± 0.42 mmol/L；P = 0.007）。尽管在所有进行口服葡萄糖耐量试验时，高胰岛素血症组的胰岛素水平均较高，但 1 小时和 2 小时的葡萄糖水平也高于 21 名匹配的正常胰岛素血症女性，且在 2 小时时仍高于 6.0 mmol/L。