Endocrinology Department, King's College Hospital, Denmark Hill, London, UK.
Clin Endocrinol (Oxf). 2010 Aug;73(2):197-200. doi: 10.1111/j.1365-2265.2009.03772.x. Epub 2009 Dec 29.
Although associations between visceral adiposity (intra-abdominal fat mass) and insulin resistance are well established, previous data include few subjects with WHO grade III obesity [body mass index (BMI) > 40 kg/m(2)]. We have investigated the relationship between visceral adiposity and insulin resistance using computed tomography (CT)-quantified fat mass and the homeostasis model assessment for insulin resistance (HOMA-IR) in patients with severe obesity.
Eighteen nondiabetic subjects with BMI > 40 kg/m(2) were recruited. BMI, and waist, hip and neck circumferences were measured. Fasting plasma insulin and glucose were measured to calculate HOMA-IR. A single slice CT scan was taken at L4 and visceral and abdominal subcutaneous adipose tissue (VAT and ASAT, respectively) quantified using 'SliceOmatic' image analysis software.
A close correlation was demonstrated between VAT and HOMA-IR (r(2) = 0.46, P = 0.002), whereas ASAT showed no relationship. Neck circumference correlated with both VAT (r(2) = 0.67, P < 0.0001) and HOMA-IR (r(2) = 0.35, P = 0.01). Waist circumference only correlated significantly with VAT (r(2) = 0.25, P = 0.03).
Visceral adiposity remains a strongly significant indicator of insulin resistance in WHO grade III obesity. Neck circumference surpasses other anthropometric measurements as a powerful marker of both VAT and insulin resistance.
尽管内脏脂肪（腹部脂肪量）与胰岛素抵抗之间存在关联已得到充分证实，但之前的数据仅包括少数 WHO 肥胖 3 级（BMI>40kg/m²）患者。我们使用 CT 定量脂肪量和胰岛素抵抗的稳态模型评估（HOMA-IR），对严重肥胖患者的内脏脂肪与胰岛素抵抗之间的关系进行了研究。
共招募了 18 名 BMI>40kg/m²的非糖尿病患者。测量 BMI、腰围、臀围和颈围。测量空腹血浆胰岛素和血糖，以计算 HOMA-IR。在 L4 进行单次 CT 扫描，并使用“SliceOmatic”图像分析软件定量测量内脏和腹部皮下脂肪（VAT 和 ASAT）。
VAT 与 HOMA-IR 之间存在密切相关性（r²=0.46，P=0.002），而 ASAT 则无相关性。颈围与 VAT（r²=0.67，P<0.0001）和 HOMA-IR（r²=0.35，P=0.01）均相关。腰围仅与 VAT 显著相关（r²=0.25，P=0.03）。
内脏脂肪仍然是 WHO 肥胖 3 级患者胰岛素抵抗的重要指标。颈围是 VAT 和胰岛素抵抗的强有力标志物，优于其他人体测量指标。
