Department of Internal Medicine IV, Division of Endocrinology, Diabetology, Nephrology, Vascular Disease and Clinical Chemistry, University of Tübingen, Member of the Deutsches Zentrum für Diabetesforschung, Otfried-Müller-Str 10, D-72076 Tübingen, Germany.
Diabetologia. 2011 Apr;54(4):864-8. doi: 10.1007/s00125-010-2006-3. Epub 2010 Dec 21.
AIMS/HYPOTHESIS: We and others recently characterised metabolically benign or healthy obesity (MHO). In the present study we investigated whether a lifestyle intervention is sufficient to place obese insulin-resistant (OIR) individuals in a position where the possible metabolic consequences are similar to those for MHO individuals.
A total of 262 non-diabetic individuals participated in a 9 month lifestyle intervention programme. Obese individuals (BMI ≥ 30.0 kg/m(2)) were stratified, based on their insulin sensitivity (IS) estimated from an OGTT, into MHO (IS in the upper quartile, n = 26) and OIR (IS in the lower three quartiles, n = 77). Total body and visceral fat were measured by magnetic resonance (MR) tomography and liver fat by (1)H-MR spectroscopy.
During the intervention, visceral fat decreased significantly in both groups (both p ≤ 0.009), whereas total body and liver fat decreased only in the OIR group (p < 0.0001; MHO p = 0.12 for total body fat and p = 0.47 for liver fat). IS improved in the OIR group (p < 0.0001), but remained essentially unchanged in the MHO group (p = 0.30). However, despite the significant increase in the OIR group, IS at follow-up barely exceeded 50% of the IS of the MHO group (OIR 9.30 ± 0.53 arbitrary units [AU]; MHO 16.41 ± 1.05 AU; p < 0.0001).
CONCLUSIONS/INTERPRETATION: IS improves during the lifestyle intervention in OIR individuals. However, it does not reach a level where adequate protection from type 2 diabetes and cardiovascular disease is expected. Thus, stratification of obese individuals based on their metabolic phenotype is important to identify those who are likely to need early pharmacological treatment in addition to the lifestyle intervention.
目的/假设：我们和其他人最近描述了代谢良好或健康肥胖（MHO）。在本研究中，我们研究了生活方式干预是否足以使肥胖胰岛素抵抗（OIR）个体处于一种状态，其中可能的代谢后果与 MHO 个体相似。
共有 262 名非糖尿病个体参加了为期 9 个月的生活方式干预计划。根据口服葡萄糖耐量试验（OGTT）估计的胰岛素敏感性（IS），将肥胖个体（BMI≥30.0kg/m2）分为 MHO（IS 处于上四分位数，n=26）和 OIR（IS 处于下三个四分位数，n=77）。使用磁共振（MR）断层扫描测量全身和内脏脂肪，使用（1）H-MR 光谱测量肝脏脂肪。
在干预过程中，两组的内脏脂肪均显著下降（均 p≤0.009），而全身和肝脏脂肪仅在 OIR 组下降（p<0.0001；MHO 组全身脂肪 p=0.12，肝脏脂肪 p=0.47）。OIR 组的 IS 改善（p<0.0001），但 MHO 组基本不变（p=0.30）。然而，尽管 OIR 组的 IS 显著增加，但仍勉强超过 MHO 组 IS 的 50%（OIR 9.30±0.53 个任意单位[AU]；MHO 16.41±1.05 AU；p<0.0001）。
结论/解释：在 OIR 个体的生活方式干预中，IS 改善。然而，它并未达到预期的 2 型糖尿病和心血管疾病的充分保护水平。因此，根据代谢表型对肥胖个体进行分层对于确定那些除了生活方式干预外还需要早期药物治疗的个体非常重要。
