Kujawska-Luczak Magdalena, Stankowiak-Kulpa Hanna, Swora-Cwynar Ewelina, Musialik Katarzyna, Bogdański Paweł, Suliburska Joanna, Grzymisławski Marian
Department of Internal Medicine, Metabolic Disorders, and Hypertension, University of Medical Sciences, Poznań, Poland.
Department of Internal and Metabolic Diseases, and Dietetics, University of Medical Sciences, Poznań, Poland.
Prz Menopauzalny. 2014 May;13(2):115-21. doi: 10.5114/pm.2014.42713. Epub 2014 May 21.
Treatment of obesity with life style modifications often fails; therefore pharmacological treatment has become a very popular approach. Metformin is one of the examined possibilities. The aim of this study was to verify indications for metformin use in obese women based on metabolic and anthropometric parameters assessed by dual-X-ray absorptiometry (DXA), to establish the degree of insulin resistance and its correlations.
Anthropometry, fat measurement by bioimpedance and metabolic profile, including lipids, and oral glucose tolerance test (OGTT) with insulin (0 and 120 min) were performed in 50 female patients diagnosed with simple obesity, aged 18-40 years. Homeostatic model assessment HOMA-R was calculated for insulin resistance, and area under the curve (AUC) for insulin response. Total, android and gynoid fat distribution, and their ratio (A/G), were measured by DXA.
From 50 women who entered the study, 33 were classified as insulin resistant (IR subgroup) and 17 as non-insulin resistant (non-IR subgroup), according to their HOMA-R indices. IR women presented higher waist circumference and DXA A/G ratio. The IR subgroup demonstrated elevated fasting triglycerides and glucose (but in the normal range) and a higher insulin response in OGTT (4.1-fold vs 2.5-fold). From different insulin measurements HOMA index turned out to have the strongest correlations with the metabolic parameters triglycerides and glucose. We found significant positive correlations between android fat and insulin: waist circumference and HOMA-R, WHR and HOMA-R, android fat and HOMA-R, A/G ratio and insulin after OGTT, and A/G ratio and HOMA-R. We found a strong correlation between WHR and A/R ratio.
67% of premenopausal obese women were insulin resistant. Measures of DXA visceral fat determined by android fat percentage and android/gynoid ratio were the strongest determinants of insulin resistance. Waist-to-hip ratio might be a simple method for determining the indications for metformin treatment.
通过生活方式改变来治疗肥胖症往往效果不佳；因此，药物治疗已成为一种非常流行的方法。二甲双胍是其中一种被研究的药物。本研究的目的是根据双能X线吸收法（DXA）评估的代谢和人体测量参数，验证肥胖女性使用二甲双胍的适应症，确定胰岛素抵抗程度及其相关性。
对50名年龄在18至40岁、被诊断为单纯性肥胖的女性患者进行人体测量、通过生物电阻抗法测量脂肪以及代谢指标检测，包括血脂，并进行口服葡萄糖耐量试验（OGTT）及胰岛素检测（0分钟和120分钟）。计算稳态模型评估的胰岛素抵抗指数（HOMA-R）以及胰岛素反应的曲线下面积（AUC）。通过DXA测量全身、腹部和臀部的脂肪分布及其比例（A/G）。
根据HOMA-R指数，50名参与研究的女性中，33名被归类为胰岛素抵抗（IR亚组），17名被归类为非胰岛素抵抗（非IR亚组）。IR女性的腰围和DXA A/G比例更高。IR亚组的空腹甘油三酯和血糖升高（但在正常范围内），且OGTT中的胰岛素反应更高（4.1倍 vs 2.5倍）。在不同的胰岛素测量指标中，HOMA指数与甘油三酯和血糖等代谢参数的相关性最强。我们发现腹部脂肪与胰岛素之间存在显著正相关：腰围与HOMA-R、腰臀比与HOMA-R、腹部脂肪与HOMA-R、OGTT后A/G比例与胰岛素以及A/G比例与HOMA-R。我们发现腰臀比与A/R比例之间存在很强的相关性。
67%的绝经前肥胖女性存在胰岛素抵抗。通过腹部脂肪百分比和腹部/臀部比例确定的DXA内脏脂肪测量指标是胰岛素抵抗的最强决定因素。腰臀比可能是确定二甲双胍治疗适应症的一种简单方法。
