Effect of a long term very low calorie diet on glucose/insulin metabolism in obesity. Influence of fat distribution on hepatic insulin extraction.

Hyperinsulinemia is a well-recognized entity of simple obesity. In upper body obesity a diminished hepatic extraction of insulin contributes to the hyperinsulinemia. SHBG levels correlate (r = 0.34, P less than 0.05) with the c-peptide/insulin molar ratio. After long term weight reduction by very low calorie dieting, not only fasting and total area insulin decreased significantly, also hepatic insulin extraction improved markedly. This observed change was related to an increase in SHBG both for men and women.