Zhang Tao, Li Ying, Zhang Huijie, Sun Dianjianyi, Li Shengxu, Fernandez Camilo, Harville Emily, Bazzano Lydia, He Jiang, Chen Wei
Department of Biostatistics, School of Public Health, Shandong University, Jinan, China.
Department of Epidemiology, Tulane University Health Sciences Center, Tulane University, 1440 Canal Street, Room 1504G, New Orleans, LA, 70112, USA.
Endocrine. 2016 Oct;54(1):93-100. doi: 10.1007/s12020-016-0948-z. Epub 2016 Apr 8.
Obesity and insulin resistance are both closely associated with type 2 diabetes mellitus (T2DM). It is, however, not clear whether the role of obesity in the development of T2DM is dependent on insulin resistance. This study aims to assess the hypothesis that insulin-sensitive adiposity is associated with a relatively lower risk of T2DM than insulin-resistant adiposity, and the adiposity-T2DM association is modified by insulin resistance in middle-aged black and white adults. The longitudinal study cohort consisted of 1588 middle-aged normoglycemic black and white adults aged 18-44 years at baseline who were followed for 16 years on average. Overweight/obesity at baseline was defined as BMI ≥25, and insulin resistance was measured using the homeostasis model assessment of insulin resistance (HOMA). The prevalence of incident pre-diabetes and T2DM was compared between the insulin-sensitive and insulin-resistant adiposity groups. The prevalence of both incident pre-diabetes and T2DM was higher in the insulin-resistant adiposity than in the insulin-sensitive adiposity group (11.5 vs. 7.5 %, p = 0.023 for pre-diabetes; 16.7 vs. 2.7 %, p < 0.001 for T2DM). In multivariable logistic analyses, adjusted for baseline age, race, sex, follow-up years, and smoking, baseline insulin-resistant obesity was associated with incident pre-diabetes (odds ratio, OR = 2.07, p = 0.046) and T2DM (OR = 8.19, p < 0.001). ORs did not differ between blacks and whites. The ORs for the association of BMI with pre-diabetes and T2DM significantly increased across increasing quartiles of baseline HOMA (p for trend = 0.032 for pre-diabetes and <0.001 for T2DM). Slopes of increasing follow-up glucose with baseline BMI, measured as regression coefficients (β), were significantly greater in insulin-resistant than in insulin-sensitive individuals (β = 0.86 vs. 0.38, p = 0.009 for difference in slopes). These findings suggest that insulin resistance amplifies the obesity-diabetes association and underscore the importance of preventing both adiposity and insulin resistance in young adults.
肥胖和胰岛素抵抗均与2型糖尿病（T2DM）密切相关。然而，肥胖在T2DM发生发展中的作用是否依赖于胰岛素抵抗尚不清楚。本研究旨在评估以下假设：与胰岛素抵抗性肥胖相比，胰岛素敏感性肥胖与T2DM风险相对较低相关，并且在中年黑人和白人成年人中，肥胖与T2DM的关联会因胰岛素抵抗而改变。纵向研究队列由1588名基线时年龄在18 - 44岁的中年血糖正常的黑人和白人成年人组成，平均随访16年。基线时超重/肥胖定义为BMI≥25，胰岛素抵抗采用胰岛素抵抗稳态模型评估（HOMA）进行测量。比较了胰岛素敏感性肥胖组和胰岛素抵抗性肥胖组中糖尿病前期和T2DM的发病率。胰岛素抵抗性肥胖组中糖尿病前期和T2DM的发病率均高于胰岛素敏感性肥胖组（糖尿病前期：11.5%对7.5%，p = 0.023；T2DM：16.7%对2.7%，p < 0.001）。在多变量逻辑分析中，校正基线年龄、种族、性别、随访年限和吸烟因素后，基线胰岛素抵抗性肥胖与糖尿病前期发病相关（比值比，OR = 2.07，p = 0.046）以及与T2DM相关（OR = 8.19，p < 0.001）。黑人和白人之间的OR值无差异。随着基线HOMA四分位数的增加，BMI与糖尿病前期和T2DM关联的OR值显著升高（糖尿病前期趋势p = 0.032，T2DM趋势p < 0.001）。以回归系数（β）衡量，胰岛素抵抗个体中随访血糖随基线BMI增加的斜率显著大于胰岛素敏感个体（β = 0.86对0.38，斜率差异p = 0.009）。这些发现表明胰岛素抵抗会放大肥胖与糖尿病的关联，并强调了在年轻人中预防肥胖和胰岛素抵抗的重要性。
