Khawaja Khadija Irfan, Mian Saqib Ali, Fatima Aziz, Tahir Ghulam Murtaza, Khan Fehmida Farrukh, Burney Saira, Hasan Ali, Masud Faisal
Department of Endocrinology and Metabolism, Services Institute of Medical Sciences and Services Hospital, Lahore, Pakistan.
Diabetes Care Centre, King Salman Hospital, Riyadh, Kingdom of Saudi Arabia.
Singapore Med J. 2018 Aug;59(8):431-438. doi: 10.11622/smedj.2018019. Epub 2018 Feb 12.
Metabolic heterogeneity among obese individuals is thought to translate into variations in cardiovascular risk. Identifying obese people with an unfavourable metabolic profile may allow preventive strategies to be targeted at high-risk groups. This study aimed to identify clinical, biochemical and immunological differences between insulin-sensitive and insulin-resistant obese subgroups, to understand the population-specific pathophysiological basis of the adverse cardiovascular risk profile in the latter group.
Cardiovascular risk indicators, including anthropometric parameters, blood pressure, acanthosis nigricans area, and related biochemical, endocrine and inflammatory markers, were determined in 255 healthy South Asian volunteers aged 18-45 years, with a 2:1 ratio of obese/overweight to normal-weight individuals. Lifetime atherosclerotic cardiovascular disease (ASCVD) risk was also calculated.
Body mass index (BMI) and insulin sensitivity-based tertiles independently showed incremental trends in waist-hip ratio, skinfold thickness, acanthosis nigricans area, blood pressure, serum lipids, hepatic enzymes, adipokines, inflammatory markers and ten-year ASCVD risk. The anthropometric, biochemical and inflammatory parameters of obese insulin-sensitive and obese insulin-resistant groups differed significantly. Extreme group analysis after excluding the middle tertiles of both insulin resistance and BMI also showed significant difference in anthropometric indicators of cardiovascular risk and estimated lifetime ASCVD risk between the two obese subgroups.
Obese insulin-sensitive individuals had a favourable metabolic profile compared to the obese insulin-resistant group. The most consistent discriminative factor between these phenotypic classes was anthropometric parameters, which underscores the importance of clinical parameters as cardiovascular risk indicators in obesity.
肥胖个体之间的代谢异质性被认为会转化为心血管风险的差异。识别代谢状况不佳的肥胖人群可能有助于将预防策略针对高危群体。本研究旨在确定胰岛素敏感型和胰岛素抵抗型肥胖亚组之间的临床、生化和免疫学差异，以了解后一组不良心血管风险特征的人群特异性病理生理基础。
对255名年龄在18至45岁的健康南亚志愿者进行了心血管风险指标测定，包括人体测量参数、血压、黑棘皮病面积以及相关的生化、内分泌和炎症标志物，肥胖/超重与正常体重个体的比例为2:1。还计算了终生动脉粥样硬化性心血管疾病（ASCVD）风险。
基于体重指数（BMI）和胰岛素敏感性的三分位数独立显示出腰臀比、皮褶厚度、黑棘皮病面积、血压、血脂、肝酶、脂肪因子、炎症标志物和十年ASCVD风险呈递增趋势。肥胖胰岛素敏感组和肥胖胰岛素抵抗组的人体测量、生化和炎症参数存在显著差异。排除胰岛素抵抗和BMI的中间三分位数后的极端组分析也显示，两个肥胖亚组在心血管风险的人体测量指标和估计的终生ASCVD风险方面存在显著差异。
与肥胖胰岛素抵抗组相比，肥胖胰岛素敏感个体具有良好的代谢特征。这些表型类别之间最一致的判别因素是人体测量参数，这突出了临床参数作为肥胖心血管风险指标的重要性。
