Ishii Satoshi, Nagai Yoshio, Sada Yukiyoshi, Fukuda Hisashi, Nakamura Yuta, Matsuba Ren, Nakagawa Tomoko, Kato Hiroyuki, Tanaka Yasushi
Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
J Clin Med Res. 2019 Mar;11(3):219-224. doi: 10.14740/jocmr3647. Epub 2019 Feb 13.
Glucagon-like peptide-1 receptor agonists have been reported to reduce body fat as well as improving glycemic control in obese patients with type 2 diabetes. However, the maximum dose of liraglutide is limited to 0.9 mg in Japan, while the international dose is 1.8 mg; and the effect of this low dose on body composition has not been assessed in detail. Accordingly, this study was performed to evaluate the effect of liraglutide on body composition when administered at 0.9 mg once daily for 24 weeks.
Nine patients were enrolled and started liraglutide at 0.3 mg once daily, which was titrated to 0.9 mg once daily after 1 - 2 weeks and continued for 24 weeks. To comprehensively investigate changes of body composition, the body fat and muscle weight were determined by dual energy absorptiometry, visceral fat volume (VFV) and abdominal subcutaneous fat volume (SFV) were measured by abdominal computed tomography (CT), and the intrahepatic lipid content (IHL) was assessed by proton magnetic resonance spectroscopy. Measurements were obtained before starting liraglutide therapy and after 12 and 24 weeks of treatment.
Fasting plasma glucose was significantly reduced from 127 ± 22 to 101 ± 14 mg/dL at 24 weeks and hemoglobin A1c (HbA1c) showed significant reduction from 6.4±0.9% to 5.2±0.5%. Body weight was reduced from 103.4 ± 14.7 to 97.0 ± 12.4 kg (mean reduction: 11.7%) and BMI decreased from 37.4 ± 6.4 to 35.0 ± 5.3 kg/m (mean reduction: 5.8%). Furthermore, VFV and IHL decreased from 5,192 ± 1,730 to 4,513 ± 1,299 cm (mean reduction: 11.9%) and 32.1±12.6% to 15.2±9.2% (mean reduction: 49.2%), respectively, but SFV did not change. Moreover, the fat index was reduced from 14.8 ± 4.4 to 12.9 ± 3.4 kg/m (mean reduction: 10.9%), but the skeletal muscle index did not change.
In obese Japanese drug-naive patients who had type 2 diabetes, treatment with liraglutide (0.9 mg once daily for 24 weeks) reduced body fat, especially visceral fat and intrahepatic fat, while having no significant effect on skeletal muscle.
据报道，胰高血糖素样肽-1受体激动剂可减少肥胖2型糖尿病患者的体脂，并改善血糖控制。然而，在日本，利拉鲁肽的最大剂量限制为0.9毫克，而国际剂量为1.8毫克；这种低剂量对身体成分的影响尚未得到详细评估。因此，本研究旨在评估利拉鲁肽每日一次服用0.9毫克，持续24周时对身体成分的影响。
招募了9名患者，开始时每日一次服用0.3毫克利拉鲁肽，1 - 2周后滴定至每日一次0.9毫克，并持续24周。为全面研究身体成分的变化，通过双能吸收法测定体脂和肌肉重量，通过腹部计算机断层扫描（CT）测量内脏脂肪体积（VFV）和腹部皮下脂肪体积（SFV），并通过质子磁共振波谱评估肝内脂质含量（IHL）。在开始利拉鲁肽治疗前以及治疗12周和24周后进行测量。
24周时，空腹血糖从127±22显著降至101±14毫克/分升，糖化血红蛋白（HbA1c）从6.4±0.9%显著降至5.2±0.5%。体重从103.4±14.7降至97.0±12.4千克（平均降低：11.7%），体重指数从37.4±6.4降至35.0±5.3千克/米（平均降低：5.8%）。此外，VFV和IHL分别从5192±1730降至4513±1299立方厘米（平均降低：11.9%）和从32.1±12.6%降至15.2±9.2%（平均降低：49.2%），但SFV没有变化。此外，脂肪指数从14.8±4.4降至12.9±3.4千克/米（平均降低：10.9%），但骨骼肌指数没有变化。
在未使用过药物的肥胖日本2型糖尿病患者中，利拉鲁肽治疗（每日一次0.9毫克，持续24周）可减少体脂，尤其是内脏脂肪和肝内脂肪，而对骨骼肌无显著影响。
