Department of Endocrinology and Metabolism, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, China.
BMJ Open Diabetes Res Care. 2021 Feb;9(1). doi: 10.1136/bmjdrc-2020-002059.
Although obesity and hyperinsulinemia are closely intercorrelated, their temporal sequence is still uncertain. This study aims to investigate the temporal relationship patterns between obesity measures and hyperinsulinemia in Chinese adults.
The longitudinal cohort consisted of 2493 participants (860 males and 1633 female, mean age 56.71 years at follow-up) for whom measurements of obesity and hyperinsulinemia measures were collected twice between 2011 and 2014, with an average follow-up time of 3 years. Cross-lagged panel analysis was used to examine the temporal relationship between obesity measures (body mass index (BMI); waist circumference (WC); hip circumference (HC); waist-to-hip ratio (WHR)) and hyperinsulinemia (insulin, homeostasis model assessment of insulin resistance (HOMA-IR), or homeostasis model assessment of beta cell function (HOMA-%β)).
After the adjustment of age, sex, smoking, drinking and follow-up years, in the BMI-insulin model, the path coefficient (β=0.229; p<0.001) of baseline BMI to follow-up insulin was significantly greater than the path coefficient (β=0.073; p<0.001) of baseline insulin to follow-up BMI (p<0.001 for β>β). In the WHR-insulin model, the path coefficient (β=0.152; p<0.001) of baseline insulin to follow-up WHR was significantly greater than the path coefficient (β=0.077; p<0.001) of baseline WHR to follow-up insulin (p=0.007 for β>β). In the WC/HC-insulin model, the path coefficients of baseline insulin to follow-up WC or HC (β) were also greater than the path coefficients of baseline WC or HC to follow-up insulin (β), but the difference between β and β were not significant. The similar temporal patterns were founded between obesity measures with HOMA-IR or HOMA-%β.
These findings indicate that there is a bidirectional relationship between obesity and hyperinsulinemia, and abdominal obesity measures are more sensitive to hyperinsulinemia measures than BMI.
肥胖和高胰岛素血症密切相关，但它们的时间顺序尚不确定。本研究旨在探讨中国成年人中肥胖指标与高胰岛素血症之间的时间关系模式。
该纵向队列包括 2493 名参与者（860 名男性和 1633 名女性，随访时平均年龄为 56.71 岁），在 2011 年至 2014 年期间两次收集肥胖和高胰岛素血症指标的测量值，平均随访时间为 3 年。交叉滞后面板分析用于检查肥胖指标（体重指数（BMI）；腰围（WC）；臀围（HC）；腰臀比（WHR））和高胰岛素血症（胰岛素、稳态模型评估的胰岛素抵抗（HOMA-IR）或稳态模型评估的β细胞功能（HOMA-%β））之间的时间关系。
在调整年龄、性别、吸烟、饮酒和随访年限后，在 BMI-胰岛素模型中，基础 BMI 到随访胰岛素的路径系数（β=0.229；p<0.001）明显大于基础胰岛素到随访 BMI 的路径系数（β=0.073；p<0.001）（p<0.001 用于β>β）。在 WHR-胰岛素模型中，基础胰岛素到随访 WHR 的路径系数（β=0.152；p<0.001）明显大于基础 WHR 到随访胰岛素的路径系数（β=0.077；p<0.001）（p=0.007 用于β>β）。在 WC/HC-胰岛素模型中，基础胰岛素到随访 WC 或 HC（β）的路径系数也大于基础 WC 或 HC 到随访胰岛素（β）的路径系数，但β和β之间的差异无统计学意义。在肥胖指标与 HOMA-IR 或 HOMA-%β 之间也发现了类似的时间模式。
这些发现表明肥胖和高胰岛素血症之间存在双向关系，腹部肥胖指标比 BMI 对高胰岛素血症指标更敏感。
