Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
Diabetologia. 2022 Jan;65(1):226-233. doi: 10.1007/s00125-021-05583-4. Epub 2021 Oct 16.
AIMS/HYPOTHESIS: Type 2 diabetes confers a greater relative increase in CVD risk in women compared with men. We examined sex differences in intraorgan fat and hepatic VLDL1-triacylglycerol (VLDL1-TG) export before and after major dietary weight loss.
A group with type 2 diabetes (n = 64, 30 male/34 female) and a group of healthy individuals (n = 25, 13 male/12 female) were studied. Intraorgan and visceral fat were quantified by magnetic resonance and VLDL1-TG export by intralipid infusion techniques.
Triacylglycerol content of the liver and pancreas was elevated in people with diabetes with no sex differences (liver 16.4% [9.3-25.0%] in women vs 11.9% [7.0-23.1%] in men, p = 0.57, and pancreas 8.3 ± 0.5% vs 8.5 ± 0.4%, p = 0.83, respectively). In the absence of diabetes, fat levels in both organs were lower in women than men (1.0% [0.9-1.7%] vs 4.5% [1.9-8.0%], p = 0.005, and 4.7 ± 0.4% vs 7.6 ± 0.5%, p< 0.0001, respectively). Women with diabetes had higher hepatic VLDL1-TG production rate and plasma VLDL1-TG than healthy women (559.3 ± 32.9 vs 403.2 ± 45.7 mg kg day, p = 0.01, and 0.45 [0.26-0.77] vs 0.25 [0.13-0.33] mmol/l, p = 0.02), whereas there were no differences in men (548.8 ± 39.8 vs 506.7 ± 29.2 mg kg day, p = 0.34, and 0.72 [0.53-1.15] vs 0.50 [0.32-0.68] mmol/l, p = 0.26). Weight loss decreased intraorgan fat and VLDL1-TG production rates regardless of sex, and these changes were accompanied by similar rates of diabetes remission (65.4% vs 71.0%) and CVD risk reduction (59.8% vs 41.5%) in women and men, respectively.
CONCLUSIONS/INTERPRETATION: In type 2 diabetes, women have liver and pancreas fat levels as high as those of men, associated with raised hepatic VLDL1-TG production rates. Dynamics of triacylglycerol turnover differ between sexes in type 2 diabetes and following weight loss. These changes may contribute to the disproportionately raised cardiovascular risk of women with diabetes.
目的/假设：2 型糖尿病使女性发生心血管疾病（CVD）的风险比男性相对增加更多。我们研究了在进行重大饮食减肥前后，2 型糖尿病患者和健康个体之间器官内脂肪和肝内 VLDL1-三酰甘油（VLDL1-TG）输出的性别差异。
研究了一组 2 型糖尿病患者（n=64，30 名男性/34 名女性）和一组健康个体（n=25，13 名男性/12 名女性）。通过磁共振成像定量测定器官内和内脏脂肪，通过静脉内输注脂肪乳剂技术测定 VLDL1-TG 输出。
糖尿病患者的肝脏和胰腺甘油三酯含量升高，且无性别差异（女性 16.4%[9.3-25.0%]，男性 11.9%[7.0-23.1%]，p=0.57，和胰腺 8.3±0.5%，男性 8.5±0.4%，p=0.83）。在没有糖尿病的情况下，女性各器官中的脂肪水平均低于男性（肝脏 1.0%[0.9-1.7%]，男性 4.5%[1.9-8.0%]，p=0.005，和胰腺 4.7±0.4%，男性 7.6±0.5%，p<0.0001）。患有糖尿病的女性的肝 VLDL1-TG 生成率和血浆 VLDL1-TG 高于健康女性（559.3±32.9 vs 403.2±45.7 mg/kg/天，p=0.01，和 0.45[0.26-0.77] vs 0.25[0.13-0.33] mmol/L，p=0.02），而男性之间没有差异（548.8±39.8 vs 506.7±29.2 mg/kg/天，p=0.34，和 0.72[0.53-1.15] vs 0.50[0.32-0.68] mmol/L，p=0.26）。无论性别如何，减肥均降低了器官内脂肪和 VLDL1-TG 生成率，这些变化伴随着相似的糖尿病缓解率（女性 65.4%，男性 71.0%）和 CVD 风险降低率（女性 59.8%，男性 41.5%）。
结论/解释：在 2 型糖尿病中，女性的肝脏和胰腺脂肪水平与男性一样高，与肝 VLDL1-TG 生成率升高有关。2 型糖尿病和减肥后，男女之间的甘油三酯周转动力学存在差异。这些变化可能导致糖尿病女性的心血管疾病风险不成比例地升高。
