Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
School of Medicine, University of Glasgow, Glasgow, UK.
Diabetologia. 2023 Jan;66(1):44-56. doi: 10.1007/s00125-022-05803-5. Epub 2022 Oct 13.
AIMS/HYPOTHESIS: South Asians have a two- to fivefold higher risk of developing type 2 diabetes than those of white European descent. Greater central adiposity and storage of fat in deeper or ectopic depots are potential contributing mechanisms. We collated existing and new data on the amount of subcutaneous (SAT), visceral (VAT) and liver fat in adults of South Asian and white European descent to provide a robust assessment of potential ethnic differences in these factors.
We performed a systematic review of the Embase and PubMed databases from inception to August 2021. Unpublished imaging data were also included. The weighted standardised mean difference (SMD) for each adiposity measure was estimated using random-effects models. The quality of the studies was assessed using the ROBINS-E tool for risk of bias and overall certainty of the evidence was assessed using the GRADE approach. The study was pre-registered with the OSF Registries ( https://osf.io/w5bf9 ).
We summarised imaging data on SAT, VAT and liver fat from eight published and three previously unpublished datasets, including a total of 1156 South Asian and 2891 white European men, and 697 South Asian and 2271 white European women. Despite South Asian men having a mean BMI approximately 0.5-0.7 kg/m lower than white European men (depending on the comparison), nine studies showed 0.34 SMD (95% CI 0.12, 0.55; I=83%) more SAT and seven studies showed 0.56 SMD (95% CI 0.14, 0.98; I=93%) more liver fat, but nine studies had similar VAT (-0.03 SMD; 95% CI -0.24, 0.19; I=85%) compared with their white European counterparts. South Asian women had an approximately 0.9 kg/m lower BMI but 0.31 SMD (95% CI 0.14, 0.48; I=53%) more liver fat than their white European counterparts in five studies. Subcutaneous fat levels (0.03 SMD; 95% CI -0.17, 0.23; I=72%) and VAT levels (0.04 SMD; 95% CI -0.16, 0.24; I=71%) did not differ significantly between ethnic groups in eight studies of women.
CONCLUSIONS/INTERPRETATION: South Asian men and women appear to store more ectopic fat in the liver compared with their white European counterparts with similar BMI levels. Given the emerging understanding of the importance of liver fat in diabetes pathogenesis, these findings help explain the greater diabetes risks in South Asians.
There was no primary direct funding for undertaking the systematic review and meta-analysis.
目的/假设：南亚人患 2 型糖尿病的风险比白种欧洲人高 2 到 5 倍。更大的中心性肥胖和更深或异位脂肪的储存是潜在的促成机制。我们整理了现有的和新的数据，关于南亚和白种欧洲成年人的皮下（SAT）、内脏（VAT）和肝脏脂肪量，以提供这些因素在种族间潜在差异的有力评估。
我们对 Embase 和 PubMed 数据库进行了系统回顾，时间从开始到 2021 年 8 月。还包括未发表的影像学数据。使用随机效应模型估计每个肥胖测量的加权标准化平均差异（SMD）。使用 ROBINS-E 工具评估研究的偏倚风险，使用 GRADE 方法评估证据的总体确定性。该研究在 OSF 注册处（https://osf.io/w5bf9）进行了预先注册。
我们总结了来自八项已发表和三项以前未发表数据集的关于 SAT、VAT 和肝脏脂肪的影像学数据，包括总共 1156 名南亚男性和 2891 名白种欧洲男性，以及 697 名南亚女性和 2271 名白种欧洲女性。尽管南亚男性的 BMI 平均值比白种欧洲男性低 0.5-0.7kg/m（取决于比较），但有九项研究显示 SAT 多 0.34 SMD（95%CI 0.12，0.55；I=83%），七项研究显示肝脏脂肪多 0.56 SMD（95%CI 0.14，0.98；I=93%），但九项研究的 VAT 相似（-0.03 SMD；95%CI -0.24，0.19；I=85%）与他们的白种欧洲同行相比。南亚女性的 BMI 约低 0.9kg/m，但五项研究显示肝脏脂肪多 0.31 SMD（95%CI 0.14，0.48；I=53%）。八项女性研究中，皮下脂肪水平（0.03 SMD；95%CI -0.17，0.23；I=72%）和 VAT 水平（0.04 SMD；95%CI -0.16，0.24；I=71%）在两个种族之间没有显著差异。
结论/解释：南亚男性和女性似乎在肝脏中储存了更多的异位脂肪，与 BMI 水平相似的白种欧洲人相比。鉴于人们对肝脏脂肪在糖尿病发病机制中的重要性的认识不断加深，这些发现有助于解释南亚人患糖尿病的风险更高。
没有为进行系统评价和荟萃分析提供直接的主要资金。
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