Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Department of Medicine, National University Hospital, Singapore.
Obesity (Silver Spring). 2023 Sep;31(9):2304-2314. doi: 10.1002/oby.23833. Epub 2023 Aug 3.
The impact of obesity on the risk for type 2 diabetes differs between males and females; however, the underlying reasons are unclear. This study aimed to investigate the effect of sex on obesity-driven changes in the mechanisms regulating glucose metabolism (insulin sensitivity and secretion) among Asian individuals without diabetes in Singapore.
The study assessed glucose tolerance using oral glucose tolerance test, insulin-mediated glucose uptake using hyperinsulinemic-euglycemic clamp, acute insulin response using an intravenous glucose challenge, and insulin secretion rates in the fasting state and in response to glucose ingestion using mathematical modeling in 727 males and 952 females who had normal body weight (n = 602, BMI < 23 kg/m ), overweight (n = 662, 23 ≤ BMI < 27.5), or obesity (n = 415, BMI ≥ 27.5).
There were no sex differences among lean individuals. Obesity gradually worsened metabolic function, and the progressive adverse effects of obesity on insulin action and secretion were more pronounced in males than females, such that among participants with obesity, females had greater insulin sensitivity, lower insulin secretion, and lower fasting insulin concentration than males. The increase in waist to hip ratio with increasing BMI was more pronounced in males than females.
The female sex exerts a protective effect on obesity-driven dysregulation of glucose metabolism in Asian individuals without diabetes.
肥胖对 2 型糖尿病风险的影响在男性和女性之间存在差异；然而，其潜在原因尚不清楚。本研究旨在调查性别对新加坡无糖尿病亚洲个体中肥胖引起的葡萄糖代谢调节机制（胰岛素敏感性和分泌）变化的影响。
该研究使用口服葡萄糖耐量试验评估葡萄糖耐量，使用高胰岛素-正常血糖钳夹评估胰岛素介导的葡萄糖摄取，使用静脉内葡萄糖挑战评估急性胰岛素反应，以及使用数学模型评估空腹和葡萄糖摄入时的胰岛素分泌率，共纳入 727 名男性和 952 名女性，他们的体重正常（n=602，BMI<23kg/m²）、超重（n=662，23≤BMI<27.5）或肥胖（n=415，BMI≥27.5）。
在体重正常的个体中，男女之间没有性别差异。肥胖逐渐恶化代谢功能，肥胖对胰岛素作用和分泌的进行性不良影响在男性中比女性更为明显，因此，在肥胖参与者中，女性的胰岛素敏感性更高，胰岛素分泌更低，空腹胰岛素浓度更低。随着 BMI 的增加，腰围与臀围的比值在男性中比女性更为明显。
在新加坡无糖尿病的亚洲个体中，女性性别对肥胖引起的葡萄糖代谢失调具有保护作用。
