Wang Linghuan, Lu Tingting, Wu Peixin, Chen Kang, Mu Yiming
Medicine School of Nankai University, No. 94, Weijin Road, Nankai District, Tianjin, 300071, China.
Department of Endocrinology, Chinese PLA General Hospital, No.28, Fuxing Road, Haidian District, Beijing, 100853, China.
BMC Endocr Disord. 2025 Jul 1;25(1):156. doi: 10.1186/s12902-025-01976-3.
Although basal metabolic rate (BMR) is involved in glucose homeostasis, existing evidence regarding its association with insulin resistance (IR) remains inconsistent across populations. This study aimed to clarify the relationship between predicted BMR and the prevalence of IR in a large, community-based Chinese population.
A total of 36,115 participants aged ≥ 40 years were included from the REACTION study. Individuals with cardiovascular disease, thyroid dysfunction, malignancy, or who were using glucose-, lipid-, or blood pressure-lowering medications were excluded. BMR was estimated using the Singapore equation, and participants were categorized into quartiles (Q1-Q4) based on BMR distribution. Logistic regression models were employed to assess the association between BMR and IR, defined by the homeostasis model assessment of insulin resistance (HOMA-IR). Covariates included sex, age, smoking status, alcohol consumption, glycemic and lipid profiles, liver and kidney function, and anthropometric indices. Sensitivity analyses using inverse probability weighting and restricted cubic spline regression were conducted to verify the robustness of the findings.
This cross-sectional study demonstrated a positive association between higher predicted BMR quartiles and increased IR risk in the overall population (P < 0.05), with a stronger association observed in women (P < 0.05). A significant interaction between gender and BMR (P for interaction < 0.05) further supported a sex-specific pattern in the BMR-IR relationship. Stratified analyses revealed consistent positive association in various subgroups stratified by age, blood pressure, body mass index (BMI), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) levels (P < 0.05). This association persisted across participants with different glucose tolerance statuses, particularly among those with normal glucose tolerance and impaired glucose regulation. The association also remained significant in both premenopausal and postmenopausal women. Sensitivity analyses confirmed the stability of the results.
Predicted BMR is independently and positively associated with IR in Chinese general population, particularly in woman. The relationship demonstrated a clear dose-response pattern and remained robust across various subgroups. Monitoring BMR dynamics and targeting modifiable metabolic factors may serve as preventive strategies against IR-relate diabetes mellitus. Further longitudinal studies are warranted to validate causality.
尽管基础代谢率（BMR）参与葡萄糖稳态，但现有关于其与胰岛素抵抗（IR）关联的证据在不同人群中仍不一致。本研究旨在阐明在中国一个大型社区人群中预测的基础代谢率与胰岛素抵抗患病率之间的关系。
从REACTION研究中纳入了总共36115名年龄≥40岁的参与者。排除患有心血管疾病、甲状腺功能障碍、恶性肿瘤或正在使用降糖、降脂或降压药物的个体。使用新加坡方程估算基础代谢率，并根据基础代谢率分布将参与者分为四分位数（Q1-Q4）。采用逻辑回归模型评估基础代谢率与胰岛素抵抗（由胰岛素抵抗稳态模型评估（HOMA-IR）定义）之间的关联。协变量包括性别、年龄、吸烟状况、饮酒情况、血糖和血脂谱、肝肾功能以及人体测量指标。进行了使用逆概率加权和受限立方样条回归的敏感性分析，以验证研究结果的稳健性。
这项横断面研究表明，在总体人群中，较高的预测基础代谢率四分位数与胰岛素抵抗风险增加呈正相关（P<0.05），在女性中观察到更强的相关性（P<0.05）。性别与基础代谢率之间的显著交互作用（交互作用P<0.05）进一步支持了基础代谢率与胰岛素抵抗关系中的性别特异性模式。分层分析显示，在按年龄、血压、体重指数（BMI）、低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C）水平分层的各个亚组中存在一致的正相关（P<0.05）。这种关联在不同糖耐量状态的参与者中均持续存在，尤其是在糖耐量正常和糖调节受损的人群中。在绝经前和绝经后女性中，这种关联也仍然显著。敏感性分析证实了结果的稳定性。
在中国普通人群中，预测的基础代谢率与胰岛素抵抗独立且呈正相关，尤其是在女性中。这种关系呈现出明显的剂量反应模式，并且在各个亚组中都保持稳健。监测基础代谢率动态并针对可改变的代谢因素可能是预防与胰岛素抵抗相关糖尿病的策略。需要进一步的纵向研究来验证因果关系。
