Dhawan J, Bray C L, Warburton R, Ghambhir D S, Morris J
Department of Cardiology, Wythenshawe Hospital, Manchester.
Br Heart J. 1994 Nov;72(5):413-21. doi: 10.1136/hrt.72.5.413.
To compare the prevalence of diabetes, hyperinsulinaemia, and associated metabolic abnormalities in immigrant Asians, Asians in India, and native white British men.
Case control study.
Wythenshawe Hospital, Manchester, United Kingdom, and Maulana Azad Medical School, New Delhi, India.
Men with angiographically proved coronary artery disease; 83 British Asians, 87 white men, and 30 Indian Asians with age matched controls.
Fasting lipid concentrations, serum glucose, and total insulin concentrations were measured in the fasting state and one and two hours after a 75 g glucose load by mouth. All subjects had a physical examination by the same observer.
Asians in the United Kingdom and in India had a higher prevalence of diabetes and impaired glucose tolerance than the white British men. Patients in all three ethnic groups had higher total insulin concentrations than their controls in the fasting state and after the glucose load. British Asian and Indian Asian patients and controls had higher total insulin concentrations than the white men in the fasting state and after the glucose load. Total insulin concentrations were similar in British and Indian Asians, though fasting concentrations were higher in British Asians than Indian Asians. White men had similar cholesterol, lower triglyceride, and higher high density lipoprotein cholesterol concentrations than Asians in the United Kingdom and in India. British Asian patients had higher cholesterol concentrations and British Asian controls had higher triglyceride concentrations than the Indian Asian groups. Asian patients and controls were more active. British and Indian Asian patients had higher waist to hip ratios than controls. The waist to hip ratio was positively correlated with insulin and triglyceride concentrations and negatively correlated with the high density lipoprotein cholesterol concentration. Fasting insulin and high density lipoprotein concentrations were independent predictors of coronary artery disease in white men, whereas in British Asians the waist to hip ratio was the strongest independent predictor. In Indian Asians the waist to hip ratio and high density lipoprotein concentration were independent predictors of coronary artery disease.
Central obesity in the subgroups of Asians studied showed a close association with hyperinsulinaemia and the risk of coronary artery disease. A predisposition to insulin resistance and its metabolic abnormalities in this group of Asians seems to be genetically determined, environmental changes after migration having only a small additional effect.
比较亚洲移民、印度亚洲人以及英国本土白人男性中糖尿病、高胰岛素血症及相关代谢异常的患病率。
病例对照研究。
英国曼彻斯特怀森肖医院以及印度新德里莫拉纳·阿扎德医学院。
经血管造影证实患有冠状动脉疾病的男性；83名英国亚裔、87名白人男性以及30名印度亚裔，并设有年龄匹配的对照组。
测量空腹状态下以及口服75克葡萄糖后1小时和2小时的空腹血脂浓度、血糖及总胰岛素浓度。所有受试者均由同一名观察者进行体格检查。
英国和印度的亚洲人患糖尿病和糖耐量受损的患病率高于英国白人男性。所有三个种族组的患者在空腹状态和葡萄糖负荷后，其总胰岛素浓度均高于各自的对照组。英国亚裔和印度亚裔患者及对照组在空腹状态和葡萄糖负荷后，其总胰岛素浓度均高于白人男性。英国亚裔和印度亚裔的总胰岛素浓度相似，不过英国亚裔的空腹浓度高于印度亚裔。白人男性的胆固醇浓度与英国和印度的亚洲人相似，甘油三酯浓度较低，高密度脂蛋白胆固醇浓度较高。英国亚裔患者的胆固醇浓度较高，英国亚裔对照组的甘油三酯浓度高于印度亚裔组。亚洲患者及对照组更为活跃。英国和印度亚裔患者的腰臀比高于对照组。腰臀比与胰岛素和甘油三酯浓度呈正相关，与高密度脂蛋白胆固醇浓度呈负相关。空腹胰岛素和高密度脂蛋白浓度是白人男性冠状动脉疾病的独立预测因素，而在英国亚裔中，腰臀比是最强的独立预测因素。在印度亚裔中，腰臀比和高密度脂蛋白浓度是冠状动脉疾病的独立预测因素。
在所研究的亚洲人群亚组中，中心性肥胖与高胰岛素血症及冠状动脉疾病风险密切相关。这组亚洲人对胰岛素抵抗及其代谢异常的易感性似乎由基因决定，移民后的环境变化仅有较小的附加影响。
