Mau M K, Grandinetti A, Arakaki R F, Chang H K, Kinney E K, Curb J D
Pacific Biomedical Research Center, Department of Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, USA.
Diabetes Care. 1997 Sep;20(9):1376-80. doi: 10.2337/diacare.20.9.1376.
To investigate whether fasting hyperinsulinemia is associated with a clustering of cardiovascular disease (CVD) risk factors, manifesting as the insulin resistance syndrome (IRS), in a population of native Hawaiians.
A total of 574 native Hawaiians > or = 30 years of age were examined for blood pressure, waist-to-hip ratio (WHR), BMI, oral glucose tolerance, and fasting lipid, insulin, and C-peptide concentrations. All statistical analyses (n = 384) excluded 190 individuals who had NIDDM or who were taking hypertension medication. Using logistic regression analysis, fasting insulin and C-peptide levels were compared with CVD risk factors (glucose intolerance, hypertension, central adiposity, elevated triglyceride levels, and low HDL cholesterol levels) after adjusting for age and obesity.
Sixty-six percent of native Hawaiians were overweight or obese, and 70% were found to have central adiposity. Fasting insulin concentrations were correlated with BMI, WHR, blood pressure, and triglyceride, HDL cholesterol, and glucose concentrations. Fasting insulin was also significantly associated with an increasing number of CVD risk factors in each participant (P < 0.001). Fasting insulin and C-peptide concentrations were independently associated with glucose intolerance, high triglyceride levels, and low HDL cholesterol levels. However, only fasting C-peptide concentrations were independently associated with hypertension and central adiposity. Apparent differences in the correlates of fasting insulin and C-peptide may be related to multiple factors and warrant further evaluation.
This study provides cross-sectional data confirming the existence of the IRS in native Hawaiians. However, further longitudinal studies are needed to examine the relationship of insulin resistance and/or surrogate markers to increased rates of NIDDM and CVD mortality in native Hawaiians.
在夏威夷原住民人群中，研究空腹高胰岛素血症是否与心血管疾病（CVD）危险因素聚集相关，即是否表现为胰岛素抵抗综合征（IRS）。
对574名年龄≥30岁的夏威夷原住民进行血压、腰臀比（WHR）、体重指数（BMI）、口服葡萄糖耐量以及空腹血脂、胰岛素和C肽浓度的检测。所有统计分析（n = 384）排除了190名患有非胰岛素依赖型糖尿病（NIDDM）或正在服用抗高血压药物的个体。采用逻辑回归分析，在调整年龄和肥胖因素后，将空腹胰岛素和C肽水平与CVD危险因素（葡萄糖耐量异常、高血压、中心性肥胖、甘油三酯水平升高和高密度脂蛋白胆固醇水平降低）进行比较。
66%的夏威夷原住民超重或肥胖，70%存在中心性肥胖。空腹胰岛素浓度与BMI、WHR、血压以及甘油三酯、高密度脂蛋白胆固醇和葡萄糖浓度相关。空腹胰岛素还与每位参与者中CVD危险因素数量的增加显著相关（P < 0.001）。空腹胰岛素和C肽浓度分别与葡萄糖耐量异常、高甘油三酯水平和低高密度脂蛋白胆固醇水平独立相关。然而，只有空腹C肽浓度与高血压和中心性肥胖独立相关。空腹胰岛素和C肽相关性的明显差异可能与多种因素有关，值得进一步评估。
本研究提供的横断面数据证实了夏威夷原住民中IRS的存在。然而，需要进一步进行纵向研究，以探讨胰岛素抵抗和/或替代标志物与夏威夷原住民NIDDM发病率增加和CVD死亡率之间的关系。
