Snehalatha C, Ramachandran A, Satyavani K, Latha E, Viswanathan V
Diabetes Research Center, Royapuram, Chennai, India.
Diabetes Care. 1998 Jan;21(1):76-9. doi: 10.2337/diacare.21.1.76.
To study 1) whether abdominal adiposity was present in adult offspring of two NIDDM parents, 2) whether abdominal adiposity was associated with the development of glucose intolerance, and 3) the association of pancreatic beta-cell function with impaired glucose tolerance (IGT) and NIDDM in these groups.
One hundred offspring whose parents both had NIDDM were studied (60 men, 40 women, mean age 34 +/- 6.9 years, BMI 27.4 +/- 4.1 kg/m2). None had a history of glucose intolerance. Nondiabetic control subjects with no family history of diabetes were also studied for comparison (21 men, 19 women, age 36 +/- 10.3 years, BMI 26 +/- 3.7 kg/m2). A standard oral glucose tolerance test was done for all, and plasma glucose, C-peptide, and insulin responses were measured. Abdominal fat measurements at L4-L5 were made using a computed axial tomography scan. Subcutaneous fat (SF), visceral fat (VF), and total fat (TF) areas were measured and VF/SF ratio was calculated. An index of insulin secretion (delta I/G) was derived as the ratio of incremental insulin at 30 min divided by 30-min plasma glucose.
IGT was detected in 32 offspring and diabetes in 21 offspring. Diabetic men had a higher TF area than the other groups. SF, VF, and VF/SF ratios were similar in control men and in offspring with normal glucose tolerance (NGT), IGT, or diabetes. Among control subjects, women had significantly lower VF than men. Female offspring had higher VF than the control subjects, but intragroup variations were absent. Fasting insulin and all C-peptide responses were higher in NGT compared with control subjects (P < 0.02). The 2-h insulin and C-peptide responses were higher in IGT subjects (P < 0.005). In diabetic subjects, the insulin-to-glucose ratio, C-peptide-to-glucose ratio, and delta I/G were significantly low compared with all other groups (P < 0.005). Multiple logistic regression analysis showed that the area of insulin response had a positive association and delta I/G had a negative association with diabetes, while age, sex, BMI, waist-to-hip ratio, abdominal fat areas, fasting and 2-h insulin, area of insulin, and the C-peptide measurements did not show independent associations. Two-hour insulin showed a positive association with IGT, while increasing area of insulin showed a negative association.
Visceral adiposity seemed to precede glucose intolerance only in women, but it had no independent association with IGT or NIDDM. Insulin resistance, indicated by higher plasma insulin response, and insulin secretory defect, indicated by low delta I/G at 30 min, were associated with diabetes. beta-cell defect was not independently associated with IGT. Increased abdominal visceral adiposity does not appear to be a prerequisite for development of IGT or diabetes in Asian Indians with a strong genetic predisposition for diabetes.
研究1）2型糖尿病患者的成年子女是否存在腹部肥胖；2）腹部肥胖是否与糖耐量异常的发生相关；3）这些人群中胰岛β细胞功能与糖耐量受损（IGT）及2型糖尿病的关系。
对100名父母均患有2型糖尿病的后代进行研究（60名男性，40名女性，平均年龄34±6.9岁，体重指数27.4±4.1kg/m²）。所有人均无糖耐量异常病史。还研究了无糖尿病家族史的非糖尿病对照者（21名男性，19名女性，年龄36±10.3岁，体重指数26±3.7kg/m²）以作比较。对所有人进行标准口服葡萄糖耐量试验，并测量血浆葡萄糖、C肽和胰岛素反应。使用计算机断层扫描在L4 - L5水平测量腹部脂肪。测量皮下脂肪（SF）、内脏脂肪（VF）和总脂肪（TF）面积，并计算VF/SF比值。胰岛素分泌指数（δI/G）通过30分钟时胰岛素增量与30分钟血浆葡萄糖的比值得出。
在32名后代中检测到IGT，21名后代患有糖尿病。糖尿病男性的TF面积高于其他组。对照男性与糖耐量正常（NGT）、IGT或糖尿病的后代的SF、VF和VF/SF比值相似。在对照者中，女性的VF明显低于男性。女性后代的VF高于对照者，但组内无差异。与对照者相比，NGT者的空腹胰岛素和所有C肽反应更高（P<0.02）。IGT患者的2小时胰岛素和C肽反应更高（P<0.005）。与所有其他组相比，糖尿病患者的胰岛素与葡萄糖比值、C肽与葡萄糖比值以及δI/G显著降低（P<0.005）。多因素逻辑回归分析显示，胰岛素反应面积与糖尿病呈正相关，δI/G与糖尿病呈负相关，而年龄、性别、体重指数、腰臀比、腹部脂肪面积、空腹和2小时胰岛素水平、胰岛素面积以及C肽测量值均未显示出独立相关性。2小时胰岛素与IGT呈正相关，而胰岛素面积增加与IGT呈负相关。
内脏肥胖似乎仅在女性中先于糖耐量异常出现，但它与IGT或2型糖尿病无独立相关性。血浆胰岛素反应升高所提示的胰岛素抵抗以及30分钟时δI/G降低所提示的胰岛素分泌缺陷与糖尿病相关。β细胞缺陷与IGT无独立相关性。对于具有强烈糖尿病遗传易感性的亚洲印度人，腹部内脏脂肪增加似乎不是IGT或糖尿病发生的先决条件。
