腹部肥胖男性内脏脂肪组织优先减少的代谢效应。
The metabolic effects of preferential reduction of visceral adipose tissue in abdominally obese men.
作者信息
Marks S J, Chin S, Strauss B J
机构信息
Clinical Nutrition and Metabolism Unit, Monash Medical Centre, Melbourne, Victoria, Australia.
出版信息
Int J Obes Relat Metab Disord. 1998 Sep;22(9):893-8. doi: 10.1038/sj.ijo.0800678.
SETTING
This study was performed on free living subjects attending the body composition laboratory on a monthly basis for a total of six months.
SUBJECTS/DESIGN: Thirty-one abdominally obese men (30 <body mass index (BMI) <40, waist-to-hip ratio (WHR)>0.95) were enrolled in a placebo-controlled randomized double-blind study, using either dexfenfluramine (d-fen) or placebo, whilst also receiving food and fitness counselling. After a two week run-in period they were randomized to either d-fen or placebo for three months. This was followed by a further three months without medication, although food and fitness counselling continued.
METHODS
Body composition assessment included anthropometry (weight, height and abdominal circumferences), dual-energy X-ray absorptiometry (DEXA) for total body fat, and intra-abdominal fat measured via magnetic resonance imaging (MRI) at the L3/L4 level. Biochemistry included serum lipids, insulin and glucose. All measurements including blood pressure were performed at baseline, three months and six months.
STATISTICAL ANALYSIS
The change within each group in the three months on medication (d-fen or placebo) was assessed by paired t-tests, whilst the difference between the groups at baseline and at three months (measured by percentage change from baseline) was assessed by unpaired t-tests. An analysis of variance was performed over the six months for the d-fen group and the placebo group separately, to determine the overall effect of three months treatment with either d-fen or placebo, three months after medication had ceased. OUTCOMES AT THREE MONTHS: At three months, BMI decreased by -5.8+/-0.8% in the group on d-fen and by -2.7+/-0.8% in the placebo group (P<0.01 d-fen vs placebo). There was also a significant difference in the reduction of the visceral fat area between the groups (-21.0+/-4.0% in the d- fen group vs -6.7+/-2.2% in the placebo group, P<0.01) although there was no significant difference between groups with regard to reduction in subcutaneous fat area. The visceral:subcutaneous fat ratio (V/S ratio) was significantly reduced between groups at three months (-13.3+/-4.9% in the d-fen group vs -0.7+/-3.0% in the placebo group, P=0.03). At three months, the only metabolic parameters to show significant difference between the two groups were total cholesterol and LDL cholesterol. Total cholesterol reduced by -12.4+/-2.0% in the d-fen group compared with -2.3+/-2.1% in the placebo group (P<0.01). LDL cholesterol reduced by -15.6+/-2.6% in the d-fen group compared with -1.2+/-2.8% in the placebo group (P<0.01). OUTCOMES AT SIX MONTHS: In the d-fen group, the reductions in BMI, abdominal circumference and % total body fat (DEXA) were sustained after three months on no medication, whereas all changes in body composition seen in the group on placebo at three months, had reverted at the three month follow-up. Both groups sustained a reduction in the insulin to glucose (I/G) ratio and systolic and diastolic blood pressure for three months after medication was ceased, while those on d-fen initially also maintained a reduction in total and LDL cholesterol.
背景
本研究对每月前往身体成分实验室的自由生活受试者进行，为期共六个月。
受试者/设计：31名腹部肥胖男性（体重指数（BMI）30＜BMI＜40，腰臀比（WHR）＞0.95）参与了一项安慰剂对照随机双盲研究，使用右芬氟拉明（d-fen）或安慰剂，同时接受饮食和健身咨询。经过两周的导入期后，他们被随机分为d-fen组或安慰剂组，为期三个月。随后三个月不服药，尽管饮食和健身咨询仍继续。
方法
身体成分评估包括人体测量学（体重、身高和腹围）、双能X线吸收法（DEXA）测量全身脂肪，以及通过磁共振成像（MRI）在L3/L4水平测量腹内脂肪。生物化学指标包括血脂、胰岛素和血糖。所有测量包括血压均在基线、三个月和六个月时进行。
统计分析
用药三个月期间（d-fen或安慰剂）每组内的变化通过配对t检验评估，而基线和三个月时组间差异（以相对于基线的百分比变化衡量）通过非配对t检验评估。对d-fen组和安慰剂组分别进行为期六个月的方差分析，以确定用药三个月后停药三个月的总体效果。三个月时的结果：三个月时，d-fen组的BMI下降了-5.8±0.8%，安慰剂组下降了-2.7±0.8%（d-fen组与安慰剂组相比，P＜0.01）。两组间内脏脂肪面积减少也有显著差异（d-fen组为-21.0±4.0%，安慰剂组为-6.7±2.2%，P＜0.01），尽管皮下脂肪面积减少在组间无显著差异。三个月时两组间内脏与皮下脂肪比率（V/S比率）显著降低（d-fen组为-13.3±4.9%，安慰剂组为-0.7±3.0%，P = 0.03）。三个月时，两组间唯一显示出显著差异的代谢参数是总胆固醇和低密度脂蛋白胆固醇。d-fen组总胆固醇下降了-12.4±2.0%，而安慰剂组下降了-2.3±2.1%（P＜0.01）。d-fen组低密度脂蛋白胆固醇下降了-15.6±2.6%，安慰剂组下降了-1.2±2.8%（P＜0.01）。六个月时的结果：在d-fen组，停药三个月后BMI、腹围和全身脂肪百分比（DEXA）的降低得以维持，而安慰剂组三个月时身体成分的所有变化在三个月随访时已恢复。停药后三个月两组的胰岛素与葡萄糖（I/G）比率以及收缩压和舒张压均持续降低，而d-fen组最初总胆固醇和低密度脂蛋白胆固醇也保持降低。
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