初发2型糖尿病患者颈动脉内中膜厚度与各代谢指标的关系

目的探讨初发2型糖尿病（T2DM）人群中颈动脉内中膜厚度（IMT）与各代谢指标的相关关系,探寻动脉粥样硬化的危险因素。方法选择正常对照组（NC）44例、糖耐量正常的单纯肥胖组（Ob）42例、新诊的2型糖尿病患者60例,所有对象于清晨空腹测量身高、体重、腰围、臀围、血压,计算体重指数（BMI）和腰臀比（WHR）;空腹检测各组生化指标,并同时行糖耐量试验（OGTY）,检测OGTT中0、30、60、120min各时点血糖及胰岛素值,利用Bergman最小模型技术计算胰岛素敏感指数（ISI）;并以高分辨率彩色血管多普勒超声检查颈总动脉（CCA）内中膜厚度。结果IMT值T2DM组较NC组（P〈0．01）及0b组显著升高（P〈0．05）。所有初发T2DM患者,IMT与年龄、甘油三酯（TC）、低密度脂蛋白（LDL—C）、餐后2h血糖（2hPG）及ISI呈正相关（P〈0．05．0．01）：与BMI、腰围呈负相关（P〈0．05）。在校正年龄、性别因素的影响后,IMT与BMI、腰围、TC、LDL-C及ISI无显著相关,与2hPG呈显著相关（r=0．461,P〈0．001）。结论2hPG是初发T2DM人群早期动脉粥样硬化（AS）的独立危险因素,降低2hPG有望改善T2DM人群的血管功能。     

Serum Chemerin Levels Are Associated with Abdominal Visceral Fat in Type 2 Diabetes

Chemerin is a recently identified adipokine suggested to play a role in obesity and its metabolic complications. The relationship between visceral obesity and serum chemerin levels in type 2 diabetes (T2DM) is unknown and may differ from that of subjects without diabetes. Therefore, we evaluated whether serum chemerin was associated with visceral abdominal obesity in patients with T2DM. A total of 218 Korean patients with T2DM were enrolled and metabolic parameters, abdominal visceral and subcutaneous fat areas, and serum chemerin levels were measured. Serum chemerin level showed positive correlation with fasting insulin, HOMA-IR, serum triglyceride, serum creatinine, urine albumin/creatinine ratio, high-sensitivity C-reactive protein (hsCRP), fibrinogen, abdominal visceral fat area, visceral to subcutaneous fat area ratio, and negatively correlation with high density lipoprotein cholesterol and creatinine clearance (CCr) after adjusting for age, gender and body mass index. Multiple linear stepwise regression analysis showed that abdominal visceral fat area (β = 0.001, P < 0.001), serum triglyceride (β = 0.001, P < 0.001), CCr (β = -0.003, P = 0.001), hsCRP (β = 0.157, P = 0.001), fibrinogen (β = 0.001, P < 0.001) and BMI (β = 0.02, P = 0.008) independently affected log transformed serum chemerin levels. Higher serum chemerin level was associated with higher level of abdominal visceral fat area, serum triglyceride, hsCRP and fibrinogen and lower level of CCr in patients with T2DM. Serum chemerin may be used as a biomarker of visceral adiposity and chemerin may play a role in inflammation, decreased renal function, and increased cardiovascular risk in T2DM.     

2型糖尿病合并高血压患者抵抗素与动脉粥样硬化的相关性研究

为探讨2型糖尿病合并高血压患者抵抗素与动脉粥样硬化(AS)的相关性,用彩色多普勒超声技术观察2型糖尿病(A组)29例患者,2型糖尿病合并高血压(B组)23例患者及20名对照组的颈动脉内中膜厚度(IMT)及斑块的变化;应用ELISA测定血浆抵抗素水平。结果表明:A组和B组抵抗素水平较对照组显著升高(P<0.01),且B组抵抗素较A组显著升高(P<0.05);抵抗素与IMT、SBP、FBG、HOMA-IR显著正相关,与FINS显著负相关;IMT与抵抗素、年龄、BMI、SBP、FBG、FINS、HbA1c、HOMA-IR显著正相关。本文提示抵抗素参与胰岛素抵抗(IR),在AS发生及发展中起着重要作用。     

Androgen excess is associated with the increased carotid intima-media thickness observed in young women with polycystic ovary syndrome

BACKGROUND: We evaluated carotid intima-media thickness (CIMT) as an early marker of atherosclerosis, as well as its main determinants among androgen excess, obesity and insulin resistance, in patients with polycystic ovary syndrome (PCOS). METHODS: We selected 40 PCOS patients and 20 non-hyperandrogenic women who were similar in terms of age and grade of obesity. Complete clinical, metabolic and hormonal profiles and left common CIMT measurements were obtained. RESULTS: Patients with PCOS presented with increased mean CIMT values when compared with controls (F = 8.575; P = 0.005), and this was independent of obesity. Five PCOS patients but no controls had increased CIMT values. CIMT correlated directly with serum total and free testosterone, androstenedione and dehydroepiandrosterone-sulfate levels and mean 24-h heart rate (HR), and inversely with the insulin sensitivity index (ISI), but no correlation was observed with the body mass index (BMI). Multiple stepwise linear regression models showed that in PCOS patients, the main determinants of CIMT were serum total testosterone or androstenedione concentrations, with no influence of ISI or the mean 24-h HR. CONCLUSIONS: Compared with control women, PCOS patients present with an increased CIMT, independent of obesity and related directly to androgen excess; this suggests that hyperandrogenism is associated with atherosclerosis and cardiovascular risk in these women.     

Sex Difference in the Associations among Obesity-Related Indices with Metabolic Syndrome in Patients with Type 2 Diabetes Mellitus

Background: The aim of this study was to investigate the associations among obesity-related indices and MetS in diabetic patients, and explore sex differences in these associations.Methods: Patients with type 2 DM were included from two hospitals in southern Taiwan. The Adult Treatment Panel III criteria for an Asian population were used to define MetS. In addition, the following obesity-related indices were evaluated: waist-to-height ratio, waist-hip ratio (WHR), conicity index (CI), body mass index (BMI), body roundness index, body adiposity index, lipid accumulation product (LAP), abdominal volume index, visceral adiposity index (VAI), abdominal volume index and triglyceride-glucose index.Results: A total of 1,872 patients with type 2 DM (mean age 64.0 ± 11.3 years, 808 males and 1,064 females) were enrolled. The prevalence rates of MetS were 59.8% and 76.4% in the males and female (p < 0.001), respectively. All of the obesity-related indices were associated with MetS in both sex (all p < 0.001). LAP and BMI had the greatest areas under the receiver operating characteristic curves in both sex. In addition, the interactions between BMI and sex (p = 0.036), WHR and sex (p = 0.016), and CI and sex (p = 0.026) on MetS were statistically significant.Conclusions: In conclusion, this study demonstrated significant relationships between obesity-related indices and MetS among patients with type 2 DM. LAP and VAI were powerful predictors in both sex. The associations of BMI, WHR and CI on MetS were more significant in the men than in the women.     

血清胰淀素水平与2型糖尿病胰岛素抵抗的关系

目的：探讨2型糖尿病（DM2）血清胰淀素水平的变化,研究胰淀素与胰岛素抵抗（IR）的关系。方法：收集初诊DM2患者46例,另选健康对照组41例,检测所有受试者空腹状态下胰淀素和血脂、血尿酸、空腹血糖及胰岛素水平,同时测定体重指数（BMI）和腰臀比（WHR）,比较各组间差异。结果：与正常组相比,DM2组的胰淀素水平亦较对照组低（P〈0.05）,胰岛素抵抗指数（Homa-IR）显著高于对照组（P〈0.05）。胰淀素与体重指数、腰臀比、空腹血糖、空腹胰岛素水平、Homa-IR、低密度脂蛋白胆固醇、三酰甘油呈显著负相关,与高密度脂蛋白胆固醇呈显著正相关。与胰岛β细胞功能、血清胆固醇、血尿酸无相关性。逐步多元回归分析提示腰臀比和空腹胰岛素水平是影响胰淀素水平最显著的因素。结论：DM2患者存在IR、低胰淀素血症,低胰淀素血症可能与DM2的IR互为因果。     

Association of general and abdominal obesities and metabolic syndrome with subclinical atherosclerosis in asymptomatic Chinese postmenopausal women

OBJECTIVE: This study aimed to investigate the relationships between obesity, especially abdominal obesity, andmetabolic syndrome (MS) with carotid intima-media thickness (IMT) and plaque, markers of subclinical atherosclerosis, in asymptomatic Chinese postmenopausal women in Hong Kong. DESIGN: A total of 518 postmenopausal women aged 50 to 64 years were recruited through random telephone dialing. Body mass index (BMI), waist circumference, waist-to-hip ratio, sociodemographic characteristics, blood pressures, medical, biochemical and lifestyle factors were obtained. MS was defined on the basis of the National Cholesterol and Education Program, Adult Treatment Panel III criteria. Subclinical atherosclerosis was determined by measuring IMT and plaque using high-resolution B-mode ultrasonography. RESULTS: Women with a BMI of 25 kg/mor greater, a waist circumference of 80 cm or greater, a waist-to-hip ratio of 0.85 or greater, or MS were observed to have higher IMT values and prevalence of plaque. Multivariate analyses revealed that waist circumference was significantly associated with IMT independent of age, hormone therapy, lifestyle and sociodemographic factors, and BMI (P < 0.05), whereas a waist-to-hip ratio of 0.85 or greater was significantly associated with plaque (odds ratio = 1.7; 95% CI: 1.0-2.8) after controlling for age, hormone therapy, lifestyle and sociodemographic factors, BMI, and the traditional cardiovascular risk factors. MS was also associated with IMT after adjustment for age, hormone therapy, lifestyle and sociodemographic factors, and BMI (P < 0.05), whereas its association with plaque was also significant (odds ratio = 1.7; 95% CI: 1.0-2.6) after controlling for age. CONCLUSIONS: Abdominal obesity and MS are independent of general obesity markers of subclinical atherosclerosis in Chinese postmenopausal women.     

Insulin Resistance Is an Important Risk Factor for Cognitive Impairment in Elderly Patients with Primary Hypertension

Purpose

Insulin resistance plays a role in the development of dementia and hypertension. We investigated a possible relationship between cognitive impairment and insulin resistance in elderly Chinese patients with primary hypertension.

Materials and Methods

One hundred and thirty-two hypertensive elderly patients (>60 years) were enrolled in this study, and assigned into either the cognitive impairment group (n=61) or the normal cognitive group (n=71). Gender, age, education, body mass index (BMI), waist hip ratio (WHR), total cholesterol (TC), triglyceride (TG), C-reactive protein (CRP), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), creatinine (Cr), fasting plasma glucose (FPG), fasting insulin (FINS), homeostasis model of assessment for insulin resistance index (HOMA-IR), systolic blood pressure, diastolic blood pressure, smoking history, atherosclerosis and the proportion of uncontrolled hypertension were compared between the two groups. Multi-factorial logistic regression analysis was performed.

Results

No significant differences were found in gender, age, TC, CRP, HDL-C, LDL-C, Cr, BP, smoking history, atherosclerosis and the proportion of uncontrolled hypertension between the two groups. The cognitive impairment group had lower education levels, and higher BMI, WHR, TG, FPG, FINS, and HOMA-IR levels than the control group. Logistic regression analysis revealed the levels of education, BMI, WHR, and HOMA-IR as independent factors that predict cognitive impairment in patients.

Conclusion

Our study demonstrates that poor education and increased BMI, WHR, and HOMA-IR are independent risk factors for cognitive impairment in elderly patients with hypertension. Insulin resistance plays an important role in the development of cognitive impairment in primary elderly hypertensive patients.     

Intima-media thickness and pulse wave velocity in hypertensive adolescents

Increased intima-media thickness (IMT) and pulse wave velocity (PWV) are noninvasive markers of early arterial wall alteration and are more widely used in adult clinical research. We investigated whether IMT and PWV are useful predictors of cardiovascular risk in hypertensive adolescents. Fifteen hypertensive adolescents (13-18 yr old, systolic BP > or = 140 mmHg, diastolic BP > or = 90 mmHg) and seventeen normotensive subjects were included. Height, weight, obesity index, body mass index (BMI), and fat distribution were obtained from each group. Serum lipid, insulin, vitamine B12, folate, renin, aldosterone, angiotensin-converting enzyme (ACE), and homocysteine levels were compared. The carotid IMT and PWV were measured. Arterial wall compliance and distensibility were calculated with the equation. High systolic blood pressure significantly correlated with height, weight, BMI, obesity index, arm circumference, fat mass, and fat distribution. Hypertensive adolescents had significantly greater cIMT (carotid intima-media thickness) and lower elastic properties such as cross-sectional compliance and distensibility of the carotid artery. The carotid IMT significantly correlated with brachial-ankle PWV. In conclusion, the measurement of carotid IMT and brachial-ankle PWV might be useful to predict the development of atherosclerosis in hypertensive adolescents.     

Comparison of anthropometric data between end-stage renal disease patients undergoing hemodialysis and healthy adults in Korea

Protein-calorie malnutrition is prevalent in hemodialysis (HD) patients. The prevalence of obesity in healthy Korean adults has increased rapidly during the last 10 years. However, there are few large scale data collections available about the current weight status of Korean HD patients. The weight statuses of 10,304 HD patients (data from the Insan Memorial Dialysis Registry 2002, Korean Society of Nephrology) were compared to those of 12,436 control subjects (age > 18) by using body mass index (BMI). Weight status was assessed by WHO classification for Asian-Pacific region [underweight (UW): < 18.5; normal weight (NW): 18.5-22.9; overweight (OW): 23-24.9; obese (OB): 25-29.9; and extremely obese (EOB): > 30 kg/m2] in both the control and HD patients. HD patients had significantly lower body weight and BMI than the controls in all age groups and in both sexes. For the male controls, the proportions of OW and OB showed a reversed U-shape, peaking at the 5th and 6th decades. of the numbers of those classified as NW and UW were relatively small. For the female controls, the proportions of OW and OB progressively increased with age. On the contrary, in HD patients, the proportions of NW and UW were large, up to more than 70%, and those of OW and OB were small in both sexes. In each age group, UW was seen significantly more in the HD group than in the control group. The 6th decade age group showed the highest prevalence ratio for UW in the HD group for both sexes, compared to the controls (Male: 17.33, Female: 17.68). The percentages of UW were related to HD duration and age in both sexes. In conclusion, Korean HD patients seem to have small proportions of OW and OB, compared to the general population, and protein-calorie malnutrition may still be an important nutritional condition.     

Waist circumference predicts metabolic cardiovascular risk in postmenopausal Chinese women

OBJECTIVE: The purpose of the study is to compare the differences in metabolic cardiovascular risk factors among postmenopausal Chinese women with or without abdominal obesity. DESIGN: The study is a cross-sectional, population-based, comparative cohort study. Each participant received anthropometric measurements and a 75-g oral glucose tolerance test after an overnight fast. The homeostasis model assessment for insulin resistance and the insulin sensitivity index, ISI, were used as measures of insulin resistance. A "metabolic cardiovascular risk score" was calculated from fasting insulin, glucose, lipids, and blood pressure. General linear models (GLM) were fit to examine the relation of waist circumference (WC) to insulin resistance and metabolic risk scores.(0,120). RESULTS: According to the International Obesity Task Force obesity criteria for Asians, 57 women had abdominal obesity (WC >/= 80 cm), and 58 had WCs less than 80 cm. The two groups were comparable in demographic variables and body mass index (BMI). The women with larger WCs were more insulin-resistant than their counterparts. The metabolic risk scores were significantly higher in women with abdominal obesity than in those without it. The results from the GLM showed that WC was an independent predictor of insulin resistance and metabolic risk scores after controlling for demographic variables (0.06- and 0.29-unit increases in homeostasis model assessment for insulin resistance and metabolic risk scores per 1 cm change in WC). Moreover, BMI neither correlated with metabolic risk scores nor affected the WC effects on insulin resistance and metabolic risk scores in the GLM. CONCLUSIONS: Postmenopausal Chinese women with abdominal obesity may carry higher metabolic cardiovascular risk than those without it. It is WC, not BMI, that predicts metabolic cardiovascular risk factors in these women.     

不同水平高血糖与高血压共同危险因子的分析

探讨不同血糖水平与高血压病发病共同危险因子。对１４９９人做了葡萄糖耐量试验（ＯＧＴＴ）及血浆胰岛素、血脂、尿微量白蛋白排泄率（ＵＡＥＲ）和体重、腰臀围比、血压等检测并进行了吸烟史、、每日吸烟量的调查。（１）在糖耐量低减（ＩＧＴ）和糖尿病（ＤＭ）组中,血压≥１８．７／１２．０ｋＰａ者的比例分别为４８．７％、５５．９％明显高于正常精耐量（ＮＧＴ）组的３２．２％,Ｐ＜０．０１;（２）ＩＧＴ和ＤＭ组的血糖、胰岛素、血脂水平、尿微量白蛋白排泄率、体重指数、年龄与ＮＧＴ组比较明显增高,Ｐ＜０．０５～Ｐ＜０．０１;（３）高血压组上述临床和生化指标与非高血压组比较也明显增设,均Ｐ＜０刀１;（４）多元逐步回归分析：血糖与胰岛素、血脂水平、ＵＡＥＲ、体重指数、血压、年龄、吸烟量呈显著正相关;血压也与上述项目及血糖呈显著正相关,Ｐ＜０．０５～Ｐ＜０．０１。糖尿病与高血压病存在共同危险因子,是相关性疾病,而且在糖耐量低减患者,这些危险因子已经存在,应早期进行综合干预。     

吡格列酮对2型糖尿病患者血浆内皮素和一氧化氮水平的影响

目的:探讨吡格列酮对2型糖尿病(T2DM)患者血浆内皮素(ET)、一氧化氮(NO)的影响。方法:70名T2DM患者,随机双盲分为安慰剂组(A组,35例)和吡格列酮组(B组,35例),治疗3个月后,检测两组患者服药前后空腹血糖(FBG)、空腹胰岛素(FINS)、糖基化血红蛋白(HbA1C)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、ET和NO,并计算胰岛素敏感指数(ISI)。结果:治疗后吡格列酮组FBG、FINS、HbA1C、TG、ET明显下降(P<0.01),HDL-C、ISI、NO显著升高(P<0.01),ET与FINS呈正相关(r=0.478,P<0.01),与ISI呈负相关(r=-0.306,P<0.01),NO与FINS呈负相关(r=-0.371,P<0.01),与ISI呈正相关(r=0.447,P<0.01);安慰剂组各参数于治疗前后无显著性差异。结论:吡格列酮能够显著降低T2DM患者的ET水平,升高NO水平。     

Serum concentrations of adiponectin,leptin, resistin,ghrelin and insulin and their association with obesity indices in obese normo- and hypertensive patients – pilot study

Introduction

Hypertension often coexists with obesity. Adipokines, ghrelin and insulin play important roles in the pathogenesis of both diseases. The aim of this study was to compare adiponectin, leptin, resistin, insulin and ghrelin mean serum concentrations and insulin resistance (HOMA-IR) in normo- and hypertensive patients with obesity.

Material and methods

All included patients were divided on the following groups: non-diabetic hypertensive patients with class I obesity (group A, n = 21) and class II/III obesity (group B, n = 10), and normotensive obese (class I)patients (group C, n = 7). Correlations between obesity indices (body mass index [BMI], waist-to-hip ratio [WHR], waist circumference [WC]), HOMA-IR, and hormone and adipokine serum levels were also analyzed.

Results

Leptin level and HOMA-IR were significantly higher in group B compared to group C (9.74 ±3.88 ng/ml vs. 4.53 ±3.00 ng/ml; p < 0.02 and 3.30 ±1.59 vs. 1.65 ±0.41; p < 0.02, respectively). A negative correlation between WC and adiponectin level (R = –0.6275; p < 0.01) and a positive correlation between WC and insulin concentration (R = 0.5122; p< 0.05) as well as with HOMA-IR (R = 0.5228; p < 0.02) were found in group A. Negative correlations between BMI and ghrelin level (R = –0.7052; p < 0.05), WHR and adiponectin level (R = –0.6912; p < 0.05) and WHR and leptin level (R = –0.6728; p < 0.05) were observed in group B.

Conclusions

Insulin resistance and leptin may be important pathogenic factors in hypertensive patients with severe obesity. Indices of abdominal obesity (WC, WHR) correlate better than BMI with HOMA-IR, insulin, adiponectin and leptin serum levels in hypertensive obese patients.     

多囊卵巢综合征患者血PAI-1和uPA含量的变化

目的观察多囊卵巢综合征(PCOS)患者外周血纤溶酶原激活抑制物1(PAI-1)和尿激酶型纤溶酶原激活物(uPA)的水平。方法实验分PCOS组和对照组,PCOS组又分为肥胖组和正常体重组,用酶联免疫吸附法(ELISA)测定PCOS组与对照组患者血浆PAI-1及血清uPA水平,并测定体重指数(BMI)、腰臀比(WHR)、空腹血糖(FPG)、空腹胰岛素及胰岛素释放试验(IRT),以稳态模型公式评估胰岛素抵抗(IR),并计算胰岛素曲线下面积(AUC)。结果PCOS组与对照组相比,黄体生成素/卵泡刺激素(LH/FSH)、睾酮(T)、空腹血糖、稳态(HOMA)指数、AUC及PAI-1含量均显著升高(P<0.05)。其中,PCOS肥胖组与正常体重组相比,HOMA指数、AUC及PAI-1含量也显著升高(P<0.05)。在相关性分析中,PAI-1与HOMA指数、PAI-1与AUC、PAI-1与BMI、HOMA-IR与BMI均有显著相关性(P<0.0001)。结论胰岛素抵抗和肥胖是影响PCOS患者PAI-1水平升高的一个很重要因素,抗PAI-1的研究可能为多囊卵巢综合征的治疗提供一个新的方法。     

Insulin resistance profile among siblings of type 2 diabetes mellitus (preliminary study)

Aim: to obtain prevalence of insulin resistance among siblings of subjects with type 2 DM and their metabolic abnormality profiles as measured by their BMI, waist circumference (WC), blood pressure, glucose intolerance, concentration of triglyceride, HDL cholesterol, and uric acid. Methods: a preliminary, cross sectional study conducted among 30 siblings from seven type 2 DM subjects under medical treatment in Dr. Cipto Mangunkusumo Hospital and other places where the subjects lived. Those subjects underwent interviews, physical examination including weight, height, abdominal circumference, blood pressure and laboratory examinations including glucose tolerance test, fasting insulin, triglycerides, HDL cholesterol and uric acid level. Data processed to obtain body mass index (BMI), homeostasis model assessment of insulin resistance (HOMA-IR) and HOMA-IR cut-off, which is determined based on 75 percentile. The criteria of hypertension, dyslipidemia, central obesity and hyperglycemia are based on Asian modification NCEP/ATP III criteria for metabolic syndrome. Hyperuricemia is diagnosed based on uric acid level >7mg/dl in men and >6 mg/dl in women. Results: the prevalence of insulin resistance among siblings of type 2 DM in this study is 26.67% with the proportion in each family varies from 0% to 75%. The most metabolic component found in this study is central obesity (56.7%), followed by hypertension (46.7%), decreased HDL cholesterol level (26.6%), hyper-triglyceridemia (26.6%) and hyperglycemia (20%). As many as three-quarters of subjects with insulin resistance have BMI >25 kg/m2. Among subjects with insulin resistance, all have central obesity, half of them have hypertension, decreased HDL cholesterol level and hyper-triglyceridemia. While hyperglycemia is found in 37.5% subjects. Conclusion: the prevalence of insulin resistance among siblings of type 2 DM in this study was 26.67% with the proportion in each family varies between 0-75%. Central obesity is the most metabolic component commonly found.     

单纯性肥胖症患者外周血Obestatin、Ghrelin与胰岛素抵抗的关系

目的:探讨单纯性肥胖症患者外周血肥胖抑制素Obestatin、Ghrelin的变化以及与胰岛素抵抗(Insulin resistance,IR)的关系.方法:选取我校2017、2018级学生为研究对象,分为体质指数(Body mass index,BMI)≥28㎏?m-2的单纯性肥胖症组(n=30)和正常对照组(n=2...     

Quality of life, overweight, and body fat distribution in middle-aged men

Measurements of obesity [body mass index (BMI)] and body fat distribution [waist-to-hip ratio (WHR)] were analyzed in 284 51-year-old men in relation to items about social, mental, and physical well-being from the G?teborg Quality of Life Instrument. Overweight participants (BMI > or = 25) reported a better home-family situation, appetite, and self-esteem, but decreased physical fitness and more pain in the legs compared with their leaner counterparts. Men with abdominal obesity (WHR > or = 1.0) experienced impaired health and physical fitness and lower self-esteem compared with those with WHR < 1.0. The abdominally obese participants were more often exhausted and experienced depressive symptoms. Abdominal pain was more frequent among those with WHR > or = 1.0. Overweight and abdominal obesity seem differently associated with social, mental, and physical well-being in men. Impaired quality of life may be causally related to the development of abdominal obesity; the mechanism involved might be increased cortisol secretion, which can redistribute body fat to central adipose tissue depots.     

IRS2基因G1057D变异与中国汉族人肥胖型2型糖尿病的相关性

目的 研究IRS2基因G1057D突变与中国汉族人2型糖尿病（type 2 diabetes mellitus，T2DM）的相关性。方法 选取辽宁汉族人T2DM组218例，健康对照组221名，各分为肥胖和非肥胖两个亚组。应用聚合酶链反应-限制性片段长度多态性方法筛查IRS2 G1057D突变并探讨与T2DM的相关性。结果 （1）IRS2 G1057D总突变频率为29％。非肥胖DM组DD型频率显著低于非肥胖对照组，Logistic回归分析显示DD型OR值为0．265；而肥胖DM组DD型频率则显著高于肥胖对照组，Logistic回归分析显示DD型的OR值为3．991。（2）在非肥胖亚组：DM组DD型的WHR高于同组GG型（P〈0．01）；对照组DD型的FPG及2hCP低于同组GG型（P〈0．05，P〈0．01），HOMA-B高于同组GG型（P〈0．01）。在肥胖亚组：DM组DD型的WHR、HOMA-IR及2hPG、2hINS、2hCP均高于同组GG型，HOMA-B低于同组GG型；对照组DD型的WHR、2hINS、HOMA-IR及HOMA-B也分别高于及低于同组GG型（均P〈0．05）。结论 IRS2基因G1057D突变以肥胖为中介与他DM相关联。     

The waist-to-hip ratio corrected for body mass index is related to serum triglycerides and high-density lipoprotein cholesterol but not to parameters of glucose metabolism in healthy premenopausal women

Summary Android obesity is associated with metabolic disorders, but the causality of this relationship remains unclear. We investigated the association of body mass index (BMI) and waist-to-hip ratio (WHR) with hormones, glucose tolerance, insulin sensitivity, serum lipoproteins, and the serum activity of hepatic enzymes in 40 healthy premenopausal women (BMI 19.2–46.1, mean 32.6±1.3 kg/M²; WHR 0.68-1.01, mean 0.82±0.02). BMI correlated with WHR (r=0.52, P<0.01). After correction for WHR, BMI was negatively correlated with high-density lipoprotein cholesterol and positively with total and very low density lipoprotein triglycerides, insulin sensitivity, blood glucose, serum insulin and glucagon. After adjustment for BMI, WHR was significantly associated with high-density lipoprotein cholesterol, total and very low density lipoprotein triglycerides, and the serum activities of hepatic enzymes but not with insulin sensitivity, blood glucose, serum insulin, or glucagon. According to these results, body fat distribution assessed by WHR is related to hypertriglyceridemia and alterations in hepatic function such as a fatty liver. WHR is not primarily related to glucose metabolism in healthy premenopausal women without preexisting metabolic disorders such as glucose intolerance. Therefore the observable association between android obesity and manifest impairment in glucose metabolism may develop secondarily during persisting hyperinsulinemia, which itself is primarily related to obesity. Thus an android body fat distribution may rather be an accompanying feature than a predictor of impaired glucose tolerance and insulin resistance.Abbreviations BMI body mass index - WHR waist-to-hip ratio - HDL high-density lipoprotein - LDL low-density lipoprotein - VLDL very low density lipoprotein - OGTT oral glucose-tolerance test - aP alkaline phosphatase - ALT alanine aminotransferase - AST aspartate aminotransferase - DHEAS dehydroepiandrostendione-sulfate Dedicated to Prof. Dr. G. Paumgartner on the occasion of his 60th birthday