腰围、BMI与胰岛素抵抗指数的相关性

目的探讨腰围（WC）和5种胰岛素抵抗（IR）及敏感性指数间的相关性,并与BMI进行比较分析。方法2456例研究对象分为2型糖尿病（DM）组、糖调节受损（IGR）组和正常糖耐量（NGT）组,比较WC、BMI和5种指数相关性在3组的差异。结果WC、BMI与5种指数均相关（P〈0.05）,与lgISI2的相关性较其他指数强（beta分别为-0.1581和-0.592）;不同糖代谢各组比较,WC与各指数间的相关DM组〉NGT组〉IGR组,BMI与各指数间的相关性随糖调节异常的加重而增强。结论WC、BMI均是评估IR及敏感性的良好指标,而WC更适于对NGT人群IR的评估。     

血清补体3与代谢综合征及胰岛素抵抗关系研究

目的探讨血清补体3（C3）与代谢综合征（MS）及其组分,以及胰岛素抵抗（IR）的关系。方法96例MS患者和141例非MS患者用免疫比浊法检测血清C3,同时检测BMI、血糖、血压、血脂。结果MS患者血清C3水平明显高于非MS患者,且C3水平随MS组分的增加而升高（P〈0．01）。相关分析显示血清C3浓度与BMI、SBP、FPG、TC、TG、HOMA—IR呈正相关。结论血清C3水平与MS组分相关,与IR有关。     

Associations of adiponectin, resistin, and tumor necrosis factor-alpha with insulin resistance

CONTEXT: Adipose tissue-derived adipokines may contribute to insulin resistance. OBJECTIVE: We tested the hypothesis that adipokines are associated with insulin resistance in a community-based cohort and that associations are maintained in people with and without the metabolic syndrome (high vs. low risk of diabetes). DESIGN, SETTING, AND PARTICIPANTS: We studied a cross-sectional sample of 2356 individuals attending the seventh examination (1998-2001) of the Framingham Offspring Study. We measured levels of glucose, insulin, adiponectin, resistin, and TNFalpha in fasting blood samples and defined metabolic syndrome by updated National Cholesterol Education Program criteria. We used ANOVA to test associations of adipokines with insulin resistance and multivariable logistic regression models to assess joint associations of adipokines and metabolic syndrome with insulin resistance. MAIN OUTCOME MEASURE: Homeostasis model (HOMA-IR), with insulin resistance defined by HOMA-IR greater than the 75th percentile, was measured. RESULTS: Age- and sex-adjusted HOMA-IR levels were inversely related to adiponectin (r = -0.40, P < 0.0001) and positively related to resistin (r = 0.13, P < 0.0001) and TNFalpha (r = 0.12, P < 0.0001). The prevalence of insulin resistance increased with decreasing tertiles of adiponectin (from 10.9% in the third to 42.5% in the first tertile; P < 0.0001) and increasing tertiles of resistin (from 19.3 to 30.9%; P < 0.0001) and TNFalpha (from 18.8 to 32.0%; P < 0.0001). Results were similar after adjustment for body mass index. These associations were present in individuals with or without the metabolic syndrome. In multivariable regression models, metabolic syndrome and adipokines individually and jointly were significantly associated with insulin resistance. CONCLUSION: Adverse levels of adipokines are associated with insulin resistance in individuals at low or high diabetes risk.     

Prepregnancy BMI influences maternal and fetal outcomes in women with isolated gestational hyperglycaemia: A multicentre study

AimThis multicentre study analyzed the maternal and fetal outcomes of women who had one elevated 3-h oral glucose tolerance test (isolated gestational hyperglycaemia [IGH]).MethodsFrom 1999 to 2003, data were collected for 606 IGH women from 31 Italian obstetric or diabetic centres, including time and mode of delivery, gestational hypertension, preeclampsia, eclampsia, congenital malformations, and neonatal mortality and morbidity, to compare them with the general pregnant Italian population. A prognostic model for the outcome of pregnancy was constructed, and the concurrence of certain specified conditions was considered a positive outcome, whereas pregnancies that failed to meet one or more of the stated conditions were classified as “complicated”.ResultsMacrosomia was significantly more frequent in women with IGH than in the normal pregnant population (10.7 vs 7.4%, respectively; P = 0.003). Stillbirth and neonatal mortality rates did not differ from those in normal pregnancies, while a slight rise in the frequency of major malformations was not statistically significant (1.48 vs 0.89%, respectively; P < 0.11). Multivariate logistic analyses confirmed that the prepregnancy body mass index (BMI) was an independent predictor of a complicated pregnancy. As for fetal growth, multivariate logistic analyses according to BMI showed that being overweight or obese were strong predictors of macrosomia.ConclusionThese findings in a large cohort of Italian women with IGH confirm the detrimental effect of even minimally altered glucose tolerance on fetal outcome. Also, prepregnancy obesity plays an important role in raising the risk of adverse perinatal outcomes in such patients.     

Associations between maternal clinical features and fetal outcomes in pregnancies of mothers with connective tissue diseases

Abstract

Objectives: The purpose of this study is to clarify associations between maternal clinical features and adverse pregnancy outcomes (APOs) in mothers with connective tissue diseases (CTDs).

Methods: We retrospectively examined maternal clinical features including backgrounds, autoantibodies, CTD flare-ups, and therapies during pregnancies as well as fetal outcomes in 90 pregnancies (66 mothers) at our hospital from January 2006 to September 2016.

Results: Underlying CTDs were SLE (N?=?41), MCTD (N?=?10), RA (N?=?15), SS (N?=?10), and others (N?=?14). Anti-SS-A antibody was detected in 60.3%, lupus anticoagulant (LAC) was in 11.4%, and anti-cardiolipin-β2glycoprotein1 antibody was in 18.5%. Flare-ups of CTDs occurred in 20 pregnancies (22.2%). Corticosteroids (CS) was administered in 73 pregnancies, immunosuppressants in four, and biologics in one. Among the 85 pregnancies other than five early abortions within 12 weeks of gestational age, 33 cases had APOs while the remaining 52 cases were normal. Although disease duration, MCTD, high dose of CS, flare-ups of CTDs, and positive LAC significantly correlated with APOs by univariate analysis, only MCTD was a significant independent predictor for APOs by multivariate analysis.

Conclusion: Disease duration, MCTD, high dose of CS, flare-ups of CTDs, and LAC might be possible predictive risk factors for APOs in pregnancies with CTDs. Of these, MCTD was a significant independent risk factor.     

Associations between depressive symptoms and insulin resistance: The Hoorn Study

Aims/hypothesis The association between depression and insulin resistance has been investigated in only a few studies, with contradictory results reported. The aim of this study was to determine whether the association between symptoms of depression and insulin resistance varies across glucose tolerance status and between men and women.Subjects and methods Cross-sectional data from a population-based cohort study in Hoorn, a medium-sized town in the Netherlands, were analysed. The study sample consisted of 541 men and women aged 55–75 years, of whom 260 had NGT, 164 had IGT and 117 had established type 2 diabetes mellitus. Main outcome measures were insulin resistance defined by the homeostasis model assessment for insulin resistance (HOMA-IR) and symptoms of depression using the Centre for Epidemiologic Studies Depression Scale (CES-D).Results In the total sample, we found a weak positive correlation between the depressive symptoms CED-D scores and HOMA-IR scores (r _s = 0.156, p < 0.001). Even weaker associations were found in subjects with NGT (r _s = 0.041, p=0.509), in subjects with IGT (r _s = 0.112, p = 0.160) and in subjects with type 2 diabetes (r _s = 0.007, p = 0.942). The association between depressive symptoms and insulin resistance was similar for men and women.Conclusions/interpretation We found only weak associations between depressive symptoms and insulin resistance, which did not differ among different glucose metabolism subgroups or between men and women.     

Associations among lifestyle status, serum adiponectin level and insulin resistance

OBJECTIVE: The aim of this study was to determine whether lifestyle status affects the insulin resistance index or serum adiponectin level, which may be responsible for the development of insulin resistance syndrome that sometimes indicates lifestyle-related diseases. METHODS: A cross-sectional study was performed. PATIENTS: Seven hundred thirty-eight males aged 30 to 65 years who had regular health checkups in our office were enrolled. Each subject's lifestyle status, level of serum adiponectin, and serum insulin level were assessed by a self-administered questionnaire based on Breslow's lifestyle index, enzyme-linked immunosorbent assay, and radioimmunoassay, respectively. Moreover, their insulin resistance indexes were assessed by the homeostasis model. RESULTS: One-way ANOVA demonstrated an inverse correlation between Breslow's index and the logarithmic insulin resistance index (p<0.0001), and a tendency of a correlation between Breslow's index and the logarithmic serum adiponectin level (p=0.0681). Multiple logistic regression analyses demonstrated that, among the seven lifestyle items in Breslow's index, body mass index of more than 26.1 kg/m2 and insufficient exercise style had 8.9 times and 2.1 times the risks for insulin resistance and the former also had 3.2 times the risk for hypoadiponectinemia. Partial correlation coefficients of these correlations were 0.336 (p<0.0001), 0.107 (p=0.0013), and 0.165, (p<0.0001), respectively. CONCLUSION: Unhealthy lifestyles may cause hypoadiponectinemia and insulin resistance followed by insulin resistance syndrome, i.e. lifestyle-related diseases. These findings present reasonable explanations for the relationships between lifestyles and lifestyle-related diseases. Improvement of unhealthy lifestyles, especially the control of body weight, may have beneficial effects against the development of lifestyle-related diseases.     

Associations between maternal methylenetetrahydrofolate reductase polymorphisms and adverse outcomes of pregnancy: the Hordaland Homocysteine Study

PURPOSE: Methylenetetrahydrofolate reductase (MTHFR) is involved in the metabolism of folate and homocysteine; a polymorphism in the MTHFR gene (677C-->T) has been associated with adverse outcomes of pregnancy. We studied whether two polymorphisms in the MTHFR gene (677C-->T and 1298A-->C) are associated with pregnancy complications, adverse outcomes, and birth defects. METHODS: MTHFR polymorphisms were determined in blood collected in 1992 and 1993 from 5883 women aged 40 to 42 years, and linked with 14,492 pregnancies in the same women recorded in the Medical Birth Registry of Norway from 1967 to 1996. RESULTS: The 677TT genotype in mothers was associated with increased risk of placental abruption (odds ratio [OR] = 2.6; 95% confidence interval [CI]: 1.4 to 4.8) compared with the CC variant. The risk of intrauterine growth restriction increased with number of T alleles (P for trend = 0.04). Compared with the 1298AA variant, the CC variant was associated with a reduced risk of very low birth weight infants (OR = 0.4; 95% CI: 0.2 to 0.8). No significant associations were found between MTHFR polymorphisms and birth defects. CONCLUSION: The maternal MTHFR 677C-->T polymorphism was a risk factor for placental abruption. The unexpected protective effect of the 1298A-->C polymorphism on very low birth weight needs further study.     

Associations of leptin, insulin resistance and thyroid function with long-term weight loss in dieting obese men

OBJECTIVE: The aim of the present study was to identify predictors of weight loss in obese men participating in a 2-year behaviour modification programme. DESIGN: Longitudinal, clinical intervention study of a behaviour modifying weight loss program. SETTING: University Hospital, Stockholm, Sweden. SUBJECTS: Forty-four obese men (age, 42.7 +/- 1.1 years: BMI, 37.1 +/- 0.6 kg m(-2), mean +/- SEM) followed for 2 years. INTERVENTIONS: Behaviour modification weight loss programme. MAIN OUTCOME MEASURES: Associations between plasma leptin and thyroid function tests, insulin resistance by homeostatic model assessment (HOMA), dietary recall and anthropometrically determined body composition. RESULTS: At baseline, there were significant correlations between plasma leptin and body mass index (BMI), fat-free mass (FFM) and insulin resistance. Median weight loss over 2 years was 4.9 kg (range, -27.2 to +11.9). Baseline serum leptin concentrations adjusted for BMI (leptin/BMI ratio) were significantly correlated with 2-year weight change (r = 0.34, P = 0.04). A subset of seven of the 44 men gained weight over the 2 years. These 'gainers' differed significantly in initial leptin/BMI ratio (0.62 +/- 0.07) compared with the 37 'losers' (0.42 +/- 0.03, P < 0.05). In a multiple regression model, baseline leptin, insulin and age predicted 22% of the variance in weight change with no additional significant contribution from BMI, FFM, waist:hip ratio, thyroid function tests or energy intake. There was a strong correlation between the change in leptin concentrations and the change in insulin resistance from baseline to 2-year follow-up (r = 0.54; P < 0.001). CONCLUSION: Baseline plasma leptin concentrations predicted long-term weight loss. Inappropriate leptin secretion or disposal, corrected for BMI, was associated with failure to maintain weight loss in obese men in a behaviour modification weight loss programme.     

NASH and insulin resistance: Insulin hypersecretion and specific association with the insulin resistance syndrome

Nonalcoholic steatohepatitis (NASH) is often linked with disorders that are clearly associated with insulin resistance (IR): obesity, type 2 diabetes mellitus, and hypertriglyceridemia. We tested the hypotheses that (1) IR is an essential requirement for the development of NASH and (2) a high association between IR and liver disease is relatively specific for NASH. We measured body mass index (BMI), waist/hip ratio, and fasting serum lipid, insulin, C-peptide, and glucose levels in 66 patients with NASH (21 with advanced fibrosis and 45 with mild fibrosis). IR was determined by the homeostasis model assessment (HOMA). We also determined the strength of the association of NASH with insulin resistance syndrome (IRS) as defined by World Health Organization criteria. To assess whether the finding of IR was relatively specific to NASH rather than simply to obesity or liver disease, we compared the results of a subset of 36 patients with less-severe NASH with 36 age- and sex-matched patients with chronic hepatitis C virus (HCV) of comparable fibrotic severity. IR was confirmed in 65 patients (98%) with NASH, and 55 (87%) fulfilled minimum criteria for IRS. IR was found in lean as well as in overweight and obese patients. The IR values and the prevalence of IRS (75% vs. 8.3%) were significantly higher in those with NASH than in comparable cases of HCV. Hyperinsulinemia was attributable to increased insulin secretion rather than decreased hepatic extraction. In conclusion, most patients with NASH have IRS, and there is a near-universal association between NASH and IR irrespective of obesity. IR is present in mild as well as advanced cases of NASH but is unusual in chronic HCV of similar fibrotic severity.     

胰岛素的糖基化作用及其与胰岛素抵抗的关系

人胰岛素在体外与不同浓度葡萄糖溶液孵育，利用氯化硝基四唑氮蓝还原反应证实胰岛素能被糖基化；利用抗胰岛素抗体分离３３例Ⅱ型糖尿病患者血清胰岛素，比色测定糖基化胰岛素水平。结果表明：糖尿病患者糖基化胰岛素水平显著升高，且与血糖呈显著正相关，与空腹血胰岛素／血糖比值和糖负荷后曲线下胰岛素／血糖面积比值呈显著负相关。说明糖基化胰岛素水平取决于血糖控制状况。且可能参与胰岛素抵抗的形成。     

Associations between insulin resistance and thrombotic risk factors in high-risk South Asian subjects.

AIMS: There is recognized association of thrombotic factors to insulin resistance in White Europeans. South Asians are more insulin resistant compared with white Europeans and express increased metabolic features of insulin resistance. The aim of the study was to determine whether there was any relationship between insulin resistance and thrombotic risk factors in healthy South Asian subjects. METHODS: Healthy South Asians (n = 185) clinically free from ischaemic heart disease, ischaemic stroke or peripheral vascular disease were randomly recruited. Partial correlations of homeostasis model assessment (HOMA) (surrogate of insulin resistance) were analysed with two fibrinolytic and five coagulation factors. RESULTS: Age and gender-adjusted HOMA was significantly correlated to plasminogen activator inhibitor-1 (0.51, P = 0.0001), tissue plasminogen activator antigen (r = 0.40, P = 0.0001), fibrinogen (r = 0.28, P = 0.0001), von Willebrand factor (r = 0.17, P = 0.03), factor XIIa (r = 0.22, P = 0.006) factor VII antigen (r = 0.19, P = 0.02) and factor XIII B subunit (r = 0.30, P = 0.001). CONCLUSIONS: Insulin resistance significantly clusters with fibrinolytic and coagulation factors in South Asians, which may contribute to high prevalence of vascular disease in this population.