Association between hypoadiponectinemia and cardiovascular risk factors in nonobese healthy adults

Adiponectin levels are significantly lower in obese adult patients with type 2 diabetes mellitus, essential hypertension, dyslipidemia, and cardiovascular disease. However, the role of hypoadiponectinemia in nonobese healthy adults has not been fully elucidated. In this study, we examined the association between hypoadiponectinemia and cardiovascular risk factors and estimated plasma adiponectin values in nonobese, apparently healthy adults. A total of 204 male and 214 female healthy individuals aged 20 to 80 years, with a body mass index (BMI) of less than 25 kg/m2, were included in this study. We measured patients' plasma adiponectin levels, serum lipid profiles, high-sensitivity C-reactive protein (hs-CRP) levels, fasting glucose levels, and fasting insulin levels. Mean values of plasma adiponectin were 5.45 +/- 3.3 microg/mL in male and 8.16 +/- 4.6 microg/mL in female subjects. The hypoadiponectinemia group (< 4.0 microg/mL) had significantly higher levels (P < .01) of BMI, fasting glucose, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and triglycerides, but lower levels of high-density lipoprotein cholesterol (HDL-C). In males, plasma adiponectin levels were inversely correlated with BMI (r = -0.32, P < .01), HOMA-IR (r = -0.14, P < .05), triglyceride levels (r = -0.17, P < .05), and hs-CRP levels (r = -0.15, P < .05), and positively correlated with HDL-C (r = 0.24, P < .01). In females, plasma adiponectin levels were negatively correlated with BMI (r = -0.31, P < .01), fasting glucose (r = -0.18, P < .01), fasting insulin (r = -0.23, P < .01), HOMA-IR (r = -0.24, P < .01), and triglyceride (r = -0.18, P < .01) levels, and positively correlated with HDL-C (r = 0.37, P < .01). Sex, age, BMI, and HDL-C (P < .01 for each) were found to be independent factors associated with plasma adiponectin levels in multivariate analysis. Hypoadiponectinemia is significantly associated with cardiovascular risk factors such as insulin resistance and atherogenic lipid profiles in nonobese, apparently healthy subjects.     

多囊卵巢综合征患者胰岛素抵抗与糖脂代谢及性激素的研究

目的通过高胰岛素正葡萄糖钳夹试验评估多囊卵巢综合征(PCOS)患者的胰岛素抵抗,探讨伴胰岛素抵抗PCOS患者糖脂代谢及性激素水平特点。方法将2017年7月至2019年2月就诊于遵义医科大学附属医院内分泌科住院及门诊的73例PCOS患者和体重指数及年龄匹配的27名健康女性行高胰岛素正葡萄糖钳夹试验,根据葡萄糖代谢率、体重指数和稳态模型评估的胰岛素抵抗指数(HOMA-IR)分组,分析PCOS患者糖脂代谢及性激素指标的变化及差异。结果在PCOS组中,糖调节受损者占3.23%(1/31),血脂代谢异常者占9.68%(3/31);而在PCOS合并胰岛素抵抗组中,糖调节受损者占7.14%(3/42),血脂代谢异常者达47.62%(20/42),5例患者被诊断为代谢综合征,占11.90%。相关分析显示,葡萄糖代谢率与体重指数、腰臀比、收缩压、空腹血糖、空腹胰岛素、HOMA-IR、皮质醇、三酰甘油、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、游离雄激素指数(FAI)和谷氨酰转肽酶(GGT)呈负相关(P<0.05),与高密度脂蛋白胆固醇(HDL-C)呈正相关(P=0.028);HOMA-IR与体重指数、腰臀比、收缩压、空腹血糖、空腹胰岛素、HbA1C、LDL-C呈正相关(P<0.05),与葡萄糖代谢率和HDL-C呈负相关(P<0.05);体重指数与腰臀比、收缩压、空腹血糖、空腹胰岛素、HOMA-IR、三酰甘油和LDL-C呈正相关(P<0.05),与葡萄糖代谢率、HDL-C和性激素结合球蛋白(SHBG)呈负相关(P<0.01)。多元线性逐步回归分析表明,体重指数、总胆固醇、三酰甘油和皮质醇是影响葡萄糖代谢率的重要因素,空腹血糖、空腹胰岛素和收缩压是HOMA-IR的重要影响因素,葡萄糖代谢率、HOMA-IR、HDL-C和SHBG仍然是影响体重指数的重要影响因素。结论FAI、SHBG和皮质醇可能参与到PCOS患者的胰岛素抵抗发生中,存在胰岛素抵抗的PCOS患者更容易发生代谢紊乱。     

低碳水化合物高营养密度膳食对肥胖儿童青少年的减重效果及糖脂代谢的影响

目的探讨低碳水化合物高营养密度膳食对肥胖儿童青少年的减重效果及糖脂代谢的影响。 方法选取2020年6月至2021年6月惠州市中心人民医院肥胖门诊及营养门诊的肥胖儿童青少年（7~18岁）37例作为研究组,选取同期22例肥胖儿童青少年作为对照组,对照组采用平衡膳食及生活方式、运动宣教干预,研究组在生活方式、运动宣教干预的基础上,采用低碳水化合物高营养密度膳食干预,共干预8周,比较两组干预前后BMI、腰臀比、身体成分分析数据以及代谢指标水平。 结果两组患者干预前的BMI、腰围、臀围、腰臀比、体脂率、内脏脂肪面积对比差异均无统计学意义（P>0.05）,在干预8周后,研究组的BMI、腰围、臀围、腰臀比、体脂率和内脏脂肪面积显著低于对照组,差异具有统计学意义（P<0.05）;干预前两组的空腹血糖（FPG）、餐后2 h血糖（2hPG）、空腹胰岛素（FINS）、餐后2 h胰岛素（2hINS）、血尿酸（UA）、血清胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）比较差异均无统计学意义（P>0.05）,干预8周后研究组的FPG、2hPG、FINS、2hINS、UA、TC、TG、LDL-C水平均显著低于干预前,且显著低于对照组,差异具有统计学意义（P<0.05）。 结论低碳水化合物高营养密度膳食短期内可以有效使肥胖儿童青少年减重,减少体脂率和内脏脂肪面积,改善其糖脂代谢。     

Prevalence of the metabolic syndrome in Zhejiang Chinese obese children and adolescents and the effect of metformin combined with lifestyle intervention

OBJECTIVE: We aimed to evaluate the prevalence of metabolic syndrome (MS) in a group of obese children and adolescents in Zhejiang in the south of China, and to compare risk factors such as insulin resistance, adiponectin level and impaired glucose tolerance (IGT) etc with that of simple obese group (SOB) and non-obese healthy group, and also to evaluate the effect of metformin and lifestyle intervention in MS group by up to a 3-month follow-up. METHODS: Three hundred and forty eight moderately or severely obese adolescents aged between 7 and 16 years were enrolled. Oral glucose tolerance test (OGTT), biochemical indicators, blood pressure and body mass index (BMI) were assessed in all of them. Three subgroups were selected (MS group, SOB and healthy control). Adiponectin levels, Whole body insulin sensitive index (WBISI), homeostasis model of insulin resistance (HOMA-IR), plasma lipid and blood pressure were compared in these three groups. Thirty out of thirty-six MS subjects with age over 10 years received metformin treatment combined with lifestyle modification. RESULTS: (1) The prevalence of MS was 10.34% among all obese subjects, which increased with the severity of obesity and reached 22.1% in severely obese children and adolescents. The occurrence of more than one complication reached 72.13%. The incidence of type 2 diabetes and IGT were 1.44 and 1.44% respectively. (2) BMI, waist-to-hip ratio (WHR) and HOMA-IR increased stepwise in the control group, SOB and MS group, whereas serum adiponectin and WBISI decreased stepwise (all P<0.01). Systolic pressure, triglyceride, total cholesterol, low-density lipoprotein cholesterol and postprandial 2-h blood glucose in the MS group increased significantly compared to those in control and SOBs (all P<0.01). A correlation analysis showed that serum levels of adiponectin and WBISI were associated with the components of MS (all P<0.05). (3) After metformin and lifestyle intervention, clinical symptoms were ameliorated, serum adiponectin levels were actually increased and HOMA-IR was dropped in 20/30 MS children who had finished a 3-months follow-up (all P<0.01). CONCLUSION: The prevalence of MS in severely obese children and adolescents in Zhejiang area has reached a high level. Insulin resistance and hypoadiponectinemia were found in these MS children. Metformin combined with lifestyle modification was confirmed to be efficient and safe in treating the obese adolescents with MS.     

High-sensitive C-reactive protein, tumor necrosis factor alpha, and cardiovascular risk factors before and after weight loss in obese children

To confirm the existence of obesity-induced inflammation and to clarify the association between such inflammation and other cardiovascular risk factors, we investigated the relationships between high-sensitive C-reactive protein (hsCRP), tumor necrosis factor alpha (TNF-alpha), obesity, blood pressure, lipids, and insulin resistance in a long-term follow-up of obese children. We compared the serum concentrations of hsCRP, TNF-alpha, high-density lipoprotein cholesterol, and triglycerides as well as blood pressure and the insulin resistance index (homeostasis model assessment [HOMA]) of 14 nonobese and 31 obese children. Furthermore, we studied the changes in these parameters in 16 obese children who lost weight and in 15 obese children without weight change over a 1-year period. In the obese children, blood pressure (P=.003), HOMA (P=.034), and triglyceride (P=.011), TNF-alpha (P=.015), and hsCRP (P<.001) levels were significantly higher, whereas high-density lipoprotein cholesterol concentrations were significantly (P=.015) lower compared with the nonobese children. Weight loss was associated with a significant decrease in hsCRP (P=.008) and triglyceride (P=.048) levels, HOMA (P<.001), and blood pressure (P=.019), whereas there were no significant changes in the children with stable weight status. The changes in hsCRP and TNF-alpha levels over the 1-year period were not significantly correlated to the changes in lipids, blood pressure, and HOMA. Obese children demonstrated significantly higher levels of hsCRP and TNF-alpha compared with nonobese children. The chronic inflammation markers TNF-alpha and hsCRP were independent of lipids, blood pressure, and insulin resistance index. Weight loss was associated with the significant decrease of hsCRP and triglyceride levels, and blood pressure.     

Early endocrine, metabolic, and sonographic characteristics of polycystic ovary syndrome (PCOS): comparison between nonobese and obese adolescents

Approximately half of all women with polycystic ovary syndrome (PCOS) are overweight or obese, and studies have reported endocrine and metabolic differences between lean and obese women with PCOS. PCOS has not been as extensively investigated in the adolescent population. The objectives of our study were to further characterize early endocrine and metabolic alterations in adolescents with PCOS and to determine whether differences between nonobese and obese women with PCOS are present early in its course. We studied an ethnically heterogeneous group of 48 adolescents: 11 nonobese with PCOS [age, 16.1 +/- 1.9 yr; body mass index (BMI), 22.5 +/- 1.5 kg/m(2)], 22 obese with PCOS (age, 15.5 +/- 1.4 yr; BMI, 35.9 +/- 6.2 kg/m(2)), and 15 obese controls (age, 14.4 +/- 1.5 yr; BMI, 35.8 +/- 7.1 kg/m(2)). Fasting levels of glucose, insulin, proinsulin, hemoglobin A1c, testosterone, SHBG, Delta4-androstenedione (Delta4-A), dehydroepiandrosterone sulfate (DHEAS), LH, FSH, IGF-I, IGF binding protein-1, free IGF-I, and lipids were measured. Six of the 11 nonobese PCOS subjects, 11 of the 22 obese PCOS subjects, and six of the 15 controls underwent standard oral glucose tolerance testing. The insulin response to the oral glucose tolerance test was measured by the insulin area under the curve (I(AUC120)). Measures of insulin sensitivity were calculated as the fasting glucose to insulin ratio, quantitative insulin sensitivity check index, and composite insulin sensitivity index. The nonobese adolescents with PCOS demonstrated higher levels of LH, SHBG, Delta4-A, DHEAS, dihydrotestosterone, free IGF-I, and high-density lipoprotein, and lower low-density lipoprotein, compared with the obese PCOS group. Fasting levels of insulin and proinsulin, I(AUC120), and log I(AUC120) were higher, and the fasting glucose to insulin ratio, quantitative insulin sensitivity check index, and composite insulin sensitivity index were lower in the obese compared with the nonobese PCOS subjects. Greater levels of LH and androgens, including total and free testosterone, Delta4-A, and DHEAS, and lower SHBG levels were found in the obese PCOS group compared with the obese controls. Adolescents with PCOS manifest clinical, metabolic, and endocrine features similar to those of adult women, and differences between nonobese and obese women with PCOS may be detected in adolescence. Our findings indicate a more pronounced alteration in the hypothalamo-pituitary-adrenal axis in nonobese adolescents with PCOS and a more marked dysregulation of insulin levels and impairment of insulin sensitivity in their obese counterparts. Our data also suggest differences in the IGF system between nonobese and obese adolescents with PCOS.     

Relationships of obesity indices to serum insulin and lipoproteins in relatives of black patients with noninsulin-dependent diabetes mellitus (NIDDM)

We have examined the relationships between obesity indices and various metabolic parameters in seven obese (body mass index (BMI) mean +/- s.e.m. 42 +/- 2.5 kg/m2), ten nonobese (BMI 25.3 +/- 1.2 kg/m2) nondiabetic female relatives of black patients with NIDDM and eight healthy controls (BMI 24.5 +/- 1.1 kg/m2). Despite the greater BMI in the obese relatives, percent body fat was not different from that of the nonobese relatives (38 +/- 2 vs 34 +/- 3 percent). Both values were, however, significantly (P less than 0.05) greater than that of the healthy controls (25 +/- 3 percent). Mean waist-to-hip circumference ratio (WHR) was greatest in obese relatives (0.89 +/- 0.01), intermediate in nonobese relatives (0.83 +/- 0.01) and least in the healthy controls (0.77 +/- 0.04). Mean sum of skinfold thickness from biceps, triceps and subscapular (SS) region was also greatest in obese relatives, intermediate in nonobese relatives and least in controls. Centrality index was not, however, different among the groups. Mean fasting serum glucose levels were slightly higher but not significantly different in the relatives compared to controls (obese 82 +/- 3; nonobese 81 +/- 4; controls 75 +/- 3 mg/dl). Following oral glucose ingestion, serum glucose rose to significantly (P less than 0.05) greater levels at 30, 60 and 90 min in the relative subgroups vs controls. Mean fasting and post-prandial peak serum insulin concentrations were significantly (P less than 0.05-0.01) greater in both relative subgroups vs controls. While mean serum glucose profiles and glucose disappearance decay (KG) following intravenous glucose load were identical in the relatives and controls, serum insulin responses were significantly greater in the relatives. The mean basal and post-stimulation serum C-peptide concentrations were similar in all the three groups, irrespective of the stimulus; thus suggesting a reduced hepatic insulin extraction in the relatives. Fasting serum cholesterol, triglyceride, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) as well as FFA levels were not different between the relatives and controls despite the hyperinsulinemia in the former group. WHR correlated with basal insulin in the relatives (r = 0.416, P less than 0.05) and controls (r = 0.68, P less than 0.01) but not with stimulated insulin, lipids and lipoproteins in any of the groups. In contrast, both percent BFM and SS thickness correlated significantly (P less than 0.001) with post-glucose insulin concentrations in the relatives only.(ABSTRACT TRUNCATED AT 400 WORDS)     

2型糖尿病合并冠心病患者血清内脂素和视黄醇结合蛋白4的临床意义

目的探讨血清内脂素(visfatin)和视黄醇结合蛋白4(RBP4)水平与2型糖尿病(T2DM)合并冠心病(CHD)的临床意义。方法选取单纯T2DM(T2DM组)患者61例、T2DM合并CHD(T2DM+CHD组)患者58例、单纯CHD(CHD组)患者60例、门诊健康体检者(对照组)60例,检测各组血清内脂素、RBP4水平、空腹血糖(FBG)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平,HbA1c和空腹血清胰岛素(FINS),计算胰岛素抵抗指数(HOMA-IR)、体重指数(BMI)及腰臀比(WHR),并作相关性分析。结果 T2DM+CHD组血清内脂素和RBP4水平均明显高于T2DM组、CHD组和对照组,差异均有统计学意义(q=2.56~3.13,均P<0.05)。T2DM+CHD组内脂素水平与WHR、RBP4、TG和HOMA-IR呈正相关(r=0.27~0.52,均P<0.05);T2DM与RBP4和HbA1c密切相关(OR=2.09~3.67,P=0.05),T2DM合并CHD与内脂素、RBP4和TG密切相关(OR=2.13~3.81,P=0.05)。结论血清内脂素和RBP4与T2DM合并CHD的发病有一定联系。     

Insulin resistance is associated with arterial stiffness independent of obesity in male adolescents.

To determine the relationship between insulin resistance (IR) and arterial stiffness independent of obesity in male adolescents, we evaluated body fat, lipid parameters, indices of IR (fasting insulin, and the homeostasis model assessment of insulin resistance [HOMA-IR]), indices of insulin sensitivity (IS) (fasting glucose/fasting insulin [GF/IF], and the quantitative insulin sensitivity check index [QUICKI]), and lifestyle parameters in 256 male adolescents. We divided the study group into the following four subgroups based on the median value of HOMA-IR and obesity: non-obese with IS, non-obese with IR, obese with IS, and obese with IR. In order to estimate arterial stiffness, we measured brachial ankle pulse wave velocity (baPWV). Despite having a high body mass index (BMI), obese-IS adolescents showed a significantly lower fasting insulin and baPWV, but had higher IS indices than non-obese-IR adolescents. After an adjustment for age, BMI, waist-to-hip ratio, mean blood pressure, heart rate, total cholesterol level, triglyceride, alanine aminotransferase (ALT) level, physical activity, and television and computer usage, multiple regression models showed that baPWV was independently correlated with IR and IS indices. In conclusion, our results demonstrate an association between IR and baPWV independent of weight, suggesting that IR is a risk factor for the development of early atherosclerosis. Interventions that decrease IR in addition to weight reduction may be necessary to alter the early development of cardiovascular risk.     

Serum retinol-binding protein 4 concentration and its ratio to serum retinol are associated with obesity and metabolic syndrome components in children

CONTEXT: Although retinol-binding protein (RBP)-4 concentrations are elevated in animal models of obesity and insulin resistance (IR), the link between RBP4 and IR in humans is less clear. There are few published data on RBP4 levels in overweight children, and most previous studies did not control for vitamin A (VA) status and/or subclinical inflammation. OBJECTIVE: The objective of the study was to measure serum RBP4, serum retinol (SR), the RBP4-to-SR molar ratio, and dietary VA intakes in normal-weight and overweight children and investigate the relationship of these variables to IR, subclinical inflammation, and the metabolic syndrome in this age group. DESIGN: This was a cross-sectional study. SETTING: The study was conducted in Northern Switzerland. PATIENTS: Patients included 6- to 14-yr-old normal-weight, overweight, and obese children (n = 79). MAIN OUTCOME MEASURES: Body mass index, body fat percentage, waist-to-hip ratio, dietary VA intakes, serum RBP4, and SR were determined. IR was assessed using fasting insulin and the quantitative insulin sensitivity check index, and components of the metabolic syndrome and indices of subclinical inflammation were measured. RESULTS: Only 3% of children had low VA status. Independent of age, VA intakes, and C-reactive protein, body mass index, body fat percentage, and waist-to-hip ratio were significant predictors of RBP4, SR, and RBP4/SR. Independent of adiposity, RBP4 and RBP4/SR were significantly correlated with serum triglycerides, and RBP4/SR was correlated with fasting insulin. The RBP4-to-SR ratio more strongly correlated with components of the metabolic syndrome than serum RBP4. CONCLUSION: Independent of subclinical inflammation and vitamin A intakes, serum RBP4 and the RBP4-to-SR ratio are correlated with obesity, central obesity, and components of the metabolic syndrome in prepubertal and early pubertal children.     

Relationships among acylation stimulating protein, adiponectin and complement C3 in lean vs obese type 2 diabetes

OBJECTIVE: The purpose of this study was to determine the relationships between adipocyte hormones acylation stimulating protein (ASP), adiponectin, complement C3 (C3) (ASP precursor) and insulin, C-reactive protein (CRP), lipid profiles and insulin resistance in lean vs obese type 2 diabetes subjects. SUBJECTS: Lean type 2 diabetes subjects (DL n = 27) vs obese type 2 diabetes subjects (DO n = 55) were compared to age-matched nondiabetic groups (Obese, OB n = 55 and control, CTL n = 50). RESULTS: The DO group demonstrated significant increases in plasma ASP and C3 with decreases in plasma adiponectin as compared to CTL. Interestingly, these increases in ASP and C3 were as high, or greater, in the DL group in spite of normal weight. By contrast adiponectin in the DL group was comparable to CTL, in spite of marked insulin resistance. C3 correlated with insulin, glucose and homeostasis model assessment of insulin resistance (HOMA-IR); ASP correlated with body mass index (BMI), glucose, insulin and plasma lipid parameters (non-esterified fatty acids (NEFA), triglyceride, cholesterol and apolipoprotein B). Adiponectin correlated with BMI, glucose, NEFA, triglyceride, high-density lipoprotein cholesterol and apolipoprotein A1 but not HOMA-IR, ASP or C3. CRP correlated only with HOMA-IR. CONCLUSION: Increased ASP and C3 are both associated with diabetes and related lipid factors but are not regulated coordinately. Adiponectin appears to be more closely related to body size (decreased in obese subjects) than insulin resistance in these subjects.     

Elevated retinol-binding protein 4 levels are associated with metabolic syndrome in Chinese people

CONTEXT: High retinol-binding protein 4 (RBP4) is thought to be associated with insulin resistance in humans. However, evidence from large-scale populations about the relationship between RBP4 and metabolic diseases is scarce. OBJECTIVE: We evaluated plasma RBP4 distribution and its association with metabolic syndrome (MetS) among middle-aged and older Chinese. RESEARCH DESIGN AND METHODS: We evaluated plasma RBP4 in a cross-sectional sample of 3289 Chinese aged from 50 to 70 yr in Beijing and Shanghai by using an in-house developed and validated sandwich ELISA. MetS was defined according to the updated National Cholesterol Education Program Adult Treatment Panel III criteria for Asian-Americans. RESULTS: RBP4 levels were higher in male and Beijing residents, compared with female and Shanghai participants (both P < 0.001). RBP4 levels were associated positively with body mass index, waist circumference, triglycerides, total and low-density lipoprotein cholesterol, blood pressure, fasting insulin, and homeostatic model assessment of insulin resistance and negatively with high-density lipoprotein cholesterol and adiponectin (all P < 0.001). In the highest RBP4 quartile, the MetS risk was significantly higher (odds ratio 2.58; 95% confidence interval 2.08-3.20) than in the lowest quartile after adjustment for potential confounders. This association remained strong (odds ratio 2.25; 95% confidence interval 1.72-2.94) after further controlling for C-reactive protein, adiponectin, homeostatic model assessment of insulin resistance, and body mass index. CONCLUSIONS: This first large-scale population study shows that elevated RBP4 levels are strongly and independently associated with MetS. Prospective studies are needed to establish the role of RBP4 in the development of MetS and related diseases.     

不同糖代谢痛风患者β细胞功能及代谢特征分析

目的 探讨痛风患者从正常糖耐量(NGT)到糖尿病不同糖代谢状态时的胰岛素抵抗与胰岛β细胞功能的演变,分析痛风合并糖代谢紊乱患者的代谢特征.方法 96例痛风患者分为糖耐量正常(NGT)组(n=35)、糖调节受损(IGR)组(n=27)及糖尿病组(n=34).测量身高、体重、血压,测定空腹血糖、空腹胰岛素、HbA1C、血清尿酸、总胆固醇、甘油三酯及C反应蛋白(CRP),计算体重指数(BMI)、稳态模型评估的胰岛素抵抗指数(HOMA-IR)、稳态模型评估的胰岛β细胞功能指数(HOMA-B)和胰岛素敏感指数(ISI).结果 糖尿病组和IGR组的BMI、餐后2h血糖(2hPG)、空腹胰岛素、HbA1C、总胆固醇、甘油三酯、CRP、HOMA-IR均高于NGT组(P<0.05或P<0.01),而糖尿病组及IGR组ISI均低于NGT组(0.023±0.018和0.024±0.017对0.052±0.026,P<0.05).NGT组、IGR组和糖尿病组HOMA-B差异有统计学意义(87.6±25.1、126.46±34.2及173.75±32.1,P<0.05).糖尿病组糖尿病家族史阳性率高于NGT组(41.17%对11.4%,P<0.05).logistic回归分析显示,年龄、BMI、收缩压、甘油三酯、CRP、ISI与糖尿病独立相关,而尿酸与糖尿病无相关性.结论 重度胰岛素抵抗、胰岛β细胞分泌功能障碍、BMI增加、C反应蛋白水平增高、脂代谢异常、遗传易感性是痛风患者合并糖尿病的主要代谢特征.     

The association between increased alanine aminotransferase activity and metabolic factors in nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) has been associated with metabolic disorders, including central obesity, dyslipidema, hypertension, and hyperglycemia. Metabolic syndrome, obesity, and insulin resistance are major risk factors in the pathogenesis of NAFLD. The aim of this study was to identify the relative contribution of the metabolic syndrome, obesity, and insulin resistance to alanine aminotransferase (ALT) activity in NAFLD. A total of 3091 subjects diagnosed with fatty liver by ultrasonography were enrolled. All components of metabolic syndrome criteria, anthropometric parameters, fasting insulin levels, high-sensitivity C-reactive protein (hs-CRP) as an inflammation marker, and ALT were measured in each subject. Homeostasis model assessment--insulin resistance (HOMA-IR) as a measure of insulin resistance and body mass index (BMI) as a measure of obesity were calculated. The prevalence of increased ALT levels (>40 IU/L) was 26.7%. Increased ALT activity was significantly associated with the following characteristics: male sex, young age, increased triglycerides, fasting glucose, fasting insulin, HOMA-IR, hs-CRP, waist circumference, BMI and diastolic blood pressure, and decreased high-density lipoprotein cholesterol (HDL-C). According to the increase in the number of metabolic syndrome components, BMI, HOMA-IR, and hs-CRP, the prevalence and odds ratio for having increased ALT activity were significantly increased. Central obesity, raised triglycerides, reduced HDL-C, and raised fasting glucose were strongly associated with increased ALT activity. In conclusion, a number of metabolic syndrome components, obesity, insulin resistance, and hs-CRP, are strong predictors of increased ALT activity in NAFLD. Central obesity, raised triglycerides, reduced HDL-C, and raised fasting glucose are metabolic syndrome components that contributed to increased ALT activity.     

Fluvastatin improves insulin resistance in nondiabetic dyslipidemic patients

Statins have multiple actions, independent of their classical effects on lipoproteins. The data about the effects of statins on insulin resistance is controversial. This study was designed to search the statin effects on nondiabetic dyslipidemic patients. Thirty-five (17 male, 18 female) consecutive dyslipidemic patients 54.25 +/- 8.81 yr were enrolled in the study. After a standard follow-up period of lifestyle modification, the patients were given fluvastatin 40 mg/d for 8 wk. Serum analyses were done both before and after treatment. Insulin resistance was assessed by homeostasis assessment model (HOMA). Fasting plasma triglyceride, total and LDL cholesterol, fasting insulin, and HOMA index were significantly reduced and HDL cholesterol was improved after fluvastatin treatment. HOMA-IR was not correlated with triglycerides, LDL, HDL, or total cholesterol levels. The same situation was present for both fasting plasma insulin and fasting plasma glucose levels. Also age was not associated with HOMA-IR and fasting plasma insulin levels. As a conclusion, the present study indicates that fluvastatin treatment improves insulin resistance in dyslipidemic patients who do not have diabetes or impaired fasting glucose. Also, the effect of fluvastatin on insulin resistance is not associated with the lowering of triglycerides. The latter finding indicates that the effect of statins on insulin sensitivity may not be related with the lowering of triglycerides in dyslipidemic patients.     

Association of abdominal fat distribution and cardiometabolic risk factors among obese Korean adolescents

The association between abdominal fat distribution and cardiometabolic risk factors using direct measures of abdominal fat in adolescents has not been extensively researched. This study was designed to investigate the association between visceral and subcutaneous fat and cardiometabolic risk factors, in obese Korean adolescents. The study enrolled 175 adolescents (72 boys, 103 girls), from ages nine to 19 years, who were referred to the Obesity Clinic of Asan Medical Center. Body mass index (BMI) and waist circumference (WC) were measured for each study participant. Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) areas were calculated by computed tomography. Blood pressure, fasting plasma glucose, total cholesterol, triglycerides, HDL cholesterol, insulin and homeostasis model assessment (HOMA) score were measured. Systolic blood pressure, HDL cholesterol, fasting insulin and the HOMA score were significantly correlated with BMI, WC, VAT and SAT. In addition, VAT was significantly correlated with diastolic blood pressure and triglyceride levels. On multiple regression analysis, VAT was independently correlated with blood pressure, triglycerides, HDL cholesterol, fasting insulin and the HOMA score, while SAT was independently correlated with systolic blood pressure, fasting insulin and the HOMA score. This study determined that cardiovascular risk factors are closely associated with VAT, while insulin resistance is closely associated with both VAT and SAT among obese Korean adolescents.     

Relationship of regional adiposity to insulin resistance and serum triglyceride levels in nonobese Japanese type 2 diabetic patients

The aim of this study was to investigate the relationships between insulin resistance and regional abdominal fat area, body mass index (BMI), and serum lipid profile in nonobese Japanese type 2 diabetic patients. A total of 63 nonobese Japanese type 2 diabetic patients aged 45 to 83 years were examined. The duration of diabetes was 8.4 +/- 0.8 years. BMI, glycosylated hemoglobin (HbA(1c)) levels, and fasting concentrations of plasma glucose, serum lipids (total cholesterol, high-density lipoprotein [HDL] cholesterol, and triglycerides), and serum insulin were measured. The low-density lipoprotein (LDL) cholesterol level was calculated using the Friedewald formula (LDL cholesterol = total cholesterol - HDL cholesterol - 1/5 triglycerides). Insulin resistance was estimated by the homeostasis model assessment (HOMA-IR). Computed tomography (CT) was used to measure cross-sectional abdominal subcutaneous and visceral fat areas in all the patients. Adipose tissue areas were determined at the umbilical level. Subcutaneous and visceral abdominal fat areas were 136.5 +/- 6.0 and 86.0 +/- 4.1 cm(2), respectively. Univariate regression analysis showed that insulin resistance was positively correlated with subcutaneous (r =.544, P <.001) and visceral (r =.408, P =.001) fat areas, BMI (r =.324, P =.009), HbA(1c) (r =.254, P =.001), serum triglycerides (r =.419, P <.001), and serum LDL cholesterol (r =.290, P =.019) levels and was negatively correlated with serum HDL cholesterol level (r =.254, P =.041). Multiple regression analyses showed that insulin resistance was independently predicted by the areas of subcutaneous (F = 6.76, P <.001) and visceral (F = 4.61, P <.001) abdominal fat and serum triglycerides (F = 8.88, P <.001) level, which explained 36.9% of the variability of insulin resistance. Moreover, the present study demonstrated that whereas BMI was positively correlated with visceral (r =.510, P <.001) and subcutaneous (r =.553, P <.001) fat areas, serum triglyceride level was positively associated with visceral (r =.302, P =.015), but not with subcutaneous (r =.222, P =.074) fat area. From these results, it can be suggested that (1) both subcutaneous and visceral abdominal fat areas are independently associated with insulin resistance and (2) visceral fat area, but not the subcutaneous one, is associated with serum triglyceride levels in our nonobese Japanese type 2 diabetic patients.     

高血压病患者血清总胆红素浓度与胰岛素抵抗水平的关系

目的　探讨高血压病患者血清总胆红素浓度与胰岛素抵抗、血糖、血脂、尿酸 (UA)的关系。方法　测定 16 5例高血压病患者的空腹血清总胆红素、血红蛋白 (Hb)、UA、总胆固醇、甘油三酯 (TG)、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇的浓度 ,口服葡萄糖耐量试验和胰岛素释放试验测定血浆葡萄糖浓度和血清胰岛素浓度 ,计算葡萄糖曲线下面积 (AUCG)和胰岛素曲线下面积 (AUCIN) ,稳态模式评估法计算胰岛素抵抗指数 (HOMA IR)。以HOMA IR 5 0 %位点 ,作为判断胰岛素抵抗的切割点 ,将高血压病患者分为胰岛素抵抗 (IR)组与胰岛素敏感 (IS)组。结果　血清总胆红素浓度 ,IR组为 (9.3± 3.3) μmol L显著低于IS组 (12 .0± 3.8) μmol L ,与HOMA IR、腰臀围比、收缩压、Hb、空腹胰岛素、TG、AUCG 、AUCIN呈显著相关关系 ;逐步回归分析显示 ,HOMA IR、AUCG 与Hb为血清总胆红素浓度的独立预测因子 ,血脂和UA均非血清总胆红素浓度的独立预测因子。结论　与胰岛素敏感的高血压病患者相比 ,伴胰岛素抵抗的高血压病患者有较低的血清总胆红素水平 ;高血压病患者血清总胆红素浓度与胰岛素抵抗、血糖与Hb直接相关 ,与血脂、UA无直接相关。     

Serum uric acid and leptin levels in metabolic syndrome: a quandary over the role of uric acid

This study investigates the impact of uric acid (UA) on the risk factors associated with metabolic syndrome. In addition, this study explores the relationship between UA and insulin resistance and serum leptin levels in metabolic syndrome. A total of 470 subjects (252 women and 218 men) were recruited from the Department of Health Management at Chang Gung Medical Center (Linkou, Taiwan). Metabolic syndrome was defined using a modified Adult Treatment Panel III (ATP III) definition. The formula for the homeostasis model assessment of insulin resistance (HOMA-IR) is as follows: fasting serum insulin (microU/mL) x fasting plasma glucose (mmol/L)/22.5. Diabetes mellitus was diagnosed in 45 subjects (9.6%); 82 subjects (17.4%) had hypertension. Hyperuricemia was diagnosed in 144 subjects (30.6%). Of these subjects, 115 (63 females and 52 males) (24.5%) were diagnosed as having metabolic syndrome. Patients with hyperuricemia had increased body mass index, waist-to-hip ratio, and triglyceride (Tg) level. The subjects also had lower high-density lipoprotein and greater hypertension. Hormone assays showed an elevation of leptin, immunoreactive insulin (IRI), and HOMA-IR in the hyperuricemia group. Uric acid appeared to be better correlated with Tg, blood pressure (both systolic and diastolic), obesity, immunoreactive insulin, and HOMA-IR. Uric acid did not correlate with leptin or blood glucose levels. Metabolic syndrome and Tg/high-density lipoprotein ratio showed a statistically significant difference in HOMA-IR using 3.8 as a cutoff value. Otherwise, there was no difference in leptin value. In conclusion, serum UA is significantly related to risk factors of metabolic syndrome except for blood glucose. Waist-to-hip ratio and HOMA-IR were statistically different in subjects with and without metabolic syndrome.     

单纯性肥胖青少年血清内脂素水平及其与年龄和高密度脂蛋白胆固醇的关系

目的 检测单纯性肥胖及正常青少年血清内脂素水平,探讨其与年龄、体重指数(BMI)、脂联素、瘦素、血脂、血糖及胰岛素水平的关系.方法 研究对象共148名,其中单纯性肥胖症青少年72例,正常对照76名.采用放射免疫分析法、酶法测定两组青少年的空腹血清内脂素、脂联素、瘦素、睾酮、甘油三酯、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇(HDL-C)等.肥胖组青少年均做口服葡萄糖耐量试验(OGTF),计算胰岛素抵抗指数(HOMA-IR)、胰岛素敏感指数(ISI)和早期胰岛素分泌指数(EISI).结果 肥胖组血清内脂素水平显著高于正常对照组[(37.65±18.28 vs 29.35±12.10) μg/L,P<0.01].正常对照组血清内脂素水平与人体测量指数及脂质参数之间无任何相关性,而肥胖组血清内脂素与年龄、EISI和Tanner分期呈负相关,与血清HDL-C水平呈正相关.并且在校正年龄、性别、体重指数后,内脂素水平与年龄及HDL-C水平仍然呈显著相关(g<0.05).结论 在中国青少年人群中,血清内脂素随年龄增长而下降,且可能参与体内HDL-C代谢的调控.