上海地区中国汉族人2型糖尿病的肥胖性状及特异性

目的　研究 2型糖尿病患者体脂异常的性状及特异性。方法　选取上海地区 36 6例年龄≥ 4 0岁的中国汉族人 ,其中 2 87例为 2型糖尿病患者 ;79例为无糖尿病、高血压及血脂紊乱对照者。检测 :(1)总体脂 :体重指数 (BMI) ;(2 )局部体脂 :腰围 (W )、臀围 (H)、股围 (F)、腹腔内脂肪面积(VA)、腹部皮下脂肪面积 (SA)及股部皮下脂肪面积 (FA) ;(3)局部体脂 /总体脂比值 (W /BMI、H/BMI、F/BMI、VA/BMI、SA/BMI及FA/BMI) ;(4 )体脂分布 :W与H比 (WHR)、W与F比 (WFR)、VA SA/FA及VA/SA ;(5 )组织胰岛素敏感性 :稳态评估模式公式 (HOMA IR)计算。结果　 2型糖尿病患者可见下列体脂异常 :(1)总体脂 :BMI增加 (P =0 0 0 13) ;(2 )腹部体脂 :腰围增加 (P <0 0 0 0 1) ,主要由于腹腔内脂肪绝对或相对增多 ,即VA、VA/SA及VA/BMI增高 (P值分别为0 0 0 11、0 0 0 2 5、0 0 0 0 8) ;(3)相对于总体脂增加 ,臀部及股部皮下脂肪 (H/BMI、F/BMI及FA/BMI)均见减少 (P值分别 <0 0 0 0 1、<0 0 0 0 1、=0 0 0 14 ) ;(4 )体脂呈向心 (躯干 )型分布 ,即WHR、WFR、VA SA/FA增高 (P值分别 <0 0 0 0 1、<0 0 0 0 2、=0 0 0 0 2 ) ,不但是由于腹腔内脂肪增加而且由于臀或下肢皮下脂肪减少。 2型糖尿病患者的上述体脂异常

Obesity in type 2 diabetes, its features and specificity

OBJECTIVE: To study the features and specificity of body fat depot abnormalities in type 2 diabetic patients. METHODS: 366 Chinese aged >or= 40, 287 with type 2 diabetics and 79 without type 2 diabetics, hypertension and dyslipidemia, underwent the following examinations: (1) total body fat depots, defined by body mass index (BMI); (2) regional body fat depots, including waist circumference (W), hip circumference (H), femoral circumference (F), intra-abdominal fat area (VA), abdominal subcutaneous fat area (SA) and femoral subcutaneous fat area (FA); (3) ratio between regional and body fat depots (W/BMI, H/BMI, F/BMI, VA/BMI, SA/BMI and FA/BMI); (4) body fat distribution, including W and H ratio (WHR), W and F ratio (WFR), VA + SA/FA, and VA/SA; and (5) tissue insulin sensitivity, expressed by homeostasis model assessment index for insulin resistance (HOMA-IR). RESULTS: The body fat depot abnormalities observed in type 2 diabetes were as follows: (1) increase in total body fat depots (BMI) (P = 0.0013); (2) increase in abdominal fat depots (W) (P < 0.0001), mainly accounted for absolute and relative increases in intra-abdominal fat depots (VA, VA/SA and VA/BMI) P = 0.0011, 0.0025, 0.0008 respectively; (3) relative decrease in hip and femoral subcutaneous fat depots (H/BMI, F/BMI and FA/BMI) (P < 0.0001, < 0.00001, = 0.0014 respectively); (4) central distribution of body fat (WHR, WFR and VA + SA/FA) (P < 0.0001, = 0.0002, = 0.0002 respectively) by increase in intra-abdominal fat depots as well as decrease in hip or femoral body fat depots. The degree of abnormalities in body fat depots and the degree of tissue insulin resistance were in parallel with the number of other metabolic diseases (hypertension and dyslipidemia) associated in type 2 diabetic patients. Stepwise regression analysis indicated that increase in total body fat depots was the major independent contibuting factor for tissue insulin resistance. Moreover, increase in intra-abdominal fat depots and decrease in femoral fat depots were also independent contributing factors for insulin resistance. CONCLUSION: Increase in intra-abdominal fat depots as well as decrease in femoral subcutaneous fat depots is not only the features of body fat distribution observed in diabetic patients, but also in subjects with metabolic syndrome.