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Item
#14
Insulin
Resistance Explained By Body Fat Accumulation
Accumulation
of intra-abdominal fat is associated with insulin resistance,
whereas accumulation of subcutaneous fat is associated with
increased plasma leptin levels.
Concurrent accumulation of fat in these two metabolically distinct
fat compartments explains the association between insulin
resistance and increased levels of plasma leptin observed in both
lean and obese subjects.
Investigators from multiple institutions, including the Veterans
Administration Puget Sound Health Care System, Harborview Medical
Center and the University of Washington in Seattle, Washington,
evaluated body fat distribution, and its contribution to insulin
sensitivity and leptin levels in both lean an obese subjects.
Of 174 study subjects, 73 men and 101 women, 56 were classified as
lean insulin-sensitive, 61 were lean insulin-resistant and 57 were
obese insulin-resistant, according to body mass index and insulin
sensitivity index. Body mass index was similar between the two
lean groups.
Subcutaneous fat was 45 percent higher in lean insulin-resistant
and 250 percent higher in obese insulin-resistant subjects
compared to those who were lean insulin-sensitive. Intra-abdominal
fat was 75 percent higher in lean insulin-resistant and 300
percent higher in obese insulin-resistant subjects compared to
those who were lean insulin-sensitive.
Fasting levels of plasma leptin were moderately elevated in the
lean insulin-resistant subjects and doubled in the obese
insulin-resistant subjects compared the insulin-sensitive
subjects.
Intra-abdominal fat was the best predictor of insulin sensitivity
in both males and females. It explained 54 percent of the variance
in insulin resistance index. Fasting leptin levels, however, were
associated with subcutaneous fat and not intra-abdominal fat.
Diabetes 2002; 51: 1005-1015
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FACT:
Data
from NHANES III showed that about 30% of adults with type 2
diabetes have microalbuminuria, and about 13% have
macroalbuminuria, with greater prevalence rates for the latter
amount in African
Americans and Mexican Americans.
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