Abstract
BackgroundAll previous studies that investigated the association between abdominal fat distribution and insulin resistance evaluated subcutaneous and visceral fat area and/or volume, but these values were not related to the body type of each subject. In the present study we have examined the association between abdominal fat distribution and peripheral (muscle)/hepatic sensitivity to insulin using the visceral to abdominal subcutaneous fat area ratio (VF/SF ratio) in male patients with type 2 diabetes mellitus. This ratio defines the predominancy of visceral or subcutaneous abdominal adiposity, independent of the body type of each individual.MethodsThirty-six type 2 diabetic male patients underwent a euglycemic insulin clamp (insulin infusion rate = 40 mU/m2·min) with 3-3H-glucose to measure insulin-mediated total body (primarily reflects muscle) glucose disposal (TGD) and suppression of endogenous (primarily reflects liver) glucose production (EGP) in response to a physiologic increase in plasma insulin concentration. Abdominal subcutaneous (SF) and intraabdominal visceral fat (VF) areas were quantitated with magnetic resonance imaging (MRI) at the level of L4–5.ResultsTGD and TGD divided by steady state plasma insulin concentration during the insulin clamp (TGD/SSPI) correlated inversely with body mass index (BMI), total fat mass (FM) measured by 3H2O, SF and VF areas, while VF/SF ratio displayed no significant relationship with TGD or TGD/SSPI. In contrast, EGP and the product of EGP and SSPI during the insulin clamp (an index hepatic insulin resistance) correlated positively with VF/SF ratio, but not with BMI, FM, VF or SF.ConclusionWe conclude that, independent of the individual's body type, visceral fat dominant accumulation as opposed to subcutaneous fat accumulation is associated with hepatic insulin resistance, whereas peripheral (muscle) insulin resistance is more closely related to general obesity (i.e. higher BMI and total FM, and increased abdominal SF and VF) in male patients with type 2 diabetes.
Highlights
All previous studies that investigated the association between abdominal fat distribution and insulin resistance evaluated subcutaneous and visceral fat area and/or volume, but these values were not related to the body type of each subject
One could hypothesize that the VF/subcutaneous fat area (SF) ratio would be a better indicator of visceral fat predominant distribution since it is independent of the individual subject's body type
MA = Mexican American; C = Caucasian; AA = African American FFM = fat free mass EGP = endogenous glucose production rate Clamp EGP = endogenous glucose production rate during insulin clamp SSPI = steady state plasma insulin concentration during insulin clamp Clamp Free Fatty Acid Concentration (FFA) = plasma free fatty acid concentration during insulin clamp total body glucose disposal (TGD) = total glucose disposal rate during insulin clamp Clamp EGP × SSPI = product of the Clamp EGP and steady state plasma insulin concentration during insulin clamp TGD/SSPI = TGD divided by SSPI VF = visceral fat area at L4–5 SF = subcutaneous fat area at L4–5
Summary
All previous studies that investigated the association between abdominal fat distribution and insulin resistance evaluated subcutaneous and visceral fat area and/or volume, but these values were not related to the body type of each subject. Men tend to accumulate adipose tissue in the abdomen, while women tend to accumulate fat in the gluteal-femoral region, in part due to the differences in androgen and/or estrogen action in vivo [18,19] Another potential explanation for the discordant reports might be the failure to account for the differences in the individual body type of the study subject. Peripheral (muscle) and hepatic insulin sensitivity can be quantitated by measuring the rate of glucose disappearance and appearance, respectively, during the euglycemic hyperinsulinemia clamp and usually expressed per min and per lean body weight These parameters of insulin action are to some extent standardized irrespectively of the total body fat mass and body type of each individual subject. One could hypothesize that the VF/SF ratio would be a better indicator of visceral fat predominant distribution since it is independent of the individual subject's body type (body weight, body height, BMI, body surface area, total fat mass, total fat free mass)
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