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【medical-news】肥胖并不一定意味着胰岛素抵抗

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Obesity does not always mean insulin resistance Story List

In some individuals, obesity predisposes to heart disease, and in some, it may not, Dr. Gerald Reaven said at the Fourth World Congress on the Insulin Resistance Syndrome.

Insulin sensitivity varies dramatically among people, and there are individuals who are overweight but who do not appear to have any insulin resistance, said Dr. Reaven, an emeritus professor at Stanford (Calif.) University, whose group was the first to develop a quantitative way to measure insulin sensitivity, back in 1970.

“Not all individuals who are obese have metabolic abnormalities that will give them coronary heart disease,” Dr. Reaven said.

Obesity does exacerbate insulin resistance, which in turn leads to the specific profile of dyslipidemia with high triglyceride levels and low HDL-cholesterol levels, but at least one-third of obese individuals do not have insulin resistance despite their weight, Dr. Reaven said.

In one study he conducted with 314 volunteers, Dr. Reaven found that of the insulin-resistant patients, 25% were of normal weight and 25% were obese (J. Am. Coll. Cardiol. 2002;40:937-43).

In another study in which he screened 261 healthy subjects, Dr. Reaven found that waist circumference was no better than body mass index at identifying who had dyslipidemia, and, therefore, cardiovascular risk (Am. J. Cardiol. 2006;98:1053-6).

Dr. Reaven also said that although not all individuals with hypertension are insulin resistant, resistance is one of the single most important predictors of hypertension, and that hypertension in the absence of insulin resistance may not be that profound a risk factor, at least according to the Copenhagen Male Study (Arch Intern. Med. 2001;161:361-6).

“If you have high blood pressure and do not have the dyslipidemia of insulin resistance, you have no increased risk of coronary heart disease, and that accounts, I am sure, for why treating blood pressure is so much more effective at reducing stroke than reducing heart disease,” he said. “The worst group by far is the group with the high blood pressure and the dyslipidemia of insulin resistance.”

In regard to the diagnosis of the metabolic syndrome, Dr. Reaven said he agrees with the American Diabetes Association that there really is no reason to label a patient as having the metabolic syndrome.

There are three guidelines for diagnosing metabolic syndrome, from the World Health Organization, the Third Report of the National Cholesterol Education Program’s Adult Treatment Panel, and the International Diabetes Federation.

But each of the guidelines has its own shortcomings that limit its usefulness, and a physician should manage a patient with any cardiovascular risk factor anyway, regardless of whether he or she has been diagnosed with metabolic syndrome, he said.

As regards helping a patient to lose weight, Dr. Reaven said he recommended a low-carbohydrate diet with less than 45% of calories from carbohydrates. Carbohydrate intake induces higher insulin levels, in turn increasing triglyceride levels. So a low-carbohydrate diet - even one high in unsaturated fat - followed by weight loss will reduce triglyceride levels and raise HDL-cholesterol levels, he said.

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2006-10-18 01:17 浏览 : 1343 回复 : 3

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2006-10-18 08:36

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Obesity does not always mean insulin resistance Story List
肥胖不一定意味着胰岛素抵抗
In some individuals, obesity predisposes to heart disease, and in some, it may not, Dr. Gerald Reaven said at the Fourth World Congress on the Insulin Resistance Syndrome.
Gerald Reaven博士在第四届世界胰岛素抵抗综合征大会上说，在一些个体中，肥胖是心脏病的易发因素，在另一些个体中则不是。
Insulin sensitivity varies dramatically among people, and there are individuals who are overweight but who do not appear to have any insulin resistance, said Dr. Reaven, an emeritus professor at Stanford (Calif.) University, whose group was the first to develop a quantitative way to measure insulin sensitivity, back in 1970.
Reaven博士是斯坦福大学的退休荣誉教授，他领导的研究小组在1970年第一次提出定量测量胰岛素测量的方法，他说，不同的个体中，胰岛素敏感性具有很大的差异，一些个体明显超重，但是没有表现出任何的胰岛素抵抗
“Not all individuals who are obese have metabolic abnormalities that will give them coronary heart disease,” Dr. Reaven said.
“并不是所有的肥胖个体都具有代谢异常而成为冠心病的高发人群”，Reaven博士说。
Obesity does exacerbate insulin resistance, which in turn leads to the specific profile of dyslipidemia with high triglyceride levels and low HDL-cholesterol levels, but at least one-third of obese individuals do not have insulin resistance despite their weight, Dr. Reaven said.
Reaven博士说，肥胖可以加剧胰岛素抵抗，从而引起血脂障碍，甘油三脂水平增高，而HDL胆固醇水平降低，但是仍然有1/3的肥胖病人虽然体重超重，但是没有胰岛素抵抗。
In one study he conducted with 314 volunteers, Dr. Reaven found that of the insulin-resistant patients, 25% were of normal weight and 25% were obese (J. Am. Coll. Cardiol. 2002;40:937-43).
在一项涉及314名志愿者的研究中，Reaven博士发现，胰岛素抵抗病人中，25%的病人体重正常，25%的病人为肥胖病人。
In another study in which he screened 261 healthy subjects, Dr. Reaven found that waist circumference was no better than body mass index at identifying who had dyslipidemia, and, therefore, cardiovascular risk (Am. J. Cardiol. 2006;98:1053-6).
在另一项涉及261名健康受试者的研究中，Reaven博士发现在发现血脂异常也就是心血管危险因素方面，腰围的效果并不比体重指数更好(Am. J. Cardiol. 2006;98:1053-6).
Dr. Reaven also said that although not all individuals with hypertension are insulin resistant, resistance is one of the single most important predictors of hypertension, and that hypertension in the absence of insulin resistance may not be that profound a risk factor, at least according to the Copenhagen Male Study (Arch Intern. Med. 2001;161:361-6).
Reaven博士还指出，虽然并不是所有的高血压病人都具有胰岛素抵抗性，而胰岛素抵抗性是预测高血压的一个最重要的因素，因此不伴胰岛素抵抗的高血压可能不是那么严重的危险因素，至少Copenhagen Male研究结果提示这样的结果。
“If you have high blood pressure and do not have the dyslipidemia of insulin resistance, you have no increased risk of coronary heart disease, and that accounts, I am sure, for why treating blood pressure is so much more effective at reducing stroke than reducing heart disease,” he said. “The worst group by far is the group with the high blood pressure and the dyslipidemia of insulin resistance.”
“如果你有高血压，但是没有胰岛素抵抗相关的血脂异常，你罹患冠心病的危险性并没有增加，我可以比较肯定的说，这可以解释为什么控制血压能够有效减少中风，而在控制冠心病方面相对之下则不理想了”，他说，“最糟糕的病人群体是那些既患有高血压，又患有胰岛素抵抗相关的血脂异常的病人。”
In regard to the diagnosis of the metabolic syndrome, Dr. Reaven said he agrees with the American Diabetes Association that there really is no reason to label a patient as having the metabolic syndrome.
在诊断代谢异常方面，Reaven说他同意美国糖尿病协会的挂念，没有必要给病人贴上代谢异常综合征的标签。
There are three guidelines for diagnosing metabolic syndrome, from the World Health Organization, the Third Report of the National Cholesterol Education Program’s Adult Treatment Panel, and the International Diabetes Federation.
诊断代谢异常综合征的指导标准有三个：世界卫生组织，成年人疾病治疗委员会国家胆固醇教育项目的第三次报告，国际糖尿病协会。
But each of the guidelines has its own shortcomings that limit its usefulness, and a physician should manage a patient with any cardiovascular risk factor anyway, regardless of whether he or she has been diagnosed with metabolic syndrome, he said.
但是每一个标准均有自己的不足，限制了其价值，不论一个病人是否具有代谢异常综合征，大夫都要对具有任何心血管危险因素的病人进行处理。
As regards helping a patient to lose weight, Dr. Reaven said he recommended a low-carbohydrate diet with less than 45% of calories from carbohydrates. Carbohydrate intake induces higher insulin levels, in turn increasing triglyceride levels. So a low-carbohydrate diet - even one high in unsaturated fat - followed by weight loss will reduce triglyceride levels and raise HDL-cholesterol levels, he said.
在帮助病人减肥方面，Reaven建议低糖饮食，碳水化合物提供的热量要少于45%，摄入碳水化合物导致胰岛素水平升高，继而增加甘油三脂的水平。他说，低糖饮食，即使其中一种食物不饱和脂肪酸含量较高，结合减肥，可以有效的降低甘油三脂水平，提高HDL胆固醇水平。

2006-10-18 12:10

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1. Reaven说他同意美国糖尿病协会的挂念
2. 诊断代谢异常综合征的指导标准有三个：(源于/出自)世界卫生组织，成年人疾病治疗委员会国家胆固醇教育项目的第三次报告，国际糖尿病协会。

2006-10-18 14:19

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