【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.
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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