中国上海地区40岁以上成人中肥胖与代谢综合征的关系

The impact of obesity on metabolic syndrome in Chinese aged over 40 in Shanghai, China

目的 在中国人中研究肥胖对代谢综合征 (MS)的影响。方法 对 5 30例年龄≥ 40岁上海地区中国人 (男 2 44例 ,女 2 86例 )检测总体脂 [体重指数 (BMI) ]、局部体脂 [腰围 (W )、臀围 (H)、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) ]、体脂分布 [W与H比 (WHR)及 (VA +SA) /FA]及胰岛素敏感性 (HOMA IR)。以单变量及多变量分析方法观察体脂、胰岛素抵抗与MS的关系。结果 (1)MS者伴总体脂及腹部体脂增多 ,后者中主要是腹腔内脂肪增加。MS者随总体脂增加 ,腹部或股部的皮下脂肪反有减少趋势。MS者尚有明显体脂分布异常 ,表现为脂肪向腹腔内积聚 ;(2 )BMI≥ 2 5kg/m2 、W≥ 97cm或VA≥ 6 5cm2 者约 1/ 5～ 1/ 6有MS。WHR≥ 0 93或 (VA +SA) /FA≥ 5 0者约 1/ 4～ 1/ 5有MS ;(3)MS者有明显胰岛素抵抗。总体脂及局部体脂是分别参与胰岛素抵抗的因素。体脂与MS的相关主要是通过体脂对胰岛素抵抗的影响。结论 尽管目前中国人肥胖程度较轻 ,中国人中MS发病亦与总体脂、腹腔内脂肪积聚及体脂分布异常致胰岛素抵抗有关。根据 1998年WHO超重和 (或 )肥胖诊断标准 ,BMI2 3～ <2 5kg/m2 的非超重中国人中约 1/ 8有MS ,考虑到肥胖对健康的危害性及为了临床早期防治MS ,目前的诊断标准?

Objective To investigate the impact of obesity on metabolic syndrome (MS,the triad of hypertension, diabetes or glucose intolerance and dyslipidemia in an individual) in Chinese Methods 530 Chinese aged ≥ 40 (male 244,female 286) were included in this study Generalized adipose tissue depots [expressed as body mass index (BMI)], regional adipose tissue depots [ waist and gluteal circumferences (W and H), intra abdominal adipose tissue area (VA), abdominal and femoral subcutaneous adipose tissue area (SA and FA)], adipose tissue distribution [W and H ratio (WHR) and (VA+SA)/FA] and insulin sensitivity (HOMA IR) were determined The relation of adipose tissue depots and insulin resistance with MS was studied by monovariate and multivariate analysis Results (1) Individuals with MS have increased generalized and abdominal adipose tissue depots, mainly with increased intra abdominal fat mass in the latter situation With increased generalized adiposity in MS subjects, the abdominal and femoral subcutaneous adipose tissue depots tend to decrease Moreover, subjects with MS have significant abnormality in adipose tissue distribution, manifesting as intra abdominal fat accumulation; (2) About 1/5 to 1/6 of the subjects with BMI≥25 kg/m 2 , W≥97 cm or VA≥ 65 cm 2, and about 1/4 to 1/5 subjects with WHR≥0 93 or (VA+SA)/FA≥5 0 could have MS; (3) Individuals with MS have significant insulin resistance Generalized and regional adipose tissue depots are independent factors accounting for insulin resistance The relationship between adipose tissue depots and MS is through the impact of the former on insulin resistance Conclusion Although the adiposity in Chinese is of relatively mild degree, the development of MS in Chinese is still related to insulin resistance resulting from generalized and regional adiposity and abnormal body fat distribution According to the 1998 WHO diagnostic criteria for overweight/ obesity, it is estimated that about 1/8 of the non overweight/obese Chinese subjects with BMI 23～<25 kg/m 2 could have MS In considering the health hazards of obesity and the early prevention of MS, the current diagnostic criteria for obesity should be revised