233例非糖尿病人群空腹血浆胰岛素水平预测体重增加的前瞻性研究

A prospective study of predicting body weight gain by fasting plasma insulin levels in 233 non diabetics

目的 探讨非糖尿病人群胰岛素抵抗及血浆胰岛素水平对体重增加的影响。方法人群调查中以口服葡萄糖耐量试验 (OGTT)筛选的非糖尿病者 2 33例〔正常糖耐量 (NGT) 134例 ,糖耐量低减 (IGT) 99例〕 ,随访观察 6年。以多因素回归分析初访胰岛素水平、胰岛素抵抗与体重增加的关系。结果 在总组 ,体重增加与初访体重指数 (BMI)呈显著负相关 (P =0 .0 0 3) ,与胰岛素敏感指数及空腹血糖水平呈显著正相关 (P =0 .0 0 6 ,P =0 .0 1) ,剔除随访中演变为糖尿病者后上述相关性没有变化。仅包括体重增加者的分析显示 ,调整年龄、性别、体重指数及胰岛素敏感性影响后初访空腹胰岛素水平均值为 8.8、12 .3、19.1及 41.6mU/L组 ,在随访中体重分别增加 1.5、3.6、4.9及 7.3kg。结论 非糖尿病人群胰岛素抵抗并不利于体重增加 ,而在胰岛素抵抗相当的情况下 。

Objective To investigate the effect of insulin resistance and plasma insulin level on weight gain in non diabetics. Methods 134 subjects with normal glucose tolerance and 99 subjects with impaired glucose tolerance were identified by oral glucose tolerance test in a population based diabetes survey. None of them involved medical intervention. The body weight was monitored for six years. Multivariate regression analysis was performed to investigate the relation between weight gain and insulin level, insulin resistance at baseline. Results After the six year follow up, body weight increased in 119 subjects (group A), total weight change and weight change per year were (3.8±0.4) and (0.6±0.1)kg respectively. Whereas in other 114 subjects body weight decreased (group B), total weight change and weight change per year were (-4.2±0.4) and (-0.7±0.1)kg respectively. The difference of weight changes between group A and group B was significant (P<0.001). The mean weight gain from lowest to top insulin sensitivity quartiles were -3.3, -1.0, 1.3, 2.4 kg after controlling for age, sex and fasting plasma glucose level. In the generally linear analysis the insulin sensitivity and insulin levels were independently positively correlated to the body weight gain (P=0.006, P<0.001). These correlations remain significant even after the exclusion of the subjects who developed diabetes in the follow up period. Both total and yearly weight gain significantly correlated to insulin sensitivity and fasting plasma insulin levels. Conclusions In non diabetics, insulin resistance does not favour body weight gain in the prospective study. However the higher fasting plasma insulin is a positive factor to the body weight gain at the presence of insulin sensitivity adjustment.