生活方式干预对超重/肥胖合并高胰岛素血症者代谢的影响

The effect of lifestyle intervention on metabolic outcomes in overweight/obese individuals with hyperinsulinemia

目的探讨单纯生活方式干预对超重/肥胖合并高胰岛素血症者代谢指标及糖代谢转归的影响,分析改善高胰岛素血症的相关因素。方法选取2021年北京市某单位年度体检人群中超重/肥胖合并高胰岛素血症(空腹胰岛素≥15 mU/L)者,按随机数字表法分为对照组(44例)、生活方式干预组(40例)。对照不进行任何干预,干预组进行为期52周饮食运动管理,比较2组患者体重指数(BMI)、腰臀围、胰岛素水平、糖代谢状态、脂代谢及尿酸情况,评估糖代谢转归,采用Spearman相关性分析干预后高胰岛素血症状态相关因素。结果2组患者基线年龄、性别、BMI、腰臀围及各代谢指标差异均无统计学意义(P>0.05);与对照组比较,生活方式干预组52周后BMI、腰围、臀围均降低,75 g口服葡萄糖耐量试验(OGTT)中空腹胰岛素(FIns)、2 h胰岛素(2 hIns)、空腹血糖(FPG)均有所改善(P<0.05)。生活方式干预组患者糖耐量异常者11例,8例(72.7%)逆转为糖耐量正常,对照组仅2例(22.2%)逆转为糖耐量正常;生活方式干预组体重变化百分比与高胰岛素血症呈负相关(P<0.01),2组患者腰围变化均与高胰岛素血症呈负相关(P<0.01)。年龄、性别、基线BMI、血糖、血脂、血尿酸及肝肾功能与52周高胰岛素血症状态无相关性(P>0.05)。结论生活方式干预可有效改善超重/肥胖者高胰岛素血症,逆转糖代谢异常,降低体重、腰围是关键因素。

Objective To investigate the effects of lifestyle intervention on metabolic indicators and glucose metabolism outcome in overweight/obese patients with hyperinsulinemia, and analyze the related factors to improve hyperinsulinemia.Methods The 84 overweight/obese individuals with hyperinsulinemia(fasting insulin≥15 mU/L) enrolled from annual physical examination population of an community in Beijing in 2021 were randomly divided into control group(44 cases) and lifestyle intervention group(40 cases).The control group was not given any intervention.The intervention group was given diet and exercise management for 52 weeks.Body mass index(BMI),waist and hip circumference, plasma insulin levels, glucose metabolism, lipid metabolism and uric acid were compared between the two groups, and the outcomes of glucose metabolism were evaluated.Spearman correlation analysis was used to analyze the hyperinsulinemia-related factors after intervention.Results There were no differences between the two groups in baseline age, gender, BMI,waist and hip circumference, and metabolic indicators(P>0.05).Compared with the control group, BMI,waist circumference and hip circumference were decreased, fasting plasma insulin(FIns) and 2 h insulin(2 hIns),fasting plasma glucose(FPG) in 75 g oral glucose tolerance test(OGTT) were improved after 52 weeks in lifestyle intervention group(P<0.05).The abnormal glucose tolerance of 8/11(72.7%) patients in the lifestyle intervention group were reversed to normal glucose tolerance, while only 2/9(22.2%) patients in the control group were reversed to normal glucose tolerance after 52 weeks.Change of body weight(%) was negatively correlated with hyperinsulinemia in the lifestyle intervention group(P<0.01),and the change of waist circumference(%) was negatively correlated with hyperinsulinemia in both groups at the 52 weeks(P<0.01).Baseline Age, sex, BMI,blood glucose, blood lipids, blood uric acid, liver function and kidney function were not correlated with hyperinsulinemia at 52 weeks(P>0.05).Conclusions Lifestyle interventions can effectively improve hyperinsulinemia in overweight/obese patients, reverse abnormal glucose metabolism, moreover, reducing body weight and waist circumference may be key factors.