Objective: Metabolic syndrome (MBS) is a significant health care problem in postmenopausal women and is driven largely by obesity. We wished to assess the prevalence of insulin resistance (IR), diagnosed using practic...Objective: Metabolic syndrome (MBS) is a significant health care problem in postmenopausal women and is driven largely by obesity. We wished to assess the prevalence of insulin resistance (IR), diagnosed using practical methods, and whether several adipocyte factors (adiponectin, leptin, resistin) or the gastric peptide ghrelin, associated with cardiovascular risk, might be abnormal and may relate to IR. Study design: We evaluated 37 obese postmenopausal women with MBS and 34 matched obese premenopausal controls, as well as 14 non-obese premenopausal controls. We measured fasting glucose and insulin, performed 75g 2 hr oral glucose tolerance and intravenous insulin tolerance tests to assess IR, and measured fasting lipids, adiponectin, leptin, resistin and ghrelin. Results: The kinetic decline in glucose after insulin (kITT) as a marker of IR was the most frequently abnormal test (abnormal in 81%), with QUICKI, HOMA, and a modification of the Matsuda-DeFronzo index (ISIM) abnormal in 76, 73, and 68%, respectively. The GIR was abnormal in only 35%of subjects. Leptin and resistin were elevated and adiponectin and ghrelin were decreased in the postmenopausal women, compared to both groups of premenopausal controls. BMI correlated strongly with markers of insulin resistance as well as adipocytokine values. After controlling for BMI, only leptin was predictive of ISIM. Conclusion: Being overweight after menopause results in worsening IR and elevations in adipocytokine levels. While BMI is the most important factor, abnormal adipocytokine secretion may enhance IR and increase cardiovascular risk in postmenopausal women.展开更多
To determine the prevalence of insul in resistance(IR)in women with polycystic ovary syndrom e(PCOS)using baseline fasting blood measurement s of glucose and insulin.Prospective clinical study.Academ ic endocrinology ...To determine the prevalence of insul in resistance(IR)in women with polycystic ovary syndrom e(PCOS)using baseline fasting blood measurement s of glucose and insulin.Prospective clinical study.Academ ic endocrinology unit in Palermo,Italy.Two hundred and sixty -sevenwomenwith PCOS,consecutively evaluated,and50consecutively se-lected ovulating controls.Fasting blood was obtained for glucose and insulin measurements fr om all women.For 60women with PCOS and 20controls an insulin tolerance test(ITT)was also performed.Assessment of normal and ab-normal values for fasting insulin,g lucose /insulin ratio,and the calculated indices of the hom eostasis model as-sessment (HOMA),quantitative sensitivity check in dex(QUICKI ),as well as Kitt(kinetic disappearance of glu-cose)values after ITT.Evaluation was performed of the ability to detect IR using these meth ods in obese and nonobese women with PCOS.Normal insulin sensitivity was defined by insulin levels<12mU /mL,glucose /insulin ratios of>6.4,HOMA values of<47,and QUICKI values of>0.333.In the entire PCOS groups,IR w as diagnosed in 65.4%of women using glucose /insu lin ratios and in77%and 79.2%using HOMA and QUICKI.I n obese women(body mass index >28in 48%of group),IR was present in 76.7%as measured by gluco se /insulin ratios but was significantly higher(95.3%)using values of ei-ther HOMA or QUICKI (P<.01).All indices correlated with Kitt values with QUICKI showing the best correlation.Insulin resistance was detected in a pproximately 80%of women with PCOS,and in 95%of obese wo men.The detection of IR is superior using the calculated indices HOMA and QUICKI.展开更多
文摘Objective: Metabolic syndrome (MBS) is a significant health care problem in postmenopausal women and is driven largely by obesity. We wished to assess the prevalence of insulin resistance (IR), diagnosed using practical methods, and whether several adipocyte factors (adiponectin, leptin, resistin) or the gastric peptide ghrelin, associated with cardiovascular risk, might be abnormal and may relate to IR. Study design: We evaluated 37 obese postmenopausal women with MBS and 34 matched obese premenopausal controls, as well as 14 non-obese premenopausal controls. We measured fasting glucose and insulin, performed 75g 2 hr oral glucose tolerance and intravenous insulin tolerance tests to assess IR, and measured fasting lipids, adiponectin, leptin, resistin and ghrelin. Results: The kinetic decline in glucose after insulin (kITT) as a marker of IR was the most frequently abnormal test (abnormal in 81%), with QUICKI, HOMA, and a modification of the Matsuda-DeFronzo index (ISIM) abnormal in 76, 73, and 68%, respectively. The GIR was abnormal in only 35%of subjects. Leptin and resistin were elevated and adiponectin and ghrelin were decreased in the postmenopausal women, compared to both groups of premenopausal controls. BMI correlated strongly with markers of insulin resistance as well as adipocytokine values. After controlling for BMI, only leptin was predictive of ISIM. Conclusion: Being overweight after menopause results in worsening IR and elevations in adipocytokine levels. While BMI is the most important factor, abnormal adipocytokine secretion may enhance IR and increase cardiovascular risk in postmenopausal women.
文摘To determine the prevalence of insul in resistance(IR)in women with polycystic ovary syndrom e(PCOS)using baseline fasting blood measurement s of glucose and insulin.Prospective clinical study.Academ ic endocrinology unit in Palermo,Italy.Two hundred and sixty -sevenwomenwith PCOS,consecutively evaluated,and50consecutively se-lected ovulating controls.Fasting blood was obtained for glucose and insulin measurements fr om all women.For 60women with PCOS and 20controls an insulin tolerance test(ITT)was also performed.Assessment of normal and ab-normal values for fasting insulin,g lucose /insulin ratio,and the calculated indices of the hom eostasis model as-sessment (HOMA),quantitative sensitivity check in dex(QUICKI ),as well as Kitt(kinetic disappearance of glu-cose)values after ITT.Evaluation was performed of the ability to detect IR using these meth ods in obese and nonobese women with PCOS.Normal insulin sensitivity was defined by insulin levels<12mU /mL,glucose /insulin ratios of>6.4,HOMA values of<47,and QUICKI values of>0.333.In the entire PCOS groups,IR w as diagnosed in 65.4%of women using glucose /insu lin ratios and in77%and 79.2%using HOMA and QUICKI.I n obese women(body mass index >28in 48%of group),IR was present in 76.7%as measured by gluco se /insulin ratios but was significantly higher(95.3%)using values of ei-ther HOMA or QUICKI (P<.01).All indices correlated with Kitt values with QUICKI showing the best correlation.Insulin resistance was detected in a pproximately 80%of women with PCOS,and in 95%of obese wo men.The detection of IR is superior using the calculated indices HOMA and QUICKI.
