Diabetes and Metabolism Journal

Korean Diabetes Association (대한당뇨병학회)
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Proinflammatory Cytokines and Insulin Resistance in Nonobsese Women with High Body Fat and Low Fat Free Mass

고지방 저제지방 비비만 여성에서 전염증성 사이토카인과 인슐린저항성

Suh, Young-Sung;Kim, Dae-Hyun;Lee, In-Kyu
서영성;김대현;이인규

  • Published : 20070300
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Abstract

Background: Adipose tissue produces and releases a variety of proinflammatory cytokines. The aim of this study was to investigate whether proinflammatory cytokines are increased and insulin resistance is presented in nonobese women with high body fat and low fat free mass.Methods: Sixty nonobese adult premenopausal women (body mass index, BMI < 25 kg/m2) were included in this study. Body composition was determined by dual energy absoprtiometry (DXA). Fasting glucose, lipid profiles, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C reactive protein (CRP) and basal insulin were measured. Results: The subjects with high body fat (≥ 30%) had higher CRP levels (P = 0.024), IL-6 levels (P = 0.008), insulin levels (P = 0.003), and homeostasis model assessment-IR (HOMA-IR) (P = 0.020) than those of the subjects with low body fat. In a subset of 32 subjects with high body fat (≥ 30%), the number of subjects with high fat free mass index (FFMI) (≥ 13.5 kg/m2) had higher atherogenic index than that of subjects with low FFMI (FFMI < 13.5 kg/m2) (P < 0.05). IL-6 was correlated with % body fat, fat mass index (FMI), and fat mass (P < 0.05). HOMA-IR was correlated with % body fat and FMI (P < 0.05). To investigate predictors of cytokines and HOMA-IR, multiple regression analysis was used. % body fat was a predictor for IL-6 and, while age and % body fat were predictors of HOMA-IR in study subjects. Conclusions: This study suggests that insulin resistance may be present in nonobese women with high body fat and low fat free mass. (J Kor Diabetes Assoc 31:136~143, 2007)

연구배경: 마른 비만은 노인에서 근육량의 감소로 인한 손상의 위험 증가뿐 아니라 인슐린이 작용하는 근육량의 감소로 인슐린저항성을 초래할 수 있을 것으로 추정된다. 또한 전염증성 사이토카인인 TNF-α, IL-6가 제2형 당뇨병과 대사성 증후군의 원인이 된다는 주장이 제기되었다. 따라서 본 연구는 고지방 저제지방지수를 가진 폐경전 비비만 여성에서 TNF-α, IL-6, CRP와 인슐린저항성의 지표가 되는 HOMA-IR에 대해 알아보고자 하였다.방법: 대상군은 동산의료원 건강증진센터를 방문한 20세 이상 성인 중 BMI 25 kg/m2 미만이면서 본 연구에 동의한 폐경 전 여성 60명으로 체지방률 30% 미만인 28명과 이상인 32명이었다. 체지방 및 제지방을 포함한 체성분 검사는 이중에너지방사선 흡수측정기 (DXA)로 측정하였다. 12시간 이상의 공복상태에서 혈액을 채취하여 TNF-α, IL-6, CRP, 인슐린, 혈당, 혈중지질을 측정하였다. 인슐린저항성은 HOMA-IR 값으로 하였다. 결과: 1. 체지방률을 30% 미만인군과 이상인 군 간의 혈중지질 및 혈당의 차이는 없었으나 AI에서 나이를 보정한 결과 체지방률 30% 이상인 군에서 유의하게 높았다 (P = 0.032). 인슐린 (P = 0.003), HOMA-IR (P = 0.020), CRP (P = 0.024) 및 IL-6 (P = 0.008)은 체지방률 30% 이상인 군에서 30% 미만인 군에 비해 유의하게 높았다.2. 체지방률 30% 이상이면서 FFMI가 13.5 kg/m2 미만인 군 (2군)과 체지방률 30% 미만이면서 FFMI 13.5 kg/m2 이상인 군 (3군) 간의 비교 결과 인슐린 (P < 0.05), CRP (P < 0.05), IL-6 (P < 0.05)에서 유의한 차이가 있었다. 체지방률 30% 이상인 군에서 FFMI가 13.5 kg/m2 미만인 군(2군)과 13.5 kg/m2 이상인 군 (4군) 간의 비교 결과 FFMI 13.5 kg/m2 이상인 군의 AI (P < 0.01)가 FFMI 13.5 kg/m2 미만인 군 보다 유의하게 높았다. 3. 나이를 보정한 후 혈중 염증 사이토카인과 신체계측지수간의 상관분석결과 IL-6는 체지방률, 체지방지수, 체지방량과 유의한 상관성이 있었다 (P < 0.05). 또한 HOMA-IR은 체지방률 및 체지방지수와 유의한 상관성이 있었다 (P < 0.05). 그러나 CRP와 TNF-α는 유의한 상관성을 보이는 신체계측지수가 없었다. 4. 단계별 회귀분석 결과 IL-6는 체지방률을 가장 잘 설명할 수 있는 신체계측지수였다 (β = 0.370, R2 = 0.137). HOMA-IR은 연령 (β = 0.354)과 체지방률 (β = 0.286)이었다 (R2 = 0.251).

Keywords

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