Contribution of the Lean Body Mass to Insulin Resistance in Postmenopausal Women With Visceral Obesity: A Monet Study

Abstract

Some insulin-resistant obese postmenopausal (PM) women are characterized by an android body fat distribution type and higher levels of lean body mass (LBM) compared to insulin-sensitive obese PM women. This study investigates the independent contribution of LBM to the detrimental effect of visceral fat (VF) levels on the metabolic profile. One hundred and three PM women (age: 58.0 ± 4.9 years) were studied and categorized in four groups on the basis of their VF (higher vs. lower) and lean BMI (LBMI = LBM (kg)/height (m 2 ); higher vs. lower). Measures included: fasting lipids, glucose homeostasis (by euglycemic/hyperinsulinemic clamp technique and 2-h oral glucose tolerance test (OGTT)), C-reactive protein (CRP) levels, fat distribution (by computed tomography (CT) scan), and body composition (by dual-energy X-ray absorptiometry). Women in the higher VF/higher LBMI group had lower glucose disposal and higher plasma insulin levels compared to the other groups. They also had higher plasma CRP levels than the women in the lower VF/lower LBMI group. VF was independently associated with insulin levels, measures of glucose disposal, and CRP levels (P < 0.05). LBMI was also independently associated with insulin levels, glucose disposal, and CRP levels (P < 0.05). Finally, significant interactions were observed between LBMI and VF levels for insulin levels during the OGTT and measures of glucose disposal (P < 0.05). In conclusion, VF and LBMI are both independently associated with alterations in glucose homeostasis and CRP levels. The contribution of VF to insulin resistance seems to be exacerbated by increased LBM in PM women.

Characterizing the profile of obese patients who are metabolically healthy

“…7,9,20 For example, our group has previously shown that the combination of high LBM and high visceral adipose tissue was associated with further deterioration in the metabolic profile compared with the combination of high visceral adipose tissue and normal LBM. 34 Whether increased LBM is a consequence of metabolic disturbances or whether it has a causal function in the development of the MAO phenotype remains to be investigated. Interestingly, a recent study showed that muscle strength was significantly higher in MHO individuals despite lower levels of LBM.…”

Anthropometric Measures and Insulin Resistance in Rural Indian Adolescents

“…The findings of these studies were validated in more recent studies in obese post-menopausal women using dualenergy X-ray absorptiometry to measure body composition and computed tomography (CT) to measure body fat distribution [36,37]. Lean mass was independently associated with insulin levels and glucose homeostasis, and the association of visceral fat with IR was enhanced by an increase in lean mass in post-menopausal women [37]. All these studies were done in obese post-menopausal women.…”

Evaluation of insulin sensitivity with a new lipid-based index in non-diabetic postmenopausal overweight and obese women before and after a weight loss intervention

“…In the case of postmenopausal women, fat redistribution and more particularly increased visceral fat is related to increased insulin resistance and high NEFA circulating levels (30,31). This could affect the performance of fasting indices as previously reported (3,6).…”