To study effects of sex on free fatty acid (FFA)-induced insulin resistance, we have examined the effects of acute elevations of plasma FFA levels on insulin-stimulated total body glucose uptake in nine healthy young women. Euglycemic-hyperinsulinemic (ϳ500 pmol/l) clamps were performed for 4 h with coinfusion of either lipid/heparin (L/H) to acutely raise plasma FFA levels (from ϳ600 to ϳ1,200 mol/l) or saline/glycerol to lower fatty acids (from ϳ600 to ϳ50 mol/l). L/H infusion inhibited insulin-stimulated glucose uptake (determined with [3-3 H]glucose) and glycogen synthesis by 31 and 40%, respectively (P < 0.01), almost completely abolished insulin suppression of endogenous glucose production (EGP) (13.6 vs. 10.0 mol ⅐ kg ؊1 ⅐ min ؊1 , NS), prevented the insulin induced increase in carbohydrate oxidation (8.1 vs. 7.4 mol ⅐ kg ؊1 ⅐ min ؊1 , NS), and stimulated fat oxidation (from 3.6 to 5.1 mol ⅐ kg ؊1 ⅐ min ؊1 , P < 0.01). These data showed that acute increases in plasma FFA levels inhibited the actions of insulin on glucose uptake, glycogen synthesis, and EGP in women to a degree similar to that previously reported in men. We conclude that at insulin and FFA levels in the postprandial range, women and men were susceptible to FFA-induced peripheral and hepatic insulin resistance. Diabetes 52:487-491, 2003 T here is strong support for the notion that free fatty acids (FFAs) are an important link between obesity, insulin resistance, and type 2 diabetes. The evidence can be summarized as follows: 1) most obese people have increased plasma FFA levels (1,2); 2) acutely raising plasma FFAs causes acute insulin resistance in nondiabetic and diabetic individuals (3-7); 3) chronically elevated plasma FFAs also produce insulin resistance. This could be shown when chronically elevated plasma FFA levels were normalized for 12 h, which increased insulin sensitivity by ϳ50% in obese nondiabetic and diabetic individuals (8). Until recently, not much attention had been paid to the possibility that sex may play a role in the effects of FFAs on insulin action. In fact, many of the studies that demonstrated that FFAs acutely inhibited insulin-stimulated glucose uptake were performed almost exclusively in men (3,5). In a recent paper, however, Frias et al. (9), while confirming the inhibitory effect of acute elevations of plasma FFAs on insulin-stimulated glucose uptake in men, failed to find similar effects in women. Because of the importance of their findings with respect to the role of FFAs in the pathogenesis of insulin resistance/type 2 diabetes (10) and because they seemed to be in conflict with the results of other studies that were performed either exclusively (7) or predominantly with women (8,11), we felt that it was important to reexamine the effects of acute elevation of plasma FFAs on insulin action in healthy women using the same experimental protocol that we and others have used previously to demonstrate FFA-induced insulin resistance in men (3,5).
RESEARCH DESIGN AND METHODSSubjects. Ten healthy normal weight wom...