Insulin Resistance, Impaired Postprandial Lipid Metabolism and Abdominal Obesity

Abstract

Objective: To review three ‘emerging risk factors’ for coronary heart disease, the physiological and pathophysiological mechanisms involved, and their inter-relationships. Background: Classical risk factors for coronary heart disease cannot adequately explain the high incidence of this disease. Abdominal obesity and impaired postprandial lipid metabolism have long been recognised as associates of coronary heart disease but only relatively recently has their importance as risk markers been established. Insulin resistance is now often seen as a common theme underlying many factors predisposing to coronary heart disease (CHD). Mechanisms: The mechanisms by which each of these markers relates to coronary heart disease may have common aspects. Specifically, they are all associated with a characteristic dyslipidaemia involving elevation of plasma triacylglycerol concentrations, reduction of high-density lipoprotein cholesterol (HDL-cholesterol) and the presence of small, dense low-density lipoprotein particles that may carry particular risk of atherogenesis. Insulin resistance is also associated with hypertension and impairment of endothelial function, and with a procoagulant state. Treatment: No specific or separate pharmacological treatment of any of these conditions separately has been shown to reduce the risk of CHD although each can be manipulated. Lifestyle modification, with increased physical activity and dietary change, may offer the best hope of primary prevention but to achieve this, interventions at government level rather than advice from individual physicians would probably be required. Conclusions: Abdominal obesity, impaired postprandial lipid metabolism and insulin resistance are all inter-related risk markers for CHD. They seem to reflect lifestyle in the developed and developing worlds and perhaps modification of lifestyle holds the greatest hope for their amelioration in the future.

Exploration of Antidiabetic and Hypolipidemic Activity of Roots of <i>Croton</i> <i>Zambesicus</i>

“…In the present study, aqueous and ethanolic extract of Croton zambesicus had significantly decreased Total Cholesterol, Triglycerides, VLDL and LDL with increase in HDL cholesterol levels along with the beneficial protective function over the heart of induced diabetic models compared to the diabetic control group (Frayn, 2002). Numerous studies have been done in the past involving and concluding the antidiabetic and hypolipidaemic effects of ethanolic extract of the roots.…”

Methodology for studying postprandial lipid metabolism

“…Since most people consume fat-containing meals at regular 4-5 h intervals as well as fatcontaining snacks, it is clear that the usual state of triglyceride metabolism for most humans is a postprandial one (Roche and Gibney, 1995;Lairon, 1996;Williams, 1996;Frayn, 2002).…”

Energy replacement attenuates the effects of prior moderate exercise on postprandial metabolism in overweight/obese men

“…Postprandial lipoproteins and their remnants may deposit into arterial walls accelerating the development of atheromatous plaques 1 and the postprandial elevation in circulating triglyceride (TG)-rich lipoproteins contributes to the accumulation of small, dense low-density lipoproteins (LDL) and a decrease in cardio-protective high-density lipoproteins (HDL); a combination known as the atherogenic phenotype. 2 In addition, postprandial hyperinsulinaemia, together with the transient postprandial increase in insulin resistance may also contribute to atherogenic progression [3][4][5] and the development of chronic insulin resistance and type 2 diabetes. 6 As humans spend the majority of the day in the postprandial state, interventions which alter postprandial metabolism may have implications for the prevention and management of metabolic diseases.…”