Gender differences in insulin resistance, body composition, and energy balance

Geer, Eliza B.; Shen, Wei

doi:10.1016/j.genm.2009.02.002

Cited by 913Adipokines, Inflammation, and Metabolic DiseasesDiabetes, Cardiovascular Risks, and LipoproteinsCardiovascular Disease and Adiposity

Gender differences in insulin resistance, body composition, and energy balance

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Geer, Eliza B., Shen, Wei·2009·Gender Medicine

DOI 10.1016/j.genm.2009.02.002PMC PMC2908522

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Abstract

Background Men and women differ substantially in regard to degrees of insulin resistance, body composition, and energy balance. Adipose tissue distribution, in particular the presence of elevated visceral and hepatic adiposity, plays a central role in the development of insulin resistance and obesity-related complications.Objective This review summarizes published data on gender differences in insulin resistance, body composition, and energy balance, to provide insight into novel gender-specific avenues of research as well as gender-tailored treatments of insulin resistance, visceral adiposity, and obesity.Methods English-language articles were identified from searches of the PubMed database through November 2008, and by reviewing the references cited in these reports. Searches included combinations of the following terms: gender, sex, insulin resistance, body composition, energy balance, and hepatic adipose tissue.Results For a given body mass index, men were reported to have more lean mass, women to have higher adiposity. Men were also found to have more visceral and hepatic adipose tissue, whereas women had more peripheral or subcutaneous adipose tissue. These differences, as well as differences in sex hormones and adipokines, may contribute to a more insulin-sensitive environment in women than in men. When normalized to kilograms of lean body mass, men and women had similar resting energy expenditure, but physical energy expenditure was more closely related to percent body fat in men than in women.Conclusion Greater amounts of visceral and hepatic adipose tissue, in conjunction with the lack of a possible protective effect of estrogen, may be related to higher insulin resistance in men compared with women.

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Subcutaneous adipose tissue tends to express aromatase at higher levels compared to visceral adipose tissue, whereas visceral adipose tissue appears to express more 17β-hydroxysteroid dehydrogenase, an enzyme that interconverts E1 and E2.
“SAT tends to express aromatase in higher levels compared to VAT, whereas VAT appears to express more of 17β-hydroxysteroid dehydrogenase (17β-HSD), an enzyme which interconverts E1 and E2 (191).”
From Metabolic impact of endogenously produced estrogens by adipose tissue in females and males across the lifespan (2025) · cites this paper as [191]
The “Depot-Specific Adipose Tissue Sex Steroids” section reports that SAT has relatively more aromatase than 17β-HSD, while VAT has more 17β-HSD than aromatase. Those are comparisons between enzymes within each depot, not direct measurements of each enzyme across SAT and VAT. The section also states that 17β-HSD converts estrone to estradiol, but does not state that the conversion works in both directions. (LLM, conf=0.84)
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Authors: Geer, E. B., & Shen, W.
Affiliations: Icahn School of Medicine at Mount Sinai (US)
St. Luke's-Roosevelt Hospital Center (US)
Corresponding author: Geer, Eliza B.
ORCID: Geer, Eliza B.
Shen, Wei
Venue: Gender Medicine
Publisher: Elsevier BV
Published: 2009-01
Volume: 6
Pages: 60-75
ISSN: 1550-8579 (ISSN-L)
DOI: 10.1016/j.genm.2009.02.002
PMC: PMC2908522
OpenAlex: W2056393440
Cited by: 913
References: 170
Citations by year: 2026: 46 · 2025: 53 · 2024: 67 · 2023: 76 · 2022: 58 · 2021: 77 · 2020: 78 · 2019: 58 · 2018: 63 · 2017: 62 · 2016: 51 · 2015: 47 · 2014: 43 · 2013: 26 · 2012: 30
FWCI: 23.81
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Gender Medicine (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute of Diabetes and Digestive and Kidney Diseases (K23DK082617)
National Center for Research Resources (M01RR000071)
Topics: Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
Keywords: insulin resistance, sex differences, body composition, energy balance, visceral adipose tissue, subcutaneous adipose tissue, lean body mass, resting energy expenditure, physical activity energy expenditure, sex hormones, adipokines, estrogen, obesity
MeSH terms: Body Composition, Energy Intake, Dehydroepiandrosterone, Energy Metabolism, Estrogens, Female, Humans, Insulin Resistance, Male, Reference Values, Sex Characteristics, Sex Hormone-Binding Globulin, Testosterone, Intra-Abdominal Fat

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Gender differences in insulin resistance, body composition, and energy balance

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