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Body Fat Distribution and Insulin Resistance in Healthy Asian Indians and Caucasians
Abstract
Previous studies have shown that Asian Indians (AIs) are insulin resistant and at high risk for developing diabetes and coronary heart disease, compared with Caucasians. To examine whether differences in body fat distribution contribute to this risk, 12 healthy AIs and 12 Caucasians matched for age and body mass index (BMI) underwent a 75-g oral glucose tolerance test, 2-h euglycemic hyperinsulinemic clamp, abdominal (L2-3) computed tomography scan, and fasting lipid and plasminogen activator inhibitor-1 (PAI-1) levels. Despite similar fasting plasma glucose levels, AIs exhibited fasting hyperinsulinemia (P = 0.001), higher glucose (P = 0.03) and insulin (P = 0.004) levels during the oral glucose tolerance test, and reduced glucose disposal rate (R(d)) (4.7 +/- 0.4 vs. 7.5 +/- 0.3 mg/kg per min, P < 0.0001) during the clamp. AIs had significantly lower high-density lipoprotein, higher low-density lipoprotein, and significantly higher PAI-1 levels (P = 0.01). Despite similar BMI, AIs had significantly greater total abdominal fat (P = 0.04) and visceral fat (P = 0.04). In all subjects, measures of fat mass were inversely correlated with R(d) during the clamp (r = -0.47 to -0.61, P < 0.01-0.001). Visceral fat mass was correlated with triglycerides, low-density lipoprotein, and high-density lipoprotein (P < 0.002-0.0001). PAI-1 was inversely correlated with R(d) in AIs (r = -0.70, P < 0.01) and not in Caucasians (r = -0.24, P = 0.44). For comparable BMI and age, healthy AIs have physiologic markers for insulin resistance, dyslipidemia, and increased cardiovascular risk, compared with Caucasians. Alterations in body fat distribution--particularly increased visceral fat--may contribute to these abnormalities.
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“Young Indians living in India were found to have more visceral and abdominal fat and reduced glucose disposal rates than Caucasians with matched age and BMI [40].”
From Advantages and Limitations of the Body Mass Index (BMI) to Assess Adult Obesity (2024) · cites this paper as [40]
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“Another study comparing 12 Asian Indians living in the USA with 12 white Caucasians reported that, although both IAATand SCATwere significantly associated with insulin resistance, only IAAT correlated with triglyceride, LDLcholesterol and HDL-cholesterol levels.(26) However, these findings were not replicated in other…”
ResultBainey, K. R., & Jugdutt, B. I. (2008) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2008.09.023 · Cited by 80
“[78] Raji A, Seely EW, Arky RA, Simonson DC.”
BackgroundKalra, A., Nair, S., & Rai, L. (2006) · Indian Journal of Medical Sciences · doi:10.4103/0019-5359.27971 · Cited by 91
“Increased visceral fat has been observed in Asian Indians, which is not apparent from their BMI.”
InfluentialA cross-sectional investigation of regional patterns of diet and cardio-metabolic risk in India
Daniel, C. R., Prabhakaran, D., Kapur, K., Graubard, B. I., Devasenapathy, N., Ramakrishnan, L., George, P. S., Shetty, H., Ferrucci, L. M., Yurgalevitch, S. M., et al. (2011) · Nutrition Journal · doi:10.1186/1475-2891-10-12 · Cited by 92
“Abdominal adiposity, impaired glucose and lipid levels, as well as hypertension in a high-proportion of study participants corresponds with the high-risk “Asian Indian phenotype” that may be a product of genetic adaptations to food insecurity, fetal or early childhood malnutrition, as well as more recent environmental…”
BackgroundMohan, V., Deepa, M., Farooq, S., Narayan, K. M. V., Datta, M., & Deepa, R. (2007) · Metabolism: Clinical and Experimental · doi:10.1016/j.metabol.2007.02.009 · Cited by 90
“This is attributed to the so-called bAsian Indian phenotypeQ characterized by increased WC despite lower body mass indices, increased visceral fat [3], and greater insulin resistance [11].”
BackgroundGulati, S., & Misra, A. (2017) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2017.92 · Cited by 96
Lu, J., Bi, Y., Wang, T., Wang, W., Mu, Y., Zhao, J., Liu, C., Chen, L., Shi, L., Li, Q., et al. (2014) · International Journal of Cardiology · doi:10.1016/j.ijcard.2014.01.073 · Cited by 85
“Given that Asians have a unique phenotype characterized by relatively high abdominal obesity and tend to have high prevalence of cardiovascular risk factors even at low body mass index (BMI) [16–19], we hypothesize that both general and abdominal obesity are risk factors for cardiovascular diseases independent of insu…”
BackgroundThe abnormal lipid profile in obesity and coronary heart disease (CHD) in Pakistani subjects
Shabana, S., Shahid, S. U., & Sarwar, S. (2020) · Lipids in Health and Disease · doi:10.1186/s12944-020-01248-0 · Cited by 113
Hulmán, Á., Simmons, R. K., Brunner, E. J., Witte, D. R., Færch, K., Vistisen, D., Ikehara, S., Mika Kivimaki, B., & Tabák, Á. G. (2017) · Diabetologia · doi:10.1007/s00125-017-4275-6 · Cited by 104
Adipose tissue, metabolic syndrome and polycystic ovary syndrome: from pathophysiology to treatment
Garruti, G., Depalo, R., Vita, M. G., Lorusso, F., Giampetruzzi, F., Damato, A. B., & Giorgino, F. (2009) · Reproductive BioMedicine Online · doi:10.1016/j.rbmo.2009.05.010 · Cited by 82
“However, excess intraperitoneal fat is more strongly correlated with insulin resistance and type-2 diabetes than subcutaneous or retroperitoneal adipose tissue (Abate et al., 1995; Goodpaster et al., 1997; Brochu et al., 2000; Kelley et al., 2000; Raji et al., 2001; Ross et al., 2002; Nielsen et al., 2004).”
BackgroundWasir, J., & Misra, A. (2004) · Metabolic Syndrome and Related Disorders · doi:10.1089/met.2004.2.14 · Cited by 83
Retnakaran, R. R., Hanley, A. J., Connelly, P. W., Sermer, M., & Zinman, B. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-1253 · Cited by 78
“One explanation for this observation is that South Asians exhibit increased visceral obesity compared with other ethnic groups at similar BMI (18).”
BackgroundSociodemographic risk factors associated with metabolic syndrome in a Mediterranean population
Buckland, G., Salas‐Salvadó, J., Roure, E., Bulló, M., & Serra‐Majem, L. (2008) · Public Health Nutrition · doi:10.1017/s1368980008003492 · Cited by 69
“When individuals with the same BMI and age but different body fat distributions are compared, those with central body fat have a greater risk of insulin resistance((41)).”
Type 2 diabetes in South Asians: A pathophysiologic focus on the Asian-Indian epidemic
Bajaj, M., & Banerji, M. A. (2004) · Current Diabetes Reports · doi:10.1007/s11892-004-0026-4 · Cited by 84
Metadata
- Authors
- Raji, A., Seely, E. W., Arky, R. A., & Simonson, D. C.
- Affiliations
- Brigham and Women's Hospital (US)
- Corresponding author
- Raji, Annaswamy
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2001-11
- Volume
- 86
- Issue
- 11
- Pages
- 5366-5371
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2036168461
- Cited by
- 541
- References
- 0
- Citations by year
- 2026: 4 · 2025: 16 · 2024: 14 · 2023: 19 · 2022: 15 · 2021: 20 · 2020: 22 · 2019: 23 · 2018: 24 · 2017: 28 · 2016: 25 · 2015: 31 · 2014: 27 · 2013: 35 · 2012: 33
- FWCI
- 6.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Center for Research Resources (M01 RR 02635, M01RR002635)
- NIH Clinical Center
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adipokines, Inflammation, and Metabolic Diseases
- Health Sciences › Medicine › Physiology (medical) › Body Composition Measurement Techniques
- Keywords
- insulin resistance, body fat distribution, visceral fat, Asian Indians, Caucasians, ethnic differences, hyperinsulinemia, glucose disposal rate, plasminogen activator inhibitor-1, dyslipidemia, abdominal fat, cardiovascular risk, diabetes risk
- MeSH terms
- Adipose Tissue, Adult, Aged, Blood Glucose, Female, Glucose Tolerance Test, Humans, India, Insulin Resistance, Lipids, Male, Middle Aged, Reference Values, Tomography, X-Ray Computed, Glucose Clamp Technique, Body Mass Index, Plasminogen Activator Inhibitor 1, White People
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