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Differences in insulin clearance between metabolically healthy and unhealthy obese subjects

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Abstract

Metabolically healthy obese (MHO) are relatively insulin sensitive and have a favorable cardio-metabolic risk profile compared with metabolically abnormal obese (MAO). To evaluate whether MAO individuals have a decreased insulin clearance compared with MHO individuals, 49 MHO, 147 MAO, and 172 non-obese individuals were analyzed in this cross-sectional study. Insulin clearance and insulin sensitivity were assessed through euglycemic hyperinsulinemic clamp. MHO subjects exhibited significant lower triglycerides, total cholesterol, 2-h post-challenge glucose, fasting and 2-h post-challenge insulin, steady-state plasma insulin, alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyltransferase as compared with MAO individuals. Disposition index was higher in MHO subjects as compared with MAO individuals after adjusting for gender and age (P = 0.04). Insulin clearance was significantly lower in MAO individuals as compared with MHO and non-obese individuals. The difference between the two obese subgroups remained significant after adjusting for gender, age, waist circumference, fat mass, and insulin-stimulated glucose disposal (P = 0.03). The hepatic insulin extraction (C-peptide/insulin) in the fasting state was significantly higher in MHO subjects as compared with MAO individuals (P < 0.0001). In univariate analysis adjusted for gender and age, insulin clearance was correlated with hepatic insulin extraction (P = 0.01). In conclusion, insulin clearance differs among obese subjects with different metabolic phenotypes. Impaired insulin clearance may contribute to sustained fasting and post-meal hyperinsulinemia observed in MAO individuals.

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Acknowledgments

This work was supported, in part, by Italian Ministry of University grant FIRB/MERIT RBNE08NKH7_002 to G. Sesti.

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Authors and Affiliations

  1. Department of Systems Medicine, University of Rome-Tor Vergata, Rome, Italy

    Maria A. Marini & Simona Frontoni

  2. Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Viale Europa, 88100, Catanzaro, Italy

    Elena Succurro, Franco Arturi, Teresa V. Fiorentino, Angela Sciacqua, Francesco Perticone & Giorgio Sesti

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  1. Maria A. Marini
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  2. Simona Frontoni
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  3. Elena Succurro
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  4. Franco Arturi
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  5. Teresa V. Fiorentino
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  6. Angela Sciacqua
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  7. Francesco Perticone
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  8. Giorgio Sesti
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Correspondence to Giorgio Sesti.

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Communicated by Massimo Porta.

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Marini, M.A., Frontoni, S., Succurro, E. et al. Differences in insulin clearance between metabolically healthy and unhealthy obese subjects. Acta Diabetol 51, 257–261 (2014). https://doi.org/10.1007/s00592-013-0511-9

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  • DOI: https://doi.org/10.1007/s00592-013-0511-9

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