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Obesity - the most
important cause of diabetes?
02/17/03 - Elderly men and women with normal
body weight still may be at risk for developing type
2 diabetes if they have large amounts of muscle fat
or visceral abdominal fat, according to new study.
"Our study found that even though an elderly person
may not be overweight, he or she might still be at
risk for developing diabetes," said Dr Bret H. Goodpaster
from the University of Pittsburgh in the US
and principal investigator of the study. "An important
factor is where in the body their excess fat is
stored."
Although the prevalence of type 2 diabetes is highest
among men and women over the age of 65, the
prevalence of obesity in this group is only 14 per cent
compared with 24 per cent for people in their 50s, said
Dr Goodpaster.
"It appears that in elderly individuals, there might be
some disassociation between obesity and the risk for
insulin resistance and type 2 diabetes," he added.
The study enrolled almost 3000 men and women, aged
74 years on average, who are participating in the Health
ABC study. The group was 48.5 per cent male and 58.3
per cent white. Fifty-one per cent were classified as
having normal glucose tolerance, 21 per cent had impaired
glucose tolerance and 24 per cent had type 2 diabetes.
Muscle and fat in the thigh and abdomen were determined
using CT scans.
The researchers report in the February issue of Diabetes Care
that prevalence of diabetes was higher among obese subjects
than among overweight or normal weight subjects, with 30
per cent of obese men and 34 per cent of obese women having
type 2 diabetes.
Despite similar amounts of thigh fat, the proportion of
intermuscular fat was higher in subjects with type 2 diabetes
and impaired glucose tolerance than in subjects with normal
glucose tolerance. Also, the proportion of visceral abdominal
fat was higher in men and women with type 2 diabetes and
impaired glucose tolerance than in those with normal glucose tolerance.
The study showed that among those with type 2 diabetes,
22 per cent were normal-weight men and 12 per cent were
normal-weight women. Another 14 per cent of men and 22
per cent of women had impaired glucose tolerance. This
means that two thirds of men with type 2 diabetes were
not obese. A similar pattern emerged for women.
"This suggests that obesity, per se, is not required for diabetes
or glucose intolerance in elderly men and women," Dr
Goodpaster said. "Fat distribution is a key determination of
insulin resistance and altered glucose homeostasis.
"The concept of the metabolically obese normal-weight
individual is likely to be of great importance in understanding
risk factors that drive the heightened risk of type 2 diabetes
in relation to ageing," he added.
Source: Diabetes Care
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