Minor long-term changes in weight have beneficial effects on insulin sensitivity and β-cell function in obese subjects
Article first published online: 3 APR 2002
Diabetes, Obesity and Metabolism
Volume 4, Issue 1, pages 19–28, January 2002
How to Cite
Rosenfalck, A. M., Hendel, H., Rasmussen, M. H., Almdal, T., Andersen, T., Hilsted, J. and Madsbad, S. (2002), Minor long-term changes in weight have beneficial effects on insulin sensitivity and β-cell function in obese subjects. Diabetes, Obesity and Metabolism, 4: 19–28. doi: 10.1046/j.1463-1326.2002.00161.x
- Issue published online: 3 APR 2002
- Article first published online: 3 APR 2002
- Received 20 December 2000; returned for revision 10 January 2001; revised version accepted 12 February 2001
- insulin sensitivity;
- frequently sampled intravenous glucose tolerance test (FSIGT);
- oral glucose tolerance test (OGTT);
- body composition;
- DXA scanning
Aim To evaluate the long-term effect of changes in body composition induced by weight loss on insulin sensitivity (SI), non-insulin mediated glucose disposal, glucose effectiveness (SG) and β-cell function.
Design Glucose metabolism was evaluated before and after participation in a two-year weight loss trial of Orlistat vs. placebo, combined with an energy and fat restricted diet.
Subjects Twelve obese patients (11 women, 1 man), age 45.8 ± 10.5 years, body weight (BW) 99.7 ± 13.3 kg, BMI 35.3 ± 2.8 kg/m2.
Measurements At inclusion and 2 years later an oral glucose tolerance test (OGTT) and a frequently sampled intravenous glucose tolerance test (FSIGT) were performed. Body composition was estimated by a dual-energy X-ray absorptiometry (DXA) whole body scanning.
Results The patients obtained varying changes in BW ranging from a weight loss of 17.8 kg to a weight gain of 6.0 kg. Corresponding changes in fat mass (FM) varied from a 40% reduction to a 19% increase. A significant decrease in both fasting (p = 0.038) and 2 h (p = 0.047) blood glucose at OGTT was found. The improvement in insulin sensitivity (SI) estimated by means of Bergmans Minimal Model, was significantly and linearly correlated to change in total FM (r = − 0.83, p = 0.0026). A multiple regression analysis showed that changes in truncal FM was the strongest predictor of change in SI explaining 67% of the variation. First phase insulin response (AIRg) remained unchanged whereas insulin disposition index increased significantly (p = 0.044). At inclusion five patients had impaired glucose tolerance of which four, who lost weight, were normalized at the retest 2 years later.
Conclusion In obese subjects long-term minimal or moderate changes in weight were found to be linearly associated with changes in insulin sensitivity. In obese subjects with impaired glucose tolerance even a minor weight loss was able to normalize glucose tolerance.