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Relationship between Generalized and Upper Body Obesity to Insulin Resistance in Asian Indian Men¹

The Center for Human Nutrition (N.A., S.M.G., A.G.), and the Department of Internal Medicine (M.C., N.A., S.M.G., A.G.), University of Texas Southwestern Medical Center, and the Department of Veteran Affairs Medical Center (M.C., S.M.G., A.G.), Dallas, Texas 75235

Address all correspondence and requests for reprints to: Nicola Abate, M.D., Department of Internal Medicine, Center for Human Nutrition, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75235-9052. E-mail: nabate{at}mednet.swmed.edu

It has been proposed that excessive insulin resistance in Asian Indians living in urban areas or migrated to western countries is responsible for the higher incidence of type 2 diabetes and coronary heart disease observed in this population. To evaluate whether Asian Indians are more insulin resistant than Caucasians and to define the role of generalized and truncal adiposity, we performed hydrodensitometry, skinfold measurements, and euglycemic-hyperinsulinemic clamps in 21 healthy Asian Indian men and 23 Caucasian men of similar age and body fat content. The glucose disposal rate (Rd) was significantly lower in the Asian Indians than in the Caucasians (3.7 ± 1.3 vs. 5.3 ± 2.0 mg/min·kg lean body mass, respectively; P = 0.003). Despite similar total body fat content, Asian Indians had higher truncal adiposity than Caucasians (sum of truncal skinfolds, 117 ± 37 and 92.4 ± 38 mm, respectively). In both Asian Indians and Caucasians, the insulin sensitivity index (Rd/plasma insulin concentrations) was inversely correlated with both total body fat (r = -0.49; P < 0.03 and r = -0.67; P < 0.001, respectively) and sum of truncal skinfold thickness (r = -0.55; P < 0.001 and r = -0.61; P < 0.002, respectively). After adjustment for total body fat and truncal skinfold thickness, Asian Indians still had a significantly lower glucose disposal rate (P = 0.04). These results show that Asian Indian men are more insulin resistant than Caucasian men independently of generalized or truncal adiposity. The excessive insulin resistance in Asian Indians is probably a primary metabolic defect and may account for the excessive morbidity and mortality from diabetes and coronary heart disease in this population.

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