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Visceral Obesity, Hepatic Lipase Activity, and Dyslipidemia in Type 1 Diabetes

Division of Endocrinology and Diabetes, University of Minnesota, Minneapolis, Minnesota 55455; and Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, Washington 98195-6426

Address all correspondence and requests for reprints to: Shalamar D. Sibley, Division of Endocrinology and Diabetes, University of Minnesota School of Medicine, Mayo Medical Code 101, 420 Delaware Street SE, Minneapolis, Minnesota 55455. E-mail: sible004{at}umn.edu.

Excessive weight gain in a subset of intensively treated Diabetes Control and Complications Trial (DCCT) subjects was associated with higher waist to hip ratio; higher triglyceride (TG), low-density lipoprotein (LDL) cholesterol, and apolipoprotein B (ApoB) in the presence of small-dense LDL; and decreased high-density lipoprotein 2 cholesterol (HDL2-C), suggesting that weight gain in these subjects resulted in higher intraabdominal fat (IAF), and an atherosclerotic dyslipidemia mediated through hepatic lipase activity (HL). Objectives were to investigate relationships between IAF, HL, and dyslipidemia and to relate IAF to previous body mass index change during the DCCT.

Sixty-one subjects were studied approximately 4 yr after DCCT closeout. IAF was positively related to HL (P < 0.001). IAF positively correlated with logTG (P < 0.001) and ApoB (P < 0.001), and negatively with LDL relative flotation rate (P < 0.001) and logHDL2-C (P = 0.001). HL accounted for most of the relationship between IAF with logHDL2-C and LDL relative flotation rate, and none of the relationship between IAF and logTG or ApoB. DCCT-related body mass index change accounted for a significant portion of logIAF variance measured 4 yr later (P < 0.001).

Elevated IAF in subjects with type 1 diabetes was related to an atherosclerotic dyslipidemia similar to that seen in individuals without diabetes who have metabolic syndrome. DCCT-related weight gain positively correlated with subsequent IAF.

This work was supported, in part, by a grant from the Juvenile Diabetes Foundation International (New York), NIH Grant DK-02456, Clinical Nutrition Research Unit (DK-35816), and the Diabetes Endocrine Research Center (DK-17047). These studies were performed on the University of Washington General Clinical Research Center NIH Grant RR-37. Dr. Sibley was also supported by an American Diabetes Association Mentor-Based Postdoctoral Fellowship awarded to Dr. Brunzell, a National Institutes of Health Clinical Research Training in Renal Diseases Fellowship, and a K23 Mentored Patient-Oriented Research Career Development Award from the NIH (1K23-DK-59445).

Abbreviations: ApoB, Apolipoprotein B; BMI, body mass index; -BMI, change in BMI; CETP, cholesteryl-ester transport protein; CT, computed tomography; DCCT, Diabetes Control and Complications Trial; EDIC, Epidemiology of Diabetes Intervention and Complications Study; HDL2-C, high-density lipoprotein 2 cholesterol; HL, hepatic lipase activity; IAF, intraabdominal fat; LDL, low-density lipoprotein; LDL-C, LDL cholesterol; LpL, lipoprotein lipase activity; Rf, relative flotation rate; sd, small-dense; TG, triglyceride; WHR, waist to hip ratio.

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