The "Obese Insulin-Sensitive" Adolescent: Importance of Adiponectin and Lipid Partitioning
Ram Weiss,
Sara E. Taksali,
Sylvie Dufour,
Catherine W. Yeckel,
Xenophon Papademetris,
Gary Cline,
William V. Tamborlane,
James Dziura,
Gerald I. Shulman and
Sonia Caprio
Departments of Pediatrics (R.W., S.E.T., C.W.Y., S.C.), Internal Medicine and Cellular and Molecular Physiology (G.C., G.I.S.), and Diagnostic Radiology and Biomedical Engineering (X.P.), General Clinical Research Center (W.V.T., J.D.), and Howard Hughes Medical Institute (S.D., G.I.S.), Yale University School of Medicine, New Haven, Connecticut 06520
Address all correspondence and requests for reprints to: Dr. Sonia Caprio, Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, P.O. Box 208064, New Haven, Connecticut 06520. E-mail: sonia.caprio{at}yale.edu.
There is a wide interindividual variation in peripheral insulinsensitivity at any given body mass index or percent body fatamong obese adolescents with normal glucose tolerance. The goalsof this study were to determine whether variability in insulinsensitivity is associated with differences in patterns of lipidpartitioning or substrate use under fasting and hyperinsulinemicconditions.
We compared 14 obese insulin-resistant adolescents with 14 obeseinsulin-sensitive controls, pair matched for age, gender, pubertalstage and body composition. Insulin sensitivity was assessedby the hyperinsulinemic-euglycemic clamp, intramyocellular lipidcontent by 1H-nuclear magnetic resonance and visceral fat bymagnetic resonance imaging.
Obese insulin-sensitive subjects had lower intramyocellular(1.64 ± 0.68 vs.2.26 ± 0.62% of water peak, P= 0.017) and visceral lipid deposition (45 ± 23 vs. 77± 52 cm2, P = 0.04) and a higher level of adiponectin,compared with their obese-resistant counterparts (8.8 ±3.6 vs. 6.5 ± 1.8 µg/dl, P = 0.015). Glycerol fluxeswere similar between the two obese groups yet occurred in theface of different concentrations of insulin. Intramyocellularlipid and visceral fat were negatively related to insulin sensitivity.
Obese insulin-sensitive adolescents are characterized by lowerlipid deposition in the intramyocellular and visceral compartmentsand greater levels of adiponectin, despite similar degree ofadiposity.
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