Korean Journal of Clinical Laboratory Science (대한임상검사과학회지)

Korean Society for Clinical Laboratory Science (대한임상검사과학회)
권호 표지
DOI QR코드

DOI QR Code

The Relationship between Lipid Accumulation Product, Insulin Resistance and Obesity in Korean Adults

대한민국 성인에서 한국 성인의 지질 축적 지수와 인슐린 저항성 및 비만의 관련성

  • Yoon, Hyun (Department of Clinical Laboratory Science, Wonkwang Health Science University)
  • 윤현 (원광보건대학교 임상병리과)
  • Received : 2022.04.06
  • Accepted : 2022.04.19
  • Published : 2022.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Lipid accumulation product (LAP) is a new index reflecting central lipid accumulation and is known to be a strong independent indicator for identifying the risk of cardiovascular disease (CVD) or diabetes mellitus (DM). This study was conducted to assess the relationship between the homeostasis model assessment of insulin resistance (HOMA-IR) and LAP according to the presence or absence of obesity in Korean adults. The study was carried out using data from the 2019 Korean National Health and Nutrition Examination Survey (KNHANES) and included 6,090 adults aged 20 years or older. There were several key findings. First, after adjusting for related variables, the mean of the HOMA-IR levels (M±SE, 95% confidence interval) was positively associated with the quartiles of LAP in the overall population (P<0.001), non-obese (P<0.001) or obese groups (P<0.001). Second, in all the groups (overall population, non-obese and obese groups), the mean value of the fasting blood glucose (all, P<0.001), insulin (all, P<0.001), and the metabolic syndrome score (all, P<0.001) increased with the increasing quartiles of LAP. Insulin resistance was thus positively associated with an increase in the LAP in Korean adults with or without obesity.

본 연구는 지질 축적 지수(lipid accumulation product, LAP)는 중심 지질 축적을 반영하는 새로운 지표로서, 심혈관 위험이나 당뇨병의 강력한 위험인자로 알려져 있다. 본 연구의 목적은 대한민국 20 성인에서 비만의 유무에 따른 지질 축적 지수와 인슐린저항성(homeostasis model assessment of insulin resistance, HOMA-IR)의 관련성에 대하여 조사하였다. 본 연구는 2019년도 국민건강영양조사 자료(2019 Korean National Health and Nutrition Examination Survey, KNHANES V-3)를 이용하여 20세 이상의 대한민국 성인 6,090명을 대상으로 실시하였다. 본 연구결과에서 중요한 결과는 다음과 같다. 첫째, 연령, 성별, 음주습관, 흡연습관, 운동습관, 수축기 및 이완기혈압, 혈중 요소 질소 및 크레아티닌을 보정한 후의 결과에서, 전체인구(P<0.001), 비만이 아닌 군(P<0.001) 및 비만군(P<0.001)에서 LAP의 사분위수가 증가함에 따라 HOMA-IR 평균값(M±SE, 95% confidence interval)이 증가하였다. 둘째, 전체인구, 비만이 아닌 군 및 비만군에서, 공복혈당(모든 그룹, P<0.001), 인슐린(모든 그룹, P<0.001) 및 대사증후군 점수(모든 그룹, P<0.001)의 평균값(M±SE, 95% CI)은 LAP의 사분위수가 증가함에 따라 증가하였다. 결론적으로, 대한민국 성인 중 비만군과 비만이 아닌 군 모두에서 지질 축적 지수가 증가함에 따라 인슐린저항성이 증가하였다.

Keywords

Acknowledgement

This paper was supported by Wonkwang Health Science University in 2022.

References

  1. Organization WH. Obesity and overweight factsheets. World Health Organization. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
  2. Oh K, Kim Y, Kweon S, Kim S, Yun S, Park S, et al. Korea National Health and Nutrition Examination Survey, 20th anniversary: accomplishments and future directions. Epidemiol Health. 2021;43:e2021025. https://doi.org/10.4178/epih.e2021025
  3. Allott EH, Hursting SD. Obesity and cancer: mechanistic insights from transdisciplinary studies. Endocr Relat Cancer. 2015;22:R365-R386. https://doi.org/10.1530/ERC-15-0400
  4. Luo L, Liu M. Adipose tissue in control of metabolism. J Endocrinol. 2016;231:R77-R99. https://doi.org/10.1530/JOE-16-0211
  5. Kahn HS. The "lipid accumulation product" performs better than the body mass index for recognizing cardiovascular risk: a population-based comparison. BMC Cardiovasc Disord. 2005;5:26. https://doi.org/10.1186/1471-2261-5-26
  6. Schaffer JE. Lipotoxicity: when tissues overeat. Curr Opin Lipidol. 2003;14:281-287. https://doi.org/10.1097/00041433-200306000-00008
  7. Martin BC, Warram JH, Krolewski A, Soeldner J, Kahn C, Bergman R. Role of glucose and insulin resistance in development of type 2 diabetes mellitus: results of a 25-year followup study. The Lancet. 1992;340:925-929. https://doi.org/10.1016/0140-6736(92)92814-v
  8. DeFronzo RA, Ferrannini E. Insulin resistance. A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care. 1991;14:173-194. https://doi.org/10.2337/diacare.14.3.173
  9. Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001;285:2486-2497. https://doi.org/10.1001/jama.285.19.2486
  10. Yoon H. Relationship between metabolic syndrome, metabolic syndrome score, insulin resistance and beta cell function in Korean adults with obesity. Korean J Clin Lab Sci. 2020;52:327-334. https://doi.org/10.15324/kjcls.2020.52.4.327
  11. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412-419. https://doi.org/10.1007/BF00280883
  12. Nam GE, Kim YH, Han K, Jung JH, Rhee EJ, Lee SS, et al. Obesity fact sheet in Korea, 2019: Prevalence of obesity and abdominal obesity from 2009 to 2018 and social factors. J Obes Metab Syndr. 2020;29:124-132. https://doi.org/10.7570/jomes20058
  13. Sung HH, Gi MY, Cha JA, Cho HE, Moon AE, Yoon H. Gender difference in the relationship between lipid accumulation product index and pulse pressure in nondiabetic Korean adults: The Korean National Health and Nutrition Examination Survey 2013-2014. Clin Exp Hypertens. 2022;44:146-153. https://doi.org/10.1080/10641963.2021.2007943
  14. Lim S. Eating a balanced diet: A healthy life through a balanced diet in the age of longevity. J Obes Metab Syndr. 2018;27:39-45. https://doi.org/10.7570/jomes.2018.27.1.39
  15. Zheng D, Dou J, Liu G, Pan Y, Yan Y, Liu F, et al. Association between triglyceride level and glycemic control among insulin-treated patients with type 2 diabetes. J Clin Endocrinol Metab. 2019;104:1211-1220. https://doi.org/10.1210/jc.2018-01656
  16. Longo M, Zatterale F, Naderi J, Parrillo L, Formisano P, Raciti GA, et al. Adipose tissue dysfunction as determinant of obesity-associated metabolic complications. Int J Mol Sci. 2019;20:2358. https://doi.org//10.3390/ijms20092358
  17. Shin KA. Comparison of predictive value of obesity and lipid related variables for metabolic syndrome and insulin resistance in obese adults. Biomed Sci Letters. 2019;25:256-266. https://doi.org/10.15616/BSL.2019.25.3.256
  18. Sun K, Lin D, Feng Q, Li F, Qi Y, Feng W, et al. Assessment of adiposity distribution and its association with diabetes and insulin resistance: a population-based study. Diabetol Metab Syndr. 2019;11:51. https://doi.org//10.1186/s13098-019-0450-x
  19. Mirmiran P, Bahadoran Z, Azizi F. Lipid accumulation product is associated with insulin resistance, lipid peroxidation, and systemic inflammation in type 2 diabetic patients. Endocrinol Metab (Seoul). 2014;29:443-449. https://doi.org/10.3803/EnM.2014.29.4.443
  20. Boren J, Taskinen MR, Olofsson SO, Levin M. Ectopic lipid storage and insulin resistance: a harmful relationship. J Intern Med 2013;274:25-40. https://doi.org/10.1111/joim.12071
  21. Chiang JK, Koo M. Lipid accumulation product: a simple and accurate index for predicting metabolic syndrome in Taiwanese people aged 50 and over. BMC Cardiovasc Disord. 2012;12:78. https://doi.org/10.1186/1471-2261-12-78
  22. Ye J. Mechanisms of insulin resistance in obesity. Front Med. 2013;7:14-24. https://doi.org/10.1007/s11684-013-0262-6
  23. Xia C, Li R, Zhang S, Gong L, Ren W, Wang Z, et al. Lipid accumulation product is a powerful index for recognizing insulin resistance in non-diabetic individuals. Eur J Clin Nutr. 2012;66:1035-1038. https://doi.org/10.1038/ejcn.2012.83
  24. Taverna MJ, Martinez-Larrad MT, Frechtel GD, Serrano-Rios M. Lipid accumulation product: a powerful marker of metabolic syndrome in healthy population. Eur J Endocrinol. 2011;164:559-567. https://doi.org/10.1530/EJE-10-1039
  25. Pineda H, Castro J, Lares M, Huerfano T, Brito S, Velasco M, et al. Lipid accumulation product (LAP) and visceral adiposity index (VAI) a simple and clinically useful surrogate marker for metabolic syndrome and cardiovascular disease predictor in non-diabetic Venezuelan adult. J.Pharm Pharm Scien. 2017;2:1-8. https://doi.org/10.24218/vjpps.2017.20
  26. Wallace TM, Levy JC, Matthews DR. Use and abuse of HOMA modeling. Diabetes Care. 2004;27:1487-1495. https://doi.org/10.2337/diacare.27.6.1487
  27. Pham H, Utzschneider KM, de Boer IH. Measurement of insulin resistance in chronic kidney disease. Curr Opin Nephrol Hypertens. 2011;20:640-646. https://doi.org/10.1097/MNH.0b013e32834b23c1