Browse > Article

The Association of Insulin Resistance with Cardiovascular Disease Risk and Dietary Factors in Korean Type 2 DM Patients  

Yu, So-Young (Department of Food and Nutrition, Ewha Womans University)
Hong, Hye-Sook (Department of Food and Nutrition, Ewha Womans University)
Lee, Hyun-Sook (Department of Sports Science, Seoul Sports Graduate University)
Choi, Young-Ju (21C Diebetics and Vascular Research Center)
Huh, Kap-Bum (21C Diebetics and Vascular Research Center)
Kim, Wha-Young (Department of Food and Nutrition, Ewha Womans University)
Publication Information
Journal of Nutrition and Health / v.40, no.1, 2007 , pp. 31-40 More about this Journal
Abstract
The purpose of this study was to investigate the association between insulin resistance and cardiovascular disease risk factors in Korean type 2 diabetes patients. The subjects were 429 (male: 218, female: 211) type 2 DM patients visited DM clinic, and they were classified into quartiles based on $K_{ITT}$ index (%/min, Insulin Tolerance Test). Anthropometric and biochemical characteristics, and dietary intakes by Food Frequency Questionnaire were assessed. The means of waist circumference, fat mass, percent body fat and abdominal fat thickness were significantly higher in the lowest quartile (the most insulin resistant group) than in the highest quartile (the least insulin resistant group) of $K_{ITT}$ index (%/min)(p<0.05), For hematological values, the lowest quartile showed significantly higher fasting blood glucose, HbA1c, C-peptide, insulin, triglyceride, ApoB/apoA-1 ratio and C-reactive protein compared to the highest quartile (p < 0.05). Moreover, $K_{ITT}$ index (%/min) was negatively correlated with waist circumference, fat mass, percent body fat, abdominal fat thickness and fasting blood concentrations of glucose, HbA1c, C-peptide, insulin, cholesterol, triglyceride, ApoB/apoA-1 ratio and C-reactive protein (p < 0.05). Nutrient intakes were not significantly different among the quartile groups of $K_{ITT}$ index (%/min) and also not correlated with insulin resistance, however, they showed correlation with obesity parameters (BMI, waist circumference, waist-hip ratio, vat mass, abdominal fat thickness), which were strongly associated with insulin resistance. In conclusion, cardiovascular disease risk would be higher as the insulin resistance grows in Korean type 2 DM patients, and nutrient intakes would affect to the insulin resistance through the effect on anthropometric parameters.
Keywords
insulin resistance; type 2 diabetes; cardiovascular disease risk factors; nutrient intakes;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 Lebovitz HE. Insulin resistance-a common link between type 2 diabetes and cardiovascular disease. Diabetes Obes Metab 8(3): 237-249, 2005   DOI   ScienceOn
2 Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation 105(9): 1135-1143, 2002   DOI   ScienceOn
3 Boden G, Sargrad K, Homoko C, Mozzoli M, Stein P. Effect of low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Ann Intern Med 142(6): 403-411, 2005   DOI   ScienceOn
4 Stoney RM, O'Dea K, Herbert KE, Dragicevict G, Giles G, Cumpston GN, Best JD. Insulin resistance as a major determinant of increased coronary heart disease risk in postmenopausal women with type 2 diabetes mellitus. Diabet Med 18(6): 476- 482, 2001   DOI   ScienceOn
5 Bastard JP, Machi M, Lagathu C, Kim MJ, Caron M, Vidal H, Capeau J, Feve B. Recent advances in the relationship between obesity, inflammation, and insulin resistance. Eur Cytokine Netw 17(1): 4-12, 2006
6 Walldius G, Jungner I, Holme I, Aastveit AH, Kolar W, Steiner E. High apolipoprotein B, low apolipoprotein A-1, and improvement in the prediction of fatal myocardial infarction (AMORIS study): a prospective study. Lancet 358(9298): 2026-2033, 2001   DOI   ScienceOn
7 Walldius G, Jungner I. The apoB/A-1 ratio: a strong, new risk factor for cardiovascular disease and a target for lipid-lowering therapy - a review of the evidence. J Intern Med 259(5): 493- 519, 2006   DOI   ScienceOn
8 Haffner SM, Valdez RA, Hazuda HP, Mitchell BD, Morales PA, Stern MP. Prospective analysis of the insulin resistance syndrome (syndrome X). Diabetes 41(6): 715-722, 1992   DOI   ScienceOn
9 Huh GB, Kim YL, An GJ, Jeong YS, Lee EJ, Im SG, Kim GL, Lee HY, Baeg IG, Choe MS, Lee JH. The correlation between insulin resistance and the pattern of body fat distribution in Korean patients with non-insulin dependent diabetes mellitus. Korean J Med 44(1): 1-18, 1993
10 Malik S, Wong ND, Franklin S, Pio J, Fairchild C, Chen R. Cardiovascular Disease in U.S. patients with metabolic syndrome, diabetes, and elevated C-reactive protein. Diabetes Care 28(3): 690-693, 2005   DOI   ScienceOn
11 Dandona P, Aljada A, Chaudhuri A, Mohanty P, Grag R. Metabolic syndrome: a comprehensive perspective based on interactions between obesity, diabetes and inflammation. Circulation 111(11): 1448-1454, 2005   DOI   ScienceOn
12 Ferrannini E, Haffner SM, Mitchell BD, Stern MP. Hyperinsulinemia: the key feature of a cardiovascular and metabolic syndrome. Diabetologia 34(6): 416-422, 1991   DOI   ScienceOn
13 Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 27(5): 1047-1053, 2004   DOI   ScienceOn
14 Haffner SM, Stern MP, Hazuda HP, Mitchell BD, Patterson JK. Cardiovascular risk factors in confirmed prediabetic individuals: does the clock for coronary heart disease start ticking before the onset of clinical diabetes? JAMA 263(1): 2893-2898, 1990   DOI   ScienceOn
15 Haffner SM. The metabolic syndrome: Inflammation, diabetes mellitus, and cardiovascular disease. Am J Cardiol 979(2A): 3A-11A, 2006
16 Ko KS, Rhee BD. Insulin resistance and metabolic syndrome. J Korean Diabetes Assoc 29(6): 501-506, 2005
17 Park YM, Sohn CM, Jang HC. Correlation of carbohydrate intake with obesity in type 2 diabetes mellitus patients. J Kor Diebetes Assoc 12(3): 254-263, 2006
18 Stehouwer CD, Gall MA, Twisk JW, Knudsen E, Emeis J. Parving H. Increased urinary albumin excretion, endothelial dysfunction and chronic low-grade inflammation in type 2 diabetes; progressive, interrelated and independently associated with risk of death. Diabetes 51(4): 1157-1165, 2002   DOI   ScienceOn
19 Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laaso M. Mortality from coronary heart disease in subjects with type 2 diabetes and without prior myocardial infarction. N Engl J Med 339(4): 229-234, 1998   DOI   ScienceOn
20 Walldius G, Jungner I. Rationale for using apolipoprotein B and apolipoprotein A-1 as indicators of cardiac risk and as targets for lipid-lowering therapy. Eur Heart J 26(3): 210-212, 2005   DOI   ScienceOn
21 Festa A, Hanley AJ, Tracy RP, D'Agostino R Jr, Haffner SM. Inflammation in the prediabetic state is related to increased insulin resistance rather than decreased insulin secretion. Circulation 108(15): 1822-1830, 2003   DOI   ScienceOn
22 Friedwald WT, Levy RI, Fredireck DS. Estimation of the concentration of low density lipoprotein cholesterol in plasma without use of the preparative ultracentrifuge. Clin Chem 18: 499-502, 1972
23 Miyashita Y, Koide N, Ohtsuka M, Ozaki H, Itoh Y, Oyama T, Uetake T, Ariga K, Shirai K. Beneficial effect of low carbohydrate in low calorie diets on visceral fat reduction in type 2 diabetic patients with obesity. Diabetes Res Clin Pract 65(3): 234-241, 2004   DOI   ScienceOn
24 Matsumoto K, Kizaki Y, Fukae S, Tomihira M, Sera Y, Ueki Y, Tominaga T, Miyake S. Insulin resistance and coronary risk factors in Japanese type 2 diabetic patients with definite coronary artery disease. Diabetes Res Clin Pract 51(3): 181-186, 2001   DOI   ScienceOn
25 Lewis GF, Carpentier A, Adeli K, Giacca A. Disordered fat storage and mobilization in the pathogenesis of insulin resistance and type 2 diabetes. Endocr Rev 23(2): 201-229, 2002   DOI   ScienceOn
26 Cho WK. Serum glucose and lipid profiles according to dietary carbohydrate and lipid intake ratio in NIDDM patients. Journal of the Korean Home Economics Association 36(11): 183-191, 1998
27 Rhee BD. Epidemiological characteristics of diabetes mellitus among Korean population. J Kor Diabetes Assoc 27(3): 173-178, 2003
28 Schulze MB, Rimm EB, Li T, Rifai N, Stampfer MJ, Hu FB. Creactive protein and incident cardiovascular events among men with diabetes. Diabetes Care 27(4): 889-894, 2004   DOI   ScienceOn
29 Yoon JY, Song YD, Lee JH, Park EJ, Kim SM, Lim HS, Lee HC, Huh KB. Effect of different levels of carbohydrate and fat intake on glucose and lipid metabolism in patients with NIDDM. J Kor Diebetes Assoc 19(2): 208-218, 1995
30 McAuley K, Mann J. Nutritional determinants of insulin resistance. J Lipid Res 47(8): 1688-1676, 2006