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Original Research Communication |
1 From the Department of Internal Medicine, Washington University School of Medicine, St Louis, and St Bartholomew's and The Royal London School of Medicine, London.
Background: Alterations in glucose metabolism during early fasting may be an important trigger of the hormonal and metabolic responses to fasting.
Objective: The purpose of this study was to determine whether glucose metabolism in response to brief starvation differs in lean and abdominally obese women.
Design: We evaluated whole-body glucose metabolism by use of stable-isotope tracer methods and glucose uptake in subcutaneous abdominal adipose tissue by use of arteriovenous balance in 7 lean [58 ± 2 kg; body mass index (BMI; in kg/m2): 21 ± 5] and 6 abdominally obese (96 ± 2 kg; BMI: 36 ± 1) women after 14 and 22 h of fasting.
Results: Between 14 and 22 h of fasting, whole-body glucose production and disposal declined in both groups (P < 0.05), but the reduction was 50% greater in lean than in obese women (P < 0.05). The decline in glucose uptake at 22 h of fasting was also lower in obese (0.11 ± 0.04 µmol•100 g-1•min-1) than in lean (0.26 ± 0.03 µmol•100 g-1•min-1) women (P < 0.05). Decreases in plasma insulin and leptin concentrations between 14 and 22 h of fasting were also lower in obese than in lean women (insulin: 20 ± 3% and 32 ± 5%; leptin: 18 ± 3% and 37 ± 6%; both P < 0.05).
Conclusions: The normal decline in glucose production and uptake that occurs during early fasting is blunted in women with abdominal obesity. These alterations in glucose metabolism are associated with a blunted decline in circulating concentrations of both insulin and leptin, which may explain some of the differences in the metabolic response to fasting observed between lean and abdominally obese persons.
Key Words: Abdominal obesity • glucose uptake • leptin • insulin • stable isotopes • women • fasting
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