Highlights
- •Insulin resistance in midlife Singaporean women is associated with obesity, large amounts of visceral adipose tissue, low physical performance, and high levels of the inflammatory marker TNF-α.
- •Women of Malay ethnicity and Indian ethnicity had higher insulin resistance than Chinese women (the reference group).
- •High levels of TNF- α also appeared to mediate the differences in insulin resistance we observed between women of Indian and Chinese ethnicity.
Abstract
Objectives
To understand the extent to which risk factors for insulin resistance are mediated
by body mass index (BMI), visceral adipose tissue (VAT), physical activity and performance,
and the inflammatory markers interleukin (IL)-6, tumor necrosis factor (TNF)- α, and
high-sensitivity C-reactive protein (hs-CRP).
Study design
A wide range of socio-demographic characteristics of Chinese, Malay and Indian women
attending routine gynecologic care in Singapore were prospectively collected. Physical
performance was objectively measured by hand grip strength and the Short Physical
Performance Battery. Percent VAT was determined by dual-energy X-ray absorptiometry.
Fasting serum concentrations of glucose, insulin, IL-6, TNF- α, and hs-CRP were measured.
Main outcome measure
was insulin resistance, expressed as the homeostatic model assessment of insulin resistance
(HOMA-IR).
Results
1159 women were analyzed, mean age 56.3 (range 45–69) years, comprising women of Chinese
(84.0%), Indian (10.2%), and Malay (5.7%) ethnic origins. The adjusted mean differences
for obesity (0.66, 95% CI 0.32–1.00), VAT area in the highest vs lowest tertile (1.03,
95% CI 0.73–1.34), low physical performance (0.63, 95% CI 0.05–1.24), and highest
vs lowest tertile of TNF- α (0.35, 95% CI 0.13–0.57) were independently associated
with HOMA-IR. Women of Malay and Indian ethnicity had higher crude HOMA-IR than Chinese
women. However, after adjustment for obesity, VAT, physical performance, and TNF-
α, no differences in mean HOMA-IR remained, when comparing Chinese women with those
of Malay ethnicity (0.27, 95% CI −0.12 to 0.66) and with those of Indian ethnicity
(0.30, 95% CI −0.01 to 0.66).
Conclusions
Insulin resistance was independently associated with obesity, high VAT, low physical
performance, and high levels of TNF- α in midlife Singaporean women. These variables
entirely explained the significant differences in insulin resistance between women
of Chinese, Malay and Indian ethnicity.
Abbreviations:
DXA (dual-energy X-ray absorptiometry), GPAQ (global physical activity questionnaire), HOMA-IR (homeostatic model assessment of insulin resistance), hs-CRP (high-sensitivity C-reactive protein), IL-6 (interleukin-6), SPPB (short physical performance battery), TNF-α (tumor necrosis factor- α), VAT (visceral adipose tissue)Keywords
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Article info
Publication history
Published online: April 27, 2020
Accepted:
April 3,
2020
Received in revised form:
March 27,
2020
Received:
January 28,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
