skeletal是什么意思letal在线翻译读音例

Contributionofskeletalmusclemassonsexdifferencesin2-hourplasma

glucoselevelsafteroralglucoseloadinThaisubjectswithnormal

glucosetolerance

ChatchalitRattarasarna,⁎

,RattanaLeelawattanab,SupamaiSoonthor乌衣巷古诗视频 npunb

aDivisionofEndocrinologyandMetabolism,DepartmentofMedicine,RamathibodiHospital,MahidolUniversity,Bangkok10400,Thailand

bDivisionofEndocrinologyandMetabolism,DepartmentofMedicine,SongklanagarindHospital,PrinceofSongkhlaUniversity,Songkhla90110,Thailand

Received13December2湲怎么读 008;accepted24June2009

Abstract

Womenhavellerskeletalmusclemassinwomenmay

ectiveofthisstudywastotestthehypothesisthatthedifferentamountofskeletal

musclemassbetweenmenandwomencontributedtosexdifferenceinpostloadplasmaglucoselevelsinsubjectswithnormalglucose

-sevenThaisubjectswithnormalglucosetolerance,23womenand24age-andbodymassindex–matchedmen,were

t,abdominalfat,analmuscleinsulin

-phaseinsulinsecretionandhepaticinsulinsensitivitywere

determinedfromoralglucosetolerancedata.-Cellfunctionwasestimatedfromthehomeostasismodelassessmentof%Bbythe

ationandlinearregressionanalysiswereperformedtoidentifyfactorscontributingto

udyshowedthatwomenhadsignificantlyhigher2-hourplasmagluc匹夫不可夺志也作文800 oselevelsand

esofinsulinsecretionandinsulinsensitivitywerenotdifferentbetweenmenandwomen.

Malesex(r=−0.360,P=.013)andappendagesleanmass(r=−0.411,P=.004)werenegativelycorrelatedwith2-hourplasmaglucose,

whereaslog2-hourinsulin(r=0.571,Pb.0001),totalbodyfat(r=0.348,P=.016),andlogabdominalfat(r=0.298,P=.042)were

relationof2-hourplasmaglucoseandsexdisappearedafteradjustmentfor

ivariatelinearregressionanalysis,log2-hourinsulin(=18.9,Pb.0001),log30-minuteinsulin(=−36.3,

P=.001),appendagesleanmass(=−1.010

−3

,P=.018),andhepaticinsulinsensitivityindex(=−17.3,P=.041)explained54.2%of

lusion,thehigherpostload2-hourplasmaglucoselevelsinwomenwasnotsexspecificbut

lyinsulinsecretion,hepaticinsulinsensitivity,andskeletalmusclemasswere

thesignificantfactorsnegativelypredicting2-hourpostloadplasmaglucoselevelsinThaisubjectswithnormalglucosetolerance.

htsreserved.

uction

Severalepidemiologicstudiesindicatethatwomenappear

tohavehigher2-hourglucoselevelsafteroralglucose

tolerancetest(OGTT)diesregardingthe

prevalenceofimpairedglucoseregulationinseveralpopula-

tionsdemonstratedthattheprevalenceofisolatedpost–

glucoseloadhyperglycemia,particularlyisolatedimpaired

glucosetolerance(IGT),ismorecommoninwomenthanin

men,whereastheprevalenceofisolatedfastinghyperglyce-

miaismorecommoninmenthaninwomen[1-4].Datafrom

13EuropeancohortsintheDECODE(DiabetesEpidemiol-

ogy:CollaborativeAnalysisofDiagnosticCriteriainEurope)

studyindicatedthatIGTwasmoreprevalentinwomenthan

inmeninallagegroupsparticularlythoseyoungerthan70

years[1].Thecommunity-basedsurveyinMauritiusshowed

thattheprevalenceofisolatedIGTwashigherinwomenand

amongnondiabeticsubjects;2-hourplasmaglucose(PG)

levelsafterOGTTwasalsohigherinwomenthaninmen[2].

ThestudybyPomerleauetal[3]inmixedpopulationof

European,SouthAsian,andAfro-Caribbeansubjectsalso

hanismbywhich2-hour

MetabolismClinicalandExperimental59(2010)172–176

⁎

.:+6622011647;fax:+6622011715.

E-mailaddress:racrt@(asarn).

0026-0495/$–seefrontmatterhts元日王安石赏析解释 reserved.

doi:10.1016/l.2009.06.029

etal[5]studiedthedifferencesinpostprandialglucose

metabolisminhealthymenandwomenandreportedthatthe

abilityofinsulintostimulateglucosedisposalmeasuredby

oralglucoseminimalmodelwaslowerinyoungwomenthan

inyoungmendespitelowervisceraladiposityintheformer.

Whole-bodyinsulinsensitivitywasnotsignificantlydiffer-

udydemonstratedthatinsulinsecretionand

postprandialhepaticglucoseproductiondidnotsignificantly

contributetothesexdifferenceinpostprandialglucoselevels

e

peripheralglucoseuptakeisresponsibleformosttotal

glucosedisposalparticularly60minutespost–oralglucose

loadandskeletalmuscleisthemajororganofperipheral

glucosedisposal[6],itispossiblethatthesmallerskeletal

musclemassinwomenmayhaveaneffectonperipheral

glucosedisposalandcontributestothehigherpostload

heless,theroleofskeletalmusclemass

inpostprandialglucoseregulationhasrarelybeenstudied.

Theobjectiveofthisstudywastotestthehypothesisthatthe

differentamountofskeletalmusclemassbetweenmenand

womenisresponsibleforthesexdifferencein2-hour

postloadPGlevelsinThaisubjectswithnormalglucose

tolerance(NGT).

tsandmethods

Forty-sevenThaisubjectswithNGT,23womenand24

men,withmeanageof33.28.8(SD)yearsandmeanbody

massindex(BMI)of22.93.9kg/

the

glucose

tolerancewasdefinedby2-hourPGlevelsafterstandard

OGTToflessthan140mg/dLandfastingglucoselevelsof

lessthan100mg/thesubjectsinthestudyhad

eadvisedtonothave

strenuousexerciseandtostopsmokingandalcoholdrinking

foratleast24hoursbeforethestudy.

Subjectsgavewritteninformedconsentbeforethe

dyprotocolwasapproved

byPrinceofSongkhlaUniversityEthicalCommittee.

dbodycompositionmeasurements

Thestandard75-gOGTTwasperformedinthemorning

mpositionwasmeasuredafter

ascollectedviaretainedintravenouscatheter

beforeandat0.5,1,and2hoursafterglucoseingestionfor

odyfat,

abdominalfat,andappendagesleanmass(thesumoflean

softtissuemassinbothrightandleftarmsandlegs)were

measuredbydual-energyx-rayabsorptiometry(DEXA

version4.7;DPX-MDLunar,Madison,WI)

bodyfatandappendagesleanmasswerecalculatedby

standardsoftware,whereasabdominalfatwasmeasuredby

manuallydefiningtheareaofmeasurementfromthetopofL1

tothebottomofL4aspreviouslydescribed[7].Appendages

leanmassmeasuredbyDEXAhasbeenshowntobehighly

correlatedwithtotalskeletalmusclemass(R2=0.96)by

multislicemagneticresonanceimagingormultislicecom-

puterizedtomographyinhealthyadults[8,9].

nsensitivityandinsulinsecretionmeasurements

Skeletalmuscleinsulinsensitivitywasmeasuredby

euglycemic-hyperinsulinemicclamponthenextmorning

afterOGTTaspreviouslydescribed[7].Briefly,aprime

continuousintravascularinfusionofregularinsulin(Actra-

pidHM;NovoNordisk,Copenhagen,Denmark)wasgiven

atarateof50mU/m2bodysurfaceareaperminutefrom0to

120minutestogetherwith20%dextrosesolutiontomaintain

glucoseat90mg/dL(5.0mmol/L)throughouttheclamp

asobtainedevery5minutesfromthedorsal

handveinkeptinathermoregulatedboxat55Cto60Cfor

nsensitivitywas

determinedfromglucoseinfusionrate(GIR)duringthelast

40minutesoftheclampandexpressedasmilligramof

glucoseperleankilogramperminute.

Hepaticinsulinsensitivityindex(ISI)iscalculatedfrom

theinverseoftheproductoftotalareaunderthecurve(AUC)

forglucoseandinsulinconcentrationsduringthefirst30

minutesoftheOGTTmultipliedby1000,where1000

representsaconstantthatallowsonetoobtainthenumbers

ductofAUCforglucoseand

insulinconcentrationsofthefirst30minutesoftheOGTT

hasbeenshowntobesignificantlycorrelated(r=0.64)with

thestandardhepaticinsulinresistancemeasuredbythe

productofbasalendogenoushepaticglucoseproductionand

fastingplasmainsulinconcentrationsinsubjectswithNGT

[10].-Cellfunctionwasestimatedfromthehomeostasis

modelassessment(HOMA)of%BbytheHOMA-2model

(availableat/homa).First-phase

insulinsecretionwasdeterminedfromOGTTdatabythe

ratiooftheincrementalinsulinandglucoseconcentrations

abovebasalat30minutes(iIns/iGlu

0-30min

).Todetermine

insulinsecretionadjustedfordegreeofperipheralinsulin

sensitivity,dispositionindexoffirst-phase(DI

0-30min

)

insulinsecretionwascalculatedbymultiplyingiIns/iGlu

0-

30min

withGIR.

micalanalysis

Bloodforplasmainsulinwascollectedandfrozenat

−80Cuntilanalysis,allwithin1monthaftercollection.

Plasmainsulinwasmeasuredbydouble-antibodyradioim-

munoassay(DiagnosticProducts,LosAngeles,CA)with

intraassaycoefficientofvariationof0.9%to4.7%.Glucose

wasmeasuredbyglucoseoxidasemethod(SynchronCX-3

Delta;BeckmanCoulter,Fullerton,CA)withinterassay

coefficientofvariationof0.9%to2.3%.

ticalanalysis

TheunpairedStudentttestwasusedformean

atwerenotnormallydistributedwere

asarnetal./MetabolismClinicalandExperimental59(2010)172–176

ationcoefficients

le

linearregressionanalysiswasperformedtoidentify

independentfactorscontributingtovariancesof2-hourPG

tisticalanalyseswereperformedusingSPSS

forWindows(version11.5;SPSS,Chicago,IL).Areaunder

.05was

consideredstatisticallysignificant.

s

Clinicalcharacteristics,glucoseandinsulinresponsesto

OGTT,aswellasparametersofinsulinsecretionandinsulin

milarageandBMI,

womenhadsignificantlyhighertotalbodyfat,lowerwaist-

hipratio(WHR),andsmallerappendagesleanmassthan

ghtherewasnodifferenceinfastingPGlevels

betweenmenandwomen,afterchallengingwith75-goral

glucose,levelsof2-hourPGweresignificantlyhigherin

erenceinfastingandpostload

insulinresponsesbetweenmenandwomenwasobserved.

Skeletalmuscleinsulinsensitivity,hepaticISI,first-phase

insulinsecretion,aswellasitsdispositionindexwerealso

notdifferent.

Malesex(r=−0.360,P=.013)andappendageslean

mass(r=−0.411,P=.004)(Fig.1)werenegatively

correlatedwith2-hourPG,whereaslog2-hourinsulin(r=

0.571,Pb.0001),totalbodyfat(r=0.348,P=.016),and

logabdominalfat(r=0.298,P=.042)werepositively

tialcorrelationof2-hour

PGandsexdisappeared(partialr=−0.044,P=not

significant),

BMI,waist,WHR,fastingPG,30-minutePG,1-hourPG,

logfastinginsulin,log30-minuteinsulin,log1-hourinsulin,

GIR,hepaticISI,HOMA%B,logiIns/iGlu

0-30min

,andlog

DI

0-30min

werenotsignificantlycorrelatedwith2-hourPG.

Bymultivariatelinearregressionanalysisusing2-hourPG

asadependentvariableandsex,appendagesleanmass,log2-

hourinsulin,andtotalbodyfatasindependentvariables,only

log2-hourinsulin(=15.1,Pb.0001)andappendageslean

Table1

Clinicalcharacteristics,PG,andinsulinresponsestoOGTTandmeasuresof

insulinsecretionandinsulinsensitivityofsubjectsinthestudy

NGTP

Women(n=23)Men(n=24)

Age(y)34.28.932.38.8NS

Weight(kg)55.110.862.79.7.015

Height(m)1.550.051.660.06b.0001

BMI(kg/m2)23.04.422.83.5NS

Waistcircumference(cm)73.79.777.411.6NS

WHR0.790.050.860.09.005

Totalbodyfat(kg)19.07.611.67.2.001

Abdominalfata(kg)1.91.11.51.1NS

Appendagesleanmass(kg)14.92.122.53.2b.0001

Glucose(mg/dL):fasting83.19.083.56.9NS

30min148.426.0153.822.1NS

1h147.132.7140.632.7NS

2h115.118.5100.519.9.013

Insulin(U/mL)a:fasting7.963.789.885.32NS

30min62.6927.6867.5537.49NS

1h83.5682.4467.7545.12NS

2h53.5828.3545.9029.69NS

iIns/iGlu

0-30min

a0.900.460.840.42NS

DI

0-30min

a8.344.946.882.99NS

HepaticISI1.200.661.120.54NS

GIR(mg/[leankgmin])9.223.28.842.94NS

HOMA%B117.636.9125.037.5NS

Dataareexpressedasmeanertglucosetomillimolesperliter,

ertinsulintopicomolesperliter,multiplyby

catesnotsignificant.

aLog-transformedbeforeanalysis.

ationofappendagesleanmassand2-hourPGlevelsafteroral

glucosechallengesinwomen(○)andmen(●)ert

glucosetomillimolesperliter,multiplyby0.056.

Table2

Predictorsof2-hourPGlevelsafter75-gOGTTinsubjectswithNGTby

multivariatelinearregressionanalysis

ModelAdjustedR2Coefficient()Standard

error

P

Model10.377b.0001

Predictors:

log2-hinsulin15.13.6b.0001

Appendages

leanmass

−1.010−3

1.010

−3

.021

Model20.505b.0001

Predictors:

log2-hinsulin18.63.4b.0001

Appendages

leanmass

−1.010−3b1.010−3

.034

log30-min

insulin

−16.44.7.001

Model30.542b.0001

Predictors:

log2-hinsulin18.93.2b.0001

Appendages

leanmass

−1.010−3b1.010−3

.018

log30-mininsulin−36.310.4.001

HepaticISI−17.38.2.041

asarnetal./MetabolismClinicalandExperimental59(2010)172–176

mass(=−1.010

−3

,P=.021)werethesignificant

independentparameterspredicting2-hourPG(model

adjustedR2=0.377,Pb.0001).Enteringlogabdominalfat

or1-hourPGintothemodeldidnotchangemodeloutcome.

AsshowninTable2,inclusionoflog30-minuteinsulin

(model2)andhepaticISI(model3)intobaselinemodel

(model1)al

model(model3)thatconsistedoflog2-hourinsulin,log30-

minuteinsulin,appendagesleanmass,andhepaticISI

explained54.2%ofthevarianceof2-hourPG.

sion

Thisstudydemonstratedthat,withsimilarageandBMI,

nonobesewomenwithNGThadsmallerappendageslean

massandgreater2-hourPGlevelsafterOGTTthanmen.

Appendagesleanmass,30-minuteinsulinlevels,andhepatic

ISIaretheindependentfactorsnegativelypredicting2-hour

PGlevels,whereas2-hourPGlevelspositivelypredict2-

e30-minuteand2-

hourinsulinlevelsandhepaticISIarenotdifferentbetween

menandwomenandappendagesleanmassmeasuredby

DEXAhasbeenshowntobestrongly此生此夜不长好明月明年何处看的意思 correlatedwithtotal

skeletalmusclemassmeasuredbycomputerizedtomogra-

phyormagneticresonanceimaging[8,9,11],itislikelythat

thesexdifferencein2-hourPGlevelsafterglucoseloadis

notsexspecificbutislargelytheresultofthesmallerskeletal

musclemassinwomen.

Thestudythatexaminestherelationshipofskeletal

musclemassandpostprandialPGlevelsinhumanisquite

nowledge,thisstudyisthefirstthat

demonstratestheeffectofskeletalmusclemassonPG

resultofthisstudyisincontrastwiththerecentfindingsby

Kuketal[12]wheretherelationshipofskeletalmusclemass

and2-hourPGlevelsafterOGTTcouldnotbedemonstrated

r,thedifferencesin

subjectcharacteristicsandstudydesignmayexplainthis

ghsubjectsinthestudyofKuketalhad

NG风雪夜归人翡翠 T,theyweremuchmoreobese(BMIN30kg/m2)than

ours;andwomenwereyoungerandheavierthanmeninthat

rmore,therelationshipofskeletalmusclemass

and2-hourPGlevelswasseparatelystudiedinmenand

hesmalldifferenceinskeletalmusclemass

inthesamesex,itispossiblethatsuchrelationshipcouldnot

ghthenegativerelationshipofappen-

dagesleanmassandpostload2-hourPGlevelsinourstudy

doesnotprovecausality,itistheoreticallynotunreasonable.

Skeletalmuscleisthemajororganofglucosedisposal

particularlyatpostprandialstate;therefore,insubjectswith

equivalentdegreesofinsulinsensitivityand-cellfunction,

thosewhohavesmallerskeletalmusclemasswouldhave

lowercapacitytoaccommodateglucosedisposalthanthose

uldresultin

etal

[13]studiedthecontributionofleanbodymasstoinsulin

resistanceinobese(BMI∼30-34kg/m2),nondiabetic,

postmenopausalwomenandreportedthatsubjectswith

highleanBMI(leanbodymassmeasuredbyDEXAdivided

byheight)hadgreaterpostloadPGlevelsthanthosewith

itivecorrelationof2-hourPGand

indings

r,wefoundthat,evenif

weusedleanBMIinouranalysis,theresultsofthestudy

wouldnotchange(datanotshown).Becausesubjectsinthe

studyofBrochuetalwereinmenopausestate,werecentrally

obese,andhadsevereinsulinresistance,itispossiblethatthe

negativerelationshipofskeletalmusclemassand2-hourPG

levelsisobliteratedbytheseveredegreeofinsulin

dingsmaypartlyexplainwhythe

prevalenceofisolatedIGTishigherinwomenthaninmen

[1-4].Whethertheeffectofskeletalmusclemasscouldhave

contributedtoahigherprevalenceofisolatedIGTinAsians

thaninwhitesisintriguing[14].Becauseourstudyrevealed

thestrongassociationofheightandleanbodymass(r=

0.808,Pb.0001),itispossiblethatthenegativeassociation

ofheightand2-hourPGresponsestoOGTTintheAusDiab

studymaybeexplainedbythedifferenceinskeletalmuscle

mass[15].

Ourstudysupportsotherpreviousstudiesinthatindexes

ofinsulinsecretionandmeasuresofinsulinsensitivitythat

includeskeletalmuscleandhepaticinsulinsensitivities

assessedbyclampmethodarenotdifferentbetweenage-

matchedmenandwomenwithNGT[5,16,17].Although

ourstudyusedOGTT-derivedhepaticinsulinresistance

indexasameanstomeasurehepaticinsulinsensitivity,this

parameterhasbeenshowntohaveasignificantcorrelation

withthatmeasuredbythestandardradiolabeledglucose

tracertechnique[10].Ourstudysuggeststhatthelower

initialinsulinsecretionandthelowerhepaticinsulin

sensitivityaretheimportantandindependentfactors

determiningthehigher2-hourPGlevelsafteroralglucose

dingsinsubjectswith

NGTareinlinewiththefindingsbyMitrakouetal[18]in

dyaddsskeletalmusclemassas

oneofthosenegativepredictors.

Thestrengthofthisstudyisthatthetechniquesofthe

measurementsusedinthestudyarewellstandardizedor

andBMIofmenandwomeninthestudywerewellmatched.

Nevertheless,y,

systemicoralglucoseappearanceafteroralglucoseload,

whichhasbeenreportedtobehigherinwomeninsome

studies,wasnotdeterminedinthisstudy[5,19].Whetherthis

factorhasaneffectonahigher2-hourPGlevelsinwomenof

ly,thesamplesizeofthestudy

r,despitethesmallsamplesize,

thestrongnegativeeffectofskeletalmusclemasson

y,

becauseourstudydidnotmeasurephysicalactivitylevels,

itispossiblethatthehigher2-hourPGlevelsobservedin

asarnetal./MetabolismClinicalandExperimental59(2010)172–176

womenareduetotheirlesserphysicalactivity[20].

However,wespeculatethatthisfactormaynotplayan

importantrolegiventhehistoryofsedentarylifestyleinall

participatingsubjectsandsimilarskeletalmuscleinsulin

ultofthisstudyis

rthisistruein

obesesubjectswithNGTorinsubjectswithabnormal

rthedifferencein

skeletalmusclemasscouldhaveaneffecton2-hourPG

r,the

patternofpostprandialglucosemetabolismafterglucoseor

mixed-mealingestionhasbeenreportedtobenotdifferent

[21].Furthermore,whetherthereisadifferenceinskeletal

musclemasspropertiesbetweenmenandwomenthatcould

havecontributedtosexdifferenceinpostload2-hourPG

ntheresultsofourstudy,it

impliesthatusingfixedamountof75-gglucosetesting

protocolforOGTTmaybeinadequatetoaccuratelycompare

postloadglucosehomeostasisbetweenmenandwomenand

untofglucose

loadshouldbeindividualizedbasedontheamountofactual

le暗暗淡淡紫 anbodymass.

Inconclusion,thehigherpostload2-hourPGlevelafter

OGTTinwomenisnotsexspecificbutisinpartaresultof

lyinsulinsecretion,

hepaticinsulinsensitivity,andskeletalmusclemasswerethe

significantfactorsnegativelypredicting2-hourpostloadPG

udiesarerequired

toelucidatetheeffectofskeletalmusclemasson

postprandialglucosehomeostasisinsubjectswithabnormal

glucosetolerance.

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