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| The metabolically obese, normal-weight individual revisited |
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| Author(s): Ruderman N, Chisholm D, Pi-Sunyer X, Schneider S |
| Source: DIABETES Volume: 47 Issue: 5 Pages: 699-713 Published: MAY 1998 |
| Times Cited: 219 References: 177 |
| Abstract: Nearby 20 years ago, it was suggested that individuals exist who are not obese on the basis of height and weight, but who, like people with overt obesity, are hyperinsulinemic, insulin-resistant, and predisposed to type 2 diabetes, hypertriglyceridemia, and premature coronary heart disease. Since then it has become increasingly clear that such metabolically obese, normal-weight (MONW) individuals are very common in the general population and that they probably represent one end of the spectrum of people with the insulin resistance syndrome. Available evidence also suggests that MONW individuals could account for the higher prevalence of type 2 diabetes, cardiovascular disease and other disorders in people with a BMI in the 20-27 kg/m(2) range who have gained modest amounts of weight (2-10 kg of adipose mass) in adult life. Specific factors that appear to predispose MONW, as well as more obese individuals, to insulin resistance include central fat distribution, inactivity, and a low Vo(2max). Because these factors are potentially reversible and because insulin resistance may contribute to the pathogenesis of many diseases, it is our premise that a compelling argument can be made for identifying MONW individuals and treating them with diet, exercise, and possibly pharmacological agents before these diseases become overt, or at least early after their onset. One reason for doing so is that disorders such as type 2 diabetes may be accompanied by irreversible consequences, e.g., ischemic heart disease and nephropathy, at the time of diagnosis or shortly thereafter. Another is that MONW individuals in general should be younger and more amenable and responsive to diet and exercise therapy than are obese patients with established disease. That long-term diet and exercise can work is suggested by two large studies in which, over 5-6 years, the incidence of diabetes was diminished in nonobese and minimally obese patients with impaired glucose tolerance. Based on these considerations and the emerging worldwide epidemic of type 2 diabetes, we believe that studies to assess whether therapies aimed at young MONW individuals can prevent the development of type 2 diabetes and other diseases, including perhaps obesity itself, are urgently needed. |
| Document Type: Review |
| Language: English |
| Reprint Address: Ruderman, N (reprint author), Boston Univ, Med Ctr, Diabet Res Unit, 88 E Newton St, Boston, MA 02118 USA |
Addresses:
1. Boston Univ, Med Ctr, Endocrinol Sect, Diabet & Metab Res Unit, Boston, MA USA
2. Boston Univ, Med Ctr, Evans Dept Med, Boston, MA USA
3. Boston Univ, Med Ctr, Dept Physiol, Boston, MA USA
4. St Vincents Hosp, Garvan Inst Med Res, Sydney, NSW 2010 Australia
5. Columbia Univ Coll Phys & Surg, St Lukes Roosevelt Hosp Ctr, Div Endocrinol, New York, NY 10032 USA
6. Univ Med & Dent New Jersey, Robert Wood Johnson Med Sch, Dept Med, Newark, NJ 07103 USA |
| Publisher: AMER DIABETES ASSOC, 1660 DUKE ST, ALEXANDRIA, VA 22314 USA |
| Subject Category: Endocrinology & Metabolism |
| IDS Number: ZL168 |
| ISSN: 0012-1797 |
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