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Studies provide insights into obese Qatari population

Hyperinsulinaemia and hyperleptinaemia are BMI independent features of morbid obesity
Weight loss did not improve dyslipidemia or hypertension

Two studies presented at ENDO2013, the annual meeting of the Endocrine Society, in San Francisco, provide valuable insights into the treatment of complications from obesity in the Qatari population.

It is known that early and rapid onset of the disease in the Qatari population, along with a primarily abdominal and omental deposition of adipose tissue is closely associated with insulin resistance, whilst longer duration of obesity in Caucasians is associated with maintenance of insulin sensitivity, independently of BMI.

As a result, researchers from the Doping Lab Qatar, Doha, Qatar and University College London, UK, wanted to assess whether inherent differences between the Qataris and Caucasians in adipose tissue secretory function and sensitivity to insulin, determines their response to interventions that reduce their adipose tissue mass.

They recruited non-diabetic morbidly obese subjects were recruited from Qatar and Caucasian patients awaiting weight reduction surgery from the UK. Blood samples were obtained before, and in a sub-set of patients after weight loss for determination of lipids, glucose, insulin and adipokines. Subjects were separated into metabolically healthy obese and pathologically obese groups based on their HOMA index (fasting plasma glucose <6.8mmol/l and insulin levels <6.5miU/ml).

The results showed that Qatari, compared to Caucasian, subjects were younger (29.8 vs 35.3 years, p=0.02), had higher insulin (16.1 vs 7.9miu/ml, p=0.01), leptin (77.8 vs 51.2ng/ml, p=0.001), IL-6 (3.9 vs 2.4pg/ml, p=0.05) and total cholesterol (4.6 vs 4.0mmol/l, p=0.01). However, their diastolic blood pressure and triglyceride were lower than in the Caucasians.

Following the separation into two groups, prevalence of metabolically healthy obese in Qatar was significantly lower than that of the Caucasians (13% vs 28%). Furthermore, metabolically healthy obese Caucasians had lower blood pressure and triglycerides than pathologically obese Caucasians, whereas there were no differences between Qatari metabolically healthy obese and pathologically obese groups.

Three months after surgery, both populations showed significant BMI reduction associated with reduction in insulin, HOMA and leptin.

“Obesity in Qatari subjects was accompanied by greater degree of hyperinsulinaemia and hyperleptinaemia compared to Caucasians, suggesting elevated fat mass contribution to the BMI in Qataris,” concluded the researchers. “The lower prevalence of metabolically healthy obese in Qataris also reflects the largely insulin resistant phenotype of the population.”

The investigators noted that in the Caucasian population the pathologically obese subjects were hypertensive and hypertriglyceridaemic compared to the metabolically healthy obese, while these differences were not apparent in the Qatari metabolically healthy obese and pathologically obese groups.

They added that the greater incidence and younger age of onset of obesity may warrant more aggressive treatment for obesity amongst the Qatari.

Insulin resistance and sensitivity

In the second study, investigators also from the Anti Doping Lab Qatar, Doha, Qatar, sought to characterise the components of insulin resistance and sensitivity in the obese Qatari population.

Forty two non-diabetic morbidly obese Qatari patients awaiting bariatric surgery and 14 age-matched healthy lean/overweight volunteers were included in the study. Following anthropometric measures recording, blood lipids, glucose, insulin and adipokines were determined before and three months after surgery. The two groups (lean/overweight and the obese subjects) were categorised into insulin resistant and insulin sensitive groups based on their HOMA index (fasting plasma glucose <6.8mmol/l and insulin levels <6.5miU/ml).

The resulst showed that in all subjects (n=56, 13 males/43 females, 30.5+/-7.5 years old, BMI37.5+/-11) obesity was associated with significant elevations in leptin, CRP, systolic blood pressure, triglyceride, fasting blood glucose, insulin and HOMA.

In the obese group, the prevalence of insulin sensitivity was 14% associated with lower fasting blood glucose, insulin and HOMA and a higher HDLC compared to insulin resistant group, despite similar age and BMI.

In the lean/overweight group, the prevalence of insulin sensitive was 28%, showing significantly lower blood pressure compared to the insulin resistant group. Following surgical weight loss, both insulin resistant and IS groups showed significant BMI reduction (42 vs 36, p=0.04), while only the insulin resistant group showed reduction in insulin (18miu/ml vs 8miu/ml, p=0.02), HOMA (4.1 vs 1.9, p=0.02) and leptin (71ng/ml vs 28ng/ml, p=0.03).

“Surprisingly in this study, lean/overweight young Qatari subjects were already significantly insulin resistant,” the researchers concluded. “As expected in obesity, leptin, blood pressure, inflammatory markers, lipids and insulin resistant were elevated. Weight loss was an effective remedy for the insulin resistance but with no concomitant improvement in either dyslipidemia or hypertension in this population.”

The results of this study are currently being investigated in a larger Qatari cohort.

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