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Article(id=1240651445297541265, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240651438955754377, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202403067, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1709568000000, receivedDateStr=2024-03-05, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773723954748, onlineDateStr=2026-03-17, pubDate=1719244800000, pubDateStr=2024-06-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773723954748, onlineIssueDateStr=2026-03-17, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773723954748, creator=13701087609, updateTime=1773723954748, updator=13701087609, issue=Issue{id=1240651438955754377, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='12', pageStart='2113', pageEnd='2912', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773723953236, creator=13701087609, updateTime=1773723953236, updator=13701087609, preIssue=null, nextIssue=null, ext=null, issueFiles=null}, startPage=2253, endPage=2261, ext={EN=ArticleExt(id=1240651445649862830, articleId=1240651445297541265, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Associations between body composition and insulin resistance in different gender communities, columnId=1228016573156360233, journalTitle=Modern Preventive Medicine, columnName=Disease Control and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To examine the correlation between body composition and insulin resistance (IR) within the general population of different genders.

Methods

The data for this study were sourced from the Hefei area data of the Chinese Residents Cardiovascular Disease and Risk Factors Monitoring Project conducted in 2021, with a total of 1 144 subjects being included,including 568 males and 576 females. The ratio of triglycerides to high-density lipoprotein cholesterol (TG/HDL-C) was used as an alternative indicator of insulin resistance. A chi-square test was employed to analyze the association between body composition metrics—such as body mass index (BMI), percent body fat (PBF), percent body muscle (PBM), visceral fat area (VFG), and waist circumference (WC)—and the TG/HDL-C ratio. Logistic regression analysis was used to identify the factors influencing body composition in individuals with a TG/HDL-C ratio exceeding the tangent point value. The dose-response relationship between body components and the TG/HDL-C ratio was explored using restricted cubic splines, a statistical method that allows for the examination of nonlinear relationships.

Results

The positive detection rate of IR (the rate of TG/HDL-C above the cut point value) was 15.85% in men and 4.69% in women.After adjusting for confounding factors, logistic regression analysis showed that compared with the control group, the risk of IR in the male population was 5.58 times in the obese group (OR=5.58, 95%CI:1.98-15.72), PBF was 7.90 times in the third quartile (OR=7.90, 95%CI:1.68-37.15), the fourth quartile of PBF was 8.20 times (OR=8.20, 95%CI:1.75-38.40), and the third quartile of PBM was 0.27 times (OR=0.27, 95%CI:0.10-0.71), the PBM was 0.09 times in the fourth quartile group (OR=0.09, 95%CI:0.02-0.44), 3.11 times in the group with high VFG (OR=3.11, 95%CI:1.45-6.68), and 4.28 times in the group with higher VFG (OR=4.28, 95%CI:1.45-12.64). Abdominal obesity was 2.21 times (OR=2.21, 95%CI:1.08-4.56). In the female population, the risk of IR was 6.61 times in the obese group (OR=6.61, 95%CI:1.08-65.66) and 8.52 times in the higher VFG group (OR=8.52, 95%CI: 1.90-70.86) (P<0.05). The limited cubic spline showed that BMI, PBF, PBM, VFG, WC had dose-response relationship and approximate linear relationship with TG/HDL-C.

Conclusion

The body composition of community residents is closely associated with the risk of insulin resistance. Individuals who are obese or have high levels of visceral fat are at greater risk for insulin resistance. To mitigate this risk, it is imperative to reinforce lifestyle interventions that prioritize maintaining a higher percentage of muscle mass.

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目的

分析不同性别一般人群的体成分与胰岛素抵抗（Insulin Resistance，IR）之间的关系。

方法

本研究数据来源于2021年中国居民心血管病及其危险因素监测项目合肥地区数据，共纳入1 144例研究对象，其中男性568人，女性576人。用甘油三酯（Triglyceride，TG）/高密度脂蛋白胆固醇（High Density Lipoprotein Cholesterol，HDL-C）作为IR的替代指标，采用卡方检验分析不同体成分（体质指数（Body Mass Index，BMI）、体脂百分比（Percentage Of Body Fat，PBF）、肌肉百分比（Percentage Of Body Muscle，PBM）、腰围（Waist Circumference，WC）和内脏脂肪等级（Visceral Fat Grade，VFG）组与TG/HDL-C之间的关系，采用logistic回归分析TG/HDL-C高于切点值的体成分影响因素，用限制性立方样条探究各体成分与TG/HDL-C之间的剂量反应关系。

结果

男性IR阳性检出率（TG/HDL-C高于切点值的率）为15.85%，女性为4.69%。在调整混杂因素后，logistic回归分析结果显示，与对照组相比，男性人群发生IR风险的体成分分组中，肥胖组是5.58倍（OR=5.58,95%CI:1.98~15.72），PBF第三四分位组是7.90倍（OR=7.90,95%CI:1.68~37.15），PBF第四四分位组是8.20倍（OR=8.20, 95%CI:1.75~38.40），PBM第三四分位组是0.27倍（OR=0.27, 95%CI:0.10~0.71），PBM第四四分位组是0.09倍（OR=0.09, 95%CI:0.02~0.44），VFG偏高组是3.11倍（OR=3.11, 95%CI:1.45~6.68），VFG高组是4.28倍（OR=4.28, 95%CI:1.45~12.64），腹型肥胖是2.21倍（OR=2.21, 95%CI:1.08~4.56）；女性人群发生IR风险的体成分分组中，肥胖组是6.61倍（OR=6.61, 95%CI:1.08~65.66），VFG高组是8.52倍（OR=8.52, 95%CI:1.90~70.86）（P<0.05）。限制性立方样条显示，BMI、PBF、PBM、VFG、WC均与TG/HDL-C存在剂量反应关系和近似线性关系。

结论

社区居民的体成分与发生胰岛素抵抗风险密切相关，肥胖人群以及高内脏脂肪人群发生胰岛素抵抗风险较高，应加强生活方式干预，保持较高肌肉率。

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王素芳，E-mail:
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施俊(1989—)，女，硕士在读，主管医师，研究方向：营养与慢性病

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Byulleten Sib Meditsiny, 2021,20(3): 95-104., articleTitle=MRI assessment of the abdominal adipose tissue and the state of the abdominal aorta in patients with coronary artery disease:association with metabolic disorders, refAbstract=null), Reference(id=1240651461563052839, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651445297541265, doi=null, pmid=null, pmcid=null, year=2019, volume=41, issue=4, pageStart=269, pageEnd=271, 286, url=null, language=null, rfNumber=[22], rfOrder=35, authorNames=黄乙欢, 王继生, 张润峰, journalName=四川生理科学杂志, refType=null, unstructuredReference=黄乙欢，王继生，张润峰，等．肌肉减少症与胰岛素抵抗相关性研究[J]．四川生理科学杂志，2019，41（4）：269-271, 286．, articleTitle=肌肉减少症与胰岛素抵抗相关性研究, refAbstract=null), Reference(id=1240651461655327528, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651445297541265, doi=null, pmid=null, pmcid=null, year=2019, volume=41, issue=4, pageStart=269, pageEnd=271, 286, url=null, language=null, rfNumber=[22], rfOrder=36, authorNames=Huang YH, Wang JS, Zhang RF, journalName=Sichuan Journal of Physiological Sciences, refType=null, unstructuredReference=Huang YH, Wang JS, Zhang RF, et al. Relationships between sarcopenia and insulin resistance in hospitalized old patients[J]. Sichuan Journal of Physiological Sciences, 2019, 41(4): 269-271, 286., articleTitle=Relationships between sarcopenia and insulin resistance in hospitalized old patients, refAbstract=null), Reference(id=1240651461747602217, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651445297541265, doi=null, pmid=null, pmcid=null, year=2022, volume=7, issue=1, pageStart=18, pageEnd=null, url=null, language=null, rfNumber=[23], rfOrder=37, authorNames=Zyoud SH, Shakhshir M, Abushanab AS, journalName=Translational Medicine Communications, refType=null, unstructuredReference=Zyoud SH, Shakhshir M, Abushanab AS, et al. Global research trends on the links between insulin resistance and obesity: a visualization analysis[J]. Translational Medicine Communications, 2022, 7(1): 18., articleTitle=Global research trends on the links between insulin resistance and obesity: a visualization analysis, refAbstract=null), Reference(id=1240651461839876906, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651445297541265, doi=null, pmid=null, pmcid=null, year=2020, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[24], rfOrder=38, authorNames=国家基层糖尿病防治管理办公室, 中华医学会糖尿病分会, journalName=中国糖尿病健康管理规范 2020, refType=null, unstructuredReference=国家基层糖尿病防治管理办公室，中华医学会糖尿病分会．中国糖尿病健康管理规范 2020[M]．北京：人民卫生出版社，2020．, articleTitle=null, refAbstract=null), Reference(id=1240651461911180075, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651445297541265, doi=null, pmid=null, pmcid=null, year=2020, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[24], rfOrder=39, authorNames=National Grassroots Diabetes Prevention and Management Office, Diabetes Branch of Chinese Medical Association, journalName=China diabetes health management standard 2020, refType=null, unstructuredReference=National Grassroots Diabetes Prevention and Management Office, Diabetes Branch of Chinese Medical Association.China diabetes health management standard 2020[M].Beijing:People’s Medical Publishing House,2020., articleTitle=null, refAbstract=null)], funds=[Fund(id=1240651456735408819, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651445297541265, awardId=81102125, language=CN, fundingSource=国家自然科学基金(81102125), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240651448971751770, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651445297541265, xref=1., ext=[AuthorCompanyExt(id=1240651448975946075, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651445297541265, companyId=1240651448971751770, language=EN, country=null, 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ArticleFig(id=1240651454520816266, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651445297541265, language=EN, label=Table 1, caption=

Basic information of research objects

, figureFileSmall=null, figureFileBig=null, tableContent=
组别男性
男性人群（n（%））IR阳性检出人群(n（%）)正常人群(n（%）)χ2P
合计568（49.65）90（15.85）478（84.15）
年龄分组（岁）26.296<0.001
18~<2599（17.43）3（3.03）96（96.97）
25~<3598（17.25）17（17.35）81（82.65）
35~<45114（20.07）30（26.32）84（73.68）
45~<55110（19.37）17（15.45）93（84.55）
55~<6555（9.68）12（21.82）43（78.18）
65~<7546（8.10）8（17.39）38（82.61）
≥7546（8.10）3（6.52）43（93.48）
文化程度2.6110.625
未上学70(12.32)7(10.00)63（90.00）
小学120(21.13)21(17.50)99（82.50）
初中141(24.82)30(21.28)111（78.72）
高中/大专138(24.30)27(19.57)111（80.43）
本科及以上99(17.43)5(5.05)94（94.95）
婚姻6.7600.034
未婚134(23.59)8(5.97)126（94.03）
已婚/再婚/同居412(72.54)79(19.17)333（80.83）
分居/离异/丧偶22(3.87)3(13.64)19（86.36）
就业18.204<0.001
在业269(47.36)68(25.28)201（74.72）
离退休98(17.25)10(10.20)88（89.80）
在校学生101(17.78)2(1.98)99（98.02）
无业或者失业100(17.61)10(10.00)90（90.00）
吸烟（最近30天）12.2090.002
不吸367(64.61)38(10.35)329（89.65）
每天都吸160(28.17)44(27.50)116（72.50）
吸烟，但不是每天都吸41(7.22)8(19.51)33（80.49）
饮酒1.6250.202
否308(54.23)40(13.00)268（87.00）
是260(45.77)50(19.23)210（80.77）
饮茶3.2000.074
否264(46.48)31(11.74)233（88.26）
是304(53.52)59(19.41)245（80.59）
高血压6.3980.011
否377(66.37)42(11.14)335（88.86）
是191(33.63)48(25.13)143（74.87）
组别女性
男性人群（n（%））IR阳性检出人群(n（%）)正常人群(n（%）)χ2P
合计576（50.35）27（4.69）549（95.31）
年龄分组（岁）8.0710.233
18~<2591（15.80）0（0.00）91（100.00）
25~<35106（18.40）4（3.77）102（96.23）
35~<45124（21.53）7（5.65）117（94.35）
45~<5596（16.67）6（6.25）90（93.75）
55~<6574（12.85）4（5.41）70（94.59）
65~<7545（7.81）2（4.44）43（95.56）
≥7540（6.94）4（10.00）36（90.00）
文化程度1.8630.761
未上学91(15.80)9(9.89)82（90.11）
小学157(27.26)8(5.10)149（94.90）
初中122(21.18)6(4.92)116（95.08）
高中/大专110(19.10)3(2.73)107（97.27）
本科及以上96(16.66)1(1.04)95（98.96）
婚姻2.3650.306
未婚125(21.70)2(1.60)123（98.40）
已婚/再婚/同居418(72.57)24(5.74)394（94.26）
分居/离异/丧偶33(5.73)1(3.03)32（96.97）
就业3.4280.330
在业224(38.89)17(7.59)207（92.41）
离退休101(17.53)4(3.96)97（96.04）
在校学生82(14.24)0(0.00)82（100.00）
无业或者失业169(29.34)6(3.55)163（96.45）
吸烟（最近30天）6.2600.044
不吸565(98.09)24(4.25)541（95.75）
每天都吸5(0.87)1(20.00)4（80.00）
吸烟，但不是每天都吸6(1.04)2(33.33)4（66.67）
饮酒0.4500.502
否510(88.54)22(4.31)488（95.69）
是66(11.46)5(7.58)61（92.42）
饮茶0.1490.699
否412(71.53)17(4.13)395（95.87）
是164(28.47)10(6.10)154（93.90）
高血压0.0040.952
否458(79.51)20(4.37)438（95.63）
是118(20.49)7(5.93)111（94.07）
), ArticleFig(id=1240651454680199828, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651445297541265, language=CN, label=表1, caption=

研究对象的基本情况

, figureFileSmall=null, figureFileBig=null, tableContent=
组别男性
男性人群（n（%））IR阳性检出人群(n（%）)正常人群(n（%）)χ2P
合计568（49.65）90（15.85）478（84.15）
年龄分组（岁）26.296<0.001
18~<2599（17.43）3（3.03）96（96.97）
25~<3598（17.25）17（17.35）81（82.65）
35~<45114（20.07）30（26.32）84（73.68）
45~<55110（19.37）17（15.45）93（84.55）
55~<6555（9.68）12（21.82）43（78.18）
65~<7546（8.10）8（17.39）38（82.61）
≥7546（8.10）3（6.52）43（93.48）
文化程度2.6110.625
未上学70(12.32)7(10.00)63（90.00）
小学120(21.13)21(17.50)99（82.50）
初中141(24.82)30(21.28)111（78.72）
高中/大专138(24.30)27(19.57)111（80.43）
本科及以上99(17.43)5(5.05)94（94.95）
婚姻6.7600.034
未婚134(23.59)8(5.97)126（94.03）
已婚/再婚/同居412(72.54)79(19.17)333（80.83）
分居/离异/丧偶22(3.87)3(13.64)19（86.36）
就业18.204<0.001
在业269(47.36)68(25.28)201（74.72）
离退休98(17.25)10(10.20)88（89.80）
在校学生101(17.78)2(1.98)99（98.02）
无业或者失业100(17.61)10(10.00)90（90.00）
吸烟（最近30天）12.2090.002
不吸367(64.61)38(10.35)329（89.65）
每天都吸160(28.17)44(27.50)116（72.50）
吸烟，但不是每天都吸41(7.22)8(19.51)33（80.49）
饮酒1.6250.202
否308(54.23)40(13.00)268（87.00）
是260(45.77)50(19.23)210（80.77）
饮茶3.2000.074
否264(46.48)31(11.74)233（88.26）
是304(53.52)59(19.41)245（80.59）
高血压6.3980.011
否377(66.37)42(11.14)335（88.86）
是191(33.63)48(25.13)143（74.87）
组别女性
男性人群（n（%））IR阳性检出人群(n（%）)正常人群(n（%）)χ2P
合计576（50.35）27（4.69）549（95.31）
年龄分组（岁）8.0710.233
18~<2591（15.80）0（0.00）91（100.00）
25~<35106（18.40）4（3.77）102（96.23）
35~<45124（21.53）7（5.65）117（94.35）
45~<5596（16.67）6（6.25）90（93.75）
55~<6574（12.85）4（5.41）70（94.59）
65~<7545（7.81）2（4.44）43（95.56）
≥7540（6.94）4（10.00）36（90.00）
文化程度1.8630.761
未上学91(15.80)9(9.89)82（90.11）
小学157(27.26)8(5.10)149（94.90）
初中122(21.18)6(4.92)116（95.08）
高中/大专110(19.10)3(2.73)107（97.27）
本科及以上96(16.66)1(1.04)95（98.96）
婚姻2.3650.306
未婚125(21.70)2(1.60)123（98.40）
已婚/再婚/同居418(72.57)24(5.74)394（94.26）
分居/离异/丧偶33(5.73)1(3.03)32（96.97）
就业3.4280.330
在业224(38.89)17(7.59)207（92.41）
离退休101(17.53)4(3.96)97（96.04）
在校学生82(14.24)0(0.00)82（100.00）
无业或者失业169(29.34)6(3.55)163（96.45）
吸烟（最近30天）6.2600.044
不吸565(98.09)24(4.25)541（95.75）
每天都吸5(0.87)1(20.00)4（80.00）
吸烟，但不是每天都吸6(1.04)2(33.33)4（66.67）
饮酒0.4500.502
否510(88.54)22(4.31)488（95.69）
是66(11.46)5(7.58)61（92.42）
饮茶0.1490.699
否412(71.53)17(4.13)395（95.87）
是164(28.47)10(6.10)154（93.90）
高血压0.0040.952
否458(79.51)20(4.37)438（95.63）
是118(20.49)7(5.93)111（94.07）
), ArticleFig(id=1240651454806028953, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651445297541265, language=EN, label=Table 2, caption=

Comparison of the positive rate of insulin resistance among different gender and body groups

, figureFileSmall=null, figureFileBig=null, tableContent=
组别男性
男性人群(n（%）)IR阳性检出人群(n（%）)正常人群(n（%）)χ2P
BMI分组37.008<0.001
偏瘦20（3.52）3(15.00)17（85.00）
正常226（39.79）14(6.19)212（93.81）
超重215（37.85）39(18.14)176（81.86）
肥胖107（18.84）34(31.78)73（68.22）
PBF分组21.428<0.001
Q1组141（24.82）7(4.96)134（95.04）
Q2组142（25.00）20(14.08)122（85.92）
Q3组142（25.00）30(21.13)112（78.87）
Q4组143（25.18）33(23.08)110（76.92）
PBM分组20.270<0.001
Q1组140（24.65）30(21.43)110（78.57）
Q2组144（25.35）34(23.61)110（76.39）
Q3组142（25.00）16(11.27)126（88.73）
Q4组142（25.00）10(7.04)132（92.96）
WC分组23.299<0.001
正常383（67.43）41(10.70)342（89.30）
腹型肥胖185（32.57）49(26.49)136（73.51）
VFG分组41.974<0.001
正常333（58.63）25(7.51)308（92.49）
偏高171（30.11）47(27.49)124（72.51）
高64（11.27）18(28.13)46（71.88）
组别女性
女性人群(n（%）)IR阳性检出人群(n（%）)正常人群(n（%）)χ2P
BMI分组9.6730.022
偏瘦26（4.51）1(3.85)25（96.15）
正常284（49.31）7(2.46)277（97.54）
超重199（34.55）14(7.04)185（92.96）
肥胖67（11.63）5(7.46)62（92.54）
PBF分组5.1570.161
Q1组144（25.00）4(2.78)140（97.22）
Q2组139（24.13）4(2.88)135（97.12）
Q3组149（25.87）8(5.37)141（94.63）
Q4组144（25.00）11(7.64)133（92.36）
PBM分组3.8360.280
Q1组144（25.00）11(7.64)133（92.36）
Q2组143（24.83）6(4.20)137（95.80）
Q3组144（25.00）5(3.47)139（96.53）
Q4组145（25.17）5(3.45)140（96.55）
WC分组4.7280.030
正常406（70.49）14(3.45)392（96.55）
腹型肥胖170（29.51）13(7.65)157（92.35）
VFG分组7.5160.023
正常263（45.66）6(2.28)257（97.72）
偏高222（38.54）13(5.86)209（94.14）
高91（15.80）8(8.79)83（91.21）
), ArticleFig(id=1240651454910886559, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651445297541265, language=CN, label=表2, caption=

分性别不同体成分组人群的胰岛素抵抗阳性检出率的比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别男性
男性人群(n（%）)IR阳性检出人群(n（%）)正常人群(n（%）)χ2P
BMI分组37.008<0.001
偏瘦20（3.52）3(15.00)17（85.00）
正常226（39.79）14(6.19)212（93.81）
超重215（37.85）39(18.14)176（81.86）
肥胖107（18.84）34(31.78)73（68.22）
PBF分组21.428<0.001
Q1组141（24.82）7(4.96)134（95.04）
Q2组142（25.00）20(14.08)122（85.92）
Q3组142（25.00）30(21.13)112（78.87）
Q4组143（25.18）33(23.08)110（76.92）
PBM分组20.270<0.001
Q1组140（24.65）30(21.43)110（78.57）
Q2组144（25.35）34(23.61)110（76.39）
Q3组142（25.00）16(11.27)126（88.73）
Q4组142（25.00）10(7.04)132（92.96）
WC分组23.299<0.001
正常383（67.43）41(10.70)342（89.30）
腹型肥胖185（32.57）49(26.49)136（73.51）
VFG分组41.974<0.001
正常333（58.63）25(7.51)308（92.49）
偏高171（30.11）47(27.49)124（72.51）
高64（11.27）18(28.13)46（71.88）
组别女性
女性人群(n（%）)IR阳性检出人群(n（%）)正常人群(n（%）)χ2P
BMI分组9.6730.022
偏瘦26（4.51）1(3.85)25（96.15）
正常284（49.31）7(2.46)277（97.54）
超重199（34.55）14(7.04)185（92.96）
肥胖67（11.63）5(7.46)62（92.54）
PBF分组5.1570.161
Q1组144（25.00）4(2.78)140（97.22）
Q2组139（24.13）4(2.88)135（97.12）
Q3组149（25.87）8(5.37)141（94.63）
Q4组144（25.00）11(7.64)133（92.36）
PBM分组3.8360.280
Q1组144（25.00）11(7.64)133（92.36）
Q2组143（24.83）6(4.20)137（95.80）
Q3组144（25.00）5(3.47)139（96.53）
Q4组145（25.17）5(3.45)140（96.55）
WC分组4.7280.030
正常406（70.49）14(3.45)392（96.55）
腹型肥胖170（29.51）13(7.65)157（92.35）
VFG分组7.5160.023
正常263（45.66）6(2.28)257（97.72）
偏高222（38.54）13(5.86)209（94.14）
高91（15.80）8(8.79)83（91.21）
), ArticleFig(id=1240651455049298596, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651445297541265, language=EN, label=Table 3, caption=

Logistic regression analysis of body composition factors affecting insulin resistance by gender

, figureFileSmall=null, figureFileBig=null, tableContent=
变量男性女性
OR值（95%CI）POR值（95%CI）P
BMI分组
偏瘦4.43（0.40~49.63）0.2271.17（0.02~3.02）0.160
正常11
超重2.65（0.98~7.15）0.0545.04（0.82~65.16）0.073
肥胖5.58（1.98~15.72）0.0016.61（1.08~65.66）0.043
PBF分组
Q1组11
Q2组3.56（0.70~18.10）0.1271.48（0.12~18.63）0.762
Q3组7.90（1.68~37.15）0.0092.47（0.22~27.14）0.461
Q4组8.20（1.75~38.40）0.0086.27（0.64~61.28）0.114
PBM分组
Q1组11
Q2组0.66（0.29~1.50）0.3200.29（0.05~1.62）0.157
Q3组0.27（0.10~0.71）0.0080.32（0.08~2.06）0.282
Q4组0.09（0.02~0.44）0.0030.18（0.02~1.82）0.148
WC分组
正常11
腹型肥胖2.21（1.08~4.56）0.0312.02（0.54~7.58）0.296
VFG分组
正常11
偏高3.11（1.45~6.68）0.0046.11（0.65~57.35）0.113
高4.28（1.45~12.64）0.0098.52（1.90~70.86）0.012
), ArticleFig(id=1240651455166739115, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651445297541265, language=CN, label=表3, caption=

不同性别影响胰岛素抵抗的体成分因素logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量男性女性
OR值（95%CI）POR值（95%CI）P
BMI分组
偏瘦4.43（0.40~49.63）0.2271.17（0.02~3.02）0.160
正常11
超重2.65（0.98~7.15）0.0545.04（0.82~65.16）0.073
肥胖5.58（1.98~15.72）0.0016.61（1.08~65.66）0.043
PBF分组
Q1组11
Q2组3.56（0.70~18.10）0.1271.48（0.12~18.63）0.762
Q3组7.90（1.68~37.15）0.0092.47（0.22~27.14）0.461
Q4组8.20（1.75~38.40）0.0086.27（0.64~61.28）0.114
PBM分组
Q1组11
Q2组0.66（0.29~1.50）0.3200.29（0.05~1.62）0.157
Q3组0.27（0.10~0.71）0.0080.32（0.08~2.06）0.282
Q4组0.09（0.02~0.44）0.0030.18（0.02~1.82）0.148
WC分组
正常11
腹型肥胖2.21（1.08~4.56）0.0312.02（0.54~7.58）0.296
VFG分组
正常11
偏高3.11（1.45~6.68）0.0046.11（0.65~57.35）0.113
高4.28（1.45~12.64）0.0098.52（1.90~70.86）0.012
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不同性别社区人群体成分与胰岛素抵抗关联研究
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施俊 1, 2 , 葛志豪 1 , 任雅婷 1 , 王素芳 1
现代预防医学 | 疾病预防控制 2024,51(12): 2253-2261
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现代预防医学 | 疾病预防控制 2024, 51(12): 2253-2261
不同性别社区人群体成分与胰岛素抵抗关联研究
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施俊1, 2, 葛志豪1, 任雅婷1, 王素芳1
作者信息
  • 1.安徽医科大学公共卫生学院营养与食品卫生学系，安徽 合肥 230001
  • 2.合肥市瑶海区疾病预防控制中心慢性病和健康教育科

    • 施俊(1989—)，女，硕士在读，主管医师，研究方向：营养与慢性病

通讯作者:

王素芳，E-mail:
Associations between body composition and insulin resistance in different gender communities
Jun SHI1, 2, Zhi-hao GE1, Ya-ting REN1, Su-fang WANG1
Affiliations
  • Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Hefei, Anhui 230001, China
出版时间: 2024-06-25 doi: 10.20043/j.cnki.MPM.202403067
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摘要
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目的

分析不同性别一般人群的体成分与胰岛素抵抗（Insulin Resistance，IR）之间的关系。

方法

本研究数据来源于2021年中国居民心血管病及其危险因素监测项目合肥地区数据，共纳入1 144例研究对象，其中男性568人，女性576人。用甘油三酯（Triglyceride，TG）/高密度脂蛋白胆固醇（High Density Lipoprotein Cholesterol，HDL-C）作为IR的替代指标，采用卡方检验分析不同体成分（体质指数（Body Mass Index，BMI）、体脂百分比（Percentage Of Body Fat，PBF）、肌肉百分比（Percentage Of Body Muscle，PBM）、腰围（Waist Circumference，WC）和内脏脂肪等级（Visceral Fat Grade，VFG）组与TG/HDL-C之间的关系，采用logistic回归分析TG/HDL-C高于切点值的体成分影响因素，用限制性立方样条探究各体成分与TG/HDL-C之间的剂量反应关系。

结果

男性IR阳性检出率（TG/HDL-C高于切点值的率）为15.85%，女性为4.69%。在调整混杂因素后，logistic回归分析结果显示，与对照组相比，男性人群发生IR风险的体成分分组中，肥胖组是5.58倍（OR=5.58,95%CI:1.98~15.72），PBF第三四分位组是7.90倍（OR=7.90,95%CI:1.68~37.15），PBF第四四分位组是8.20倍（OR=8.20, 95%CI:1.75~38.40），PBM第三四分位组是0.27倍（OR=0.27, 95%CI:0.10~0.71），PBM第四四分位组是0.09倍（OR=0.09, 95%CI:0.02~0.44），VFG偏高组是3.11倍（OR=3.11, 95%CI:1.45~6.68），VFG高组是4.28倍（OR=4.28, 95%CI:1.45~12.64），腹型肥胖是2.21倍（OR=2.21, 95%CI:1.08~4.56）；女性人群发生IR风险的体成分分组中，肥胖组是6.61倍（OR=6.61, 95%CI:1.08~65.66），VFG高组是8.52倍（OR=8.52, 95%CI:1.90~70.86）（P<0.05）。限制性立方样条显示，BMI、PBF、PBM、VFG、WC均与TG/HDL-C存在剂量反应关系和近似线性关系。

结论

社区居民的体成分与发生胰岛素抵抗风险密切相关，肥胖人群以及高内脏脂肪人群发生胰岛素抵抗风险较高，应加强生活方式干预，保持较高肌肉率。

体成分  /  胰岛素抵抗  /  TG/HDL-C  /  剂量—反应关系
Objective

To examine the correlation between body composition and insulin resistance (IR) within the general population of different genders.

Methods

The data for this study were sourced from the Hefei area data of the Chinese Residents Cardiovascular Disease and Risk Factors Monitoring Project conducted in 2021, with a total of 1 144 subjects being included,including 568 males and 576 females. The ratio of triglycerides to high-density lipoprotein cholesterol (TG/HDL-C) was used as an alternative indicator of insulin resistance. A chi-square test was employed to analyze the association between body composition metrics—such as body mass index (BMI), percent body fat (PBF), percent body muscle (PBM), visceral fat area (VFG), and waist circumference (WC)—and the TG/HDL-C ratio. Logistic regression analysis was used to identify the factors influencing body composition in individuals with a TG/HDL-C ratio exceeding the tangent point value. The dose-response relationship between body components and the TG/HDL-C ratio was explored using restricted cubic splines, a statistical method that allows for the examination of nonlinear relationships.

Results

The positive detection rate of IR (the rate of TG/HDL-C above the cut point value) was 15.85% in men and 4.69% in women.After adjusting for confounding factors, logistic regression analysis showed that compared with the control group, the risk of IR in the male population was 5.58 times in the obese group (OR=5.58, 95%CI:1.98-15.72), PBF was 7.90 times in the third quartile (OR=7.90, 95%CI:1.68-37.15), the fourth quartile of PBF was 8.20 times (OR=8.20, 95%CI:1.75-38.40), and the third quartile of PBM was 0.27 times (OR=0.27, 95%CI:0.10-0.71), the PBM was 0.09 times in the fourth quartile group (OR=0.09, 95%CI:0.02-0.44), 3.11 times in the group with high VFG (OR=3.11, 95%CI:1.45-6.68), and 4.28 times in the group with higher VFG (OR=4.28, 95%CI:1.45-12.64). Abdominal obesity was 2.21 times (OR=2.21, 95%CI:1.08-4.56). In the female population, the risk of IR was 6.61 times in the obese group (OR=6.61, 95%CI:1.08-65.66) and 8.52 times in the higher VFG group (OR=8.52, 95%CI: 1.90-70.86) (P<0.05). The limited cubic spline showed that BMI, PBF, PBM, VFG, WC had dose-response relationship and approximate linear relationship with TG/HDL-C.

Conclusion

The body composition of community residents is closely associated with the risk of insulin resistance. Individuals who are obese or have high levels of visceral fat are at greater risk for insulin resistance. To mitigate this risk, it is imperative to reinforce lifestyle interventions that prioritize maintaining a higher percentage of muscle mass.

Body composition  /  Insulin resistance  /  TG/HDL-C  /  Dose-response relationship
施俊, 葛志豪, 任雅婷, 王素芳. 不同性别社区人群体成分与胰岛素抵抗关联研究. 现代预防医学, 2024 , 51 (12) : 2253 -2261 . DOI: 10.20043/j.cnki.MPM.202403067
Jun SHI, Zhi-hao GE, Ya-ting REN, Su-fang WANG. Associations between body composition and insulin resistance in different gender communities[J]. Modern Preventive Medicine, 2024 , 51 (12) : 2253 -2261 . DOI: 10.20043/j.cnki.MPM.202403067
正文
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胰岛素抵抗（Insulin Resistance，IR）是许多代谢性疾病的主要诱因，也是2型糖尿病发病的重要环节[1]。研究指出[2]，体重增加引起IR会增加糖尿病前期进展为糖尿病的患病风险，肥胖人群发生糖尿病的风险比正常体重人群高1.76倍[3]。2020年的报告显示[4]，中国成年居民有34.3%超重，而肥胖率达16.4%，形势不容乐观。相较于全身性肥胖，腹部肥胖者的IR程度显著高于腰围（Waist Circumference，WC）正常的人群，WC是影响IR的一个重要危险因素，而内脏脂肪等级（Visceral Fat Grade，VFG）相较于体质指数（Body Mass Index，BMI）和WC，能更好地预测代谢异常，并对IR的影响更大[5]。在2型糖尿病中，脂代谢的异常实际上是糖代谢紊乱的根本原因[6]。IR是2型糖尿病的重要发病机制，通过监测IR，可以评估居民罹患糖尿病其等他代谢性疾病的风险，并据此调节干预措施。
研究[7-11]发现甘油三酯（Triglyceride，TG）与高密度脂蛋白胆固醇（High Density Lipoprotein Cholesterol，HDL-C）的比值可以作为IR的反应指标，原因可能是基层医院医疗资源和胰岛素检验技术的缺乏和有限，寻找一种简便又准确的替代指标进行IR的筛查具有重要意义。
目前，国内外[12-13]的研究主要着眼于糖尿病患者或者糖尿病前期患者中某个单一体成分与IR的关系，而对于不同性别的一般人群中多个体成分与IR之间的关联研究则相对较少，本研究在合肥地区社区一般人群中开展，分性别探讨不同体成分与IR之间的关系，并采用IR替代指标分析影响IR的高危体成分因素，旨在探索做好社区居民发生代谢性疾病的预防控制工作。
1　材料（资料、内容）与方法
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1.1　调查对象
本研究数据来源于2021年中国居民心血管病及其危险因素监测项目合肥地区数据，在合肥某区共13个街道66个社居委中，通过简单随机抽样2个街道，在被抽中的街道中采用SRS方法分别抽取3个居委会，共计6个社居委，每个社居委采取SRS方法分性别（男女比1:1），以及按照18~<25岁、25~<35岁、35~<45岁、45~<55岁、55~<65岁、65~<75岁、≥75岁共计7个年龄段的全国人口构成比抽取常住居民作为调查对象，样本量计算以成人糖尿病患病率为主要依据指标，中国成人糖尿病患病率为11.9%[4]，以95%的可信度，允许误差2.13%，则样本量至少为887人，考虑到80%应答率，应调查人数为1 108名，本研究实际调查1 263人，去除不应答或存在缺失值等情况，获得有效样本1 200份。排除调查时已诊断为糖尿病或正在使用胰岛素、降糖药的人群，最终1 144例一般人群数据（男性568例，女性576例）纳入研究，年龄在18-87岁之间，平均年龄44.24±17.50岁。本研究获瑶海区疾病预防控制中心伦理委员会批准（YH2023008），调查对象均签署知情同意书。
1.2　调查方法
1.2.1　一般资料收集
通过问卷收集研究对象的年龄、性别、文化程度、婚姻、就业、吸烟、饮酒、饮茶和高血压患病情况。
1.2.2　a.人体成分测定
使用InBody H20人体成分分析仪对居民进行体成分测定。被测者于测试前2 h内空腹，测试前排空大小便，禁止剧烈运动和淋浴洗澡，女性避开经期，除去身上电子物品及重物，着轻便衣物并赤脚站于机器上，足部充分接触底部电极，双手充分接触手部电极。测定调查对象的体质量、肌肉量（骨骼肌含量）、体脂肪量、体脂百分比和内脏脂肪指数。
b.身高测量：使用HGM-300型超声身高体重仪，研究对象着轻薄衣物并脱鞋帽，直立站在仪器上，双臂自然放置在身体两侧，眼睛平视前方，读数结果取2次均值，精确至0.1 cm。
c.腰围测量：用无伸缩性软尺进行测量。要求被测者取站立位，双足自然分开，两臂环抱于胸前，以腋中线肋骨下缘和髂脊连线中点水平位置为测定点，标双侧测定点，软尺自然贴紧皮肤，通过两个测定点测量周径，于平静呼气中读数，精确到0.1cm，取两次平均值。
d.指标定义：BMI=体重（kg）/身高2（m2）：<18.5为偏瘦，18.5～23.9为正常，24.0～27.9为超重，≥28为肥胖[4]。体脂百分比（Percentage of Body Fat，PBF）和肌肉百分比（Percentage Of Body Muscle，PBM）：按照四分位法，分男女计算PBF和PBM的Q1，Q2和Q3界值数值，并进行第一、第二、第三和第四四分位分组。WC：分两组，正常组男性<90cm，女性<85cm；腹型肥胖组男性≥90 cm，女性≥85 cm[4]。VFG：正常组等级区间为1～9，偏高组等级区间为10～14，高组等级区间为15～30[14]。
1.2.3　生化指标测定
调查对象禁食12 h以上，清晨抽取静脉血5 ml，送检至合肥市千麦医学检验中心，采用罗氏Cobas C501全自动生化分析仪进行TG和HDL-C的检测。
1.2.4　IR替代指标
TG/HDL-C作为IR的一个独立影响因子和预测指标，已成为衡量和评估中国人IR的有效指标和可靠标记物，本研究以TG/HDL-C作为IR替代指标[7-11]，以TG/HDL-C比值≥2.27作为筛查IR的适宜切点[15]。
1.3　统计分析
本研究采用SPSS 23.0和R 4.3.3分析，计数资料用n（%）表示，采用卡方检验分析人口学指标、体成分（BMI、PBF、PBM、VFG和WC）分组与IR之间的关系，采用二元logistic回归分析IR高于切点值的体成分影响因素，用限制性立方样条探究各体成分与IR之间的剂量反应关系。检验水准α=0.05，双侧检验。
2　结果
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2.1　基本特征
共纳入1 144名研究对象，其中男性IR阳性检出人群（TG/HDL-C高于切点值）的人数占比为15.85%，女性为4.69%。在IR阳性检出人群和正常人群分组中，男性组中年龄段、婚姻、就业、吸烟、高血压和女性组中吸烟的差异均有统计学意义（P<0.05）。见表1。
2.2　研究人群不同体成分组的胰岛素抵抗情况
男性人群中，与对照组相比，肥胖组、PBF第四四分位组、PBM第一四分位组、VFG高组和腹型肥胖组的IR阳性检出人群占比较高。
女性人群中，与对照组相比，肥胖组、VFG高组和腹型肥胖组的IR阳性检出人群占比较高。见表2。
2.3　影响胰岛素抵抗的体成分因素logistic回归分析
以调查对象IR是否阳性检出为因变量，体成分分组为自变量。在调整8个人口学特征混杂因素后，结果显示，每个体成分与同组对照组相比，男性人群发生IR风险的体成分分组中，肥胖组是5.58倍（OR=5.58,95%CI:1.98~15.72），PBF第三四分位组是7.90倍（OR=7.90,95%CI:1.68~37.15），PBF第四四分位组是8.20倍（OR=8.20, 95%CI:1.75~38.40），PBM第三四分位组是0.27倍（OR=0.27, 95%CI:0.10~0.71），PBM第四四分位组是0.09倍（OR=0.09, 95%CI:0.02~0.44），VFG偏高组是3.11倍（OR=3.11, 95%CI:1.45~6.68），VFG高组是4.28倍（OR=4.28, 95%CI:1.45~12.64），腹型肥胖是2.21倍（OR=2.21, 95%CI:1.08~4.56）；女性人群发生IR风险的体成分分组中，肥胖组是6.61倍（OR=6.61, 95%CI:1.08~65.66），VFG高组是8.52倍（OR=8.52, 95%CI:1.90~70.86）（P<0.05）。见表3。
2.4　各体成分与胰岛素抵抗的剂量——反应关系
以体成分为X轴，左侧Y轴为IR阳性检出的OR值和95%的CI，在调整年龄、文化、婚姻、就业、吸烟、饮酒、饮茶和高血压情况混杂因素后，使用限制性立方样条模型（RCS）拟合结果显示，无论男性还是女性，BMI、PBF、PBM、VFG、WC均与TG/HDL-C分别存在剂量反应关系(P-Total<0.05)，且5种体成分与TG/HDL-C具有近似线性关系，其中男性P-Nonlinear(BMI)=0.151 1，P-Nonlinear(PBF)=0.053 3，P-Nonlinear(PBM)=0.124 3，P-Nonlinear(VFG)=0.203 2，P-Nonlinear(WC)=0.900 5；女性P-Nonlinear(BMI)=0.334 6，P-Nonlinear(PBF)=0.337 6，P-Nonlinear(PBM)=0.059 0，P-Nonlinear(VFG)=0.720 4，P-Nonlinear(WC)=0.654 0。见图1至图5。
3　讨论
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本研究中，男性IR阳性检出率为15.85%，且大于女性，说明社区人群发生IR的风险不容忽视，尤其是男性人群。IR是代谢综合征的关键特征之一，它与多种心血管危险因素相关联，影响IR的因素众多，包括疾病和非疾病因素，然而一般人群中，非疾病因素是影响IR的主要原因[16]。有研究[17]通过对日本健康体检人群进行分析，探讨IR与人体成分的关系，得出IR是日本成年人从胖到瘦身体成分的标志物，类似的研究[18]也证实一般人群中体成分与IR存在相关性。
既往研究中[19-20]，IR与体重、BMI、WC、PBF和内脏脂肪水平有很强的相关性。WC和BMI是评估IR及敏感性的有效工具，尤其是WC，它更适用于评估糖耐量正常人群IR的状况。有资料表明[21]，与人体总脂肪含量相比，中心性肥胖与IR的相关性更强。腹部脂肪沉积在各种代谢紊乱，包括IR的发病机制中起着关键作用，提示总体体脂含量在体内分布与IR相关。另有研究表明[22]，肌肉减少症与IR存在独立相关性，且肌肉减少症患者的IR程度更加严重。本研究发现无论男性还是女性，BMI、PBF、PBM、VFG、WC与IR均存在剂量反应关系和近似线性关系。在男性的肥胖组、PBF最高组、PBM最低组、VFG高组、腹型肥胖组和女性的肥胖组、VFG高组和腹型肥胖组的社区居民中，IR阳性检出率均较高，可能是由于人体脂肪含量增加，肌肉减少，炎症水平增高，加剧了IR的发生。这与体成分和IR关系的既往研究相似，表明TG/HDL-C是IR的有效预测因子，且体成分指标对于IR的预测有一定的临床应用价值。
回归分析结果显示，男性的肥胖组、PBF的第三四分位和第四四分位组、VFG的偏高组和高组、腹型肥胖组是发生IR的危险因素，PBM的第三四分位和第四四分位组是发生IR的保护因素；女性的肥胖组、VFG的高组是发生IR的危险因素。这与既往研究中内脏脂肪指数比腹壁脂肪指数更能预测IR[13]，肥胖是IR和2型糖尿病的通道[23]的结论相似，提示肥胖、体脂含量高以及内脏型肥胖的人群更易发生IR，保持身体较高的肌肉率对于维持IR水平的正常至关重要，而稳定控制胰岛素水平有助于有效地预防糖尿病等代谢性疾病的发生。男女研究结果的差异可能源于不同性别的身体成分构成和分布的不同，从而导致体成分与IR之间的关联在男性人群中的研究结果更具有显著性。
本研究来自国家项目，分层抽样较为合理和均匀，且人体测量和生化指标检测结果较为客观，偏倚性较少，但由于是横断面研究，较难得出体成分和IR的因果关系，且以合肥地区为调查对象，结果推广到其他人群还有待进一步研究。
综上所述，社区居民想要减缓代谢性的疾病发生，应首先进行生活方式的干预，建议超重或腹型肥胖者在初期减重5%~10%[24]，以降低体重，减少内脏脂肪，保持正常的体脂率和肌肉率。
基金
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  • 国家自然科学基金(81102125)
文献
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参考文献 引证文献
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2024年第51卷第12期
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doi: 10.20043/j.cnki.MPM.202403067
  • 接收时间：2024-03-05
  • 首发时间：2026-03-17
  • 出版时间：2024-06-25
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  • 收稿日期：2024-03-05
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国家自然科学基金(81102125)
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    1.安徽医科大学公共卫生学院营养与食品卫生学系，安徽 合肥 230001
    2.合肥市瑶海区疾病预防控制中心慢性病和健康教育科

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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