Bedeutung der Körperfettverteilung für die Entstehung von Insulinresistenz und Typ-2-Diabetes

Zusammenfassung

Während die Bedeutung der generalisierten und abdominellen Adipositas für die Insulinresistenz und das gesteigerte Diabetesrisiko in epidemiologischen und experimentellen Untersuchungen in der Vergangenheit umfassend demonstriert wurde, ist die Bedeutung der viszeralen bzw. subkutanen abdominalen Fettverteilung diesbezüglich noch nicht hinreichend klar. Eine Vielzahl von epidemiologischen Daten deutet auf ein vermehrtes Auftreten von Insulinresistenz und ein erhöhtes Diabetesrisiko bei viszeraler Adipositas hin. Dabei spielen möglicherweise die erhöhten freien Fettsäuren, eine vermehrte Aktivität der 11β-Hydroxysteroid-Dehydrogenase Typ 1, niedrigere Testosteron- und Wachstumshormonspiegel oder die vermehrte Bildung von Plasminogen-Aktivator-Inhibitor-1 und von Zytokinen, wie TNF-α und IL-6, eine wichtige Rolle. Insgesamt bleiben bezüglich des subkutanen Abdominalfettes noch viele Fragen ungeklärt. Möglicherweise trägt dieses aber entscheidend zur pathogenen Rolle des Abdominalfettes bei. Aktuell findet sich eine wachsende Evidenz für die metabolische Bedeutung weiterer Fettkompartimente, wie z. B. dem intramuskulären Lipidgehalt.

Abstract

The effect of generalized obesity and particularly central body fat distribution on insulin resistance and incidence of type 2 diabetes was convincingly demonstrated in epidemiological and experimental studies. However, the impact of visceral and subcutaneous abdominal fat depots remains unclear. Various epidemiological data suggested an increased risk of insulin resistance and type 2 diabetes in individuals with visceral obesity. High free fatty acids, elevated activity of 11β-hydroxysteroid dehydrogenase type 1 in visceral adipose tissue, low levels of testosterone, growth hormone and IGF-1 or the increased secretion of plasminogen activator inhibitor-1 and of several cytokines, like TNF-α and IL-6 are candidates potentially mediating these effects. The impact of other abdominal fat compartments like subcutaneous abdominal adipose tissue is still under debate, even if some studies indicate a separate effect of this fat compartment on insulin resistance and glucose tolerance. Furthermore a growing body of evidence suggests insulin resistance inducing effects of increased intramyocellular lipid levels. However, the precise impact of the muscular lipid content and the mechanisms linking intramyocellular fat and insulin resistance are still not fully understood.

Schlüsselwörter

abdominelle Adipositas - viszerales Fettgewebe - subkutanes Fettgewebe - Diabetes mellitus - Insulinresistenz - Fettgewebshormone

Key words

abdominal obesity - visceral fat - subcutaneous fat - diabetes mellitus - insulin resistance - adipocytokines

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