Abstract
OBJECTIVE--To examine the hypothesis, in a community not studied before, that insulin resistance associated with centralised adiposity is the mechanism underlying the predisposition of Asian immigrant communities to both ischaemic heart disease and diabetes mellitus. DESIGN--Cross sectional study within one socioeconomic stratum. SETTING--Two factories in the textile sector in Bradford, West Yorkshire. SUBJECTS--Male manual workers of Asian (110) and non-Asian origin (156) aged 20-65 years. RESULTS--Diabetes was almost three times more prevalent in the Asian group. Two hours after an oral glucose load Asian men had double the serum insulin concentrations of non-Asian men (p < 0.0001). Asian men also had significantly lower concentrations of plasma total cholesterol (p < 0.03), high density lipoprotein cholesterol (HDL) (HDL2, p < 0.0001; HDL3, p < 0.0001), and apolipoprotein AI (p < 0.0001). Fasting plasma triglyceride concentrations were slightly higher (p = 0.072) in the Asian men; thus the ratio of triglyceride cholesterol was higher (p = 0.006). The inter-relation between serum insulin and plasma lipid concentrations indicated metabolic differences between the ethnic groups. Insulin concentrations were associated with cholesterol concentrations in the Asian men only and there was a lack of association between triglyceride, low density lipoprotein cholesterol, and HDL cholesterol in this group. The risk marker profile in the Asian men was therefore quite different to that of their non-Asian counterparts and was associated with a greater tendency to centralised adiposity. CONCLUSION--These data support the insulin resistance hypothesis and thus have important implications for strategies for the prevention of heart disease in Asian communities in the United Kingdom.
Full text
PDF







Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Allain C. C., Poon L. S., Chan C. S., Richmond W., Fu P. C. Enzymatic determination of total serum cholesterol. Clin Chem. 1974 Apr;20(4):470–475. [PubMed] [Google Scholar]
- Ashwell M., Cole T. J., Dixon A. K. Obesity: new insight into the anthropometric classification of fat distribution shown by computed tomography. Br Med J (Clin Res Ed) 1985 Jun 8;290(6483):1692–1694. doi: 10.1136/bmj.290.6483.1692. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Balarajan R. Ethnic differences in mortality from ischaemic heart disease and cerebrovascular disease in England and Wales. BMJ. 1991 Mar 9;302(6776):560–564. doi: 10.1136/bmj.302.6776.560. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bucolo G., David H. Quantitative determination of serum triglycerides by the use of enzymes. Clin Chem. 1973 May;19(5):476–482. [PubMed] [Google Scholar]
- Friedewald W. T., Levy R. I., Fredrickson D. S. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972 Jun;18(6):499–502. [PubMed] [Google Scholar]
- Garg A., Helderman J. H., Koffler M., Ayuso R., Rosenstock J., Raskin P. Relationship between lipoprotein levels and in vivo insulin action in normal young white men. Metabolism. 1988 Oct;37(10):982–987. doi: 10.1016/0026-0495(88)90157-6. [DOI] [PubMed] [Google Scholar]
- Gidez L. I., Miller G. J., Burstein M., Slagle S., Eder H. A. Separation and quantitation of subclasses of human plasma high density lipoproteins by a simple precipitation procedure. J Lipid Res. 1982 Nov;23(8):1206–1223. [PubMed] [Google Scholar]
- Kukita H., Hamada M., Hiwada K., Kokubu T. Clinical significance of measurements of serum apolipoprotein A-I, A-II and B in hypertriglyceridemic male patients with and without coronary artery disease. Atherosclerosis. 1985 May;55(2):143–149. doi: 10.1016/0021-9150(85)90093-0. [DOI] [PubMed] [Google Scholar]
- McKeigue P. M., Marmot M. G., Syndercombe Court Y. D., Cottier D. E., Rahman S., Riemersma R. A. Diabetes, hyperinsulinaemia, and coronary risk factors in Bangladeshis in east London. Br Heart J. 1988 Nov;60(5):390–396. doi: 10.1136/hrt.60.5.390. [DOI] [PMC free article] [PubMed] [Google Scholar]
- McKeigue P. M., Miller G. J., Marmot M. G. Coronary heart disease in south Asians overseas: a review. J Clin Epidemiol. 1989;42(7):597–609. doi: 10.1016/0895-4356(89)90002-4. [DOI] [PubMed] [Google Scholar]
- McKeigue P. M., Shah B., Marmot M. G. Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet. 1991 Feb 16;337(8738):382–386. doi: 10.1016/0140-6736(91)91164-p. [DOI] [PubMed] [Google Scholar]
- Miller G. J., Beckles G. L., Alexis S. D., Byam N. T., Price S. G. Serum lipoproteins and susceptibility of men of Indian descent to coronary heart disease. The St James Survey, Trinidad. Lancet. 1982 Jul 24;2(8291):200–203. doi: 10.1016/s0140-6736(82)91041-8. [DOI] [PubMed] [Google Scholar]
- Miller G. J., Kotecha S., Wilkinson W. H., Wilkes H., Stirling Y., Sanders T. A., Broadhurst A., Allison J., Meade T. W. Dietary and other characteristics relevant for coronary heart disease in men of Indian, West Indian and European descent in London. Atherosclerosis. 1988 Mar;70(1-2):63–72. doi: 10.1016/0021-9150(88)90100-1. [DOI] [PubMed] [Google Scholar]
- NEEL J. V. Diabetes mellitus: a "thrifty" genotype rendered detrimental by "progress"? Am J Hum Genet. 1962 Dec;14:353–362. [PMC free article] [PubMed] [Google Scholar]
- Reaven G. M. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes. 1988 Dec;37(12):1595–1607. doi: 10.2337/diab.37.12.1595. [DOI] [PubMed] [Google Scholar]
- Rifai N., King M. E. Immunoturbidimetric assays of apolipoproteins A, AI, AII, and B in serum. Clin Chem. 1986 Jun;32(6):957–961. [PubMed] [Google Scholar]
- Rubenstein A. H., Seftel H. C., Miller K., Bersohn I., Wright A. D. Metabolic response to oral glucose in healthy South African white, Indian, and African subjects. Br Med J. 1969 Mar 22;1(5646):748–751. doi: 10.1136/bmj.1.5646.748. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Stern M. P., Haffner S. M. Body fat distribution and hyperinsulinemia as risk factors for diabetes and cardiovascular disease. Arteriosclerosis. 1986 Mar-Apr;6(2):123–130. doi: 10.1161/01.atv.6.2.123. [DOI] [PubMed] [Google Scholar]
- Tobey T. A., Greenfield M., Kraemer F., Reaven G. M. Relationship between insulin resistance, insulin secretion, very low density lipoprotein kinetics, and plasma triglyceride levels in normotriglyceridemic man. Metabolism. 1981 Feb;30(2):165–171. doi: 10.1016/0026-0495(81)90167-0. [DOI] [PubMed] [Google Scholar]