Previous studies have shown that Asian Indians (Als) are insulin resistant
and at high risk for developing diabetes and coronary heart disease, compar
ed with Caucasians. To examine whether differences in body fat distribution
contribute to this risk, 12 healthy Als and 12 Caucasians matched for age
and body mass index (BMI) underwent a 75-g oral glucose tolerance test, 2-h
euglycemic hyperinsulinemic clamp, abdominal (L2-3) computed tomography sc
an, and fasting lipid and plasminogen activator inhibitor-1 (PAI-1) levels.
Despite similar fasting plasma glucose levels, AIs exhibited fasting hyper
insulinemia (P = 0.001), higher glucose (P = 0.03) and insulin (P = 0.004)
levels during the oral glucose tolerance test, and reduced glucose disposal
rate (R-d) (4.7 +/- 0.4 as. 7.5 +/- 0.3 mg/kg per min, P < 0.0001) during
the clamp. AIs had significantly lower high-density lipoprotein, higher low
-density lipoprotein, and significantly higher PAI-1 levels (P = 0.01). Des
pite similar BMI, Als had significantly greater total abdominal fat (P = 0.
04) and visceral fat (P = 0.04). In all subjects, measures of fat mass were
inversely correlated with Rd during the clamp (r = -0.47 to -0.61, P < 0.0
1-0.001). Visceral fat mass was correlated with triglycerides, low-density
lipoprotein, and high-density lipoprotein (P < 0.002-0.0001). PAI-1 was inv
ersely correlated with Rd in Als (r = -0.70, P < 0.01) and not in Caucasian
s (r = -0.24, P = 0.44). For comparable BMI and age, healthy AIs have physi
ologic markers for insulin resistance, dyslipidemia, and increased cardiova
scular risk, compared with Caucasians. Alterations in body fat distribution
-particularly increased visceral fat-may contribute to these abnormalities.