Recognition of borderline carbohydrate-lipid metabolism disturbance: an incipient form of type IV hyperlipoproteinemia?
Blood glucose and insulin responses to oral glucose were measured in 33 men: 8 normal, 13 with borderline carbohydrate-lipid metabolism disturbance (BCLMD) (pre-beta-lipoproteinemia with normal cholesterol and triglyceride levels), and 12 with mild Type IV hyperlipoproteinemia. Average age was 30 years, and the percentage of ideal weight was 101%. Borderline patients exhibited hyperinsulinemia following oral glucose, notably at 30 min; they also demonstrated an apparent impairment in homeostatic control of blood glucose level, with a greater-than-normal decline in blood glucose in the 3- to 4-h period (by profile analysis). The Type IV patients, though of normal weight and adiposity, exhibited elevated late incremental insulin area (LIIA) (1-5 h) responses. Combining all data, fasting triglycerides correlated with LIIA (p = 0.0002); LIIA correlated with the percentage of adipose mass (p = 0.003), suggesting that LIIA reflects insulin resistance. Lipoprotein electrophoresis remains useful for detecting pre-beta-lipoproteinemia, which may occur even in persons with normal cholesterol and triglyceride levels. When present, it suggests the possibility of hyperinsulinemia following glucose ingestion, which in turn has been shown to be an independent predictor for the development of coronary heart disease. To gain increased understanding of the natural history of hypertriglyceridemia, persons with BCLMD should be studied separately from those with normal lipid and carbohydrate metabolism and from those with hypertriglyceridemia.
Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor.
D R
DR
Bassett
W D
WD
Block
E N
EN
Dean
A A
AA
White
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D050260:Carbohydrate Metabolism; D002784:Cholesterol / Q000097:blood; D004032:Diet; D005951:Glucose Tolerance Test; D006801:Humans; D006953:Hyperlipoproteinemia Type IV / Q000378:metabolism*; D007328:Insulin / Q000097:blood; D050356:Lipid Metabolism; D008297:Male; D008659:Metabolic Diseases / Q000378:metabolism*; D012044:Regression Analysis; D014280:Triglycerides / Q000097:blood
D001786:Blood Glucose; D007328:Insulin; D014280:Triglycerides; D002784:Cholesterol