title: Gender-related differences in the metabolic response to fasting.
abstract: BACKGROUND
  Free fatty acids (FFA) may induce insulin resistance via synthesis of intramyocellular ceramide. During fasting, women have lower plasma glucose levels than men despite higher plasma FFA, suggesting protection from FFA-induced insulin resistance.
  
  
  OBJECTIVE
  We studied whether the relative protection from FFA-induced insulin resistance during fasting in women is associated with lower muscle ceramide concentrations compared with men. MAIN OUTCOME MEASURES AND DESIGN: After a 38-h fast, measurements of glucose and lipid fluxes and muscle ceramide and fatty acid translocase/CD36 were performed before and after a hyperinsulinemic euglycemic clamp.
  
  
  RESULTS
  Plasma glucose levels were significantly lower in women than men with a trend for a lower endogenous glucose production in women, whereas FFA and lipolysis were significantly higher. Insulin-mediated peripheral glucose uptake was not different between sexes. There was no gender difference in muscle ceramide in the basal state, and ceramide did not correlate with peripheral glucose uptake. Muscle fatty acid translocase/CD36 was not different between sexes in the basal state and during the clamp.
  
  
  CONCLUSIONS
  After 38 h of fasting, plasma FFA were higher and plasma glucose was lower in women compared with men. The higher plasma FFA did not result in differences in peripheral insulin sensitivity, possibly because of similar muscle ceramide and fatty acid translocase/CD36 levels in men and women. We suggest that during fasting, women are relatively protected from FFA-induced insulin resistance by preventing myocellular accumulation of ceramide.
authors.affiliation: Department of Endocrinology and Metabolism, Laboratory of Endocrinology, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands. m.r.soeters@amc.uva.nl
authors.forename: Maarten R
authors.initials: MR
authors.lastname: Soeters
authors.forename: Hans P
authors.initials: HP
authors.lastname: Sauerwein
authors.forename: Johanna E
authors.initials: JE
authors.lastname: Groener
authors.forename: Johannes M
authors.initials: JM
authors.lastname: Aerts
authors.forename: Mariëtte T
authors.initials: MT
authors.lastname: Ackermans
authors.forename: Jan F C
authors.initials: JF
authors.lastname: Glatz
authors.forename: Eric
authors.initials: E
authors.lastname: Fliers
authors.forename: Mireille J
authors.initials: MJ
authors.lastname: Serlie
mesh_terms: D052242:Adiponectin / Q000097:blood; D000293:Adolescent; D000328:Adult; D001481:Basal Metabolism; D001786:Blood Glucose / Q000032:analysis; D018955:CD36 Antigens / Q000032:analysis; D002518:Ceramides / Q000032:analysis; D004734:Energy Metabolism / Q000502:physiology; D005215:Fasting / Q000097:blood / Q000378:metabolism*; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005260:Female; D005934:Glucagon / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007328:Insulin / Q000097:blood; D008297:Male; D018482:Muscle, Skeletal / Q000737:chemistry; D012727:Sex Characteristics
chemical_list: C499918:ADIPOQ protein, human; D052242:Adiponectin; D001786:Blood Glucose; D018955:CD36 Antigens; D002518:Ceramides; D005230:Fatty Acids, Nonesterified; D007328:Insulin; D005934:Glucagon; D006854:Hydrocortisone