title: Determinants of insulin-resistant phenotypes in normal-weight and obese Black African women.
abstract: OBJECTIVE
  Subsets of metabolically "healthy obese" and "at-risk" normal-weight individuals have been previously identified. The aim of this study was to explore the determinants of these phenotypes in black South African (SA) women.
  
  
  METHODS
  From a total of 103 normal-weight (BMI <or= 25 kg/m(2)) and 122 obese (BMI >or= 30 kg/m(2)) black SA women, body composition, fat distribution, blood pressure, fasting glucose levels, insulin resistance, and lipid profiles were measured. Questionnaires relating to family history, physical activity energy expenditure (PAEE), and socio-demographic variables were administered. The subjects were classified as insulin sensitive or insulin resistant according to the homeostasis model assessment of insulin resistance (HOMA-IR) (>or=1.95 insulin resistant).
  
  
  RESULTS
  Our study showed that 22% of the normal-weight women were insulin resistant and 38% of the obese women were insulin sensitive. Increased visceral adipose tissue (VAT) (P=0.001) and decreased VAT/leg fat mass (P <or= 0.001), independent of total body fatness, distinguished between the phenotypes. Moreover, the insulin-sensitive women were of higher socioeconomic status, did more leisure and vigorous PAEE and were less likely to use injectable contraceptives. Using a regression model, body fat distribution, percent body fat, age, log leisure PAEE, and use of injected contraception accounted for 35% of the variance in HOMA-IR in the normal-weight women. In the obese women, 34% of the variance in HOMA-IR was explained by the same variables, excluding PAEE. No differences in smoking status or family history of metabolic disease were found between the phenotypes.
  
  
  CONCLUSIONS
  Central fat distribution, total adiposity, socioeconomic status, leisure PAEE, and use of injectable contraceptives distinguished between insulin-sensitive and insulin-resistant black SA women.
authors.affiliation: UCT/MRC Research Unit for Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: Courtney L
authors.initials: CL
authors.lastname: Jennings
authors.forename: Estelle V
authors.initials: EV
authors.lastname: Lambert
authors.forename: Malcolm
authors.initials: M
authors.lastname: Collins
authors.forename: Yael
authors.initials: Y
authors.lastname: Joffe
authors.forename: Naomi S
authors.initials: NS
authors.lastname: Levitt
authors.forename: Julia H
authors.initials: JH
authors.lastname: Goedecke
mesh_terms: D050154:Adiposity / Q000208:ethnology; D000328:Adult; D044383:Black People / Q000706:statistics & numerical data*; D015992:Body Mass Index; D001835:Body Weight; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000009:adverse effects; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D007267:Injections; D007333:Insulin Resistance / Q000208:ethnology*; D009043:Motor Activity; D009765:Obesity / Q000208:ethnology* / Q000503:physiopathology; D010641:Phenotype; D012016:Reference Values; D012307:Risk Factors; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014504:Urban Health / Q000706:statistics & numerical data
chemical_list: D003271:Contraceptive Agents, Female