title: Gender differences in insulin resistance, body composition, and energy balance.
abstract: BACKGROUND
  Men and women differ substantially in regard to degrees of insulin resistance, body composition, and energy balance. Adipose tissue distribution, in particular the presence of elevated visceral and hepatic adiposity, plays a central role in the development of insulin resistance and obesity-related complications.
  
  
  OBJECTIVE
  This review summarizes published data on gender differences in insulin resistance, body composition, and energy balance, to provide insight into novel gender-specific avenues of research as well as gender-tailored treatments of insulin resistance, visceral adiposity, and obesity.
  
  
  METHODS
  English-language articles were identified from searches of the PubMed database through November 2008, and by reviewing the references cited in these reports. Searches included combinations of the following terms: gender, sex, insulin resistance, body composition, energy balance, and hepatic adipose tissue.
  
  
  RESULTS
  For a given body mass index, men were reported to have more lean mass, women to have higher adiposity. Men were also found to have more visceral and hepatic adipose tissue, whereas women had more peripheral or subcutaneous adipose tissue. These differences, as well as differences in sex hormones and adipokines, may contribute to a more insulin-sensitive environment in women than in men. When normalized to kilograms of lean body mass, men and women had similar resting energy expenditure, but physical energy expenditure was more closely related to percent body fat in men than in women.
  
  
  CONCLUSIONS
  Greater amounts of visceral and hepatic adipose tissue, in conjunction with the lack of a possible protective effect of estrogen, may be related to higher insulin resistance in men compared with women.
authors.affiliation: Division of Endocrinology, Department of Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA. eliza.geer@mssm.edu
authors.forename: Eliza B
authors.initials: EB
authors.lastname: Geer
authors.forename: Wei
authors.initials: W
authors.lastname: Shen