oa Postprandial Hyperinsulinaemia And Hyperproinsulinaemia Are Early Predictors Of Cardiovascular Disease In Apparently Healthy Young Qatari Women

Background. Insulin resistance and the prevalence of diabetes are high in the Middle Eastern population and in people of South Asian origin. Because of epidemic proportions that diseases have reached in these populations. It is important to find early markers along with preventative interventions. Recent data indicates that the metabolic defect in the pre-diabetic condition relates more strongly to post-prandial deficiency than to the fasted state. Women have lower levels of risk factors for metabolic disease when assessed in the post-absorptive state. However, very few reports have investigated these in the post-prandial state, especially amongst an Arab population. Objectives. This study investigated systemic cardiovascular risk factors both in the fasted and post-prandial state in a healthy, non-diabetic female local population. Methods. A cohort of young female, non-diabetic subjects representative of a general Qatari population was recruited. The study was approved by the national ethical committee and all subjects gave written informed consent. Subjects attended after an overnight fast and blood samples were taken prior to and 30 and 120 minutes after ingesting a liquid mixed meal. Anthropometric measures included age, height, weight, blood pressure and pulse. Bioimpedance was used to measure body fat (%, mass and distribution) andBasel Metabolic Rate {BMR},(Tanita MC-980). Glucose (hexokinase, Roche), lipids (Roche), insulin and proinsulin (Mercodia),Glucose like peptide1 {GLP-1},(Millipore) and adipokines (R & D Systems) were all determined. Data were analysed by SPSS version 22.0 for windows. Parametric tests were used for normally distributed data and non-parametric analysis for skewed dataare shown in the text as Mean {SD} or Median {Interquertal range }. Results. The subjects were young (Age 29.8 {4.9} years), non-obese (BMI 25.6 {4.7} kg/m2}, normotensive (systolic BP 109 {10} and diastolic BP 72 {6} mmHg) and normolipidaemic (Total-cholesterol 3.5 {0.7}, LDL-cholesterol 2.0 {0.4}, HDL-cholesterol 1.3 {0.3}, triglycerides 0.6 {0.2} mmol/L). Their total body fat was relatively high (34 {6.5} %), which was reflected by elevated levels of systemic leptin (30.8 {17.5-53.0} ng/ml) and lower adiponectin (8.1 {6.0-11.3} ?g/ml). Despite no apparent fasting or post-prandial hyperglycaemic and HOMA-IR levels being normal, post-prandial hyperinsulinaemia and hyperproinsulinaemia were significant (see Table). Proinsulin also constituted 19% of total insulin-like molecules. Discussion. Young normal-weight Qatari women with no apparent metabolic disease are hyperinsulinaemic and hyperproinsulinaemic in the fed state. Thus, elevated post-prandial levels of insulin-like molecules may be an early, sensitive marker for the metabolic defect that precedes cardiometabolic disease in this population. Table. Fasting and post-prandial concentrations of insulin-like molecules VariablesFasting30 minutes120 minutes Glucose (mmol/L)4.6 (0.3)5.0 (0.7)4.3 (0.5) Insulin (mIU/L)5.1 (4.0-6.3)50.5 (31.5-57.9)28.8 (23.2-37.4) Proinsulin (pmol/L)8.1 (5.7-11.4)22.3 (14.0-38.7)34.3 (22.0-49.6) GLP-1 (pmol/L)2.0 (1.8-2.4)8.4 (6.0-11.3)7.0 (3.3-9.6) Data ar shown as mean (SD) or median (interquartile range).