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Sex Differences in the Associations Between Visceral Adiposity and Hepatic Insulin Clearance in Type 2 Diabetes
Aiping Yang1, Fan Pu1, Yiwan Guo1
1Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan 430022, China; Hubei Provincial Clinical Research Center for Precision Radiology & Interventional Medicine, Wuhan 430022, China; Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China.
Aims:
To investigate sex-related differences in the association of body fat distribution with hepatic insulin clearance (HIC) in type 2 diabetes mellitus (T2DM), determining whether HIC associates more strongly with static hepatic steatosis or visceral adiposity.
Methods:
We retrospectively analyzed 234 inpatients with T2DM (146 men, 88 women). Regional and ectopic fat were quantified via deep-learning computed tomography (CT). HIC was derived from oral glucose tolerance tests. Multivariable regression and propensity score matching (PSM) identified independent HIC determinants.
Results:
Men had larger visceral adipose tissue (VAT) areas; women had higher hepatic fat. VAT was independently associated with systemic insulin resistance. After adjusting for insulin resistance, VAT was positively associated with HIC in women (β = 0.395, P = 0.008), but not men (β = -0.047, P = 0.636). These patterns persisted in the PSM cohort (P for interaction = 0.025), even after additional adjustment for insulin resistance (P for interaction = 0.07). CT-assessed hepatic fat showed no independent association with HIC.
Conclusions:
The association between visceral adiposity and HIC is sex-related, with preserved adaptation in women but not in men. Visceral adiposity is more strongly associated with clearance dynamics than static hepatic steatosis, improving the pathophysiological characterization of T2DM.
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