Aims/hypothesis

Type 2 diabetes confers a greater relative increase in CVD risk in women compared with men. We examined sex differences in intraorgan fat and hepatic VLDL1-triacylglycerol (VLDL1-TG) export before and after major dietary weight loss.

Methods

A group with type 2 diabetes (n = 64, 30 male/34 female) and a group of healthy individuals (n = 25, 13 male/12 female) were studied. Intraorgan and visceral fat were quantified by magnetic resonance and VLDL1-TG export by intralipid infusion techniques.

Results

Triacylglycerol content of the liver and pancreas was elevated in people with diabetes with no sex differences (liver 16.4% [9.3–25.0%] in women vs 11.9% [7.0–23.1%] in men, p = 0.57, and pancreas 8.3 ± 0.5% vs 8.5 ± 0.4%, p = 0.83, respectively). In the absence of diabetes, fat levels in both organs were lower in women than men (1.0% [0.9–1.7%] vs 4.5% [1.9–8.0%], p = 0.005, and 4.7 ± 0.4% vs 7.6 ± 0.5%, p< 0.0001, respectively). Women with diabetes had higher hepatic VLDL1-TG production rate and plasma VLDL1-TG than healthy women (559.3 ± 32.9 vs 403.2 ± 45.7 mg kg⁻¹ day⁻¹, p = 0.01, and 0.45 [0.26–0.77] vs 0.25 [0.13–0.33] mmol/l, p = 0.02), whereas there were no differences in men (548.8 ± 39.8 vs 506.7 ± 29.2 mg kg⁻¹ day⁻¹, p = 0.34, and 0.72 [0.53–1.15] vs 0.50 [0.32–0.68] mmol/l, p = 0.26). Weight loss decreased intraorgan fat and VLDL1-TG production rates regardless of sex, and these changes were accompanied by similar rates of diabetes remission (65.4% vs 71.0%) and CVD risk reduction (59.8% vs 41.5%) in women and men, respectively.

Conclusions/interpretation

In type 2 diabetes, women have liver and pancreas fat levels as high as those of men, associated with raised hepatic VLDL1-TG production rates. Dynamics of triacylglycerol turnover differ between sexes in type 2 diabetes and following weight loss. These changes may contribute to the disproportionately raised cardiovascular risk of women with diabetes.

Graphical abstract

中文翻译：

---

器官内脂肪水平和肝脏脂质代谢的性别差异：饮食减肥后对心血管健康和2型糖尿病缓解的影响

目标/假设

与男性相比，2 型糖尿病导致女性 CVD 风险相对增加更大。我们检查了主要饮食减肥前后器官内脂肪和肝脏 VLDL1-三酰甘油 (VLDL1-TG) 输出的性别差异。

方法

对一组 2 型糖尿病患者（n  = 64，30 名男性/34 名女性）和一组健康个体（n  = 25，13 名男性/12 名女性）进行了研究。通过磁共振定量器官内和内脏脂肪，并通过脂肪注射技术输出 VLDL1-TG。

结果

糖尿病患者肝脏和胰腺的三酰甘油含量升高，无性别差异（女性肝脏为 16.4% [9.3–25.0%]，男性为 11.9% [7.0–23.1%]，p =  0.57，胰腺为 8.3 ± 0.5 % 与 8.5 ± 0.4%，分别为p  = 0.83）。在没有糖尿病的情况下，女性两个器官的脂肪水平均低于男性（1.0% [0.9–1.7%] vs 4.5% [1.9–8.0%]，p  = 0.005，以及 4.7 ± 0.4% vs 7.6 ± 0.5%） ，p < 0.0001，分别）。糖尿病女性的肝脏 VLDL1-TG 生成率和血浆 VLDL1-TG 高于健康女性（559.3 ± 32.9 vs 403.2 ± 45.7 mg kg ⁻¹  day ⁻¹，p  = 0.01，以及 0.45 [0.26–0.77] vs 0.25 [0.13） –0.33] mmol/l，p  = 0.02），而男性则没有差异（548.8 ± 39.8 vs 506.7 ± 29.2 mg kg ⁻¹  day ⁻¹，p  = 0.34，以及 0.72 [0.53–1.15] vs 0.50 [0.32 –0.68] 毫摩尔/升，p  = 0.26）。无论性别如何，体重减轻都会降低器官内脂肪和 VLDL1-TG 生成率，这些变化伴随着女性和男性糖尿病缓解率（65.4% vs 71.0%）和 CVD 风险降低率（59.8% vs 41.5%）相似。 。

结论/解释

在 2 型糖尿病中，女性的肝脏和胰腺脂肪水平与男性一样高，这与肝脏 VLDL1-TG 生成率升高有关。在 2 型糖尿病和减肥后，三酰甘油周转的动态在性别之间存在差异。这些变化可能会导致女性糖尿病患者的心血管风险异常升高。

图形概要