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Epidemiology/Health services research
Bidirectional temporal relationship between obesity and hyperinsulinemia: longitudinal observation from a Chinese cohort
  1. Chao Xu1,2,3,
  2. Guangshuai Zhou4,5,
  3. Meng Zhao1,2,3,
  4. Xu Zhang1,2,3,
  5. Li Fang1,2,3,
  6. Qingbo Guan1,2,3,
  7. Haiqing Zhang1,2,3,
  8. Ling Gao2,3,6,
  9. Tao Zhang4,
  10. Jiajun Zhao1,2,3
  1. 1Department of Endocrinology and Metabolism, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
  2. 2Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, China
  3. 3Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, China
  4. 4Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
  5. 5Department of Quality Management Office, Zibo Central Hospital, Zibo, China
  6. 6Scientific Center, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
  1. Correspondence to Professor Tao Zhang; taozhang{at}sdu.edu.cn; Professor Jiajun Zhao; jjzhao{at}sdu.edu.cn

Abstract

Introduction Although obesity and hyperinsulinemia are closely intercorrelated, their temporal sequence is still uncertain. This study aims to investigate the temporal relationship patterns between obesity measures and hyperinsulinemia in Chinese adults.

Research design and methods The longitudinal cohort consisted of 2493 participants (860 males and 1633 female, mean age 56.71 years at follow-up) for whom measurements of obesity and hyperinsulinemia measures were collected twice between 2011 and 2014, with an average follow-up time of 3 years. Cross-lagged panel analysis was used to examine the temporal relationship between obesity measures (body mass index (BMI); waist circumference (WC); hip circumference (HC); waist-to-hip ratio (WHR)) and hyperinsulinemia (insulin, homeostasis model assessment of insulin resistance (HOMA-IR), or homeostasis model assessment of beta cell function (HOMA-%β)).

Results After the adjustment of age, sex, smoking, drinking and follow-up years, in the BMI-insulin model, the path coefficient (β2=0.229; p<0.001) of baseline BMI to follow-up insulin was significantly greater than the path coefficient (β1=0.073; p<0.001) of baseline insulin to follow-up BMI (p<0.001 for β2>β1). In the WHR-insulin model, the path coefficient (β1=0.152; p<0.001) of baseline insulin to follow-up WHR was significantly greater than the path coefficient (β2=0.077; p<0.001) of baseline WHR to follow-up insulin (p=0.007 for β1>β2). In the WC/HC-insulin model, the path coefficients of baseline insulin to follow-up WC or HC (β1s) were also greater than the path coefficients of baseline WC or HC to follow-up insulin (β2s), but the difference between β1s and β2s were not significant. The similar temporal patterns were founded between obesity measures with HOMA-IR or HOMA-%β.

Conclusions These findings indicate that there is a bidirectional relationship between obesity and hyperinsulinemia, and abdominal obesity measures are more sensitive to hyperinsulinemia measures than BMI.

  • obesity
  • insulin resistance
  • longitudinal studies
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjdrc-2020-002059

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    Footnotes

    • CX and GZ contributed equally.

    • Contributors CX, GZ, TZ and JZ generated the hypothesis, directed implementation, and wrote the manuscript. GZ and TZ contributed to analytic strategy and statistical analyses. MZ, XZ, LF, QG, HZ, LG and JZ supervised the field activities and data collection and edited the manuscript.

    • Funding This study was supported by grants from National Natural Science Foundation of China (81670720, 81973147, 81573246, and 81974124), Cheeloo Young Scholars Program of Shandong University, and special funds for Taishan Scholar Project (No. tsqn20161071).

    • Disclaimer The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Ethics approval The study protocols were approved by the Committee of Human Research at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine (NCT01506869). Written informed consent was obtained from all participants.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.