Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Paper
  • Published:

Evidence for insulin resistance in black women from South Africa

International Journal of Obesity volume 24, pages 1340–1346 (2000)Cite this article

Abstract

OBJECTIVE: The rate of glucose disposal was determined in 10 black and 10 white obese nondiabetic urban women from South Africa to assess insulin resistance.

DESIGN AND METHODS: Euglycemic hyperinsulinemic clamp and body composition analysis.

RESULTS: Age, body mass index (BMI), anthropometric measurements and body composition were similar in both groups of women. A five-level computed tomography (CT) scan showed a similar mean subcutaneous fat mass in both groups of women (black obese women 555±9.0 vs white obese women 532±6.0 cm2), but less visceral fat in black obese women (90±3.0 vs 121±3.1 cm2; P<0.05). Black obese women had higher fasting free fatty acid (997±69 vs 678±93 μmol/l; P<0.05) and lactate concentrations (1462±94 vs 1038±39 μmol/l; P<0.05), but lower fasting insulin levels (87±12 vs 155±9 pmol/l; P<0.001). Black obese women also had a more favorable HDL: total cholesterol ratio (30.5% vs 23.0%; P<0.04). The mean glucose disposal rate (M) and disposal expressed as glucose sensitivity index (M/I) were reduced in the black obese women vs white obese women (M: 7.1±0.8 vs 13.7±1.0 mmol/kg·min−1×100; P<0.01, and M/I: 0.12±0.01 vs 0.24±0.02 mmol/kg·min−1/pmol/l×1000; P<0.01). Only black obese women showed a significant decrease in C-peptide levels during the clamp (2.9±0.22 vs 1.2±0.12 nmol/l; P<0.001). During the euglycemic period, the black obese women had higher lactate levels at all time points, but only the white obese women had increased lactate levels (918±66 to 1300±53 μmol/l; P<0.05).

CONCLUSION: Black obese women demonstrate a higher degree of insulin resistance, despite less visceral fat and a higher HDL: total-cholesterol ratio. In addition, endogenous β-cell secretory function in black obese women appears to be more sensitive to the suppressive effect of exogenous insulin administration. The significant increase in lactate levels in white obese women confirms that they are more insulin sensitive.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 2
Figure 1

Similar content being viewed by others

References

  1. Rossouw JE, du Plessis JP, Benadé AJS, Jordaan PCJ, Kotzé JP, Jooste PL, Ferreira JJ . Coronary risk factor screening in three rural communities. The CORIS baseline study S Afr Med J 1983 64: 430–436.

    CAS  PubMed  Google Scholar 

  2. Seedat YK . Face, environment and blood pressure: the South African experience J Hypertens 1983 1: 7–12.

    Article  CAS  PubMed  Google Scholar 

  3. Joffe BI, Seftel HC . Diabetes mellitus in the black communities of Southern Africa J Intern Med 1994 235: 137–142.

    Article  CAS  PubMed  Google Scholar 

  4. Omar MAK, Seedat MA, Motala AA, Dyer RB, Becker P . The prevalence of diabetes mellitus and impaired glucose tolerance in a group of urban South African blacks S Afr Med J 1993 83: 641–643.

    CAS  PubMed  Google Scholar 

  5. Seftel HC . The rarity of coronary heart disease in South African blacks S Afr Med J 1978 54: 99–105.

    CAS  PubMed  Google Scholar 

  6. Isles CG, Milne FJ . Low mortality from ischaemic heart disease among urban blacks in South Africa J Clin Hypertens 1987 3: 749–775.

    CAS  PubMed  Google Scholar 

  7. Walker ARP, Bhanjee D, Walker BF, Martin AP . Serum high density lipoprotein cholesterol, glucose tolerance and other variables in obese black adolescent girls S Afr Med J 1979 56: 221–224.

    CAS  PubMed  Google Scholar 

  8. Steyn K, Jooste PL, Bourne L, Fourie J, Badenhorst CJ, Bourne DE, Langenhoven ML, Lombard CJ, Truter H, Katzenellenbogen J, Marais M, Oelofse A . Risk factors for coronary heart disease in the black population of the Cape Peninsula. The BRISK study S Afr Med J 1991 79: 480–485.

    CAS  PubMed  Google Scholar 

  9. Van der Merwe M-T, Crowther NJ, Schlaphoff GP, Boyd IH, Gray IP, Joffe BI, Lönnroth PN . Lactate and glycerol release from the subcutaneous adipose tissue of obese urban women from South Africa; important metabolic implications J Clin Endocrinol Metab 1998 83: 4084–4091.

    CAS  PubMed  Google Scholar 

  10. Walker ARP, Walker BG, Walker AJ, Vorster HH . Low frequency of adverse sequela of obesity in South African rural black women Int J Vitam Nutr Res 1989 59: 224–228.

    CAS  PubMed  Google Scholar 

  11. Cameron N, Getz B . Sex differences in the prevalence of obesity in rural African adolescents Int J Obes Relat Metab Disord 1997 21: 775–782.

    Article  CAS  PubMed  Google Scholar 

  12. Buthelezi EP, Van der Merwe MT, Lönnroth PN, Gray IP, Crowther NJ . Ethnic differences in the sensitivity of adipocyte lipolytic activity to insulin Obes Res 2000 8: 171–178.

    Article  CAS  PubMed  Google Scholar 

  13. Van der Merwe MT, Wing JR, Celgow LH, Gray IP, Lönn L, Joffe BI, Lönnroth PN . Metabolic indices in relation to body composition changes during weight loss on dexfenfluramine in obese women from two South African ethnic groups Int J Obes Relat Metab Disord 1996 20: 768–776.

    CAS  PubMed  Google Scholar 

  14. Van der Merwe M-T, Jansson P-A, Crowther NJ, Boyd IH, Gray PI, Joffe BI, Lönnroth PN . Lactate and glycerol release from subcutaneous adipose tissue in black and white lean men J Clin Endocrinol Metab 1999 84: 2888–2895.

    CAS  PubMed  Google Scholar 

  15. Rubenstein AH, Seftel HC, Miller K, Bersohn I, Wright AD . Metabolic response to oral glucose in healthy South African white, Indian and African subjects Br Med J 1969 1: 748–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Shires R, Joffe BI, Seftel HC . Maximal pancreatic beta-cell stimulation and the counter-regulatory hormonal response in South African black and white obese subjects S Afr Med J 1985 67: 845–847.

    CAS  PubMed  Google Scholar 

  17. Hawkins M, Barzilai N, Hu M, Chen W, Rossetti L . Role of the glucosamine pathway in fat induced insulin resistance J Clin Invest 1997 99: 2173–2182.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Zhou YP, Grill VE . Long term exposure to fatty acids and ketones inhibits β-cell function in human pancreatic islets of Langerhans J Clin Endocrinol Metab 1995 80: 1584–1590.

    CAS  PubMed  Google Scholar 

  19. Polonsky KS, Rubenstein AH . C-peptide as a measure of the secretion and hepatic extraction of insulin: pitfalls and limitations Diabetes 1984 33: 486–493.

    Article  CAS  PubMed  Google Scholar 

  20. Wojcikowski C, Blackman J, Ostrega D . Lack of effect of high dose biosynthetic human C-peptide on pancreatic hormone release in normal subjects Metabolism 1990 39: 827–833.

    Article  CAS  PubMed  Google Scholar 

  21. Polonsky K, Jaspan J, Pugh W, Cohen D, Schneider M, Schwartz T, Moossa AB, Tager H, Rubenstein AH . Metabolism of C-peptide in the dog J Clin Invest 1983 72: 1114–1123.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Katz I, Rubenstein AH . Metabolism of pro-insulin, insulin and C-peptide in the rat J Clin Invest 1973 52: 113–1121.

    Google Scholar 

  23. Faber OK, Hagen C, Binder C . Kinetics of human connecting peptide in normal and diabetic subjects J Clin Invest 1978 62: 197–202.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Polonsky KS, Given BD, Hirsch L, Shapiro ET, Tillil H, Beebe C, Galloway JA, Frank BH, Karrison T, Van Cauter E . Quantitative study of insulin secretion and clearance in normal and obese subjects J Clin Invest 1988 81: 435–411.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Loomis ME . An enzymatic fluorometric method for the determination of lactic acid J Lab Clin Med 1961 57: 966–969.

    CAS  PubMed  Google Scholar 

  26. Kvist H, Chowdbury B, Grangard U, Tylén U, Sjöstrom L . Total and visceral adipose tissue volumes derived from measurements with computed tomography in adult men and women: predictive equations Am J Physiol 1988 253: E228–E231.

    Google Scholar 

  27. Kvist H, Sjöstrom L, Tylén U . Adipose tissue volume determinations in women by computed tomography. Technical considerations Int J Obes 1986 10: 53–67.

    CAS  Google Scholar 

  28. Sachur N, Eckel RH . Insulin stimulation of adipose tissue lipoprotein lipase: use of euglycemic clamp technique J Clin Invest 1982 16: 13–20.

    Google Scholar 

  29. De Fronzo RA, Tobin JD, Andres R . Glucose clamp technique: a method for quantifying insulin secretion and resistance Am J Physiol 1979 237: E214–E224.

    CAS  Google Scholar 

  30. Pacini G, Bergman PN . An adaptive program for controlling the blood sugar Comput Meth Programs Biomed 1983 16: 13–20.

    Article  CAS  Google Scholar 

  31. Bergman RN, Ider YZ, Bowden CR, Cobelli C . Quantitative estimation of insulin sensitivity Am J Physiol 1979 236: E667–E667.

    CAS  PubMed  Google Scholar 

  32. Bonnici F, Hough S, Huddle K . Type II diabetes mellitus clinical guidelines at primary health care level S Afr Med J 1997 87: 497–812.

    Google Scholar 

  33. Ferannini E, Barret EJ, Bevilacque S, De Fronzo PA . Effects of free fatty acids on glucose production and utilization in man J Clin Invest 1983 72: 1737–1747.

    Article  Google Scholar 

  34. Shepherd PR, Kahn BB . Mechanisms of disease: glucose transporters and insulin action—implications for insulin resistance and diabetes mellitus New Engl J Med 1999 341: 217–225.

    Article  Google Scholar 

  35. Boden G . Role of fatty acids in the pathogenesis of insulin resistance and NIDDM Diabetes 1997 46: 3–10.

    Article  CAS  Google Scholar 

  36. Hawkins M, Barzilai N, Hu M, Chen W, Rossetti L . Role of glucosamine pathway in fat induced insulin resistance J Clin Invest 1997 99: 2173–2182.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Usui I, Takata Y, Imamura T, Morioka H, Sasaoka T, Sawa T, Ishihara H, Ishiki M, Kobayashi M . Fatty acid induced insulin resistance in rat-1 fibroblasts overexpressing human insulin receptors: impaired insulin-stimulated mitogen activated protein kinase activity Diabetologia 1997 40: 894–901.

    Article  CAS  PubMed  Google Scholar 

  38. Zhai YP, Grill VE . Long-term exposure to fatty acids and ketones inhibits β-cell function in human pancreatic islets of Langerhans J Clin Endocrinol Metab 1995 80: 1584–1590.

    Google Scholar 

  39. Padisso G, Gambardella A, Amato L . Opposite effects of short and long-term fatty acid infusion on insulin secretion on healthy subjects Diabetologia 1995 38: 1295–1299.

    Article  Google Scholar 

  40. Felber JP, Ferrannini E, Golay A, Meyer HU, Thiebaud D, Curchod B, Maeder E, Jéquier E, De Fronzo RA . Role of lipid oxidation in pathogenesis of insulin resistance of obesity in type II diabetes Diabetes 1987 36: 1341–50.

    Article  CAS  PubMed  Google Scholar 

  41. Lillioja S, Bogardus C, Mott DM, Kennedy AL, Knowler WC, Howard BV . Relationship between insulin-mediated glucose disposal and lipid metabolism in man J Clin Invest 1985 75: 1106–1115.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Baugnères PF, Artavia-Loria E, Henry S, Basdevant A, Castano L . Increased basal glucose production and utilization in children with recent onset obesity versus adults with long-term obesity Diabetes 1989 38: 477–483.

    Article  Google Scholar 

  43. Frayn KN . Metabolic Regulation. A Human Perspective, Chapters 3 and 5 London: Portland Press 1997.

  44. Mårin P, Rebuffe-Scrive M, Smith U, Björntorp P . Glucose uptake in human adipose tissue Metabolism 1987 36: 1154–1160.

    Article  PubMed  Google Scholar 

  45. Jansson P-A, Smith U, Lönnroth P . Evidence for lactate production by human adipose tissue in vivo Diabetologia 1990 33: 253–256.

    Article  CAS  PubMed  Google Scholar 

  46. Randle PJ, Newsholme EA, Garland PB . Regulation of glucose uptake by muscle: effects of fatty acids, ketone bodies pyruvate, and of alloxan-diabetes and starvation, on the uptake and metabolic fate of glucose in rat heart and diaphragm muscles Biochem J 1964 93: 652–665.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Lovejoy JC, Newby FD, Gebhart SSP, DiGirolamo M . Insulin resistance in obesity is associated with elevated basal lactate levels and diminished lactate appearance following intravenous glucose and insulin Metabolism 1992 41: 22–27.

    Article  CAS  PubMed  Google Scholar 

  48. Yki-Järvinen H, Helve E, Sane T, Nurjhan N, Taskinen M-R . Insulin inhibition of overnight glucose production and gluco-neogenesis from lactate in NIDDM Am J Physiol 1989 256: E732–739.

    PubMed  Google Scholar 

  49. Yki-Järvinen H, Bogardus C, Foley JE . Regulation of plasma lactate concentration in resting human subjects Metabolism 1990 39: 859–864.

    Article  PubMed  Google Scholar 

  50. Zouvanis M, Pieterse AC, Seftel HC, Joffe BI . Clinical characteristics and outcome of hyperglycemic emergencies in Johannesburg Africans Diabetic Med 1997 14: 603–606.

    Article  CAS  PubMed  Google Scholar 

  51. Joffe BI, Wing JR, Zouvanis M, Pieterse A, Seftel HC . NIDDM in African-Americans and black South Africans: many similarities but some important differences Diabetes Care 1996 19: 1451-1452.

    Article  Google Scholar 

  52. Joffe BI, Panz VR, Wing JR, Raal FJ, Seftel HC . Pathogenesis of non-insulin-dependent diabetes mellitus in the black population of Southern Africa Lancet 1992 340: 460–462.

    Article  CAS  PubMed  Google Scholar 

  53. Wing JR, Panz VR, Joffe BI, Seftel HC . Changes in glucose disposal and cellular insulin binding in obese black southern African patients with type 2 diabetes mellitus before and after sulphonylurea therapy Diabetic Med 1993 10: 50–55.

    Article  CAS  PubMed  Google Scholar 

  54. Boden G, Chen X, DeSantis R, Kolaczynski J, Moris M . Evidence that suppression of insulin secretion by insulin itself is neurally mediated Metabolism 1993 42: 786–789.

    Article  CAS  PubMed  Google Scholar 

  55. Wasada T, Acki K, Babazono T, Kuroki H, Arii H, Saeki A, Omori Y . Insulin sensitivity and negative insulin feedback after pancreas transplantation in insulin-dependent diabetic patients Endocr J 1995 42: 747–752.

    Article  CAS  PubMed  Google Scholar 

  56. Marchetti P, Sharp DW, McLear M, Finke EH, Olack B, Swanson C, Giannarelli R, Navalesi R, Lacy PE . Insulin inhibits its own secretion from isolated, perfused human pancreatic islets Acta Diabetol 1995 32: 75–77.

    Article  CAS  PubMed  Google Scholar 

  57. Argoud GM, Schade DS, Eaton RP . Insulin suppresses its own secretion in vivo Diabetes 1987 36: 959–962.

    Article  CAS  PubMed  Google Scholar 

  58. Flier JS, Minaker KL, Landsberg L, Young JB, Pallotta J, Rowe JW . Impaired in vivo insulin clearance inpatients with severe target-cell resistance to insulin Diabetes 1982 31: 132–135.

    Article  CAS  PubMed  Google Scholar 

  59. Peiris AN, Stagner JI, Vogel PL, Samols E, Nakagawa A . Lack of insulin feedback inhibition in non obese and obese men Metabolism 1993 42: 371–375.

    Article  CAS  PubMed  Google Scholar 

  60. Lovejoy JC, de la Bretonne J, Klemperer M, Tulley R . Abdominal fat distribution and metabolic risk factors: effect of race Metabolism 1996 45: 1119–1124.

    Article  CAS  PubMed  Google Scholar 

  61. Walker ARP . The epidemiology of coronary heart disease in South Africa SAMJ 1999 89 (Suppl 1): 12–13.

    Google Scholar 

Download references

Acknowledgements

The authors wish to thank Mrs Jenny Pieters for typing the manuscript, Dr Thang Han for providing technical assistance, and Sisters Nancy Holden and Nomsa Ramela for providing assistance in the dayward. The chemical analyses of this study were supported by a grant from the SAIMR. The remainder of the costs were carried by the first author in a personal capacity.

Author information

Authors and Affiliations

  1. Carbohydrate and Lipid Metabolism Research Group, University of the Witwatersrand Medical School, Johannesburg, South Africa

    M-T van der Merwe & BI Joffe

  2. Chemical Pathology, University of the Witwatersrand Medical School, Johannesburg, South Africa

    NJ Crowther & IP Gray

  3. Radiology, University of the Witwatersrand Medical School, Johannesburg, South Africa

    GP Schlaphoff

  4. Department of Internal Medicine, University of Göteborg, Göteborg, Sweden

    PN Lönnroth

Authors
  1. M-T van der Merwe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. NJ Crowther
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. GP Schlaphoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. IP Gray
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. BI Joffe
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. PN Lönnroth
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M-T van der Merwe.

Rights and permissions

Reprints and permissions

About this article

Cite this article

van der Merwe, MT., Crowther, N., Schlaphoff, G. et al. Evidence for insulin resistance in black women from South Africa. Int J Obes 24, 1340–1346 (2000). https://doi.org/10.1038/sj.ijo.0801416

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ijo.0801416

Keywords

This article is cited by

Search

Advanced search

Quick links