preprints.org > biology and life sciences > anatomy and physiology > doi: 10.20944/preprints201909.0247.v3

Preprint Article Version 3 Preserved in Portico This version is not peer-reviewed

Version 1 : Received: 20 September 2019 / Approved: 21 September 2019 / Online: 21 September 2019 (01:46:31 CEST)
Version 2 : Received: 8 October 2019 / Approved: 9 October 2019 / Online: 9 October 2019 (04:21:56 CEST)
Version 3 : Received: 10 February 2023 / Approved: 14 February 2023 / Online: 14 February 2023 (09:38:06 CET)

The investigation by the integrated approach newly introduced for this study indicates that insulin resistance (IR) would develop first preferentially in the muscle tissue with a relatively low cell turnover and then progress in sequence to the subcutaneous adipose tissue, to the visceral adipose tissue, and to the liver with higher cell turnovers. Moreover, metabolic disruptions due to IR vary widely from tissue to tissue, contrary to the conventional notion that IR merely impairs glucose uptake in the whole body. This warrants that IR be divided better into four distinct tissue specific IRs: muscle insulin resistance (MIR), subcutaneous adipose insulin resistance (s-AIR), visceral adipose insulin resistance (v-AIR), and hepatic insulin resistance (HIR). Tissue-specific IRs developing in the order of MIR, s-AIR, v-AIR, and HIR – producing tissue specific metabolic disruptions – would amount to nothing but the whole body insulin resistance (WBIR) evolving in four distinctively insulin resistant stages. The four stage metabolic evolution from rapid weight gain to visceral obesity to rapid weight loss to full blown diabetes not only complies well with the natural development history of diabetes but also resolves most of the controversies regarding obesity or diabetes, including visceral obesity, obesity paradox, and dawn phenomenon that have long remained metabolic puzzles. In addition, the four-stage WBIR evolution model refutes the entrenched notion of the lipid-induced insulin resistance (LIIR) but supports instead the glycation-induced insulin resistance (GIIR) proposed in this study. A speculation is that the glycation reaction activated ever more with WBIR evolving may serve as the common thread connecting each other a cluster of disorders or diseases that are often collectively referred to as the metabolic syndrome, such as obesity, diabetes, cardio/cerebral vasculopathy, nephropathy, neuropathy, and retinopathy.

obesity; obesity paradox; diabetes; insulin resistance (IR); whole body insulin resistance (WBIR); tissue specific insulin resistance; muscle insulin resistance (MIR); subcutaneous insulin resistance (s AIR); visceral adipose insulin resistance (v AIR); hepatic insulin resistance (HIR); lipid induced insulin resistance (LIIIR); glycation induced insulin resistance (GIIIR); metabolic syndrome

Biology and Life Sciences, Anatomy and Physiology