Adipose Tissue Insulin Resistance in South Asian and Nordic Women after Gestational Diabetes Mellitus

Ahalya Anita Suntharalingam Kvist; Archana Sharma; Christine Sommer; Elisabeth Qvigstad; Hanne Løvdal Gulseth; Stina Therese Sollid; Ingrid Nermoen; Naveed Sattar; Jason Gill; Tone Møller Tannæs; Kåre Inge Birkeland; Sindre Lee-Ødegård

doi:10.3390/metabo14050288

Adipose Tissue Insulin Resistance in South Asian and Nordic Women after Gestational Diabetes Mellitus

Metabolites. 2024 May 18;14(5):288. doi: 10.3390/metabo14050288.

Authors

Ahalya Anita Suntharalingam Kvist^{1

2}, Archana Sharma^{1

3}, Christine Sommer², Elisabeth Qvigstad^{1

2}, Hanne Løvdal Gulseth⁴, Stina Therese Sollid⁵, Ingrid Nermoen^{1

3}, Naveed Sattar⁶, Jason Gill⁶, Tone Møller Tannæs⁷, Kåre Inge Birkeland^{1

2}, Sindre Lee-Ødegård^{1

2}

Affiliations

¹ Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway.
² Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, 0424 Oslo, Norway.
³ Department of Endocrinology, Akershus University Hospital, 1478 Lørenskog, Norway.
⁴ Norwegian Institute of Public Health, 0213 Oslo, Norway.
⁵ Department of Medicine, Drammen Hospital, Vestre Viken Health Trust, 3004 Drammen, Norway.
⁶ School of Cardiovascular and Metabolic Health, University of Glasgow, BHF Glasgow Cardiovascular Research Centre, 126 University Place, Glasgow G12 8TA, UK.
⁷ EpiGen, Medical Division, Akershus University Hospital, 1478 Lørenskog, Norway.

Abstract

South Asians (SAs) have a higher risk of developing type 2 diabetes (T2D) than white Europeans, especially following gestational diabetes mellitus (GDM). Despite similar blood glucose levels post-GDM, SAs exhibit more insulin resistance (IR) than Nordics, though the underlying mechanisms are unclear. This study aimed to assess markers of adipose tissue (AT) IR and liver fat in SA and Nordic women post-GDM. A total of 179 SA and 108 Nordic women in Norway underwent oral glucose tolerance tests 1-3 years post-GDM. We measured metabolic markers and calculated the AT IR index and non-alcoholic fatty liver disease liver fat (NAFLD-LFS) scores. Results showed that normoglycaemic SAs had less non-esterified fatty acid (NEFA) suppression during the test, resembling prediabetes/T2D responses, and higher levels of plasma fetuin-A, CRP, and IL-6 but lower adiponectin, indicating AT inflammation. Furthermore, normoglycaemic SAs had higher NAFLD-LFS scores, lower insulin clearance, and higher peripheral insulin than Nordics, indicating increased AT IR, inflammation, and liver fat in SAs. Higher liver fat markers significantly contributed to the ethnic disparities in glucose metabolism, suggesting a key area for intervention to reduce T2D risk post-GDM in SAs.

Keywords: South Asian; adipose tissue; fetuin-A; gestational diabetes; inflammation; insulin clearance; insulin resistance; liver fat; non-esterified fatty acids; pre-hepatic insulin; type 2 diabetes.

Grants and funding

This study was funded by the Research Council of Norway, grant number 273252. The study funder was not involved in the design of the study; the collection, analysis, and interpretation of data; writing of the manuscript; and did not impose any restrictions regarding the publication of the manuscript. S.L.-Ø is supported by the Novo Nordisk Fonden Excellence Emerging Grant in Endocrinology and Metabolism 2023 (NNF23OC0082123).