The current study was undertaken to investigate fatty acid metabolism by skeletal muscle to examine potential mechanisms that could lead to increased muscle triglyceride in obesity. Sixteen lean and 40 obese research volunteers had leg balance measurement of glucose and free fatty acid (FFA) uptake (fractional extraction of [9,10 (3)H]oleate) and indirect calorimetry across the leg to determine substrate oxidation during fasting and insulin-stimulated conditions. Muscle obtained by percutaneous biopsy had lower carnitine palmitoyl transferase (CPT) activity and oxidative enzyme activity in obesity (P < 0.05). During fasting conditions, obese subjects had an elevated leg respiratory quotient (RQ, 0.83 +/- 0.02 vs. 0.90 +/- 0.01; P < 0.01) and reduced fat oxidation but similar FFA uptake across the leg. During insulin infusions, fat oxidation by leg tissues was suppressed in lean but not obese subjects; rates of FFA uptake were similar. Fasting values for leg RQ correlated with insulin sensitivity (r = -0.57, P < 0.001). Thirty-two of the obese subjects were restudied after weight loss (WL, -14.0 +/- 0.9 kg); insulin sensitivity and insulin suppression of fat oxidation improved (P < 0.01), but fasting leg RQ (0.90 +/- 0.02 vs. 0.90 +/- 0.02, pre-WL vs. post-WL) and muscle CPT activity did not change. The findings suggest that triglyceride accumulation in skeletal muscle in obesity derives from reduced capacity for fat oxidation and that inflexibility in regulating fat oxidation, more than fatty acid uptake, is related to insulin resistance.

A number of biochemical defects have been identified in glucose metabolism within skeletal muscle in obesity, and positive effects of weight loss on insulin resistance are also well established. Less is known about the capacity of skeletal muscle for the metabolism of fatty acids in obesity-related insulin resistance and of the effects of weight loss, though it is evident that muscle contains increased triglyceride. The current study was therefore undertaken to profile markers of human skeletal muscle for fatty acid metabolism in relation to obesity, in relation to the phenotype of insulin-resistant glucose metabolism, and to examine the effects of weight loss. Fifty-five men and women, lean and obese, with normal glucose tolerance underwent percutaneous biopsy of vastus lateralis skeletal muscle for determination of HADH, CPT, heparin-releasable (Hr) and tissue-extractable (Ext) LPL, CS, COX, PFK, and GAPDH enzyme activities, and content of cytosolic and plasma membrane FABP. Insulin sensitivity was measured using the euglycemic clamp method. DEXA was used to measure FM and FFM. In skeletal muscle of obese individuals, CPT, CS, and COX activities were lower while, conversely, they had a higher or similar content of FABP(C) and FABP(PM) than in lean individuals. Hr and Ext LPL activities were similar in both groups. In multivariate and simple regression analyses, there were significant correlations between insulin resistance and several markers of FA metabolism, notably, CPT and FABP(PM). These data suggest that in obesity-related insulin resistance, the metabolic capacity of skeletal muscle appears to be organized toward fat esterification rather than oxidation and that dietary-induced weight loss does not correct this disposition.

The purpose of the present study was to describe the extent of the variation in some of the common characteristics of human skeletal muscle. A total of 418 biopsies was obtained from the vastus lateralis muscle of 270 healthy sedentary and 148 physically active individuals of both sexes. The lowest and highest proportion of type I muscle fiber observed were 15 and 85%, respectively. Coefficients of variation (CV) reached approximately 30% for the proportion of types I and IIA fibers and were two times higher for the proportion of type IIB fiber. The smallest and largest mean muscle fiber cross-sectional areas (CSA) were approximately 1,100 microns 2 and 9,500 microns 2, respectively. Mean CSA of the various fiber types exhibited CV of approximately 23%. CV reached 30% for the activity of creatine kinase, ranged between 28 and 41% for the glycolytic enzyme markers, and between 34 and 44% for the aerobic-oxidative enzyme markers. The mean proportion of type I fiber was lower in male than in female muscles, whereas the mean CSA of all fiber types was smaller in female than in male muscles. Levels of glycolytic enzyme markers were higher in male than in female skeletal muscles. However, activities of aerobic-oxidative enzyme markers were similar in males and females. These results reveal the existence of large interindividual variability and gender differences in the most common characteristics of the human skeletal muscle.

IntroductionThis study was undertaken to assess utilization of FFA by skeletal muscle in patients with non-insulin-dependent diabetes mellitus (NIDDM). 11 NIDDM and 9 nondiabetic subjects were studied using leg balance methods to Patients with non-insulin-dependent diabetes mellitus (NIDDM)' have a number of abnormalities of lipid metabolism which may contribute to the increased morbidity and mortality associated with this syndrome (1, 2). Among the abnormalities of lipid metabolism in NIDDM is increased plasma FFA (3). Increased fasting rates of lipolysis (4), insulin resistance in suppression of lipolysis (3, 5), and impaired clearance of plasma FFA, particularly in relation to hyperglycemia (6), contribute to elevated plasma FFA in NIDDM. During postabsorptive metabolism, lipid oxidation provides approximately three-quarters of energy production in healthy individuals and plasma FFA contribute substantially to lipid oxidation (7). Uptake and oxidation of plasma FFA occur in liver, kidney, skeletal muscle, and myocardium, as well as other tissues, so that the site(s) responsible for impaired systemic clearance of FFA in NIDDM is uncertain. However, it does seem unlikely that hepatic utilization of FFA is reduced in NIDDM, as it is generally considered that hepatic fat oxidation is increased and a key factor in potentiating gluconeogenesis (8,9). In skeletal muscle, lipid is the predominate oxidative substrate during postabsorptive conditions in nondiabetics, accounting for -80% of oxygen consumption by muscle (10-12). Previously, we found that RQ across the leg during postabsorptive conditions was increased in subjects with NIDDM during conditions of fasting hyperglycemia (13). The elevation of leg RQ suggests that skeletal muscle utilization of plasma FFA could be impaired in NIDDM during postabsorptive conditions. Capaldo et al. ( 14) found that forearm FFA uptake was similar in NIDDM and nondiabetic subjects, yet the NIDDM subjects in that study were lean and had been rendered euglycemic before measuring muscle FFA uptake. Therefore, the findings of the study by Calpaldo et al., which is the only previous investigation of muscle FFA uptake in NIDDM, may not fully apply to the majority of patients with NIDDM, most of whom are obese, nor may these findings pertain to hyperglycemic conditions. The current study was undertaken, therefore, to test the hypothesis that muscle FFA utilization is impaired in NIDDM during fasting hyperglycemia. The leg balance method was used in conjunction with an infusion of labeled oleate to measure uptake of FFA, and limb indirect calorimetry was used to obtain the RQ across the leg. Because the metabolic profile of skeletal muscle and fiber type characteristics can be important determinants of substrate utilization (15), vastus lateralis muscle was obtained by percutaneous biopsy for these characterizations. The leg balance measurements were conducted during postabsorptive conditions, then carried forward for 6 h after ingestion of a fat-enriched meal. The findings in...

The insulin resistance of skeletal muscle in glucose-tolerant obese individuals is associated with reduced activity of oxidative enzymes and a disproportionate increase in activity of glycolytic enzymes. Because non-insulin-dependent diabetes mellitus (NIDDM) is a disorder characterized by even more severe insulin resistance of skeletal muscle and because many individuals with NIDDM are obese, the present study was undertaken to examine whether decreased oxidative and increased glycolytic enzyme activities are also present in NIDDM. Percutaneous biopsy of vatus lateralis muscle was obtained in eight lean (L) and eight obese (O) nondiabetic subjects and in eight obese NIDDM subjects and was assayed for marker enzymes of the glycolytic [phosphofructokinase, glyceraldehyde phosphate dehydrogenase, hexokinase (HK)] and oxidative pathways [citrate synthase (CS), cytochrome-c oxidase], as well as for a glycogenolytic enzyme (glycogen phosphorylase) and a marker of anaerobic ATP resynthesis (creatine kinase). Insulin sensitivity was measured by using the euglycemic clamp technique. Activity for glycolytic enzymes (phosphofructokinase, glyceraldehye phosphate dehydrogenase, HK) was highest in subjects with subjects with NIDDM, following the order of NIDDM > O > L, whereas maximum velocity for oxidative enzymes (CS, cytochrome-c oxidase) was lowest in subjects with NIDDM. The ratio between glycolytic and oxidative enzyme activities within skeletal muscle correlated negatively with insulin sensitivity. The HK/CS ratio had the strongest correlation (r = -0.60, P < 0.01) with insulin sensitivity. In summary, an imbalance between glycolytic and oxidative enzyme capacities is present in NIDDM subjects and is more severe than in obese or lean glucose-tolerant subjects. The altered ratio between glycolytic and oxidative enzyme activities found in skeletal muscle of individuals with NIDDM suggests that a dysregulation between mitochondrial oxidative capacity and capacity for glycolysis is an important component of the expression of insulin resistance.

The mechanism by which FFA metabolism inhibits intracellular insulin-mediated muscle glucose metabolism in normal humans is unknown. We used the leg balance technique with muscle biopsies to determine how experimental maintenance of FFA during hyperinsulinemia alters muscle glucose uptake, oxidation, glycolysis, storage, pyruvate dehydrogenase (PDH), or glycogen synthase (GS). 10

Regional fat distribution is an important determinant of insulin resistance in obesity. In the current study, the relationship between skeletal muscle insulin sensitivity, mid-thigh muscle composition, and the metabolic profile of muscle was investigated. Muscle composition was assessed by computed tomography of the mid-thigh, and by activities of marker enzymes of aerobic-oxidative and glycolytic pathways and muscle fiber typing using biopsies of the vastus lateralis muscle. Muscle with reduced Hounsfield attenuation on computed tomography scans was increased in proportion to obesity, and was strongly related to insulin resistance, reduced muscle oxidative capacity, and increased anaerobic and glycolytic capacities by muscle. These findings suggest that as part of its expression of insulin resistance, skeletal muscle of obese individuals is also poorly equipped for substrate oxidation and manifests increased storage of fat.

Maintenance of reduced or elevated body weight results in respective decreases or increases in energy expended in physical activity, defined as 24-h energy expenditure excluding resting energy expenditure and the thermic effect of feeding, beyond those attributable to weight change. We examined skeletal muscle work efficiency by graded cycle ergometry and, in some subjects, rates of gastrocnemius muscle ATP flux during exercise by magnetic resonance spectroscopy (MRS), in 30 subjects (15 males, 15 females) at initial weight and 10% below initial weight and in 8 subjects (7 males, 1 female) at initial weight and 10% above initial weight to determine whether changes in skeletal muscle work efficiency at altered body weight were correlated with changes in the energy expended in physical activity. At reduced weight, muscle work efficiency was increased in both cycle ergometry [mean (SD) change = +26.5 (26.7)%, P < 0.001] and MRS [ATP flux change = -15.2 (23.2)%, P = 0.044] studies. Weight gain resulted in decreased muscle work efficiency by ergometry [mean (SD) change = -17.8 (20.5)%, P = 0.043]. Changes in muscle efficiency at altered body weight accounted for 35% of the change in daily energy expended in physical activity.