Dietary Lipid Induced Insulin Resistance

In the first aim, investigators will test whether a short-term high SFA-diet induces and
increases insulin resistance in participants with normal and abnormal glucose tolerance,
respectively, and determine the associated changes in muscle, adipose tissue and inflammatory
cell composition, pathway activation and insulin signaling. Investigators will identify
changes in specific signal pathways within these tissues and cells that are hypothesized to
mediate or modulate insulin action. Primary mechanisms and pathways examined will include
local tissue and systemic inflammation, formation of bioactive lipid intermediates,
generation of endoplasmic reticulum (ER) stress, and mitochondrial dysfunction/reactive
oxygen formation. By performing studies in participants with normal glucose tolerance and in
those with abnormal glucose tolerance investigators will also determine whether the extent
and mechanisms of insulin resistance vary with initial degrees of glucose intolerance.

In the second aim, to determine if the extent and mechanisms of insulin resistance vary with
dietary composition, investigators will determine whether diets of similar caloric content as
the SFA-diet, but enriched in monounsaturated fatty acids or carbohydrates, also induce
insulin resistance and whether similar or different mechanistic pathways are responsible.
Identifying similarities and differences between diets in inflammatory cell and tissue
changes and comparing their relationships with peripheral and tissue insulin action will
further clarify which cell and tissue events are most closely linked to development of
insulin resistance.

In the final aim, to identify the temporal sequence of mechanistic pathways for insulin
resistance and the role of cell and tissue cross-talk in these events, investigators will
evaluate inflammatory cell, skeletal muscle and adipose tissue composition and pathway
changes after acute, subacute, and more chronic dietary challenges in the same individuals.
This will also permit assessment of whether repeated dietary challenges create changes in
tissues that resemble those found in more chronic and advanced states of insulin resistance.

Inclusion Criteria:

- Body mass index (BMI) from 25-35 kg/m2

- normal glucose tolerance (NGT) diagnosis based on fasting glucose value 100mg/dl and 2
hr glucose <140 mg/dl after a standard 75 gm glucose load; impaired fasting glucose
(IFG) on fasting glucose value ≥100 and <126 mg/dl and 2 hr glucose <140 mg/dl;
impaired glucose tolerance (IGT) based on 2 hr glucose ≥140 and <200 mg/dl and a
fasting glucose <126 mg/dl

- Fasting triglyceride levels <500 mg/dl

Exclusion Criteria:

- Type 1 or 2 diabetes mellitus or a hemoglobin A1c value ≥ 6.5 mg/dl

- Any diabetes medications in the past month, thiazolidinedione medications in the prior
3 months or prior regular use of insulin

- Use of diets, medications (e.g., steroids, weight loss medications ) or current or
planned behavior changes (e.g. acute weight loss, exercise training) that will
influence changes in IR

- Creatinine >2.0 mg/dl or other laboratory evidence of significant active disease,
including hepatic enzyme elevation >2x normal and anemia, known "Nonalcoholic Fatty
Liver Disease", bleeding risk

- Malabsorption of fat or other nutrients, severe lactose intolerance or other
significant gastrointestinal or pancreatic problems, or recent history of nausea or
vomiting

- Acute bacterial or viral illness or evidence of other active infection in the past 4
weeks

- Cardiovascular event, stable or unstable angina or other major illness in the past 6
months

- Current regular use of anti-inflammatory medications (e.g. salicylates > 1 gm/ day) or
antioxidants in excess of a daily multi-vitamin, including supplements (e.g. fish
oils)

- Lipid lowering medications must be at a stable dose for at least 2 months prior to
participation

- Ethanol consumption more than 4 oz day; more than occasional smoker

- Reproductively active women not on contraceptives

- Known allergies, prior reactions or contraindications to proposed clinical agents (e.g
Octreotide)