Relationship between Abdominal Fat Accumulation and Insulin Resistance in Hemodialysis Patients

Gohda, Tomohito; Gotoh, Hiromichi; Tanimoto, Masuhisa; Sato, Michiko; Io, Hiroaki; Kaneko, Kayo; Hamada, Chikuma; Tomino, Yasuhiko

doi:10.1291/hypres.31.83

Cited by 36 publications

(29 citation statements)

References 31 publications

(25 reference statements)

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“…In our results, we showed that the abdominal adiposity, either measured by WC or Ci, did not correlate with IR indices after multivariable adjustments (table 3). Two small-scale studies [20,21] also demonstrated similar results as ours; that is, abdominal adiposity was not an optimal indicator of IR in dialysis population. We commonly used WC as the measure of abdominal adiposity in the general population; however, WC represented both visceral adipose tissue and subcutaneous adipose tissue and the distinguished adipose tissue corresponded to different outcome results [22,23].…”

Section: Discussionsupporting

confidence: 84%

Liver Fat Contents, Abdominal Adiposity and Insulin Resistance in Non-Diabetic Prevalent Hemodialysis Patients

et al. 2014

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Background: The liver fat contents and abdominal adiposity correlate well with insulin resistance (IR) in the general population. However, the relationship between liver fat content, abdominal adiposity and IR in non-diabetic hemodialysis (HD) patients remains unclear. This study aimed to clarify the associations among these factors. Methods: This is a cross-sectional, observational study. All patients received abdominal ultrasound for liver fat content. Abdominal adiposity was quantified with the conicity index (Ci) and waist circumference (WC). We checked the homeostasis model assessment for insulin resistance index (HOMA-IR) for IR. Results: A total of 112 patients (60 women) were analyzed. Subjects with higher liver fat contents and WC had higher IR indices. But Ci did not correlate with IR indices. In both the multi-variable linear regression model and the logistic regression model, only higher liver fat content predicted a severe IR status. Conclusions: Liver fat contents have a remarkable correlation with IR; however, abdominal adiposity, measured either by Ci or WC, dose not independently correlate with IR in non-diabetic prevalent HD patients.

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Section: Discussionsupporting

confidence: 84%

Liver Fat Contents, Abdominal Adiposity and Insulin Resistance in Non-Diabetic Prevalent Hemodialysis Patients

et al. 2014

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“…Nevertheless, persons with potential significant fluid overload were excluded from this study, and bioimpedance was performed after a dialysis session when patients had reached their dry weight. Furthermore, because of limitations associated with the use of bioimpedance analysis for assessing body fat mass, the differentiation between subcutaneous and metabolically active visceral fat could not be assessed in the present study (25). Finally, insulin resistance is a consequence of high energy intake in nondiabetic hemodialysis patients, but it was not possible to infer that the increase in HOMA-IR was causally related to an adverse CV outcome in a 12-wk intervention.…”

Section: Discussionmentioning

confidence: 90%

Adiposity and insulin resistance in nondiabetic hemodialysis patients: effects of high energy supplementation

Hung

Tarng

2009

The American Journal of Clinical Nutrition

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Background: In contrast to the general population, a higher body mass index is associated with better survival among hemodialysis patients. Theoretically, high energy supplementation in these patients ought to lead to weight gain over time, but the benefits of this strategy are unclear. Objective: The objective was to assess whether high energy supplementation in nondiabetic hemodialysis patients might adversely affect insulin resistance-a known risk factor for cardiovascular disease. Design: We first investigated the association between body fat mass and insulin resistance (homeostasis model assessment of insulin resistance; HOMA-IR) in nondiabetic hemodialysis patients in a cross-sectional analysis (study 1). Of the 106 individuals studied, 55 were randomly assigned to either high energy supplementation (an extra 475 kcal/d; n = 28) or not (n = 27) for 12 wk to assess prospective changes in body fat mass and insulin resistance (study 2). Results: In study 1, body fat mass (P , 0.05) and C-reactive protein (CRP) (P , 0.05) each contributed independently to HOMA-IR. In study 2, 41 patients completed the study. The 20 patients who received high energy supplementation had a significantly greater increase in body fat mass (P , 0.05), CRP (P , 0.05), and HOMA-IR (P , 0.001) than did the 21 controls. Conclusions: Body fat mass and CRP are primary determinants of insulin resistance in nondiabetic hemodialysis patients. High energy supplementation, because it increases adiposity and inflammation, exacerbates insulin resistance. A long-term study is needed to clarify the metabolic effects of high energy supplementation on cardiovascular disease outcomes in hemodialysis patients.Am J Clin Nutr 2009;90:64-9.

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“…The incidence of cardiovascular disease is high even in non-obese individuals with a BMI within the normal range who have an accumulation of visceral fat. 21 Recently, VFA has been significantly associated with insulin resistance 22 and with the prevalence of CVD in participants from the Framingham Heart Study; 23 thus, the accurate assessment of both body fat distribution and VFA is critical for assessing the risk of arteriosclerotic disease. Ohkawa et al 24 reported that VFA in hemodialysis patients increased irrespective of BMI, and a positive relationship existed between VFA and atherosclerosis.…”

Section: Discussionmentioning

confidence: 99%

Potential impact of renin–angiotensin system inhibitors and calcium channel blockers on plasma high-molecular-weight adiponectin levels in hemodialysis patients

Nakagawa

Yao²,

Hirayama³

et al. 2011

Hypertens Res

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Although metabolic syndrome confers an increased risk of cardiovascular disease in the general population, little is known about the alteration of abdominal adiposity and its association with adipocytokines in hemodialysis patients. We investigated the plasma high-molecular-weight (HMW) adiponectin level and its relationship to visceral fat area (VFA) and various markers of atherosclerosis in hemodialysis patients. In a cross-sectional study, conventional cardiovascular risk factors, plasma total and HMW adiponectin, the number of components of the metabolic syndrome and, using computed tomography, the distribution of abdominal adiposity were assessed in 144 hemodialysis patients (90 men and 54 women; mean age, 60.7 years) and 30 age-and sex-matched patients with chronic kidney disease (CKD). Plasma HMW adiponectin levels in hemodialysis patients were significantly higher than those in patients with CKD, negatively associated with VFA and serum triglycerides and positively associated with plasma total adiponectin, as well as the HMW-to-total adiponectin ratio in men and women (all Po0.05) in a simple regression analysis. In a multiple regression analysis, VFA was a significant determinant of HMW adiponectin in hemodialysis patients. Furthermore, after adjustment for classical risk factors, HMW adiponectin levels were significantly higher in patients undergoing treatment with renin-angiotensin system inhibitors or calcium channel blockers compared with patients not undergoing such treatment. This study shows that plasma HMW adiponectin levels were negatively associated with VFA and positively associated with treatment with blockade of the renin-angiotensin system and of the calcium channel. Therefore, these drugs might be effective for improving adipocytokine-related metabolic abnormalities in hemodialysis patients.

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Relationship between Abdominal Fat Accumulation and Insulin Resistance in Hemodialysis Patients

Abstract: It is well known that obesity and insulin resistance are closely related to the development of type 2 diabetes.However, the exact pathogenic mechanism underlying the insulin resistance in renal disease has not been

Cited by 36 publications

References 31 publications

Liver Fat Contents, Abdominal Adiposity and Insulin Resistance in Non-Diabetic Prevalent Hemodialysis Patients

Liver Fat Contents, Abdominal Adiposity and Insulin Resistance in Non-Diabetic Prevalent Hemodialysis Patients

Adiposity and insulin resistance in nondiabetic hemodialysis patients: effects of high energy supplementation

Potential impact of renin–angiotensin system inhibitors and calcium channel blockers on plasma high-molecular-weight adiponectin levels in hemodialysis patients

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