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 clarified. The purpose of the present study was to clarify the contribution of abdominal (visceral and subcutaneous) fat accumulation to insulin resistance and various clinical parameters, including C-reactive protein (CRP), in hemodialysis (HD) patients. Visceral and subcutaneous fat areas (VFA and SFA) were evaluated at the umbilical level by CT. Insulin resistance was estimated by the homeostasis model assessment−insulin resistance index (HOMA-IR) in 80 HD patients. Insulin resistance and CRP seemed to be closely correlated with fat-related parameters such as body mass index (BMI), VFA and SFA. HOMA-IR was positively correlated with BMI, VFA, SFA, triglycerides (TG), remnant-like particle (RLP)-cholesterol and CRP in simple regression analysis. In multiple stepwise regression analysis, SFA and RLP-cholesterol were predominant determinants of HOMA-IR in HD patients. Furthermore, CRP was positively correlated with BMI, VFA, SFA, TG, high-density lipoprotein (HDL)-cholesterol, atherosclerosis index (AI), immunoreactive insulin (IRI) and HOMA-IR in simple regression analysis. In multiple stepwise regression analysis, VFA and HDL-cholesterol were predominant determinants of CRP in HD patients. In conclusion, insulin resistance and CRP were related to fat-related parameters such as BMI, VFA and SFA in HD patients. Furthermore, the contribution of SFA to insulin resistance was much higher than that of VFA, while the opposite relation was recognized for CRP. (Hypertens Res 2008; 31: 83−88)
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Saijo Y, Kiyota N, Kawasaki Y, et al : Relationship between C-reactive protein and visceral adipose tissue in healthy Japanese subjects. Diabetes Obes Metab 2004; 6: 249–258.
Nakanishi N, Shiraishi T, Wada M : Association between C-reactive protein and insulin resistance in a Japanese population: the Minoh Study. Intern Med 2005; 44: 542–547.
Ridker PM, Rifai N, Rose L, Buring JE, Cook NR : Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med 2002; 347: 1557–1565.
Ridker PM, Rifai N, Cook NR, Bradwin G, Buring JE : Non-HDL cholesterol, apolipoproteins A-I and B100, standard lipid measures, lipid ratios, and CRP as risk factors for cardiovascular disease in women. JAMA 2005; 294: 326–333.
Mohamed-Ali V, Goodrick S, Rawesh A, et al : Subcutaneous adipose tissue releases interleukin-6, but not tumor necrosis factor-alpha, in vivo. J Clin Endocrinol Metab 1997; 82: 4196–4200.
Mak RH, DeFronzo RA : Glucose and insulin metabolism in uremia. Nephron 1992; 61: 377–382.
Kobayashi S, Maejima S, Ikeda T, Nagase M : Impact of dialysis therapy on insulin resistance in end-stage renal disease: comparison of haemodialysis and continuous ambulatory peritoneal dialysis. Nephrol Dial Transplant 2000; 15: 65–70.
Gautier JF, Mourier A, de Kerviler E, et al : Evaluation of abdominal fat distribution in noninsulin-dependent diabetes mellitus: relationship to insulin resistance. J Clin Endocrinol Metab 1998; 83: 1306–1311.
Banerji MA, Faridi N, Atluri R, Chaiken RL, Lebovitz HE : Body composition, visceral fat, leptin, and insulin resistance in Asian Indian men. J Clin Endocrinol Metab 1999; 84: 137–144.
Shoji T, Emoto M, Nishizawa Y : HOMA index to assess insulin resistance in renal failure patients. Nephron 2001; 89: 348–349.
Degoulet P, Legrain M, Reach I, et al : Mortality risk factors in patients treated by chronic hemodialysis. Report of the Diaphane collaborative study. Nephron 1982; 31: 103–110.
Fleischmann E, Teal N, Dudley J, May W, Bower JD, Salahudeen AK : Influence of excess weight on mortality and hospital stay in 1346 hemodialysis patients. Kidney Int 1999; 55: 1560–1567.
Kopple JD, Zhu X, Lew NL, Lowrie EG : Body weight-for-height relationships predict mortality in maintenance hemodialysis patients. Kidney Int 1999; 56: 1136–1148.
Combe C, Chauveau P, Laville M, et al, French Study Group Nutrition in Dialysis : Influence of nutritional factors and hemodialysis adequacy on the survival of 1,610 French patients. Am J Kidney Dis 2001; 37 ( 1 Suppl 2): S81–S88.
Iwasaki T, Nakajima A, Yoneda M, Terauchi Y : Relationship between the serum concentrations of C-reactive protein and parameters of adiposity and insulin resistance in patients with type 2 diabetes mellitus. Endocr J 2006; 53: 345–356.
Yatagai T, Nagasaka S, Taniguchi A, et al : Hypoadiponectinemia is associated with visceral fat accumulation and insulin resistance in Japanese men with type 2 diabetes mellitus. Metabolism 2003; 52: 1274–1278.
Taniguchi A, Nakai Y, Sakai M, et al : Relationship of regional adiposity to insulin resistance and serum triglyceride levels in nonobese Japanese type 2 diabetic patients. Metabolism 2002; 51: 544–548.
Abate N, Garg A, Peshock RM, Stray-Gundersen J, Adams-Huet B, Grundy SM : Relationship of generalized and regional adiposity to insulin sensitivity in men with NIDDM. Diabetes 1996; 45: 1684–1693.
Kelley DE, Williams KV, Price JC, McKolanis TM, Goodpaster BH, Thaete FL : Plasma fatty acids, adiposity, and variance of skeletal muscle insulin resistance in type 2 diabetes mellitus. J Clin Endocrinol Metab 2001; 86: 5412–5419.
Yamauchi T, Kuno T, Takada H, Nagura Y, Kanmatsuse K, Takahashi S : The impact of visceral fat on multiple risk factors and carotid atherosclerosis in chronic haemodialysis patients. Nephrol Dial Transplant 2003; 18: 1842–1847.
Odamaki M, Furuya R, Ohkawa S, et al : Altered abdominal fat distribution and its association with the serum lipid profile in non-diabetic haemodialysis patients. Nephrol Dial Transplant 1999; 14: 2427–2432.
Higashi K, Ito T, Nakajima K, et al : Remnant-like particles cholesterol is higher in diabetic patients with coronary artery disease. Metabolism 2001; 50: 1462–1465.
Takase H, Shoji K, Hase T, et al : Effect of diacylglycerol on postprandial lipid metabolism in non-diabetic subjects with and without insulin resistance. Atherosclerosis 2005; 180: 197–204.
Hirany S, O'Byrne D, Devaraj S, et al : Remnant-like particle-cholesterol concentrations in patients with type 2 diabetes mellitus and end-stage renal disease. Clin Chem 2000; 46: 667–672.
Inoue T, Inagaki H, Hashimoto S, et al : Remnant-like lipoprotein particle level and insulin resistance are associated with in-stent restenosis in patients with stable angina. Coron Artery Dis 2007; 18: 319–322.
Shinohara K, Shoji T, Emoto M, et al : Insulin resistance as an independent predictor of cardiovascular mortality in patients with end-stage renal disease. J Am Soc Nephrol 2002; 13: 1894–1900.
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Gohda, T., Gotoh, H., Tanimoto, M. et al. Relationship between Abdominal Fat Accumulation and Insulin Resistance in Hemodialysis Patients. Hypertens Res 31, 83–88 (2008). https://doi.org/10.1291/hypres.31.83
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DOI: https://doi.org/10.1291/hypres.31.83
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