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dc.contributor.authorSakkas, Giorgos K
dc.contributor.authorKaratzaferi, Christina
dc.contributor.authorZintzaras, Elias
dc.contributor.authorGiannaki, Christoforos D
dc.contributor.authorLiakopoulos, Vassilios
dc.contributor.authorLavdas, Eleftherios
dc.contributor.authorDamani, Eleni
dc.contributor.authorLiakos, Nikos
dc.contributor.authorFezoulidis, Ioannis
dc.contributor.authorKoutedakis, Yiannis
dc.contributor.authorStefanidis, Ioannis
dc.date.accessioned2010-09-20T13:16:37Z
dc.date.available2010-09-20T13:16:37Z
dc.date.issued2008-12
dc.identifier.citationAmerican journal of physiology. Regulatory, integrative and comparative physiology, 295 (6): R1721-9en
dc.identifier.issn0363-6119
dc.identifier.pmid18832089
dc.identifier.doi10.1152/ajpregu.00935.2007
dc.identifier.urihttp://hdl.handle.net/2436/111404
dc.description.abstractHemodialysis patients exhibit insulin resistance (IR) in target organs such as liver, muscles, and adipose tissue. The aim of this study was to identify contributors to IR and to develop a model for predicting glucose intolerance in nondiabetic hemodialysis patients. After a 2-h, 75-g oral glucose tolerance test (OGTT), 34 hemodialysis patients were divided into groups with normal (NGT) and impaired glucose tolerance (IGT). Indices of insulin sensitivity were derived from OGTT data. Measurements included liver and muscle fat infiltration and central adiposity by computed tomography scans, body composition by dual energy X-ray absorptiometer, sleep quality by full polysomnography, and functional capacity and quality of life (QoL) by a battery of exercise tests and questionnaires. Cut-off points, as well as sensitivity and specificity calculations were based on IR (insulin sensitivity index by Matsuda) using a receiver operator characteristics (ROC) curve analysis. Fifteen patients were assigned to the IGT, and 19 subjects to the NGT group. Intrahepatic fat content and visceral adiposity were significantly higher in the IGT group. IR indices strongly correlated with sleep disturbances, visceral adiposity, functional capacity, and QoL. Visceral adiposity, O2 desaturation during sleep, intrahepatic fat content, and QoL score fitted into the model for predicting glucose intolerance. A ROC curve analysis identified an intrahepatic fat content of > 3.97% (sensitivity, 100; specificity, 35.7) as the best cutoff point for predicting IR. Visceral and intrahepatic fat content, as well as QoL and sleep seemed to be involved at some point in the development of glucose intolerance in hemodialysis patients. Means of reducing fat depots in the liver and splachnic area might prove promising in combating IR and cardiovascular risk in hemodialysis patients.
dc.language.isoenen
dc.publisherAmerican Physiological Societyen
dc.subject.meshAbsorptiometry, Photonen
dc.subject.meshAdiposityen
dc.subject.meshAdolescenten
dc.subject.meshAdulten
dc.subject.meshAgeden
dc.subject.meshFemaleen
dc.subject.meshGlucose Intoleranceen
dc.subject.meshGlucose Tolerance Testen
dc.subject.meshHumansen
dc.subject.meshInsulin Resistanceen
dc.subject.meshIntra-Abdominal Faten
dc.subject.meshLiveren
dc.subject.meshMaleen
dc.subject.meshMiddle Ageden
dc.subject.meshModels, Biologicalen
dc.subject.meshMuscle, Skeletalen
dc.subject.meshNutritional Statusen
dc.subject.meshPolysomnographyen
dc.subject.meshPredictive Value of Testsen
dc.subject.meshQuality of Lifeen
dc.subject.meshQuestionnairesen
dc.subject.meshROC Curveen
dc.subject.meshRenal Dialysisen
dc.subject.meshRisk Assessmenten
dc.subject.meshRisk Factorsen
dc.subject.meshSleep Disordersen
dc.subject.meshTomography, X-Ray Computeden
dc.subject.meshYoung Adulten
dc.titleLiver fat, visceral adiposity, and sleep disturbances contribute to the development of insulin resistance and glucose intolerance in nondiabetic dialysis patients.en
dc.typeJournal article
dc.identifier.journalAmerican journal of physiology. Regulatory, integrative and comparative physiologyen
html.description.abstractHemodialysis patients exhibit insulin resistance (IR) in target organs such as liver, muscles, and adipose tissue. The aim of this study was to identify contributors to IR and to develop a model for predicting glucose intolerance in nondiabetic hemodialysis patients. After a 2-h, 75-g oral glucose tolerance test (OGTT), 34 hemodialysis patients were divided into groups with normal (NGT) and impaired glucose tolerance (IGT). Indices of insulin sensitivity were derived from OGTT data. Measurements included liver and muscle fat infiltration and central adiposity by computed tomography scans, body composition by dual energy X-ray absorptiometer, sleep quality by full polysomnography, and functional capacity and quality of life (QoL) by a battery of exercise tests and questionnaires. Cut-off points, as well as sensitivity and specificity calculations were based on IR (insulin sensitivity index by Matsuda) using a receiver operator characteristics (ROC) curve analysis. Fifteen patients were assigned to the IGT, and 19 subjects to the NGT group. Intrahepatic fat content and visceral adiposity were significantly higher in the IGT group. IR indices strongly correlated with sleep disturbances, visceral adiposity, functional capacity, and QoL. Visceral adiposity, O2 desaturation during sleep, intrahepatic fat content, and QoL score fitted into the model for predicting glucose intolerance. A ROC curve analysis identified an intrahepatic fat content of > 3.97% (sensitivity, 100; specificity, 35.7) as the best cutoff point for predicting IR. Visceral and intrahepatic fat content, as well as QoL and sleep seemed to be involved at some point in the development of glucose intolerance in hemodialysis patients. Means of reducing fat depots in the liver and splachnic area might prove promising in combating IR and cardiovascular risk in hemodialysis patients.


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