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Title: Glucose intolerance associated with hypoxia in people living at high altitudes in the Tibetan highland
Authors: Okumiya, Kiyohito
Sakamoto, Ryota  kyouindb  KAKEN_id
Ishimoto, Yasuko
Kimura, Yumi
Fukutomi, Eriko
Ishikawa, Motonao
Suwa, Kuniaki
Imai, Hissei
Chen, Wenling
Kato, Emiko
Nakatsuka, Masahiro
Kasahara, Yoriko
Fujisawa, Michiko
Wada, Taizo
Wang, Hongxin
Dai, Qingxiang
Xu, Huining
Qiao, Haisheng
Ge, Ri Li
Norboo, Tsering
Tsering, Norboo
Kosaka, Yasuyuki
Nose, Mitsuhiro
Yamaguchi, Takayoshi
Tsukihara, Toshihiro
Ando, Kazuo  kyouindb  KAKEN_id
Inamura, Tetsuya
Takeda, Shinya  kyouindb  KAKEN_id
Ishine, Masayuki
Otsuka, Kuniaki
Matsubayashi, Kozo
Author's alias: 奥宮, 清人
坂本, 龍太
竹田, 晋也
松林, 公蔵
Issue Date: 23-Feb-2016
Publisher: BMJ Publishing Group
Journal title: BMJ Open
Volume: 6
Issue: 2
Thesis number: e009728
Abstract: Objectives: To clarify the association between glucose intolerance and high altitudes (2900-4800 m) in a hypoxic environment in Tibetan highlanders and to verify the hypothesis that high altitude dwelling increases vulnerability to diabetes mellitus (DM) accelerated by lifestyle change or ageing. Design: Cross-sectional epidemiological study on Tibetan highlanders. Participants: We enrolled 1258 participants aged 40-87 years. The rural population comprised farmers in Domkhar (altitude 2900-3800 m) and nomads in Haiyan (3000-3100 m), Ryuho (4400 m) and Changthang (4300-4800 m). Urban area participants were from Leh (3300 m) and Jiegu (3700 m). Main outcome measure: Participants were classified into six glucose tolerance-based groups: DM, intermediate hyperglycaemia (IHG), normoglycaemia (NG), fasting DM, fasting IHG and fasting NG. Prevalence of glucose intolerance was compared in farmers, nomads and urban dwellers. Effects of dwelling at high altitude or hypoxia on glucose intolerance were analysed with the confounding factors of age, sex, obesity, lipids, haemoglobin, hypertension and lifestyle, using multiple logistic regression. Results: The prevalence of DM (fasting DM)/IHG (fasting IHG) was 8.9% (6.5%)/25.1% (12.7%), respectively, in all participants. This prevalence was higher in urban dwellers (9.5% (7.1%)/28.5% (11.7%)) and in farmers (8.5% (6.1%)/28.5% (18.3%)) compared with nomads (8.2% (5.7%)/15.7% (9.7%)) (p=0.0140/0.0001). Dwelling at high altitude was significantly associated with fasting IHG+fasting DM/fasting DM (ORs for >4500 and 3500-4499 m were 3.59/4.36 and 2.07/1.76 vs <3500 m, respectively). After adjusting for lifestyle change, hypoxaemia and polycythaemia were closely associated with glucose intolerance. Conclusions: Socioeconomic factors, hypoxaemia and the effects of altitudes ≥3500 m play a major role in the high prevalence of glucose intolerance in highlanders. Tibetan highlanders may be vulnerable to glucose intolerance, with polycythaemia as a sign of poor hypoxic adaptation, accelerated by lifestyle change and ageing.
Rights: This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
URI: http://hdl.handle.net/2433/216103
DOI(Published Version): 10.1136/bmjopen-2015-009728
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