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dc.contributor.authorOkumiya, Kiyohitoen
dc.contributor.authorSakamoto, Ryotaen
dc.contributor.authorIshimoto, Yasukoen
dc.contributor.authorKimura, Yumien
dc.contributor.authorFukutomi, Erikoen
dc.contributor.authorIshikawa, Motonaoen
dc.contributor.authorSuwa, Kuniakien
dc.contributor.authorImai, Hisseien
dc.contributor.authorChen, Wenlingen
dc.contributor.authorKato, Emikoen
dc.contributor.authorNakatsuka, Masahiroen
dc.contributor.authorKasahara, Yorikoen
dc.contributor.authorFujisawa, Michikoen
dc.contributor.authorWada, Taizoen
dc.contributor.authorWang, Hongxinen
dc.contributor.authorDai, Qingxiangen
dc.contributor.authorXu, Huiningen
dc.contributor.authorQiao, Haishengen
dc.contributor.authorGe, Ri Lien
dc.contributor.authorNorboo, Tseringen
dc.contributor.authorTsering, Norbooen
dc.contributor.authorKosaka, Yasuyukien
dc.contributor.authorNose, Mitsuhiroen
dc.contributor.authorYamaguchi, Takayoshien
dc.contributor.authorTsukihara, Toshihiroen
dc.contributor.authorAndo, Kazuoen
dc.contributor.authorInamura, Tetsuyaen
dc.contributor.authorTakeda, Shinyaen
dc.contributor.authorIshine, Masayukien
dc.contributor.authorOtsuka, Kuniakien
dc.contributor.authorMatsubayashi, Kozoen
dc.contributor.alternative奥宮, 清人ja
dc.contributor.alternative坂本, 龍太ja
dc.contributor.alternative竹田, 晋也ja
dc.contributor.alternative松林, 公蔵ja
dc.description.abstractObjectives: 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.en
dc.rightsThis 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.en
dc.titleGlucose intolerance associated with hypoxia in people living at high altitudes in the Tibetan highlanden
dc.typejournal article-
dc.type.niitypeJournal Article-
dc.identifier.jtitleBMJ Openen
dcterms.accessRightsopen access-
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