Glucose intolerance associated with hypoxia in people living at high altitudes in the Tibetan highland

Kiyohito Okumiya, Ryota Sakamoto, Yasuko Ishimoto, Yumi Kimura, Eriko Fukutomi, Motonao Ishikawa, Kuniaki Suwa, Hissei Imai, Wenling Chen, Emiko Kato, Masahiro Nakatsuka, Yoriko Kasahara, Michiko Fujisawa, Taizo Wada, Hongxin Wang, Qingxiang Dai, Huining Xu, Haisheng Qiao, Ri Li Ge, Tsering NorbooNorboo Tsering, Yasuyuki Kosaka, Mitsuhiro Nose, Takayoshi Yamaguchi, Toshihiro Tsukihara, Kazuo Ando, Tetsuya Inamura, Shinya Takeda, Masayuki Ishine, Kuniaki Otsuka, Kozo Matsubayashi

研究成果: Article査読

28 被引用数 (Scopus)

抄録

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.

本文言語English
論文番号e009728
ジャーナルBMJ open
6
2
DOI
出版ステータスPublished - 2016
外部発表はい

ASJC Scopus subject areas

  • 医学(全般)

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