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Adiposity and insulin resistance in nondiabetic hemodialysis patients: effects of high-energy supplementation^1,2,3

¹ From the Department and Institute of Physiology, National Yang-Ming University, Taipei (D-CT); the Division of Nephrology, Buddhist Tzu Chi General Hospital, Taipei Branch (S-CH); and the Division of Nephrology, Department of Medicine and Immunology Research Center, Taipei Veterans General Hospital, Taipei, Taiwan (D-CT).

² Supported by grants from the National Science Council (NSC 95-2314-B-010-077 and 96-2628-B-010-001-MY3), Taipei Veterans General Hospital (V97S5-004 and V97C1-093), and Buddhist Tzu Chi General Hospital, Taipei Branch (TCRD-TPE-95-45).

³ Address correspondence to D-C Tarng, Department and Institute of Physiology, National Yang-Ming University and Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital. No. 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan. E-mail: dctarng{at}vghtpe.gov.tw.

ABSTRACT

Background: In contrast to the general population, a higher body mass index is associated with better survival among hemodialysis patients. Theoretically, high-energy supplementation in these patients ought to lead to weight gain over time, but the benefits of this strategy are unclear.

Objective: The objective was to assess whether high-energy supplementation in nondiabetic hemodialysis patients might adversely affect insulin resistance—a known risk factor of cardiovascular disease.

Design: We first investigated the association between body fat mass and insulin resistance (homeostasis model assessment of insulin resistance; HOMA-IR) in nondiabetic hemodialysis patients in a cross-sectional analysis (study 1). Of the 106 individuals studied, 55 were randomly assigned to either high-energy supplementation (an extra of 475 kcal/d; n = 28) or not (n = 27) for 12 wk to assess prospective changes in body fat mass and insulin resistance (study 2).

Results: In study 1, body fat mass (P < 0.05) and C-reactive protein (CRP) (P < 0.05) each contributed independently to HOMA-IR. In study 2, 41 patients completed the study. The 20 patients who received high-energy supplementation had a significantly greater increase in body fat mass (P < 0.05), CRP (P < 0.05), and HOMA-IR (P < 0.001) than did the 21 controls.

Conclusions: Body fat mass and CRP are primary determinants of insulin resistance in nondiabetic hemodialysis patients. High-energy supplementation, because it increases adiposity and inflammation, exacerbates insulin resistance. A long-term study is needed to clarify the metabolic effects of high-energy supplementation on cardiovascular disease outcomes in hemodialysis patients.

Received for publication January 5, 2009. Accepted for publication April 14, 2009.