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The Association of Dietary Insulin Load and Dietary Insulin Index With Body Composition in Paralympic Athletes With Hemophilia and Undergoing Hemodialysis: A Cross-Sectional Study Publisher



Beba M ; Gholizadeh M ; Yazdi RK ; Ostadrahimi A ; Djafarian K
Authors

Source: Nutrire Published:2026


Abstract

Background: Patients with hemophilia and those undergoing hemodialysis are at increased risk of several chronic conditions, including cardiovascular diseases, obesity, and insulin resistance. Dietary intake, particularly carbohydrate consumption, may influence body composition which is directly associated with athletic performance. Therefore, this study aimed to examine the association of dietary insulin load (DIL) and dietary insulin index (DII) with body composition parameters in Paralympic athletes with hemophilia or undergoing hemodialysis. Methods: A cross-sectional study was conducted on 100 Paralympic table tennis athletes with hemophilia and undergoing hemodialysis during the early 2022 pre-competitive season. Dietary intake was assessed using a validated 147-item semi-quantitative food frequency questionnaire (FFQ). DIL and DII were calculated after obtaining the food insulin index for each food item. Physical activity was assessed using the short form of the International Physical Activity Questionnaire (IPAQ). Body composition parameters were evaluated using skinfold measurements and a bioelectrical impedance analyzer (BIA). Results: A multiple linear regression analysis revealed significant inverse associations between DII and both body fat mass and percentage body fat in athletes with hemophilia. Additionally, among athletes undergoing hemodialysis, DII was significantly inversely associated with fat-free mass (FFM), percentage of FFM, and percent muscle mass. Conclusion: This study highlights significant inverse associations between DII and several body composition parameters in Paralympic athletes with hemophilia and those undergoing hemodialysis. However, due to the cross-sectional design, causality cannot be inferred. © The Author(s), under exclusive licence to Springer Nature Switzerland AG 2026.
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