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Martins MA, Neves AN, Moss T, Martins WH, Pereira GV, Pessôa KVDO, da Silva MH, de Abreu LC. Psychometric Validation of the Brazilian Portuguese Version of the Derriford Appearance Scale-24 (DAS-24) for People Living with HIV/AIDS. Healthcare (Basel) 2020; 8:healthcare8040569. [PMID: 33348532 PMCID: PMC7767182 DOI: 10.3390/healthcare8040569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/10/2020] [Accepted: 11/26/2020] [Indexed: 01/20/2023] Open
Abstract
The changes in appearance of people living with HIV/AIDS (PLHA) interferes with how people around them react to their body, how social interactions take place, and how each person perceives and accepts their body. The definition of itself can be severely challenged when the body changes as a result of illness and the person does not look healthier anymore. People living with HIV/AIDS (PLHA) are an especially vulnerable group when it comes to “distress” and the psychosocial impact of appearance, yet the assessment of body image changes in these people was subjective in Brazil. The aim of this paper was to assess the psychometric properties of the Brazilian version of Derriford Appearance Scale 24 (DAS-24) for a sample of Brazilians living with HIV/AIDS. A sample of 400 patients were recruited from an HIV/AIDS ambulatory, aged between 18 and 78 years, of both sexes. The psychometric properties of DAS-24 were investigated while using confirmatory factor analysis (CFA), with unweighted least square estimation and listwise deletion for missing data. The adjustment of three structural models previously established for DAS-24 (single-factor, two-factor, and three-factor) was investigated. Evidences of construct validity—convergent and discriminant—and internal consistency—Cronbach’s alpha and construct reliability—were also generated for the measure model. The results showed that the one-factor model had the best adjustment, after eliminating items 8, 17, and 20, and accepting the covariance of errors between items 4 and 10; 9 and 23; 11 and 14; and, 14 and 22. Additionally, validity and reliability evidence were satisfactory for the model. The Brazilian Portuguese version of DAS-24 seems to be a psychometrically sound scale for measuring body image distress for people living with HIV/AIDS (PLHA).
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Affiliation(s)
- Marcos Alberto Martins
- Laboratório de Delineamento de Estudos e Escrita Científica, Centro Univeristário Saúde ABC, Santo André, São Paulo 09060-870, Brazil; (W.H.M.); (G.V.P.); (L.C.d.A.)
- Hospital Samaritano de São Paulo—Cirurgia Plástica, São Paulo 01232-010, Brazil
- Correspondence:
| | - Angela Nogueira Neves
- Divisão de Pesquisa, Escola de Educação Física do Exército, Rio de Janeiro 22291-090, Brazil;
| | - Tim Moss
- Postgraduate Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol BS16 1QY, UK;
| | - Walter Henrique Martins
- Laboratório de Delineamento de Estudos e Escrita Científica, Centro Univeristário Saúde ABC, Santo André, São Paulo 09060-870, Brazil; (W.H.M.); (G.V.P.); (L.C.d.A.)
- Hospital Samaritano de São Paulo—Cirurgia Plástica, São Paulo 01232-010, Brazil
- Programa Municipal de IST/AIDS e Hepatites Virais de São Bernardo do Campo, São Bernardo do Campo, São Paulo 04121-000, Brazil;
| | - Gerson Vilhena Pereira
- Laboratório de Delineamento de Estudos e Escrita Científica, Centro Univeristário Saúde ABC, Santo André, São Paulo 09060-870, Brazil; (W.H.M.); (G.V.P.); (L.C.d.A.)
| | | | | | - Luiz Carlos de Abreu
- Laboratório de Delineamento de Estudos e Escrita Científica, Centro Univeristário Saúde ABC, Santo André, São Paulo 09060-870, Brazil; (W.H.M.); (G.V.P.); (L.C.d.A.)
- School of Medicine, University of Limerick, V94 T9PX Limerick, Ireland
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Mahboub N, Rizk R, Karavetian M, de Vries N. Nutritional status and eating habits of people who use drugs and/or are undergoing treatment for recovery: a narrative review. Nutr Rev 2020; 79:627-635. [PMID: 32974658 PMCID: PMC8114851 DOI: 10.1093/nutrit/nuaa095] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
A comprehensive overview is presented of the nutritional issues faced by people who use drugs or are undergoing treatment for recovery. Chronic substance use affects a person’s nutritional status and body composition through decreased intake, nutrient absorption, and dysregulation of hormones that alter the mechanisms of satiety and food intake. Anthropometrics alone is not the best indicator of nutritional status, because this population has hidden deficiencies and disturbed metabolic parameters. Socioeconomic factors (eg, higher education, higher income, presence of a partner, living at home) positively affect nutritional status. Scarce available data on users undergoing treatment indicate improvement in anthropometric and metabolic parameters but with micronutrient intake remaining suboptimal. Weight gain is noted especially among women who use drugs and potentially increases their risk of relapse. Finally, specific amino acids and omega-3 fatty acids are promising in decreasing relapse and improving mental health during treatment; however, additional high-quality studies are needed. Nutrition intervention for people who use drugs or are undergoing treatment for recovery is underused; comprehensive programs addressing this population’s unique needs are necessary. Future research will identify which components are needed.
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Affiliation(s)
- Nadine Mahboub
- Department of Nutrition and Food Sciences, Lebanese International University, Beirut, Lebanon, and Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - Rana Rizk
- Institut National de Santé Publique, d'Epidémiologie Clinique et de Toxicologie, The Lebanese University, Beirut, Lebanon, and Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Mirey Karavetian
- College of Natural and Health Sciences, Zayed University, Dubai, United Arab Emirates
| | - Nanne de Vries
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
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Chen M, Hung CL, Yun CH, Webel AR, Longenecker CT. Sex Differences in the Association of Fat and Inflammation Among People with Treated HIV Infection. Pathog Immun 2019; 4:163-179. [PMID: 31508536 PMCID: PMC6728135 DOI: 10.20411/pai.v4i1.304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 07/29/2019] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Ectopic fat deposition may contribute to chronic inflammation in people with HIV (PWH). To provide information for future mechanistic studies of metabolic risk in this population, we sought to determine which fat measures relate more strongly to inflammation and whether the fat-inflammation relationship is modified by sex or HIV status. METHODS We conducted a cross-sectional study of 105 PWH and 20 age- and sex-matched HIV-negative controls. Interleukin-6 (IL-6) and high-sensitivity C reactive protein (hs-CRP) levels were measured from plasma. Pericardial fat (PCF) and thoracic periaortic adipose tissue (TAT) volumes and peri-right coronary artery (RCA), left atrium (LA) roof, and liver densities were measured from cardiac CT scans. Unadjusted and multivariate adjusted linear regression models were used to determine the relationship between ectopic fat measures and inflammation biomarkers. RESULTS Forty participants had BMI < 25, 33 had BMI 25 to 30, and 52 had BMI > 30. Systolic blood pressure and insulin resistance increased with BMI. Participants with higher BMI had a higher CD4+ count. In models adjusted for demographics, HIV status, and metabolic risk factors, BMI was positively associated with IL-6 and hs-CRP. Ectopic PCF and TAT volumes were positively associated with IL-6 and hs-CRP; however, these relationships were somewhat attenuated in adjusted models. LA roof (but not peri-RCA) fat radiodensity was inversely associated with hs-CRP in fully adjusted models, and the association with IL-6 was borderline statistically signifi-cant (P = 0.054). IL-6 was more strongly associated with BMI and LA roof density in women than in men (P for interaction = 0.05). CONCLUSIONS Among PWH receiving antiretroviral therapy, higher BMI and excessive ectopic fat burden were associated with circulating markers of systemic inflammation. Because these measures appear to be more strongly related to inflammation among women than men, future clinical studies of metabolic risk and inflammation among PWH should include sex-stratified analyses.
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Affiliation(s)
- Marcelo Chen
- Department of Urology; MacKay Memorial Hospital; Taipei, Taiwan
- Department of Cosmetic Applications and Management; Mackay Junior College of Medicine, Nursing and Management; Taipei, Taiwan
| | - Chung-Lieh Hung
- Division of Cardiology; Department of Internal Medicine; Mackay Memorial Hospital; Taipei, Taiwan
- Department of Medicine; Mackay Medical College; Taipei, Taiwan
| | - Chun-Ho Yun
- Department of Radiology; Mackay Memorial Hospital; Taipei, Taiwan
- Department of Nursing; Mackay Junior College of Medicine; Nursing and Management; Taipei, Taiwan
| | - Allison R Webel
- Frances Payne Bolton School of Nursing; Case Western Reserve University; Cleveland, Ohio
| | - Chris T Longenecker
- Division of Cardiovascular Medicine; Case Western Reserve University School of Medicine; Cleveland, Ohio
- University Hospitals Harrington Heart & Vascular Institute; Cleveland, Ohio
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Aghdassi E, Arendt B, Salit IE, Allard JP. Estimation of Body Fat Mass Using Dual-Energy X-Ray Absorptiometry, Bioelectric Impedance Analysis, and Anthropometry in HIV-Positive Male Subjects Receiving Highly Active Antiretroviral Therapy. JPEN J Parenter Enteral Nutr 2017; 31:135-41. [PMID: 17308254 DOI: 10.1177/0148607107031002135] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this pilot study was to compare estimates of percentage body fat mass (FM) by bioelectric impedance analysis (BIA) and skinfold measurements (SF) with estimates obtained from dual-energy x-ray absorptiometry (DEXA) in 47 HIV-infected male subjects receiving highly active antiretroviral therapy (HAART). As different patterns of abdominal fat accumulation might affect the body FM estimation, correlation and agreement of these methods were also compared in patients with waist to hip ratio (WHR) < or =0.9 and >0.9. METHODS Body FM was estimated by BIA and by measuring skinfold thickness at biceps, triceps, and subscapular area, and was compared with DEXA as the reference method using paired t-test. RESULTS Estimates by SF were significantly higher and by BIA were significantly lower compared with DEXA for all subjects. This relationship persisted only in those with WHR >0.9. Both BIA and SF correlated significantly with DEXA, but they did not agree. However, both techniques showed a small intermethod bias, and the precision was within the acceptable range. This relationship persisted in those with WHR >0.9. In comparison with measurement by BIA, SF showed poorer agreement (larger bias and error). CONCLUSION For population studies and perhaps to monitor changes over time for intervention studies, the bias for both BIA and SF methods is relatively small and errors and precisions are within the acceptable range when compared with DEXA, and thus all 3 techniques can be used for routine monitoring of total body FM in male subjects with HIV infection.
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Palella FJ, McKibben R, Post WS, Li X, Budoff M, Kingsley L, Witt MD, Jacobson LP, Brown TT. Anatomic Fat Depots and Coronary Plaque Among Human Immunodeficiency Virus-Infected and Uninfected Men in the Multicenter AIDS Cohort Study. Open Forum Infect Dis 2016; 3:ofw098. [PMID: 27419170 PMCID: PMC4943560 DOI: 10.1093/ofid/ofw098] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 05/10/2016] [Indexed: 11/13/2022] Open
Abstract
Methods. In a cross-sectional substudy of the Multicenter AIDS Cohort Study, noncontrast cardiac computed tomography (CT) scanning for coronary artery calcium (CAC) scoring was performed on all men, and, for men with normal renal function, coronary CT angiography (CTA) was performed. Associations between fat depots (visceral adipose tissue [VAT], abdominal subcutaneous adipose tissue [aSAT], and thigh subcutaneous adipose tissue [tSAT]) with coronary plaque presence and extent were assessed with logistic and linear regression adjusted for age, race, cardiovascular disease (CVD) risk factors, body mass index (BMI), and human immunodeficiency virus (HIV) parameters. Results. Among HIV-infected men (n = 597) but not HIV-uninfected men (n = 343), having greater VAT was positively associated with noncalcified plaque presence (odds ratio [OR] = 1.04, P < .05), with a significant interaction (P < .05) by HIV serostatus. Human immunodeficiency virus-infected men had lower median aSAT and tSAT and greater median VAT among men with BMI <25 and 25–29.9 kg/m2. Among HIV-infected men, VAT was positively associated with presence of coronary plaque on CTA after adjustment for CVD risk factors (OR = 1.04, P < .05), but not after additional adjustment for BMI. There was an inverse association between aSAT and extent of total plaque among HIV-infected men, but not among HIV-uninfected men. Lower tSAT was associated with greater CAC and total plaque score extent regardless of HIV serostatus. Conclusions. The presence of greater amounts of VAT and lower SAT may contribute to increased risk for coronary artery disease among HIV-infected persons.
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Affiliation(s)
| | | | | | - Xiuhong Li
- Johns Hopkins University , Baltimore, Maryland
| | - Matthew Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, California
| | | | - Mallory D Witt
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, California
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Kirunda BE, Fadnes LT, Wamani H, Van den Broeck J, Tylleskär T. Population-based survey of overweight and obesity and the associated factors in peri-urban and rural Eastern Uganda. BMC Public Health 2015; 15:1168. [PMID: 26602893 PMCID: PMC4659217 DOI: 10.1186/s12889-015-2506-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 11/17/2015] [Indexed: 12/11/2022] Open
Abstract
Background In sub-Saharan Africa (SSA), the rising prevalence of overweight, obesity and non-communicable diseases co-exists with the high burden of under-nutrition. The paucity of data on adulthood overweight and obesity, disaggregated by socio-demographic characteristics and in rural settings in SSA calls for research. We determined the prevalence of underweight, overweight/obesity and associated factors among adults in peri-urban and rural Uganda. Methods A cross-sectional study of 1210 randomly selected adults aged ≥ 18 years was conducted in Iganga-Mayuge Health and Demographic Surveillance Site in eastern Uganda in 2013. Height, weight and socio-demographic variables were assessed. Overweight was defined as BMI = 25.0-29.99 kg/m2, obesity ≥ 30 kg/m2 and overweight/obesity ≥ 25 kg/m2. Logistic regression was used to identify factors associated with overweight/obesity. Results Of the participants, 7 % were underweight (8.1 % of men; 5.9 % of women, p = 0.99); 17.8 % were overweight (12.4 % of men; 23.1 % of women, p < 0.001); and 7 % were obese (2.0 % of men; 12.7 % of women, p < 0.001). Overweight prevalence was 15.8 % and 23.8 % among rural and peri-urban adults, respectively (p < 0.001). Obesity prevalence was 3.9 % and 17.8 % among rural and peri-urban adults, respectively (p < 0.001). Factors associated with overweight/obesity were: being female, adjusted odds ratio (AOR) 4.3 (95 % confidence interval (PloS one 8:e75640, 20013) 3.2–5.9); peri-urban residence AOR 2.6 (1.9–3.6); being in age group 35–44, AOR 3.1 (1.8–5.3); 45–54 AOR 4.1 (2.3–7.3); 55–64 AOR 2.6 (1.4–5.0); ≥ 65 years AOR 3.1 (1.6–6.0); and having socio-economic status (SES) in the third AOR 2.8 (1.7–4.6), fourth 2.5 (1.5–4.2) and fifth 2.7 (1.6–4.4) quintile. Conclusions Overweight/obesity was prevalent among adults. Overweight/obese was associated with being female, being aged 35 years and older, residing in a peri-urban area and having a higher SES. The time has come to develop interventions to prevent and control overweight/obesity. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2506-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Barbara Eva Kirunda
- Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, School of Public Health, P.O. Box 7072, Kampala, Uganda. .,Centre for International Health, University of Bergen, P.O. Box 7800, 5020, Bergen, Norway.
| | - Lars Thore Fadnes
- Centre for International Health, University of Bergen, P.O. Box 7800, 5020, Bergen, Norway. .,Department of Clinical Dentistry, University of Bergen, P.O. Box 7800, 5020, Bergen, Norway.
| | - Henry Wamani
- Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, School of Public Health, P.O. Box 7072, Kampala, Uganda.
| | - Jan Van den Broeck
- Centre for International Health, University of Bergen, P.O. Box 7800, 5020, Bergen, Norway
| | - Thorkild Tylleskär
- Centre for International Health, University of Bergen, P.O. Box 7800, 5020, Bergen, Norway.
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McCormick CL, Francis AM, Iliffe K, Webb H, Douch CJ, Pakianathan M, Macallan DC. Increasing Obesity in Treated Female HIV Patients from Sub-Saharan Africa: Potential Causes and Possible Targets for Intervention. Front Immunol 2014; 5:507. [PMID: 25431572 PMCID: PMC4230180 DOI: 10.3389/fimmu.2014.00507] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 09/29/2014] [Indexed: 11/30/2022] Open
Abstract
Objectives: To investigate changing nutritional demographics of treated HIV-1-infected patients and explore causes of obesity, particularly in women of African origin. Methods: We prospectively reviewed nutritional demographics of clinic attenders at an urban European HIV clinic during four one-month periods at three-yearly intervals (2001, 2004, 2007, and 2010) and in two consecutive whole-year reviews (2010–2011 and 2011–2012). Risk-factors for obesity were assessed by multiple linear regression. A sub-study of 50 HIV-positive African female patients investigated body-size/shape perception using numerical, verbal, and pictorial cues. Results: We found a dramatic rise in the prevalence of obesity (BMI > 30 kg/m2), from 8.5 (2001) to 28% (2011–2012) for all clinic attenders, of whom 86% were on antiretroviral treatment. Women of African origin were most affected, 49% being obese, with a further 32% overweight (BMI 25–30 kg/m2) in 2012. Clinical factors strongly associated with obesity included female gender, black African ethnicity, non-smoking, age, and CD4 count (all P < 0.001); greater duration of cART did not predict obesity. Individual weight-time trends mostly showed slow long-term progressive weight gain. Investigating body-weight perception, we found that weight and adiposity were underestimated by obese subjects, who showed a greater disparity between perceived and actual adiposity (P < 0.001). Obese subjects targeted more obese target “ideal” body shapes (P < 0.01), but were less satisfied with their body shape overall (P = 0.02). Conclusion: Seropositive African women on antiretroviral treatment are at heightened risk of obesity. Although multifactorial, body-weight perception represents a potential target for intervention.
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Affiliation(s)
- Claire L McCormick
- Clinical Infection Unit & Department of Genitourinary Medicine, St. George's Healthcare NHS Trust , London , UK
| | - Arianne M Francis
- Infection and Immunity Research Institute, St. George's, University of London , London , UK
| | - Kim Iliffe
- Infection and Immunity Research Institute, St. George's, University of London , London , UK
| | - Helen Webb
- Clinical Infection Unit & Department of Genitourinary Medicine, St. George's Healthcare NHS Trust , London , UK
| | - Catherine J Douch
- Clinical Infection Unit & Department of Genitourinary Medicine, St. George's Healthcare NHS Trust , London , UK
| | - Mark Pakianathan
- Clinical Infection Unit & Department of Genitourinary Medicine, St. George's Healthcare NHS Trust , London , UK
| | - Derek C Macallan
- Clinical Infection Unit & Department of Genitourinary Medicine, St. George's Healthcare NHS Trust , London , UK ; Infection and Immunity Research Institute, St. George's, University of London , London , UK
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Sharma A, Bynum SA, Schneider MF, Cox C, Tien PC, Hershow RC, Gustafson D, Plankey MW. Changes in Body Mass Index Following HAART Initiation among HIV-Infected Women in the Women's Interagency HIV Study. ACTA ACUST UNITED AC 2014; 5. [PMID: 25580365 DOI: 10.4172/2155-6113.1000323] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Examine changes in, and factors associated with changing body mass index (BMI) in women following highly active antiretroviral therapy (HAART) initiation. METHODS 1177 HIV-infected Women's Interagency HIV Study participants who contributed 10,754 years of follow-up following HAART initiation were studied. Changes in median BMI up to 15 years following HAART initiation, and the highest and lowest BMI reached following HAART initiation were summarized by pre-HAART BMI category (<18.5 [underweight], 18.5-<25.0 [normal weight], 25.0-<30.0 [overweight], 30.0-<40.0 [obese], and ≥ 40.0 [morbidly obese]). Multivariate mixed effects ordinal logistic regression estimated the degree of association of each exposure of interest with post-HAART BMI. RESULTS Before HAART, 39% percent of women had normal BMI, 31% were overweight, 23% were obese, and 5% were morbidly obese. Following HAART initiation, median BMI change (per 5 years) was 0.21 kg/m2 (90% confidence interval [CI]: -1.33, 0.42) for those with normal pre-HAART BMI, 0.39 kg/m2 (90% CI: 0.15,0.66) for overweight, 0.31 kg/m2 (90% CI: -1.18,0.67) for obese, and -0.36kg/m2 for morbidly obese women. After initiating HAART, 40% with normal pre-HAART BMI became overweight at some point; of those overweight, 46% remained overweight and 47% became obese; 71% of obese women remained obese and 27% became morbidly obese. Each year of nucleoside analog reverse transcriptase inhibitor use was associated with a 3% decreased odds of reaching a higher BMI category (OR 0.97, 95% CI: 0.95, 0.99), while each year of protease inhibitor or non-nucleoside analog reverse transcriptase inhibitor use were associated with a 6% (OR 1.06, 95% CI: 1.04, 1.08) and 5%(OR 1.05, 95% CI: 1.01, 1.08) increased odds of having a higher BMI category, respectively. CONCLUSIONS Although overweight and obesity are highly prevalent in this large cohort of HIV-infected, minority women, HAART use was associated with only a modest increase in BMI over time.
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Affiliation(s)
- Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Shalanda A Bynum
- Department of Social and Behavioral Sciences, Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Michael F Schneider
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christopher Cox
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Phyllis C Tien
- Department of Medicine, University of California at San Francisco, USA
| | - Ronald C Hershow
- Department of Epidemiology, University of Illinois at Chicago, USA
| | - Deborah Gustafson
- Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Michael W Plankey
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA
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Mokori A, Kabehenda MK, Nabiryo C, Wamuyu MG. Reliability of scored patient generated subjective global assessment for nutritional status among HIV infected adults in TASO, Kampala. Afr Health Sci 2011; 11 Suppl 1:S86-92. [PMID: 22135651 DOI: 10.4314/ahs.v11i3.70076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Establish the reliability of the scored Patient Generated-Subjective Global Assessment (PG-SGA) in determining nutritional status among Antiretroviral Therapy (ART) naive HIV-infected adults. METHODS A descriptive, cross sectional study among outpatient medical clinics, in The AIDS Support Organization (TASO), Mulago Centre, Kampala, Uganda. The study group (n=217) consisted of male (n=60) and female (n=157) HIV patients (18-67 years). Purposive sampling was used. Anthropometry (weight, height, BMI), nutritional history (body weight, dietary intake, gastrointestinal symptoms, functional capacity and infections), and clinical status were assessed. Sensitivity and specificity of PG-SGA were determined using Receiver Operating Characteristic (ROC) curve. Data collection was done from April-May 2008. RESULTS Only 12% of the subjects were underweight and over half (58.2%) had normal weight. The PG-SGA had low sensitivity (69.2%) and specificity (57.1%) at categorizing the risk for malnutrition indicated by BMI< 18.5. CONCLUSION There was a high prevalence of malnutrition among the study group. Overall, this study indicated the PG-SGA could not adequately discriminate between underweight and normal patients. The tool was not reliable enough for determining nutritional status in this population.
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Affiliation(s)
- A Mokori
- Department of Food Science and Technology, Makerere University, Kampala, Uganda.
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Polsky S, Floris-Moore M, Schoenbaum EE, Klein RS, Arnsten JH, Howard AA. Incident hyperglycaemia among older adults with or at-risk for HIV infection. Antivir Ther 2011; 16:181-8. [PMID: 21447867 DOI: 10.3851/imp1711] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND HIV infection has been associated with development of prediabetes and diabetes. Optimum screening practices for these disorders in HIV-infected populations remain unclear. METHODS We screened 377 adults, with or at-risk for HIV infection, for incident hyperglycaemia (prediabetes or diabetes) using two oral glucose tolerance tests (OGTTs) a median of 18.6 months apart. We determined proportion of incident cases detected by fasting and 120-min plasma glucose levels. Independent predictors of incident hyperglycaemia were identified using logistic regression. RESULTS The baseline OGTT was consistent with diabetes in 7% of participants and with prediabetes in 31%. Among 352 normoglycaemic and prediabetic participants at baseline, 19 (5%) developed diabetes on follow-up. Among participants normoglycaemic at baseline, an additional 38 (16%) developed prediabetes. Overall 52% of incident hyperglycaemia cases were detected by fasting plasma glucose alone, 33% by a 120-min glucose level alone and 15% by both. Factors independently associated with incident hyperglycaemia included age ≥50 years and body mass index ≥30 kg/m(2). Neither HIV infection nor highly active antiretroviral therapy (HAART) use were associated with increased risk of diabetes. CONCLUSIONS Incident hyperglycaemia is common among older adults with or at-risk for HIV infection. HIV-infected individuals with classic diabetes risk factors should be screened for hyperglycaemia regardless of HAART use. OGTTs might be the preferred screening strategy in HIV-infected individuals at high risk for developing hyperglycaemia.
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Affiliation(s)
- Sarit Polsky
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado, Denver, USA
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Andany N, Raboud JM, Walmsley S, Diong C, Rourke SB, Rueda S, Rachlis A, Wobeser W, Macarthur RD, Binder L, Rosenes R, Loutfy MR. Ethnicity and gender differences in lipodystrophy of HIV-positive individuals taking antiretroviral therapy in Ontario, Canada. HIV CLINICAL TRIALS 2011; 12:89-103. [PMID: 21498152 DOI: 10.1310/hct1202-89] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE This study assessed ethnicity and gender differences in prevalence, type, and severity of antiretroviral-associated lipodystrophy in HIV-positive individuals in Ontario. METHODS This was a cross-sectional analysis of the Ontario Cohort Study (OCS), a prospective study of HIV-positive patients in Ontario. Lipodystrophy was defined as at least 1 major or 2 minor self-reported changes of peripheral lipoatrophy and/or central lipohypertrophy. Prevalence, type, and severity were compared by ethnicity (Black, White, or Other) and gender. Univariate and multivariate logistic regression analyses identified predictors of lipodystrophy. RESULTS Data were available for 778 participants (659 men, 119 women). There were 517 Whites, 121 Blacks, and 140 patients of Other ethnicities. In univariate analyses, Whites reported more peripheral lipoatrophy (P = .004) and abdominal lipohypertrophy (P = .04); these ethnic differences were observed in males (P = .05 and P = .03, respectively) but not females. Males reported more peripheral lipoatrophy (P = .01), whereas females had more central lipohypertrophy (P < .0001) and mixed fat redistribution (P < .0001). Multivariable regression analyses revealed Black women to be most vulnerable to lipodystrophy (P = .02), particularly lipohypertrophy (P < .0001). CONCLUSIONS Ethnicity and gender are important factors influencing lipodystrophy. Combining lipoatrophy and lipohypertrophy into a single entity is not appropriate. Black women were most vulnerable to lipohypertrophy, which has important implications for antiretroviral therapy roll-out in Africa.
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Affiliation(s)
- Nisha Andany
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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12
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Abstract
While communicable diseases such as human immunodeficiency virus/acquired immune deficiency syndrome, malaria, and tuberculosis have continued to pose greater threats to the public health system in sub-Saharan Africa (SSA), it is now apparent that non-communicable diseases such as diabetes mellitus are undoubtedly adding to the multiple burdens the peoples in this region suffer. Type 2 diabetes mellitus (T2DM) is the most common form of diabetes (90-95%), exhibiting an alarming prevalence among peoples of this region. Its main risk factors include obesity, rapid urbanization, physical inactivity, ageing, nutrition transitions, and socioeconomic changes. Patients in sub-Saharan Africa also show manifestations of beta-cell dysfunction and insulin resistance. However, because of strained economic resources and a poor health care system, most of the patients are diagnosed only after they have overt symptoms and complications. Microvascular complications are the most prevalent, but metabolic disorders and acute infections cause significant mortality. The high cost of treatment of T2DM and its comorbidities, the increasing prevalence of its risk factors, and the gaps in health care system necessitate that solutions be planned and implemented urgently. Aggressive actions and positive responses from well-informed governments appear to be needed for the conducive interplay of all forces required to curb the threat of T2DM in sub-Saharan Africa. Despite the varied ethnic and transitional factors and the limited population data on T2DM in sub-Saharan Africa, this review provides an extensive discussion of the literature on the epidemiology, risk factors, pathogenesis, complications, treatment, and care challenges of T2DM in this region.
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Affiliation(s)
- Vivian C Tuei
- Department of Molecular Biosciences, Bioengineering University of Hawaii, Honolulu, USA
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13
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Forrester JE, Tucker KL, Skinner S, Terrin N. Drug use and weight loss in HIV-infected Hispanic men. AIDS Care 2008; 20:868-75. [PMID: 18608065 DOI: 10.1080/09540120701767174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Weight loss is an independent risk factor for mortality in HIV but the role of drug use in HIV-related weight loss is not well described. We conducted this study to determine the role of drug use in HIV-related weight loss. Men (n=304), all of whom were Hispanic, were recruited into one of three groups: HIV-infected drug users; HIV-non-infected drug users; and HIV-infected non-drug users. Body mass index (BMI) was measured at successive visits. The groups were re-categorized based on self-reported drug use at the current visit into: (1) users of cocaine alone; (2) users of cocaine and opiates; (3) users of opiates alone; (4) former drug users; and (5) those who denied ever using drugs (all HIV-infected). The effect on BMI of the duration of use of the specific drug types was evaluated using repeated-measures analyses. Longer duration of exclusive opiate use or mixed cocaine and opiate use did not affect BMI in the men, regardless of HIV status. Exclusive cocaine use was associated with a decline in BMI among HIV-infected men (-0.070 kg/m(2) per month duration of use; SE=0.033; p=0.037) but not among HIV-uninfected men (0.024 kg/m(2) per month; SE=0.023; p=0.29). Adjustment for marijuana, cigarette and alcohol use in all men, or for CD4 count, viral load or HIV medication use in the HIV-infected men, did not alter the conclusions. We conclude that the use of opiates or combined opiates and cocaine does not increase the risk of weight loss in the presence or absence of HIV infection. Exclusive cocaine use may exacerbate weight loss in HIV-infection.
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Affiliation(s)
- J E Forrester
- Tufts University School of Medicine, Boston, MA, USA.
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14
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Abstract
The objective of the study was to identify predictors of obesity. One hundred eleven nonobese and 48 obese HIV-1 seropositive patients provided information on medical history and other characteristics. They were then asked to detect the passage of 2-s time intervals while the contingent negative variation (CNV) was recorded. Obese patients were healthier, more likely to be receiving Highly Active Antiretroviral Therapy, and less likely to be substance dependent. Obese patients also exhibited a greater CNV slope and responded prematurely. A path model suggested that CD4+count and protease inhibitor use directly predicted obesity. Depression had no direct effect. However, when incorporated into a hypothetical construct, "mood dysregulation," that also included childhood conduct problems and stimulant dependence, the shared variance among the indicators did predict obesity. This relationship was mediated through premature response preparation (anterior scalp CNV amplitude) and its hypothesized association with impatience/impulsivity.
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Affiliation(s)
- Lance O Bauer
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut 0603-2103, USA.
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15
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Christensen DL, Eis J, Hansen AW, Larsson MW, Mwaniki DL, Kilonzo B, Tetens I, Boit MK, Kaduka L, Borch-Johnsen K, Friis H. Obesity and regional fat distribution in Kenyan populations: impact of ethnicity and urbanization. Ann Hum Biol 2008; 35:232-49. [PMID: 18428015 DOI: 10.1080/03014460801949870] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Obesity is increasing rapidly in Africa, and may not be associated with the same changes in body composition among different ethnic groups in Africa. OBJECTIVE To assess abdominal visceral and subcutaneous fat thickness, prevalence of obesity, and differences in body composition in rural and urban Kenya. SUBJECTS AND METHODS In a cross-sectional study carried out among Luo, Kamba and Maasai in rural and urban Kenya, abdominal visceral and subcutaneous fat thicknesses were measured by ultrasonography. Height and weight, waist, mid-upper arm circumferences, and triceps skinfold thickness were measured. Body mass index (BMI), arm fat area (AFA) and arm muscle area (AMA) were calculated. RESULTS Among 1430 individuals (58.3% females) aged 17-68 years, abdominal visceral and subcutaneous fat, BMI, AFA and waist circumference (WC) increased with age, and were highest in the Maasai and in the urban population. AMA was only higher with increasing age among males. The prevalence of overweight (BMI > or = 25) (39.8% vs. 15.8%) and obesity (BMI > or = 30) (15.5% vs. 5.1%) was highest in the urban vs. rural population. CONCLUSION Abdominal visceral and subcutaneous fat thickness was higher with urban residency. A high prevalence of overweight and obesity was found. The Maasai had the highest overall fat accumulation.
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Affiliation(s)
- Dirk L Christensen
- Steno Diabetes Center, Gentofte, Denmark, University of Copenhagen, Frederiksberg, Denmark.
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16
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Quach LA, Wanke CA, Schmid CH, Gorbach SL, Mwamburi DM, Mayer KH, Spiegelman D, Tang AM. Drug use and other risk factors related to lower body mass index among HIV-infected individuals. Drug Alcohol Depend 2008; 95:30-6. [PMID: 18243579 PMCID: PMC3837518 DOI: 10.1016/j.drugalcdep.2007.12.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Revised: 12/03/2007] [Accepted: 12/04/2007] [Indexed: 01/24/2023]
Abstract
Malnutrition is associated with morbidity and mortality in HIV-infected individuals. Little research has been conducted to identify the roles that clinical, illicit drug use and socioeconomic characteristics play in the nutritional status of HIV-infected patients. This cross-sectional analysis included 562 HIV-infected participants enrolled in the Nutrition for Healthy Living study conducted in Boston, MA and Providence, RI. The relationship between body mass index (BMI) and several covariates (type of drug use, demographic, and clinical characteristics) were examined using linear regression. Overall, drug users had a lower BMI than non-drug users. The BMI of cocaine users was 1.4 kg/m(2) less than that of patients who did not use any drugs, after adjusting for other covariates (p=0.02). The BMI of participants who were over the age of 55 years was 2.0 kg/m(2) less than that of patients under the age of 35, and BMI increased by 0.3 kg/m(2) with each 100 cells/mm(3) increase in CD4 count. HAART use, adherence to HAART, energy intake, AIDS status, hepatitis B and hepatitis C co-infections, cigarette smoking and depression were not associated with BMI in the final model. In conclusion, BMI was lower in drug users than non-drug users, and was lowest in cocaine users. BMI was also directly associated with CD4 count and inversely related to age more than 55 years old. HIV-infected cocaine users may be at higher risk of developing malnutrition, suggesting the need for anticipatory nutritional support.
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Affiliation(s)
| | - Christine A Wanke
- Tufts University School of Medicine, Boston, MA,Tufts-New England Medicine Center, Boston, MA
| | | | | | | | - Kenneth H. Mayer
- Brown University, Providence, RI,The Miriam Hospital, Providence, RI
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17
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Cofrancesco J, Brown TT, Luo RF, John M, Stewart KJ, Dobs AS. Body composition, gender, and illicit drug use in an urban cohort. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2007; 33:467-74. [PMID: 17613974 DOI: 10.1080/00952990701301616] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This cross-sectional study of adult (137 male, 128 female), urban, community dwelling users and nonusers of illicit drugs evaluated associations of demographic, medical, and drug factors with body composition. The population was 49% HIV-positive and 94% African-American. In multivariate analysis, there were no body composition differences among males based on drug use. Among females, the highest tertile of drug use had less fat (12.3 vs.19.9 kg, p = .01) and lower body mass index (21.9 vs. 25.1, p = .01) versus less frequent or nonusers. These data suggest a sex difference in body composition associated with drug use.
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Affiliation(s)
- Joseph Cofrancesco
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA.
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18
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Albu JB, Kenya S, He Q, Wainwright M, Berk ES, Heshka S, Kotler DP, Engelson ES. Independent associations of insulin resistance with high whole-body intermuscular and low leg subcutaneous adipose tissue distribution in obese HIV-infected women. Am J Clin Nutr 2007; 86:100-6. [PMID: 17616768 PMCID: PMC2670485 DOI: 10.1093/ajcn/86.1.100] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Obesity and insulin resistance are growing problems in HIV-positive (HIV+) women receiving highly active antiretroviral therapy (HAART). OBJECTIVE The objective was to determine the contribution of adipose tissue (AT) enlargement and distribution to the presence of insulin resistance in obese HIV+ women. DESIGN Whole-body intermuscular AT (IMAT), visceral AT (VAT), subcutaneous AT (SAT), and SAT distribution (leg versus upper body) were measured by whole-body magnetic resonance imaging. Insulin sensitivity (S(I)) was measured with an intravenous glucose tolerance test in obese HIV+ women recruited because of their desire to lose weight (n=17) and in obese healthy controls (n=32). RESULTS The HIV+ women had relatively less whole-body SAT and more VAT and IMAT than did the controls (P<0.05 for all). A significant interaction by HIV status was observed for the relation of total SAT with S(I) (P<0.001 for the regression's slope interactions after adjustment for age, height, and weight). However, relations of IMAT, VAT, and SAT distribution (leg SAT as a percentage of total SAT; leg SAT%) with S(I) did not differ significantly between groups. For both groups combined, the best model predicting a low S(I) included significant contributions by both high IMAT and low leg SAT%, independent of age, height, and weight, and no interaction between groups was observed (overall r(2)=0.44, P=0.0003). CONCLUSION In obese HIV+ women, high whole-body IMAT and low leg SAT% distribution are independently associated with insulin resistance.
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Affiliation(s)
- Jeanine B Albu
- Endocrine, Diabetes and Nutrition Division, the New York Obesity Research Center, St Luke's Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY 10025, USA.
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19
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Howard AA, Lo Y, Floris-Moore M, Klein RS, Fleischer N, Schoenbaum EE. Hepatitis C virus infection is associated with insulin resistance among older adults with or at risk of HIV infection. AIDS 2007; 21:633-41. [PMID: 17314526 PMCID: PMC2423380 DOI: 10.1097/qad.0b013e3280464db7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To determine the associations of hepatitis C virus (HCV) infection with insulin resistance and abnormal glucose tolerance in a cohort of older adults with or at risk of HIV infection. DESIGN A cross-sectional study of 267 HIV-infected and 179 at-risk-uninfected adults without a history of diabetes mellitus. METHODS HCV antibody assays and RNA levels were performed to assess HCV status. Antiretroviral use, family history of diabetes, sedentary behavior, and sociodemographic data were obtained using standardized interviews. Fasting insulin levels and oral glucose tolerance tests were performed to assess two outcomes, the homeostasis model assessment of insulin resistance and abnormal glucose tolerance [impaired glucose tolerance (IGT) or diabetes]. RESULTS Of 446 participants, 265 (59%) were HCV seropositive; of these, 199 (75%) had detectable HCV-RNA levels. Insulin resistance was greater among HCV-seropositive compared with seronegative participants, adjusting for body mass index, Hispanic ethnicity, age greater than 55 years, sedentary behavior (watching television > 4 h/day), HIV status, HAART, and protease inhibitor (PI) use. Ninety-eight participants (22%) had abnormal glucose tolerance (69 with IGT and 29 with diabetes). Among HIV-infected participants, 25% were on non-PI HAART and 52% were on PI HAART, but HAART and PI use were not associated with insulin resistance or abnormal glucose tolerance. Among obese participants, abnormal glucose tolerance was more common in HCV-seropositive than seronegative individuals, whereas among non-obese participants there was no association. CONCLUSION The potential impact of HCV co-infection and obesity on glucose metabolism should be recognized in clinical care, and addressed in future research studies of HIV-infected individuals.
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Affiliation(s)
- Andrea A Howard
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York 10467, USA.
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20
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Mitsui T, Shimaoka K, Tsuzuku S, Kajioka T, Sakakibara H. Accuracy of body fat assessment by bioelectrical impedance in Japanese middle-aged and older people. J Nutr Sci Vitaminol (Tokyo) 2007; 52:154-6. [PMID: 16802697 DOI: 10.3177/jnsv.52.154] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Bioelectrical impedance analysis (BIA) is commonly used to measure the percentage of body fat (%BF), but its accuracy is controversial. In addition, the equations are specific to the group for which they were established. As far as we know, there is no study examining the accuracy of BIA in Japanese middle-aged and older people. We compared %BF assessed using BIA with that of dual-energy X-ray absorptiometry (DEXA) in 102 female and 51 male local residents aged 40 to 78 y. Simple correlation coefficients were 0.79 for females and 0.69 for males, which are statistically significant (p<0.001). However, BIA tended to overestimate %BF in the lower BF group and underestimate it in the BF higher group, and only 45.1% for female and 47.1% for male subjects were measured accurately, i.e., within 10% of the measurement by DEXA. This result suggests that this model of BIA is an alternative for estimating %BF in Japanese middle-aged and older people as well as when subjects are within a normal body fat range, but greater accuracy is needed for lean and overweight subjects.
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Affiliation(s)
- Takahiro Mitsui
- Research Center of Health, Physical Fitness and Sports, Nagoya University, Furocho, Japan
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