Dysglycemia associations with adipose tissue among HIV-infected patients after 2 years of antiretroviral therapy in Mwanza: a follow-up cross-sectional study
Identifieur interne : 000915 ( Main/Exploration ); précédent : 000914; suivant : 000916Dysglycemia associations with adipose tissue among HIV-infected patients after 2 years of antiretroviral therapy in Mwanza: a follow-up cross-sectional study
Auteurs : George Praygod [Tanzanie] ; John Changalucha [Tanzanie] ; Saidi Kapiga [Tanzanie, Royaume-Uni] ; Robert Peck [Tanzanie, États-Unis] ; Jim Todd [Royaume-Uni] ; Suzanne Filteau [Royaume-Uni]Source :
- BMC Infectious Diseases [ 1471-2334 ] ; 2017.
Abstract
Data on the burden of dysglycemia among HIV-infected patients on antiretroviral therapy (ART) in Africa are limited. We determined the prevalence of pre-diabetes and diabetes among HIV-infected patients who started ART when malnourished 2 to 3 years previously and investigated the association of dysglycemia with body composition.
Malnourished (body mass index (BMI) < 18.5 kg/m2) HIV-infected patients who were enrolled in the Nutritional Support for Africans Starting Antiretroviral Therapy (NUSTART) trial from 2011 to 2013 were followed-up from March to August 2015. Anthropometric, fat mass and fat-free mass by bioelectrical impedance, and C-reactive protein (CRP) data were collected at baseline and follow-up. At follow-up, we defined fasting glucose of 6.1–6.9 mmol/L as impaired fasting glucose (IFG) and 2-h oral glucose tolerance test (OGTT) glucose of ≥7.8 to <11.1 mmol/L as impaired glucose tolerance (IGT). Both of these were considered pre-diabetes. Fasting glucose of ≥7.0 mmol/L or impaired glucose tolerance of ≥11.1 mmol/L was defined as diabetes mellitus. The relation of pre-diabetes and diabetes with body composition was assessed using logistic regression.
Two hundred seventy-three (57%) of 478 patients who were alive at trial conclusion were followed-up. The mean age was 41.5 (SD 9.8) years and 65.2% (178) were females. The mean follow-up BMI was 19.9 (SD 2.8) kg/m2, 12 (4.4%) were either overweight or obese, and 61 (22.3%) patients had pre-diabetes or diabetes. In multiple regression, upper tertiles of baseline hip circumference (OR: 0.41, 95% CI: 0.2, 0.8) and fat mass index (OR: 0.20 (0.1, 0.5), and upper tertiles of follow-up waist circumference (OR: 0.22 (0.1, 0.5), BMI (OR: 0.32 (0.1, 0.7), fat mass index (OR: 0.19 (0.1, 0.5) and the middle tertile of follow-up fat-free mass (OR: 0.36, 95% CI: 0.1, 0.8) were associated with lower risk of pre-diabetes and diabetes (
Low rather than high measures of adipose tissue were associated with increased risk of pre-diabetes and diabetes. Additional studies are needed to further investigate the role of body composition and control of glucose metabolism in the pathogenesis of diabetes among persons living with HIV in Africa.
The online version of this article (doi:10.1186/s12879-017-2209-z) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1186/s12879-017-2209-z
PubMed: 28137307
PubMed Central: 5282875
Affiliations:
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York</wicri:regionArea></affiliation></author><author><name sortKey="Todd, Jim" sort="Todd, Jim" uniqKey="Todd J" first="Jim" last="Todd">Jim Todd</name><affiliation wicri:level="1"><nlm:aff id="Aff5"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0425 469X</institution-id><institution-id institution-id-type="GRID">grid.8991.9</institution-id><institution></institution><institution>London School of Hygiene and Tropical Medicine,</institution></institution-wrap>London, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>London</wicri:regionArea></affiliation></author><author><name sortKey="Filteau, Suzanne" sort="Filteau, Suzanne" uniqKey="Filteau S" first="Suzanne" last="Filteau">Suzanne Filteau</name><affiliation wicri:level="1"><nlm:aff id="Aff5"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0425 469X</institution-id><institution-id institution-id-type="GRID">grid.8991.9</institution-id><institution></institution><institution>London School of Hygiene and Tropical Medicine,</institution></institution-wrap>London, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>London</wicri:regionArea></affiliation></author></analytic><series><title level="j">BMC Infectious Diseases</title><idno type="eISSN">1471-2334</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Data on the burden of dysglycemia among HIV-infected patients on antiretroviral therapy (ART) in Africa are limited. We determined the prevalence of pre-diabetes and diabetes among HIV-infected patients who started ART when malnourished 2 to 3 years previously and investigated the association of dysglycemia with body composition.</p></sec><sec><title>Methods</title><p>Malnourished (body mass index (BMI) < 18.5 kg/m<sup>2</sup>) HIV-infected patients who were enrolled in the Nutritional Support for Africans Starting Antiretroviral Therapy (NUSTART) trial from 2011 to 2013 were followed-up from March to August 2015. Anthropometric, fat mass and fat-free mass by bioelectrical impedance, and C-reactive protein (CRP) data were collected at baseline and follow-up. At follow-up, we defined fasting glucose of 6.1–6.9 mmol/L as impaired fasting glucose (IFG) and 2-h oral glucose tolerance test (OGTT) glucose of ≥7.8 to <11.1 mmol/L as impaired glucose tolerance (IGT). Both of these were considered pre-diabetes. Fasting glucose of ≥7.0 mmol/L or impaired glucose tolerance of ≥11.1 mmol/L was defined as diabetes mellitus. The relation of pre-diabetes and diabetes with body composition was assessed using logistic regression.</p></sec><sec><title>Results</title><p>Two hundred seventy-three (57%) of 478 patients who were alive at trial conclusion were followed-up. The mean age was 41.5 (SD 9.8) years and 65.2% (178) were females. The mean follow-up BMI was 19.9 (SD 2.8) kg/m<sup>2</sup>, 12 (4.4%) were either overweight or obese, and 61 (22.3%) patients had pre-diabetes or diabetes. In multiple regression, upper tertiles of baseline hip circumference (OR: 0.41, 95% CI: 0.2, 0.8) and fat mass index (OR: 0.20 (0.1, 0.5), and upper tertiles of follow-up waist circumference (OR: 0.22 (0.1, 0.5), BMI (OR: 0.32 (0.1, 0.7), fat mass index (OR: 0.19 (0.1, 0.5) and the middle tertile of follow-up fat-free mass (OR: 0.36, 95% CI: 0.1, 0.8) were associated with lower risk of pre-diabetes and diabetes (<italic>P</italic> < 0.05 for all). Baseline and follow-up CRP were not predictors.</p></sec><sec><title>Conclusions</title><p>Low rather than high measures of adipose tissue were associated with increased risk of pre-diabetes and diabetes. Additional studies are needed to further investigate the role of body composition and control of glucose metabolism in the pathogenesis of diabetes among persons living with HIV in Africa.</p></sec><sec><title>Electronic supplementary material</title><p>The online version of this article (doi:10.1186/s12879-017-2209-z) contains supplementary material, which is available to authorized users.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Mbanya, Jc" uniqKey="Mbanya J">JC Mbanya</name></author><author><name sortKey="Motala, Aa" uniqKey="Motala A">AA Motala</name></author><author><name sortKey="Sobngwi, E" uniqKey="Sobngwi E">E Sobngwi</name></author><author><name sortKey="Assah, Fk" uniqKey="Assah F">FK Assah</name></author><author><name sortKey="Enoru, St" uniqKey="Enoru S">ST Enoru</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Young, F" uniqKey="Young F">F 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sortKey="Praygod, George" sort="Praygod, George" uniqKey="Praygod G" first="George" last="Praygod">George Praygod</name></noRegion><name sortKey="Changalucha, John" sort="Changalucha, John" uniqKey="Changalucha J" first="John" last="Changalucha">John Changalucha</name><name sortKey="Kapiga, Saidi" sort="Kapiga, Saidi" uniqKey="Kapiga S" first="Saidi" last="Kapiga">Saidi Kapiga</name><name sortKey="Peck, Robert" sort="Peck, Robert" uniqKey="Peck R" first="Robert" last="Peck">Robert Peck</name><name sortKey="Peck, Robert" sort="Peck, Robert" uniqKey="Peck R" first="Robert" last="Peck">Robert Peck</name></country><country name="Royaume-Uni"><noRegion><name sortKey="Kapiga, Saidi" sort="Kapiga, Saidi" uniqKey="Kapiga S" first="Saidi" last="Kapiga">Saidi Kapiga</name></noRegion><name sortKey="Filteau, Suzanne" sort="Filteau, Suzanne" uniqKey="Filteau S" first="Suzanne" last="Filteau">Suzanne Filteau</name><name sortKey="Todd, Jim" sort="Todd, Jim" uniqKey="Todd J" first="Jim" last="Todd">Jim Todd</name></country><country name="États-Unis"><noRegion><name sortKey="Peck, Robert" sort="Peck, Robert" uniqKey="Peck R" first="Robert" last="Peck">Robert Peck</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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