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Increasing Obesity in Treated Female HIV Patients from Sub-Saharan Africa: Potential Causes and Possible Targets for Intervention.

McCormick CL, Francis AM, Iliffe K, Webb H, Douch CJ, Pakianathan M, Macallan DC - Front Immunol (2014)

Bottom Line: 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.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).Although multifactorial, body-weight perception represents a potential target for intervention.

View Article: PubMed Central - PubMed

Affiliation: Clinical Infection Unit & Department of Genitourinary Medicine, St. George's Healthcare NHS Trust , London , UK.

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/m(2)), 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/m(2)) 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.

No MeSH data available.


Related in: MedlinePlus

Changing nutritional status of HIV-clinic attenders according to ethnicity and gender. Values represent number of participants by gender [males (A) and females (B)], ethnicity (filled columns, Asian; shaded columns, black African; open columns, white Caucasian), and by BMI category: wasted (<18.5), undernourished (18.5–20), normal (20–25), overweight (25–30), and obese (>30 kg/m2). Data from 2001 to 2010 represent one-month prospective reviews, 2001 (n = 164; 96:68 male:female), 2004 (n = 204; 114:90), 2007 (n = 196; 109:87), and 2010 (n = 373; 213:160). Data from 2012 represent attenders over a whole year (n = 1031); similar data were obtained in 2011 (not shown). The small number of subjects in other ethnic groups is not shown for clarity.
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Figure 1: Changing nutritional status of HIV-clinic attenders according to ethnicity and gender. Values represent number of participants by gender [males (A) and females (B)], ethnicity (filled columns, Asian; shaded columns, black African; open columns, white Caucasian), and by BMI category: wasted (<18.5), undernourished (18.5–20), normal (20–25), overweight (25–30), and obese (>30 kg/m2). Data from 2001 to 2010 represent one-month prospective reviews, 2001 (n = 164; 96:68 male:female), 2004 (n = 204; 114:90), 2007 (n = 196; 109:87), and 2010 (n = 373; 213:160). Data from 2012 represent attenders over a whole year (n = 1031); similar data were obtained in 2011 (not shown). The small number of subjects in other ethnic groups is not shown for clarity.

Mentions: One-month clinic datasets for nutritional demographics included 164, 204, 196, and 373 subjects in 2001, 2004, 2007, and 2010 respectively. Time-trends in BMI clearly showed an increasing prevalence of obesity over this period (Figure 1). This trend was most marked in women of black African descent; when each demographic group was considered separately (Figure S1 in Supplementary Material) this was the group most affected. In 2001, only 20% of black African women were obese, but this value increased progressively with each prospective three-yearly review, reaching 49% in 2012, a 2.5-fold increase in the prevalence of obesity over 10 years (Figure 1B). Male obesity also increased over the same time period, from 2 to 13%, although resulting levels of obesity were less marked (Figure 1A). This observation was not due to major changes in the overall demographics of patients attending the clinic (Figure S2 in Supplementary Material).


Increasing Obesity in Treated Female HIV Patients from Sub-Saharan Africa: Potential Causes and Possible Targets for Intervention.

McCormick CL, Francis AM, Iliffe K, Webb H, Douch CJ, Pakianathan M, Macallan DC - Front Immunol (2014)

Changing nutritional status of HIV-clinic attenders according to ethnicity and gender. Values represent number of participants by gender [males (A) and females (B)], ethnicity (filled columns, Asian; shaded columns, black African; open columns, white Caucasian), and by BMI category: wasted (<18.5), undernourished (18.5–20), normal (20–25), overweight (25–30), and obese (>30 kg/m2). Data from 2001 to 2010 represent one-month prospective reviews, 2001 (n = 164; 96:68 male:female), 2004 (n = 204; 114:90), 2007 (n = 196; 109:87), and 2010 (n = 373; 213:160). Data from 2012 represent attenders over a whole year (n = 1031); similar data were obtained in 2011 (not shown). The small number of subjects in other ethnic groups is not shown for clarity.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4230180&req=5

Figure 1: Changing nutritional status of HIV-clinic attenders according to ethnicity and gender. Values represent number of participants by gender [males (A) and females (B)], ethnicity (filled columns, Asian; shaded columns, black African; open columns, white Caucasian), and by BMI category: wasted (<18.5), undernourished (18.5–20), normal (20–25), overweight (25–30), and obese (>30 kg/m2). Data from 2001 to 2010 represent one-month prospective reviews, 2001 (n = 164; 96:68 male:female), 2004 (n = 204; 114:90), 2007 (n = 196; 109:87), and 2010 (n = 373; 213:160). Data from 2012 represent attenders over a whole year (n = 1031); similar data were obtained in 2011 (not shown). The small number of subjects in other ethnic groups is not shown for clarity.
Mentions: One-month clinic datasets for nutritional demographics included 164, 204, 196, and 373 subjects in 2001, 2004, 2007, and 2010 respectively. Time-trends in BMI clearly showed an increasing prevalence of obesity over this period (Figure 1). This trend was most marked in women of black African descent; when each demographic group was considered separately (Figure S1 in Supplementary Material) this was the group most affected. In 2001, only 20% of black African women were obese, but this value increased progressively with each prospective three-yearly review, reaching 49% in 2012, a 2.5-fold increase in the prevalence of obesity over 10 years (Figure 1B). Male obesity also increased over the same time period, from 2 to 13%, although resulting levels of obesity were less marked (Figure 1A). This observation was not due to major changes in the overall demographics of patients attending the clinic (Figure S2 in Supplementary Material).

Bottom Line: 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.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).Although multifactorial, body-weight perception represents a potential target for intervention.

View Article: PubMed Central - PubMed

Affiliation: Clinical Infection Unit & Department of Genitourinary Medicine, St. George's Healthcare NHS Trust , London , UK.

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/m(2)), 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/m(2)) 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.

No MeSH data available.


Related in: MedlinePlus