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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

Relationship of perceived and ideal body size to current nutritional status. (A) Perceived body weight: True (filled triangles, dashed line), usual (filled circles), and ideal (open squares) body weight, expressed in kilograms (normalized to BMI) of patients according to current nutritional status category. “True” represents measured values, and “Usual” and “Ideal” were derived from questionnaire responses. (B) Perceived body shape from silhouettes corresponding to known BMI values (Series A) compared to true BMI (filled triangles). Data are shown for perceived “current” shape (filled circles) and “ideal” shape (open squares). (C) Perceived body shape from numbered silhouettes (Series B) expressed as “current” shape (filled circles) and “ideal” shape (open squares). (D) Subjects’ happiness with current body-weight scored from 1 to 5 (1, very unhappy; 2, unhappy; 3, not bothered; 4, happy; 5, very happy) according to current BMI category. All data shown are means ± 1 SEM.
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Figure 2: Relationship of perceived and ideal body size to current nutritional status. (A) Perceived body weight: True (filled triangles, dashed line), usual (filled circles), and ideal (open squares) body weight, expressed in kilograms (normalized to BMI) of patients according to current nutritional status category. “True” represents measured values, and “Usual” and “Ideal” were derived from questionnaire responses. (B) Perceived body shape from silhouettes corresponding to known BMI values (Series A) compared to true BMI (filled triangles). Data are shown for perceived “current” shape (filled circles) and “ideal” shape (open squares). (C) Perceived body shape from numbered silhouettes (Series B) expressed as “current” shape (filled circles) and “ideal” shape (open squares). (D) Subjects’ happiness with current body-weight scored from 1 to 5 (1, very unhappy; 2, unhappy; 3, not bothered; 4, happy; 5, very happy) according to current BMI category. All data shown are means ± 1 SEM.

Mentions: Since it has been argued that weight perception differs in women of African origin (28), we investigated the contribution of body-weight perception to obesity in the subgroup of 50 African women. Most were first-generation immigrants (median duration in the UK 10 years), mostly (86%) from urban areas. Mean age was 40 years (range 20–60). Weight perception was explored using three complementary modalities. First, using weight in kilograms, subjects expressed a mean value for “usual” weight close to their current weight (Figure 2A, shown normalized to BMI). “Ideal” weights, however, differed between groups, correlating positively with BMI group (r = 0.70, P < 0.0001; Figure 2A). Thus, more obese subjects identified “ideal” body weights in the overweight range according to WHO criteria (mean BMI for ideal weights: 29.1 kg/m2). These values were significantly higher than the “ideal” values given by normal-weight women (23.0 kg/m2; P < 0.0001, one-way ANOVA).


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)

Relationship of perceived and ideal body size to current nutritional status. (A) Perceived body weight: True (filled triangles, dashed line), usual (filled circles), and ideal (open squares) body weight, expressed in kilograms (normalized to BMI) of patients according to current nutritional status category. “True” represents measured values, and “Usual” and “Ideal” were derived from questionnaire responses. (B) Perceived body shape from silhouettes corresponding to known BMI values (Series A) compared to true BMI (filled triangles). Data are shown for perceived “current” shape (filled circles) and “ideal” shape (open squares). (C) Perceived body shape from numbered silhouettes (Series B) expressed as “current” shape (filled circles) and “ideal” shape (open squares). (D) Subjects’ happiness with current body-weight scored from 1 to 5 (1, very unhappy; 2, unhappy; 3, not bothered; 4, happy; 5, very happy) according to current BMI category. All data shown are means ± 1 SEM.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Relationship of perceived and ideal body size to current nutritional status. (A) Perceived body weight: True (filled triangles, dashed line), usual (filled circles), and ideal (open squares) body weight, expressed in kilograms (normalized to BMI) of patients according to current nutritional status category. “True” represents measured values, and “Usual” and “Ideal” were derived from questionnaire responses. (B) Perceived body shape from silhouettes corresponding to known BMI values (Series A) compared to true BMI (filled triangles). Data are shown for perceived “current” shape (filled circles) and “ideal” shape (open squares). (C) Perceived body shape from numbered silhouettes (Series B) expressed as “current” shape (filled circles) and “ideal” shape (open squares). (D) Subjects’ happiness with current body-weight scored from 1 to 5 (1, very unhappy; 2, unhappy; 3, not bothered; 4, happy; 5, very happy) according to current BMI category. All data shown are means ± 1 SEM.
Mentions: Since it has been argued that weight perception differs in women of African origin (28), we investigated the contribution of body-weight perception to obesity in the subgroup of 50 African women. Most were first-generation immigrants (median duration in the UK 10 years), mostly (86%) from urban areas. Mean age was 40 years (range 20–60). Weight perception was explored using three complementary modalities. First, using weight in kilograms, subjects expressed a mean value for “usual” weight close to their current weight (Figure 2A, shown normalized to BMI). “Ideal” weights, however, differed between groups, correlating positively with BMI group (r = 0.70, P < 0.0001; Figure 2A). Thus, more obese subjects identified “ideal” body weights in the overweight range according to WHO criteria (mean BMI for ideal weights: 29.1 kg/m2). These values were significantly higher than the “ideal” values given by normal-weight women (23.0 kg/m2; P < 0.0001, one-way ANOVA).

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