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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

Discrepancy between current and ideal body shape from body shape silhouettes. (A) Discrepancy (current minus ideal) silhouette score groups, shown according to the corresponding current mean BMI for that group (groups with scores 1 and 2 were small so were conflated), showing higher discrepancy scores correspond to higher BMI’s (r = 0.37, intercept 26.9 kg/m2, P < 0.01, n = 47). (B) Filled squares: discrepancy scores by current silhouette score where higher silhouette score indicates greater adiposity (r = 0.61, P < 0.001, n = 47). Comparison is made with normative data (open diamonds) from a large Caucasian population (n = 16,728) (41).
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Figure 3: Discrepancy between current and ideal body shape from body shape silhouettes. (A) Discrepancy (current minus ideal) silhouette score groups, shown according to the corresponding current mean BMI for that group (groups with scores 1 and 2 were small so were conflated), showing higher discrepancy scores correspond to higher BMI’s (r = 0.37, intercept 26.9 kg/m2, P < 0.01, n = 47). (B) Filled squares: discrepancy scores by current silhouette score where higher silhouette score indicates greater adiposity (r = 0.61, P < 0.001, n = 47). Comparison is made with normative data (open diamonds) from a large Caucasian population (n = 16,728) (41).

Mentions: The difference between current shape and ideal shape is customarily expressed as a “discrepancy score” (DS, = current – ideal shape) (41, 42), which can be taken as a surrogate marker for the drive to lose weight. As expected, and as widely observed in non-HIV populations, this score was greater in those with higher BMI. The intercept-value (DS = 0) corresponding to a threshold for body image dissatisfaction was 26.9 kg/m2 in this cohort (Figure 3A), a value in the “overweight” range, intermediate between published values for white urban Americans (24.6 kg/m2) and African-Americans (29.3 kg/m2) (42). Similarly, those with high DS scores identified themselves with fatter silhouettes (Figure 3B), but their drive to lose weight appeared “blunted” when compared to population-based normative data for Caucasians (41), each DS score corresponding to a silhouette about one score fatter than controls.


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)

Discrepancy between current and ideal body shape from body shape silhouettes. (A) Discrepancy (current minus ideal) silhouette score groups, shown according to the corresponding current mean BMI for that group (groups with scores 1 and 2 were small so were conflated), showing higher discrepancy scores correspond to higher BMI’s (r = 0.37, intercept 26.9 kg/m2, P < 0.01, n = 47). (B) Filled squares: discrepancy scores by current silhouette score where higher silhouette score indicates greater adiposity (r = 0.61, P < 0.001, n = 47). Comparison is made with normative data (open diamonds) from a large Caucasian population (n = 16,728) (41).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Discrepancy between current and ideal body shape from body shape silhouettes. (A) Discrepancy (current minus ideal) silhouette score groups, shown according to the corresponding current mean BMI for that group (groups with scores 1 and 2 were small so were conflated), showing higher discrepancy scores correspond to higher BMI’s (r = 0.37, intercept 26.9 kg/m2, P < 0.01, n = 47). (B) Filled squares: discrepancy scores by current silhouette score where higher silhouette score indicates greater adiposity (r = 0.61, P < 0.001, n = 47). Comparison is made with normative data (open diamonds) from a large Caucasian population (n = 16,728) (41).
Mentions: The difference between current shape and ideal shape is customarily expressed as a “discrepancy score” (DS, = current – ideal shape) (41, 42), which can be taken as a surrogate marker for the drive to lose weight. As expected, and as widely observed in non-HIV populations, this score was greater in those with higher BMI. The intercept-value (DS = 0) corresponding to a threshold for body image dissatisfaction was 26.9 kg/m2 in this cohort (Figure 3A), a value in the “overweight” range, intermediate between published values for white urban Americans (24.6 kg/m2) and African-Americans (29.3 kg/m2) (42). Similarly, those with high DS scores identified themselves with fatter silhouettes (Figure 3B), but their drive to lose weight appeared “blunted” when compared to population-based normative data for Caucasians (41), each DS score corresponding to a silhouette about one score fatter than controls.

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