Patients living with HIV have quantitatively inadequate food consumption.

Objective: The objective of the current study was to estimate energy expenditure and compare it with the usual food consumption of PLWH, and to determine whether duration of high-potency antiretroviral therapy (HAART) influenced nutritional intake and adequacy. Materials and methods: Anthropometric measurements and bioelectrical impedance analysis (BIA) provided data for estimating resting energy expenditure (REE) using Melchior's equations. Dietary Reference Intakes (DRIs) and 24-Hour Recall were used to verify if reported food intake aligned with energy, macro and micronutrient recommendations. Results: Sixty one patients with a mean age of 52 ± 9.4 years and who had a high frequency of diabetes mellitus (24.5%), hypertension (54%), and dyslipidemia (90.1%) were evaluated. Estimated REE of female and male patients with less than 10 years of HAART was 1791 (1717.5; 1887.2) and 1941 (1808; 2335.6), and their estimated energy intake was 900.5 (847;1221.9) and 2095.4 (1297.5; 2496.4), respectively. The estimated REE for female and male patients with more than 10 years of HAART was 1796.20 (1598.9;1820.7) and 2105 (1913.4; 2308), and their estimated energy intake was 1566 (1353.1; 1764.3) and 1999.7 (1706.5; 2508.1), respectively. Being on HAART for more than 10 years was associated with increased energy intake (533 (95% CI 3; 1063) kcals), but not with meeting energy requirements. Conclusion: Patients had an atherogenic metabolic profile, inadequate dietary pattern, and a similar REE, regardless of HAART duration, contributing even more to the increased risk of cardiovascular diseases.

Patients living with HIV have quantitatively inadequate food consumption

ABSTRACT Objective: The objective of the current study was to estimate energy expenditure and compare it with the usual food consumption of PLWH, and to determine whether duration of high-potency antiretroviral therapy (HAART) influenced nutritional intake and adequacy. Materials and methods: Anthropometric measurements and bioelectrical impedance analysis (BIA) provided data for estimating resting energy expenditure (REE) using Melchior's equations. Dietary Reference Intakes (DRIs) and 24-Hour Recall were used to verify if reported food intake aligned with energy, macro and micronutrient recommendations. Results: Sixty one patients with a mean age of 52 ± 9.4 years and who had a high frequency of diabetes mellitus (24.5%), hypertension (54%), and dyslipidemia (90.1%) were evaluated. Estimated REE of female and male patients with less than 10 years of HAART was 1791 (1717.5; 1887.2) and 1941 (1808; 2335.6), and their estimated energy intake was 900.5 (847;1221.9) and 2095.4 (1297.5; 2496.4), respectively. The estimated REE for female and male patients with more than 10 years of HAART was 1796.20 (1598.9;1820.7) and 2105 (1913.4; 2308), and their estimated energy intake was 1566 (1353.1; 1764.3) and 1999.7 (1706.5; 2508.1), respectively. Being on HAART for more than 10 years was associated with increased energy intake (533 (95% CI 3; 1063) kcals), but not with meeting energy requirements. Conclusion: Patients had an atherogenic metabolic profile, inadequate dietary pattern, and a similar REE, regardless of HAART duration, contributing even more to the increased risk of cardiovascular diseases.

Body fat redistribution and changes in lipid and glucose metabolism in people living with HIV/AIDS. / Redistribuição de gordura corporal e alterações no metabolismo de lipídeos e glicose em pessoas vivendo com HIV/AIDS.

INTRODUCTION: The HIV lipodystrophy syndrome is characterized by changes in metabolism, and body composition that increase cardiovascular risk of people living with HIV/AIDS (PLWHA) using highly active antiretroviral therapy (HAART). OBJECTIVE: To assess the prevalence of lipodystrophy and changes in lipid and glucose metabolism in PLWHA in use of HAART. METHODS: For the anthropometric evaluation we measured weight, height and abdominal circumference (AC). For the lipodystrophy evaluation we conducted physical examination (subjective) and the (objective) examination of absorptiometry with X-ray dual energy (DEXA) by fat mass ratio (FMR). We also conducted lipid profile tests and fasting glucose and used the criteria suggested by The National Cholesterol Education Program III for metabolic disorders classification. RESULTS: The final sample consisted of 262 patients with a mean age of 44.3 ± 10.2 years. Lipodystrophy, according to the physical examination, was present in 47.7% (95%CI 41.7 - 53.8) of patients, while the prevalence using FMR (DEXA) was 40.8% (95%CI 33.1 - 48.5). Most (53.0%; 95%CI 47.0 - 59.1) of the patients showed increased abdominal adiposity according to AC. The most prevalent metabolic alterations were reduced HDL (67.6%; 95%CI 61.9 - 73.2) and hypertriglyceridemia (55.7%; 95%CI 49.7 - 61.7). CONCLUSION: The high prevalence of lipodystrophy and changes in lipid and glucose metabolism show the importance of early intervention in this group of patients to prevent cardiovascular complications.

INTRODUÇÃO: A síndrome da lipodistrofia do HIV é caracterizada por alterações no metabolismo e na composição corporal, que aumentam o risco cardiovascular de pessoas vivendo com HIV/AIDS (PVHA) em uso da terapia antirretroviral de alta potência (TARV). OBJETIVO: Avaliar a prevalência de lipodistrofia e de alterações do metabolismo de lipídios e glicose em PVHA em uso da TARV. MÉTODOS: Para avaliação antropométrica foram aferidos peso, estatura e circunferência abdominal (CA). Para avaliação da lipodistrofia foi realizado o exame físico (subjetivo) e o exame (objetivo) de absortometria com raios X de dupla energia (DEXA) por meio da razão de massa gorda (RMG). Foram também realizados exames de lipidograma e glicemia de jejum e utilizados os critérios sugeridos pelo The National Cholesterol Education Program III para classificação de alterações metabólicas. RESULTADOS: A amostra final consistiu em 262 pacientes com idade média de 44,3 ± 10,2 anos. A lipodistrofia, de acordo com o exame físico, esteve presente em 47,7% (IC95% 41,7 - 53,8) dos pacientes, enquanto pela RMG (DEXA) sua prevalência foi de 40,8% (IC95% 33,1 - 48,5). A maioria (53,0%; IC95% 47,0 - 59,1) dos pacientes apresentou aumento de adiposidade abdominal segundo a CA. As alterações metabólicas mais presentes foram o HDL reduzido (67,6%; IC95% 61,9 - 73,2) e a hipertrigliceridemia (55,7%; IC95% 49,7 - 61,7). CONCLUSÕES: A alta prevalência de lipodistrofia e alterações do metabolismo de lipídios e glicose evidenciam a importância da intervenção precoce nesse grupo de pacientes para prevenir complicações cardiovasculares.

Redistribuição de gordura corporal e alterações no metabolismo de lipídeos e glicose em pessoas vivendo com HIV/AIDS / Body fat redistribution and changes in lipid and glucose metabolism in people living with HIV/AIDS

RESUMO: Introdução: A síndrome da lipodistrofia do HIV é caracterizada por alterações no metabolismo e na composição corporal, que aumentam o risco cardiovascular de pessoas vivendo com HIV/AIDS (PVHA) em uso da terapia antirretroviral de alta potência (TARV). Objetivo: Avaliar a prevalência de lipodistrofia e de alterações do metabolismo de lipídios e glicose em PVHA em uso da TARV. Métodos: Para avaliação antropométrica foram aferidos peso, estatura e circunferência abdominal (CA). Para avaliação da lipodistrofia foi realizado o exame físico (subjetivo) e o exame (objetivo) de absortometria com raios X de dupla energia (DEXA) por meio da razão de massa gorda (RMG). Foram também realizados exames de lipidograma e glicemia de jejum e utilizados os critérios sugeridos pelo The National Cholesterol Education Program III para classificação de alterações metabólicas. Resultados: A amostra final consistiu em 262 pacientes com idade média de 44,3 ± 10,2 anos. A lipodistrofia, de acordo com o exame físico, esteve presente em 47,7% (IC95% 41,7 - 53,8) dos pacientes, enquanto pela RMG (DEXA) sua prevalência foi de 40,8% (IC95% 33,1 - 48,5). A maioria (53,0%; IC95% 47,0 - 59,1) dos pacientes apresentou aumento de adiposidade abdominal segundo a CA. As alterações metabólicas mais presentes foram o HDL reduzido (67,6%; IC95% 61,9 - 73,2) e a hipertrigliceridemia (55,7%; IC95% 49,7 - 61,7). Conclusões: A alta prevalência de lipodistrofia e alterações do metabolismo de lipídios e glicose evidenciam a importância da intervenção precoce nesse grupo de pacientes para prevenir complicações cardiovasculares.

ABSTRACT: Introduction: The HIV lipodystrophy syndrome is characterized by changes in metabolism, and body composition that increase cardiovascular risk of people living with HIV/AIDS (PLWHA) using highly active antiretroviral therapy (HAART). Objective: To assess the prevalence of lipodystrophy and changes in lipid and glucose metabolism in PLWHA in use of HAART. Methods: For the anthropometric evaluation we measured weight, height and abdominal circumference (AC). For the lipodystrophy evaluation we conducted physical examination (subjective) and the (objective) examination of absorptiometry with X-ray dual energy (DEXA) by fat mass ratio (FMR). We also conducted lipid profile tests and fasting glucose and used the criteria suggested by The National Cholesterol Education Program III for metabolic disorders classification. Results: The final sample consisted of 262 patients with a mean age of 44.3 ± 10.2 years. Lipodystrophy, according to the physical examination, was present in 47.7% (95%CI 41.7 - 53.8) of patients, while the prevalence using FMR (DEXA) was 40.8% (95%CI 33.1 - 48.5). Most (53.0%; 95%CI 47.0 - 59.1) of the patients showed increased abdominal adiposity according to AC. The most prevalent metabolic alterations were reduced HDL (67.6%; 95%CI 61.9 - 73.2) and hypertriglyceridemia (55.7%; 95%CI 49.7 - 61.7). Conclusion: The high prevalence of lipodystrophy and changes in lipid and glucose metabolism show the importance of early intervention in this group of patients to prevent cardiovascular complications.

Comparing the Ability of Anthropometric Indicators in Identifying Metabolic Syndrome in HIV Patients.

BACKGROUND: Highly active antiretroviral therapy (HAART) can cause side effects in HIV patients, as the metabolic syndrome. Early identification of risk for development of cardiovascular diseases using available reliable and practical methods is fundamental. On this basis, the aim of this study was to compare the effectiveness of anthropometric indicators to identify metabolic syndrome in HIV patients on HAART. METHODS: It is a cross-sectional study. A number of 280 stable HIV patients were studied. It measured weight, height, waist circumference (WC), hip circumference (HP), thigh circumference (TC) and calculated body mass index (BMI), body adiposity index (BAI), waist to hip ratio (WHR) and waist to thigh ratio (WTR). There was also a performance of biochemical tests of lipid profile and fasting glucose. Systemic blood pressure was measured. The criteria proposed by the National Cholesterol Education Program III (NCEP-ATP III) to metabolic syndrome classification was used. Individuals were divided in groups with or without metabolic alterations and their anthropometric indicators were compared. Receiver operating characteristic (ROC) curves were designed for each anthropometric indicator using the metabolic syndrome classification to identify sensitivity and specificity. RESULTS: WC was a good tool to identify each metabolic disorder separately: total cholesterol (only females, p<0.05), triglycerides (only males, p<0.001), HDL cholesterol (p<0.05), LDL cholesterol (p<005) and fasting glycemic (p<005). WC also showed the best performance to identify metabolic syndrome in both genders (areas under the curve (AUCs): 0.79 and 0.76 for male and female, respectively), while BAI proved to be an inadequate indicator (AUCs: 0.63 and 0.67 for males and females), respectively, in this population. CONCLUSIONS: The central adiposity measure (WC) had the best performance to identify metabolic syndrome, and it is a convenient, cheap and reliable tool that can be used in clinical practice routinely to prevent cardiovascular complications in HIV patients.

Development of predictive equations for total and segmental body fat in HIV-seropositive patients.

OBJECTIVES: The central point of the HIV lipodystrophy syndrome is changes in body composition that mainly involve the loss of fat in the limbs and face (lipoatrophy) and/or fat gain in the abdominal region and back neck (lipohypertrophy). Currently, the determination of fat per body segment in this group can be obtained by imaging methods such as dual-energy X-ray absorptiometry (DXA) but not by methods that would be more feasible in the practical clinics. The aim of this study was to develop equations to estimate total body fat and fat in each segment using anthropometric and bioelectrical impedance analysis (BIA) variables in HIV-seropositive patients. METHODS: We measured circumferences (arm, waist, hip, thigh, calf), skinfolds (biceps, triceps, subscapular, suprailiac) and conducted examinations of BIA, segmental BIA, and DXA in 100 HIV-seropositive men on highly active antiretroviral therapy. Equations were developed by linear regression from these variables to estimate total and segmental fat (arm, leg, and trunk). RESULTS: We developed a model for estimation of total body fat with BIA variables and a model based on anthropometric variables. To estimate segmental fat, we developed one model for each segment using anthropometric variables. The coefficients of determination for models of total fat-free mass (BIA and anthopometry), arm fat, trunk fat, and leg fat were 0.87, 0.84, 0.66, 0.76, and 0.5, respectively. CONCLUSIONS: The equations proposed in this study allow the assessment of total body fat and fat per body segment with data obtained from accessible, accurate, and reliable methods used in clinical practice.

Estudo sobre composição corporal, metabolismo e proteína de ligação do retinol em indivíduos infectados pelo vírus da imunodeficiência humana (HIV) de São Paulo, Brasil / Study of body composition and metabolism and retinol binding protein in human immunodeficiency virus subjects from São Paulo, Brazil

Objetivo: Avaliar a composição corporal, metabolismo e proteína de ligação do retinol (RBP) e RBP-4 e valores de retinol em indivíduos infectados pelo HIV. Métodos: Homens com idades entre os 19 e60 anos foram divididos em dois grupos: infectados pelo HIV (HIV+, n = 20) e não infectados pelo HIV(n = 20). Todos os indivíduos foram submetidos à absorciometria de raios-X de dupla energia (DXA) para avaliar a composição corporal e foram coletadas as amostras de sangue para medidas de retinol, RBP,RBP-4, glicose, triglicérides (TG) e lipoproteína de alta densidade (HDL). Resultados: O grupo HIV+ apresentou menor massa gorda em perna (18,5 ± 7%) e relação ao grupo controle (26,1 ± 6,7 %). Foram observados valores mais baixos de HDL no grupo HIV+ (29 ± 5 mg / dL) e níveis mais elevados de TG (282 ± 176) do que o controle(respectivamente 33 ± 3mg/dL, 144 ± 43 mg / dl). A proporção de TG para HDL, considerada como parâmetro para avaliar resistência insulínica foi maior no grupo HIV+ (10 ± 9) do que no grupo Controle (4 ± 1). Nenhum resultado significativofoi encontrado para diferenças entre grupos quanto aretinol, RBP e RBP-4. Conclusão: Indivíduos infectados pelo HIV apresentaram alterações metabólicas e de composição corporal, confirmando presença de síndrome da lipodistrofia, mas não houve diferença para o retinol, RBP e RBP-4, em comparação ao grupo controle (AU)

Objective: To evaluate body composition, metabolism and RBP, RBP4 and retinol values in HIV-patients. Methods: Males aged between 19 and 60 were divided into two groups: infected by HIV (HIV +, n = 20) and not infected by HIV (n = 20). All subjects were submitted to X-ray absorptiometry (DXA) to assess body composition and blood samples were collected to measured retinol, RBP, RBP-4, glucose, triglycerides (TG) and high-density lipoprotein (HDL). Results: The HIV + group showed significant lower fat mass on leg (18,5 ± 7%) than control (respectively 26 ± 6,7 %). It was observed lower levels of HDL in HIV+ group (29 ± 5 mg/dL), and higher levels of TG (282 ± 176) than in control group (respectively 33 ±3mg/dL, 144 ± 43 mg / dl). The ratio of TG to HDL, considered as insulin resistance parameter was higher in HIV+ group (10 ± 9) than control (4 ± 1). Neither statistical significant result was found for retinol, RBP and RBP-4. Conclusion: HIV patients had metabolic and body composition changes, confirming lipodystrophy syndrome, but there was no difference for retinol, RBP and RBP-4 compared to control group (AU)

Bioelectrical impedance vector analysis (BIVA) in stable preterm newborns.

OBJECTIVE: To observe the behavior of the plotted vectors on the RXc (R - resistance - and Xc - reactance corrected for body height/length) graph through bioelectrical impedance analysis (BIVA) and phase angle (PA) values in stable premature infants, considering the hypothesis that preterm infants present vector behavior on BIVA suggestive of less total body water and soft tissues, compared to reference data for term infants. METHODS: Cross-sectional study, including preterm neonates of both genders, in-patients admitted to an intermediate care unit at a tertiary care hospital. Data on delivery, diet and bioelectrical impedance (800 mA, 50 kHz) were collected. The graphs and vector analysis were performed with the BIVA software. RESULTS: A total of 108 preterm infants were studied, separated according to age (< 7 days and ≥ 7 days). Most of the premature babies were without the normal range (above the 95% tolerance intervals) existing in literature for term newborn infants and there was a tendency to dispersion of the points in the upper right quadrant, RXc plan. The PA was 4.92° (±2.18) for newborns < 7 days and 4.34° (±2.37) for newborns ≥ 7 days. CONCLUSION: Premature infants behave similarly in terms of BIVA and most of them have less absolute body water, presenting less fat free mass and fat mass in absolute values, compared to term newborn infants.

Análise vetorial de impedância bioelétrica (BIVA) em recém-nascidos pré-termo estáveis / Bioelectrical impedance vector analysis (BIVA) in stable preterm newborns

OBJETIVO: Observar o comportamento dos vetores ponteados no gráfico de resistência e de reactância corrigidos pelo comprimento corporal (RXc) através da análise vetorial de impedância bioelétrica (BIVA) e os valores de ângulo de fase (AF) em recém-nascidos (RNs) pré-termo estáveis, considerando a hipótese que o RN pré-termo apresenta o seu comportamento vetorial na BIVA sugestivo de menor quantidade de água e de tecidos moles corporais, comparativamente à referência do RN a termo. MÉTODOS: Foi realizado estudo de corte transversal em RNs pré-termo, de ambos os sexos, que se encontravam em uma unidade de cuidados intermediários de um hospital terciário. Coletaram-se dados relacionados ao nascimento e à alimentação, bem como dados de bioimpedância elétrica (800 mA, 50 kHz). Os gráficos e as análises vetoriais foram realizados através do BIVA software. RESULTADOS: Um total de 108 RNs pré-termo foram estudados, separados por faixa etária (< 7 dias e > 7 dias). A maioria dos RNs pré-termo encontrou-se fora da normalidade (acima dos intervalos de tolerância de 95%) existentes na literatura para RNs a termo, e observou-se uma tendência para a dispersão dos pontos no quadrante superior direito no gráfico RXc. O AF dos RNs < 7 dias foi de 4,92° (±2,18), e a dos RNs > 7 dias, de 4,34° (±2,37). CONCLUSÃO: Os RNs pré-termo se comportam de maneira semelhante entre si. A maioria deles possui menor quantidade absoluta de água corporal e apresenta menor quantidade tanto de massa livre de gordura quanto de massa gorda, em valores absolutos, quando comparados com os RNs a termo.

OBJECTIVE: To observe the behavior of the plotted vectors on the RXc (R - resistance - and Xc - reactance corrected for body height/length) graph through bioelectrical impedance analysis (BIVA) and phase angle (PA) values in stable premature infants, considering the hypothesis that preterm infants present vector behavior on BIVA suggestive of less total body water and soft tissues, compared to reference data for term infants. METHODS: Cross-sectional study, including preterm neonates of both genders, in-patients admitted to an intermediate care unit at a tertiary care hospital. Data on delivery, diet and bioelectrical impedance (800 mA, 50 kHz) were collected. The graphs and vector analysis were performed with the BIVA software. RESULTS: A total of 108 preterm infants were studied, separated according to age (< 7 days and > 7 days). Most of the premature babies were without the normal range (above the 95% tolerance intervals) existing in literature for term newborn infants and there was a tendency to dispersion of the points in the upper right quadrant, RXc plan. The PA was 4.92° (±2.18) for newborns < 7 days and 4.34° (±2.37) for newborns > 7 days. CONCLUSION: Premature infants behave similarly in terms of BIVA and most of them have less absolute body water, presenting less fat free mass and fat mass in absolute values, compared to term newborn infants.

Avaliação da composição corporal por diferentes métodos em pacientes soropositivos para HIV em terapia antiretroviral

Introdução: Atualmente pacientes soropositivos para HIV em uso de terapia antirretroviral de alta potência (TARV) apresentam-se estáveis clinicamente, entretanto tem-se observado alterações de composição corporal e metabólicas denominadas de síndrome da lipodistrofia. O ponto central da síndrome são alterações da composição corporal que envolve principalmente a perda de gordura em membros e face (lipoatrofia)e/ou ganho de gordura na região abdominal e dorso cervical (lipohipertrofia). Até o momento, nesse grupo a determinação de gordura por segmento corporal pode ser obtida por métodos de imagem como a absorciometria dos raios X de dupla energia (DXA), mas não por medidas antropométricas, que seriam mais viáveis na prática clínica. Torna-se importante acompanhar a quantidade de gordura por segmento utilizando métodos práticos e de baixo custo afim de otimizar o tratamento deste grupo. Objetivos: Comparar valores obtidos por medidas antropométricas e por bioimpedância elétrica (BIA total e segmentar) de estimativa de composição corporal com valores obtidos pelo padrão ouro (DXA) em pacientes soropositivos para HIV em TARV. Métodos: Foram aferidas circunferências (braço, cintura, quadril, coxa e panturrilha), pregas cutâneas (bíceps, tríceps, subescapular, supra-ilíaca) e realizados exames de BIA total e segmentar e DXA em 26 pacientes soropositivos para HIV. Foram aplicados testes de correlação e concordância entre os diferentes métodos com o padrão ouro DXA. Conclusões: Os achados do estudo estão em concordância com os da literatura, pois os pacientes estudados apresentam parâmetros metabólicos alterados condizentes com a síndrome da lipodistrofia dos pacientes soropositivos para HIV. O método BIA se mostrou adequado para estimar composição corporal total nesse grupo. Porém, torna-se crucial a elaboração de equações preditivas específicas ...