Changes in Abdominal Fat following Antiretroviral Therapy Initiation in HIV-Infected Individuals Correlate with Waist Circumference and Self-Reported Changes

Abstract

Background We examined whether waist circumference (WC) and self-reported abdominal size changes can estimate visceral adipose tissue (VAT) changes for those initiating antiretroviral therapy (ART). Methods Prospectively collected data from ACTG A5257 and its metabolic substudy, A5260s, were used for this analysis. ART-naïve HIV-infected participants were randomized to one of three contemporary ART regimens. Changes in abdominal CT-measured VAT and total adipose tissue (TAT) and DXA-measured trunk fat were tested for association with WC changes (by Pearson correlation) and categories of self-reported abdominal size changes (by ANOVA) between entry and week 96. Linear models compared WC and self-reported changes. Results The study population (N=328) was predominantly male (90%) and white non-Hispanic (44%) with a baseline median age of 36 years and BMI of 25 kg/m2. At week 96, median WC change was +2.8 cm. Of those reporting at week 96, 53% indicated “No Change/Lost”, 39% “Gained Some/Somewhat Larger”, and 8% “Gained A Lot/Much Larger” as their self-reported changes. Trunk fat, VAT, and TAT changes differed across self-reported groups (ANOVA p<0.0001 for all), and the group ordering was as expected. WC changes were strongly correlated with CT and DXA changes (trunk fat: ρ=0.72, p<0.0001; VAT: ρ=0.52, p<0.0001; TAT: ρ=0.62, p<0.0001). While WC changes explained a greater proportion of VAT, TAT, and trunk fat variation, self-reported changes remained a significant predictor after controlling for WC (p<0.05). Conclusions WC and self-reported abdominal changes each correlated directly with imaging-derived abdominal fat measures, and can be used as reliable, affordable tools for central adiposity assessment.

Abdominal obesity, sarcopenia, and osteoporosis are associated with frailty in men living with and without HIV

“…We found a strong, positive correlation between WC and VAT in both the entire cohort (r=0.62, p<0.0001) and the men with HIV (r=0.56, p<0.0001). Our findings corroborate a prior study that showed self-reported waist gain and WC correlated with DXA- and CT-derived measures of abdominal fat, including VAT, among adults with HIV [52]. Furthermore, the strong association between WC and frailty emphasizes the clinical importance of WC measurement, and suggests that WC may be an easy, clinically accessible marker for adults with HIV at increased risk for frailty.…”

Changes in Waist Circumference in HIV-Infected Individuals Initiating a Raltegravir or Protease Inhibitor Regimen: Effects of Sex and Race

“…Some strengths of our study were that it utilized prospectively collected clinical trial data to examine predictors of longitudinal abdominal changes over 96 weeks and included a large sample size to address the questions of interest. Based on previous findings, WC and self-report can be used as surrogate measures of abdominal VAT increases [ 26 ]. In this study, we were able to demonstrate the clinical utility of these simple, cost-effective tools for observing abdominal fat changes.…”

“…Although standard measurements of central fat accumulation, such as computed tomography (CT) and dual x-ray absorptiometry (DXA), remain high-cost and labor-intensive, other forms of measurement such as waist circumference (WC) and self-reported abdominal size changes have been shown to be correlated with measurements of abdominal adipose tissue increases. We have previously demonstrated in the A5260s substudy that both WC and self-reported changes in fat are strongly associated with CT- and DXA-measured abdominal fat changes, including VAT changes [ 26 ].…”

Insulin Resistance in HIV-Patients: Causes and Consequences

“…In fact, a recent study showed that when considering BMI, 60–70% of HIV-infected patients are considered overweight or obese ( 104 – 108 ). In most patients, there is an increase in visceral adipose tissue (VAT), which is usually indicative of a more deleterious metabolic profile ( 109 – 111 ).…”