Fitch Kathleen V, Anderson Ellen J, Hubbard Jane L, Carpenter Sara J, Waddell William R, Caliendo Angela M, Grinspoon Steven K
Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, MA 02114, USA.
AIDS. 2006 Sep 11;20(14):1843-50. doi: 10.1097/01.aids.0000244203.95758.db.
A large percentage of HIV-infected patients receiving HAART develop the metabolic syndrome. In this study, we sought to determine whether lifestyle modification improves metabolic syndrome criteria, including waist circumference, blood pressure, fasting blood sugar, triglycerides, and HDL-cholesterol among HIV-infected patients with the metabolic syndrome.
We conducted a randomized, 6-month study in HIV-infected patients with metabolic syndrome as defined by the National Cholesterol Education Program. Subjects were randomly assigned to an intensive lifestyle modification program, which included weekly one-on-one counseling sessions with a registered dietician, or observation (control group).
Metabolic syndrome criteria and cardiovascular parameters, including blood pressure, body composition, submaximal stress testing, lipids and other biochemical parameters were determined.
Thirty-four patients were randomly assigned and 28 subjects completed the study. Compared with the control group, subjects randomly assigned to the lifestyle modification program demonstrated significant decreases in waist circumference (-2.6 +/- 1.1 versus 1.2 +/- 1.0 cm, P = 0.022), systolic blood pressure (-13 +/- 4 versus 4 +/- 4 mmHg, P = 0.008), hemoglobin A1C (-0.1 +/- 0.1 versus 0.2 +/- 0.1%, P = 0.017), lipodystrophy score (-1.2 +/- 0.3 versus 0.9 +/- 0.6, P = 0.006) and increased activity (17.7 +/- 14.3 versus -33.1 +/- 12.7 metabolic equivalents, P = 0.014) as measured by the Modifiable Activity Questionnaire, but lipid levels did not improve.
These data demonstrate that intensive lifestyle modification significantly improved important cardiovascular risk indices in HIV-infected patients with the metabolic syndrome. Lifestyle modification may be a useful strategy to decrease cardiovascular risk in this population.
接受高效抗逆转录病毒治疗（HAART）的大部分HIV感染患者会出现代谢综合征。在本研究中，我们试图确定生活方式的改变是否能改善代谢综合征的各项指标，包括腰围、血压、空腹血糖、甘油三酯以及HIV感染的代谢综合征患者的高密度脂蛋白胆固醇。
我们对符合美国国家胆固醇教育计划定义的HIV感染代谢综合征患者进行了一项为期6个月的随机研究。受试者被随机分配到强化生活方式改变计划组，该计划包括每周与注册营养师进行一对一咨询，或观察组（对照组）。
测定代谢综合征指标和心血管参数，包括血压、身体成分、次极量运动试验、血脂及其他生化参数。
34例患者被随机分配，28例受试者完成了研究。与对照组相比，随机分配到生活方式改变计划组的受试者腰围显著减小（-2.6±1.1 vs 1.2±1.0 cm，P = 0.022），收缩压显著降低（-13±4 vs 4±4 mmHg，P = 0.008），糖化血红蛋白显著降低（-0.1±0.1 vs 0.2±0.1%，P = 0.017），脂肪代谢障碍评分显著降低（-1.2±0.3 vs 0.9±0.6，P = 0.006），且根据可改变活动问卷测量，活动量增加（17.7±14.3 vs -33.1±12.7代谢当量，P = 0.014），但血脂水平未改善。
这些数据表明，强化生活方式改变显著改善了HIV感染的代谢综合征患者的重要心血管风险指标。生活方式改变可能是降低该人群心血管风险的有效策略。
