Samaras Katherine, Wand Handan, Law Matthew, Emery Sean, Cooper David A, Carr Andrew
Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, NSW 2010, Australia.
Curr HIV Res. 2009 Jul;7(4):454-61. doi: 10.2174/157016209788680589.
Highly active antiretroviral therapy (HAART) for HIV-infection is associated with lipodystrophy, insulin resistance, increased prevalence of disturbances in glucose tolerance and diabetes, hyperlipidemia and increased cardiovascular risk. Whether dietary intake influences total body fat, visceral fat, insulin resistance, glucose metabolism, lipid metabolism and circulating inflammatory markers in HIV-infected subjects with lipodystrophy is unclear and the focus of this report. We examined the dietary intake of 106 male HIV-infected HAART-recipients with lipodystrophy, enrolled in a study of the effects of rosiglitazone. All subjects had normal glucose tolerance. Dietary intakes were determined at study entry using Food Frequency Questionnaires and examined cross-sectionally against body composition by dual-energy Xray absorptiometry, visceral obesity by computed tomography, fasting glucose, insulin, lipids, adiponectin, leptin, insulin resistance (by HOMA). Energy underreporters were identified and excluded. After exclusion of underreporters (n = 22) we found no relationships between diet composition (% dietary fat, %carbohydrate) and BMI, %body fat and visceral adiposity (p>0.3). Only modest relationships were found between BMI and fat subtypes: polyunsaturated fats (g/day) (r = 0.14, p = 0.007), monounsaturated fat (g/d) (r = 0.06, p = 0.001), saturated fat (g/d) (r = 0.02, p<0.0001). Only saturated fat related to % total body fat (g/d: r = 0.08, p<0.0001, %energy intake: r = 0.16, p<0.0001). No nutrient related to visceral adiposity by CT. Dietary fat intake (expressed as a % of energy intake) was not related to total cholesterol, HDL cholesterol, triglycerides, fasting insulin, glucose, leptin, adiponectin or HOMA-IR (p>0.4). Fat subtype did not relate to fasting insulin, insulin resistance, total cholesterol, HDL, triglycerides, glucose, adiponectin. In conclusion, there are weak relationships between saturated fat intake and adiposity in HIV-infected subjects with lipodystrophy, using gold standard measures of body fat. There were no relationships between nutrient intake and visceral adiposity, any measure of glucose metabolism, insulin resistance or adipokines. Only interventional, prospective studies will determine whether any nutritional strategy can assist in ameliorating the metabolic complications associated with HIV lipodystrophy.
用于治疗HIV感染的高效抗逆转录病毒疗法（HAART）与脂肪代谢障碍、胰岛素抵抗、糖耐量异常和糖尿病患病率增加、高脂血症以及心血管疾病风险增加有关。饮食摄入是否会影响患有脂肪代谢障碍的HIV感染者的全身脂肪、内脏脂肪、胰岛素抵抗、葡萄糖代谢、脂质代谢和循环炎症标志物尚不清楚，这也是本报告的重点。我们调查了106名患有脂肪代谢障碍且正在接受HAART治疗的男性HIV感染者的饮食摄入情况，这些患者参与了一项关于罗格列酮疗效的研究。所有受试者的糖耐量均正常。在研究开始时使用食物频率问卷确定饮食摄入量，并通过双能X线吸收法对身体成分进行横断面检查，通过计算机断层扫描检查内脏肥胖情况，同时检测空腹血糖、胰岛素、血脂、脂联素、瘦素、胰岛素抵抗（通过稳态模型评估法）。识别并排除能量摄入低报者。排除低报者（n = 22）后，我们发现饮食成分（膳食脂肪百分比、碳水化合物百分比）与体重指数、体脂百分比和内脏脂肪量之间没有相关性（p>0.3）。仅发现体重指数与脂肪亚型之间存在适度相关性：多不饱和脂肪（克/天）（r = 0.14，p = 0.007）、单不饱和脂肪（克/天）（r = 0.06，p = 0.001）、饱和脂肪（克/天）（r = 0.02，p<0.0001）。只有饱和脂肪与全身脂肪百分比相关（克/天：r = 0.08，p<0.0001，能量摄入百分比：r = 0.16，p<0.0001）。没有营养素与通过计算机断层扫描测得的内脏脂肪量相关。膳食脂肪摄入量（以能量摄入的百分比表示）与总胆固醇、高密度脂蛋白胆固醇、甘油三酯、空腹胰岛素、血糖、瘦素、脂联素或稳态模型评估胰岛素抵抗指数无关（p>0.4）。脂肪亚型与空腹胰岛素、胰岛素抵抗、总胆固醇、高密度脂蛋白、甘油三酯、血糖、脂联素无关。总之，对于患有脂肪代谢障碍的HIV感染者，使用金标准的身体脂肪测量方法发现饱和脂肪摄入量与肥胖之间存在微弱关系。营养素摄入量与内脏脂肪量、任何葡萄糖代谢指标、胰岛素抵抗或脂肪因子之间均无关系。只有干预性前瞻性研究才能确定任何营养策略是否有助于改善与HIV脂肪代谢障碍相关的代谢并发症。
