Amare Hiwot, Olsen Mette F, Friis Henrik, Kæstel Pernille, Andersen Åse B, Abdissa Alemseged, Yilma Daniel, Girma Tsinuel, Faurholt-Jepsen Daniel
Department of Internal Medicine, Jimma University, Jimma, Ethiopia.
JUCAN Research Centre, Jimma University, Jimma, Ethiopia.
BMC Nutr. 2021 Oct 18;7(1):60. doi: 10.1186/s40795-021-00462-y.
Without high-quality nutritional support, there is a risk that people infected with human immunodeficiency virus (HIV) will replace lost muscle mass with fat mass when initiating antiretroviral therapy (ART). We have shown that lipid-based nutrient supplements (LNS) with whey or soy considerably increases lean mass among Ethiopian people with HIV starting ART. Here, we aim to assess the effects of LNS on insulin function and glucose metabolism.
This is a secondary analysis of a randomized trial testing the effect of three-month supplementation with LNS containing whey (LNS/whey) or soy (LNS/soy) among people with HIV. LNS/whey and LNS/soy groups were combined and then were compared against the non-supplemented group. The outcomes were change in fasting plasma-glucose (FPG), and 30-min glucose and 120-min glucose after oral glucose tolerance test. We further assessed effect on glycated hemoglobin (HbA1c), fasting insulin, homeostatic model assessment index for beta-cell function (HOMA-B) and insulin resistance (HOMA-IR).
Of the 318 patients enrolled, 268 (84.3%) had available FPG and HbA1c and included. After 3 months of ART, HbA1c tended to be 2 mmol/mol higher in the LNS supplemented group, most pronounced among those receiving whey as the protein source. LNS led to higher 30-min glucose (0.5 mmol/L, 95% CI 0.2, 0.8) and 120-min glucose (0.4 mmol/L, 95% CI 0.03, 0.8) and a > 50% increase in fasting insulin, HOMA-B and HOMA-IR compared to the non-supplemented.
Among Ethiopian people with HIV initiating ART, short-term LNS intake increased glucose and insulin levels, and tended to increase HbA1c, potentially leading to more insulin resistance. Higher intake of carbohydrates with LNS could influence glycemic status. Whether these metabolic changes in early HIV treatment are beneficial or increase long-term risk of metabolic disorders needs to be explored.
如果没有高质量的营养支持，感染人类免疫缺陷病毒（HIV）的人在开始抗逆转录病毒治疗（ART）时，存在用脂肪量替代丢失的肌肉量的风险。我们已经表明，含乳清或大豆的脂质基营养补充剂（LNS）能显著增加开始接受ART治疗的埃塞俄比亚HIV感染者的瘦体重。在此项研究中，我们旨在评估LNS对胰岛素功能和葡萄糖代谢的影响。
这是一项随机试验的二次分析，该试验测试了为期三个月补充含乳清（LNS/乳清）或大豆（LNS/大豆）的LNS对HIV感染者的影响。将LNS/乳清组和LNS/大豆组合并，然后与未补充组进行比较。观察指标为空腹血糖（FPG）的变化，以及口服葡萄糖耐量试验后30分钟血糖和120分钟血糖。我们进一步评估了对糖化血红蛋白（HbA1c）、空腹胰岛素、β细胞功能稳态模型评估指数（HOMA-B）和胰岛素抵抗（HOMA-IR）的影响。
在纳入的318例患者中，268例（84.3%）有可用的FPG和HbA1c数据并被纳入分析。接受ART治疗3个月后，补充LNS组的HbA1c往往高出2 mmol/mol，在以乳清作为蛋白质来源的患者中最为明显。与未补充组相比，LNS导致30分钟血糖升高（0.5 mmol/L，95%CI 0.2，0.8）和120分钟血糖升高（0.4 mmol/L，95%CI 0.03，0.8），空腹胰岛素、HOMA-B和HOMA-IR升高超过50%。
在开始接受ART治疗的埃塞俄比亚HIV感染者中，短期摄入LNS会增加血糖和胰岛素水平，并可能导致HbA1c升高，从而可能导致更多的胰岛素抵抗。LNS中碳水化合物摄入量较高可能会影响血糖状态。早期HIV治疗中的这些代谢变化是有益的还是会增加代谢紊乱的长期风险，有待进一步探索。
