Dietary intake and dyslipidemia arising from combination antiretroviral therapy for HIV infection: a systematic review

Revisar e sintetizar as evidências científicas disponíveis sobre a relação entre o consumo alimentar e dislipidemia em pacientes infectados pelo HIV em terapia antirretroviral combinada de alta atividade (TARV). Desenvolveu-se uma revisão sistemática de literatura. Foram pesquisados estudos originais e duas categorias de exposição dietética foram revisadas: consumo de energia e nutriente ou consumo de uma dieta teste. Foi feita síntese narrativa dos estudos selecionados. Os achados foram sintetizados segundo a categoria de desfecho metabólico (efeito sobre colesterol total e LDL-c, efeito sobre HDL-c e efeito sobre triglicérides). Vinte estudos originais foram incluídos na revisão, sendo 13 ensaios clínicos e 7 estudos epidemiológicos observacionais. A suplementação com ácido graxo ω-3 resultou em significativa redução nos níveis séricos de triglicérides. Observou-se evidência insuficiente acerca da efetividade de intervenções dietéticas na prevenção e controle das dislipidemias em pacientes infectados pelo HIV em uso de TARV.To review and synthesize the available scientific evidence on the relationship between dietary intake and dyslipidemias in HIV-infected patients in combination antiretroviral therapy (ART). A systematic review of literature was carried out. Original and published studies were investigated and two categories of dietary exposure were considered: energy and nutrient intake, and consumption of a test diet. A narrative review of included studies was conducted. The findings were summarized according to category of metabolic outcomes (effect on total cholesterol and LDL-c, effect on HDL-c and effect on triglycerides). Twenty original studies were included in this review, being 13 clinical trials and 7 observational studies. ω-3 fatty acid supplementation led to a significant decrease in triglycerides. There was very little evidence on the effectiveness of dietary interventions for the prevention and control of dyslipidemias in HIV-infected patients receiving ART

Self-reported Body Changes and Associated Factors in Persons Living with HIV

The study aimed at verifying the associated factors of self-perceived body changes in adults living with HIV in highly-active antiretroviral therapy (HAART) in the city of São Paulo, Brazil. This cross-sectional study was conducted among people living with HIV on HAART for at least three months. A standardized questionnaire was used for assessing self-perceived body changes. Associated factors relating to self-reported body changes in people living with HIV (PLHIV) were assessed with Student's t-test and chi-square test. In total, 507 patients were evaluated. The mean time since diagnosis was 6.6 years [standard deviation (SD)±4.1], and the mean duration of HAART was 5.1 years (SD±3.3). Self-perceived body changes were reported by 79.5% of the participants and were associated with viral load and duration of HAART. Fibre intake was lower among males who gained in abdominal fat (p=0.035). HAART-related body changes were reported by the large majority of the population and were associated with demographic and clinical variables

Assessment of plasma amyloid-β42/40 and cognitive decline among community-dwelling older adults

Importance: Plasma measurement of amyloid-β (Aβ) peptides has been associated with cognitive function, but evidence of its ability to identify cognitive decline is still scarce. Objective: To investigate the associations between plasma Aβ42/40 and cognitive decline over time among community-dwelling older adults with subjective memory concerns. Design, Setting, and Participants: This multicenter cohort study used data from volunteers in the 5-year study Multidomain Alzheimer Preventive Trial (MAPT). Participants were aged 70 years or older and observed for a median (interquartile range) of 3.9 (2.0-4.0) years. Recruitment of participants started in May 2008 and ended in February 2011. Follow-up ended in April 2016. Data analysis was conducted from April to October 2020. Exposure: Plasma Aβ42 and Aβ40 were measured at 12 months for 448 participants (92.8%) and at 24 months for the rest. The moment of Aβ assessment was defined as the baseline for this study. Main Outcomes and Measures: Cognitive function was assessed at 12, 24, 36, 48, and 60 months by a composite cognitive score based on 4 tests; Mini Mental State Examination (MMSE); Clinical Dementia Rating, sum of boxes; and Alzheimer Disease Cooperative Study-Activities of Daily Living. Mixed-effect linear regressions were performed. Results: A total of 483 participants (median [IQR] age, 76.0 [73.0-80.0]; 286 [59.2%] women) were analyzed. Of them, 161 (33.3%) were classified as low plasma Aβ42/40 (≤0.107). After adjusting for age, sex, education, body mass index, Geriatric Depression Scale score, apolipoprotein E ε4 genotype, and MAPT intervention groups, low plasma Aβ42/40 was associated with more pronounced decline in composite cognitive score (adjusted between-group mean difference: -0.20, 95% CI, -0.34 to -0.07; P = .004) and decline in MMSE score (adjusted between-group mean difference: -0.59; 95% CI, -1.07 to -0.11; P = .02) during the follow-up period compared with the group with an Aβ42/40 ratio greater than 0.107. Conclusions and Relevance: In this study, low plasma Aβ42/40 was associated with more pronounced decline in cognitive function (measured by multiple outcomes) over time. Findings suggest that plasma Aβ42/40 may be used to identify people at risk of cognitive decline, being an alternative to more complex and expensive measures, such as positron emission tomography imaging or cerebrospinal fluid measurement

Associations among osteocalcin, leptin and metabolic health in children ages 9-13 years in the United States

BACKGROUND: This study aimed to investigate the relationships among osteocalcin, leptin and metabolic health outcomes in children ages 9-13 years. METHODS: This was a cross-sectional analysis of baseline data from 161 boys and 157 girls (ages 9-13 years) who previously participated in a double-blinded randomized placebo controlled trial of vitamin D supplementation. Relationships among fasting serum total osteocalcin (tOC), undercarboxylated osteocalcin (ucOC), leptin, and metabolic health outcomes were analyzed. RESULTS: Approximately 52% of study participants were obese based on percent body fat cutoffs (>25% for boys and >32% for girls) and about 5% had fasting serum glucose within the prediabetic range (i.e. 100 to 125 mg/dL). Serum tOC was not correlated with leptin, glucose, insulin, HOMA-IR, or HOMA-β after adjusting for percent body fat. However, serum ucOC negatively correlated with leptin (partial r = -0.16; p = 0.04) and glucose (partial r = -0.16; p = 0.04) after adjustment for percent body fat. Leptin was a positive predictor of insulin, glucose, HOMA-IR, and HOMA-β after adjusting for age, sex and percent body fat (all p < 0.001). CONCLUSIONS: These data depict an inverse relationship between leptin and various metabolic health outcomes in children. However, the notion that tOC or ucOC link fat with energy metabolism in healthy children was not supported

Relationship between fat mass and bone: associations between vitamin D, osteocalcin, adipokines and glucose homeostasis among children and adolescents

Introdução: O tecido adiposo e o osso dialogam entre si e influenciam a homeostase da glicose por meio da ação de seus produtos (leptina, adiponectina e osteocalcina). A insuficiência de vitamina D (VD) pode levar a alterações metabólicas em ambos tecidos. Objetivos: Investigar as relações entre concentrações séricas de 25 hidroxivitamina D [25(OH)D], osteocalcina, adipocinas, marcadores do metabolismo da glicose e estado nutricional em crianças e adolescentes. Métodos: Estudo transversal com 198 indivíduos brasileiros (14 a 18 anos) e 318 norte-americanos (8 a 13 anos). Coleta de sangue (após jejum de 12h) foi realizada para mensurar 25(OH)D, paratormônio (PTH), osteocalcina carboxilada (cOC), adiponectina (A), colesterol total, triglicérides, HDL-c, LDL-c e VLDL-c (amostra brasileira); osteocalcina total (tOC) (amostra norte-americana); glicose, insulina, osteocalcina não-carboxilada (ucOC) e leptina (L) (em ambas as amostras). Marcadores do metabolismo da glicose (HOMA-IR, HOMA- e QUICKI) foram calculados. Nos indivíduos brasileiros, o nível de atividade física foi determinado, e a ingestão alimentar foi mensurada por um Recordatório de 24 horas, repetido em 62,6 por cento da amostra. Resultados: População brasileira Indivíduos com excesso de peso (42,6 por cento ) apresentaram menores concentrações de 25(OH)D, adiponectina, cOC, ucOC, HDL-c e QUICKI, e maiores PTH, leptina, LDL-c, VLDL-c, colesterol total, triglicérides, insulina, HOMA-IR e HOMA-, comparados aos eutróficos (p<0,05). A 25(OH)D se correlacionou positivamente com ucOC (r=0,326; p<0,0001), adiponectina (r=0,151; p=0,034) e HDL-c (r=0,323; p<0,0001), e negativamente com IMC (r= -0,294; p<0,0001). A associação entre 25(OH)D e ucOC permaneceu após ajustes para idade, IMC e estação do ano (R² parcial=0,071, p<0,0001), porém ambas não se correlacionaram a marcadores do metabolismo da glicose. Fortes correlações foram observadas, porém, entre leptina e insulina (r=0,746; p<0,0001), HOMA-IR (r=0,720; p<0,0001), HOMA- (r=0,703; p<0,0001) e QUICKI (r= -0,749; p<0,0001). A razão A/L foi menor nos sedentários/insuficientemente ativos (2,2, DP=4,0 vs 5,6, DP=12,3; p=0,01), comparados aos ativos/muito ativos. A 25(OH)D foi positivamente associada à ingestão de VD, após ajustes para sexo, exposição solar e estação do ano (R2 15 parcial=0,026; p=0,02). População norte-americana Comparados aos eutróficos, indivíduos com excesso de peso (43,1 por cento ) apresentaram maior leptina, insulina, HOMA-IR e HOMA-, e menor QUICKI (p<0,0001 para todos). Concentrações de ucOC se correlacionaram negativamente com leptina (r= -0,162; p=0,04) e glicose (r= -0,159; p=0,04), porém somente a associação com leptina foi mantida após ajuste para idade, sexo e porcentagem de massa gorda corporal (R² parcial =0,03; p=0,0275). Concentrações de leptina se relacionaram com todos os marcadores do metabolismo da glicose, mesmo após ajustes para idade, sexo e porcentagem de massa gorda (insulina: R² parcial=0,23; glicose: R² parcial=0,04; HOMA-IR: R² parcial=0,23; HOMA-: R² parcial=0,09; QUICKI: R² parcial=0,23, p<0,001 para todos) Conclusões: Os resultados confirmam as relações entre excesso de peso, leptina e marcadores do metabolismo da glicose em crianças e adolescentes brasileiros e norte-americanos. Concentrações de 25(OH)D se correlacionaram negativamente ao IMC e leptina e positivamente à ucOC. A relação entre osteocalcina e a homeostase da glicose, contudo, não foi diretamente observada. Estes achados reforçam a importância do combate à obesidade, principalmente durante a infância e adolescência, período marcado por importantes mudanças corporais e fisiológicas.Introduction: Bone and adipose tissue interact and influence glucose homeostasis through the action of their products (leptin, adiponectin and osteocalcin). Vitamin D insufficiency can lead to metabolic alterations in both tissues. Objectives: To investigate the relationships between serum 25 hidroxivitamin D [25(OH)D], osteocalcin, adipokines, markers of glucose metabolism and nutritional status among children and adolescents. Methods: Cross-sectional study with 198 Brazilian (14 to 18 years old) and 318 American (8 to 13 years old) individuals. Blood was collected after 12-hour fasting to measure 25(OH)D, parathyroid hormone (PTH), carboxylated osteocalcin (cOC), adiponectin (A), total cholesterol, triglycerides, HDL-c, LDL-c and VLDL-c (Brazilian sample); total osteocalcin (tOC) (American sample); glucose, insulin, undercarboxylated osteocalcin (ucOC) and leptin (L) (both samples). Markers of glucose metabolism were calculated (HOMA-IR, HOMA- and QUICKI). Among Brazilian individuals, physical activity level was determined and food intake was assessed by a 24-hour food record, repeated in 62.6 per cent of the sample. Results: Brazilian population Individuals with weight excess (42.6 per cent from the total) presented lower serum 25(OH)D, adiponectin, cOC, ucOC, HDL-c and QUICKI, and higher PTH, leptin, LDL-c, VLDL-c, total cholesterol, triglycerides, insulin, HOMA-IR and HOMA-, compared to normal weight individuals (p<0.05). Serum 25(OH)D positively correlated with ucOC (r=0.326; p<0.0001), adiponectin (r=0.151; p=0.034) and HDL-c (r=0.323; p<0.0001), and negatively correlated with BMI (r = -0.294; p<0.0001). The association between 25(OH)D and ucOC persisted after adjusting for age, BMI and season of the year (partial R² = 0.071, p<0.0001), but none of them were related to markers of glucose metabolism. Strong correlations were observed between leptin and insulin (r = 0.746; p<0.0001), HOMA-IR (r = 0.720; p<0.0001), HOMA- (r = 0.703; p<0.0001) and QUICKI (r = -0.749; p<0.0001). A/L ratio was lower among sedentary/insufficiently active subjects (2.2, SD=4.0 vs 5.6, SD=12.3; p=0.01), compared to active/very active subjects. Serum 25(OH)D positively associated with vitamin D intake, after adjusting for sex, sun exposure and season of the year in regression analysis (partial R2=0.026; p=0.02). American population Compared to normal weight individuals, those with weight 17 excess (43.1 per cent ) presented higher leptin, insulin, HOMA-IR and HOMA-, and lower QUICKI (p<0.0001 for all). Serum ucOC negatively correlated with leptin (r = -0.162; p=0.04) and glucose (r = -0.159; p=0.04), but only the association with leptin persisted after adjusting for age, sex and body fat mass percentage (partial R² = 0.03; p=0.0275). Leptin concentrations were related with all markers of glucose metabolism, even after adjusting for age, sex and fat mass (insulin: partial R² = 0.23; glucose: partial R² = 0.04; HOMA-IR: partial R² = 0.23; HOMA-: partial R² = 0.09; partial QUICKI: R² = 0.23, p<0.001 for all). Conclusions: Results confirm the relationship between weight excess, leptin and markers of glucose metabolism among Brazilian and American children and adolescents. Serum 25(OH)D negatively correlated with BMI and leptin and positively correlated with ucOC. However, the relationship between osteocalcin and glucose homeostasis was not directly observed. Findings reinforce the importance if fighting obesity, especially during childhood and adolescence, ages in which important physiological alterations and body changes occur

Comparison between body mass index and a body shape index with adiponectin/leptin ratio and markers of glucose metabolism among adolescents

Background: Besides body mass index (BMI), new parameters have been developed to classify individual body shape. Aim: To investigate the relationship between BMI, waist circumference (WC), a body shape index (ABSI) and ABSI-adolescents among adolescents and verify which would better predict lower adiponectin/leptin (A/L) ratio and disturbances on glucose metabolism. Subjects and methods: A cross-sectional study with 197 Brazilian adolescents of 14–18 years. Serum leptin, adiponectin, glucose and insulin were measured. A/L ratio, ABSI, ABSI-adolescents, BMI, homeostasis model assessment estimates of insulin resistance (HOMA-IR) and β-cell function (HOMA-β) and the quantitative insulin sensitivity check index (QUICKI) were calculated. Results: ABSI-adolescents positively correlated with WC (r = 0.83, p < 0.0001) and BMI (r = 0.66, p < 0.0001), but stronger correlations were observed between WC and BMI (r = 0.95, p < 0.0001). ABSI-adolescents, BMI and WC negatively correlated with A/L ratio (all p < 0.0001). The correlation between BMI and A/L ratio was the strongest (r = −0.63, p < 0.001). A/L ratio, BMI, WC and ABSI-adolescents correlated with markers of glucose metabolism (all p < 0.0001) and the strongest correlation was observed with BMI (QUICKI: r = −0.75; HOMA-IR: r = 0.76; HOMA-β: r = 0.77; insulin: r = 0.79). Associations were confirmed by linear regression analysis, adjusted for sex and age. Conclusions: ABSI-adolescents, but not ABSI, was related to A/L ratio and to markers of glucose metabolism, but not more strongly than BMI and WC

Inadequate food intake among adults living with HIV

CONTEXT AND OBJECTIVE The number of people living with HIV (PLHIV) in Brazil is between 600,000 and 890,000. Assessing the diet is important in planning healthcare actions and improving PLHIV's quality of life. This study aimed to estimate the prevalence of inappropriate protein, total fat, saturated fat, carbohydrate, fiber, sodium, calcium and cholesterol intake among PVHIV on highly-active antiretroviral therapy (HAART). DESIGN AND SETTING Cross-sectional study in nine Specialized STD/AIDS Healthcare Centers in São Paulo. METHODS Men and women aged 20 to 59 years, on HAART for at least three months, were included. Nutrient intake was assessed using 24-hour food recall applied in person and repeated among 30% of the population by telephone. The between and within-person variances were corrected. RESULTS 507 individuals were evaluated: 58% male, mean age 41.7 years (standard deviation, SD = 7.8). The mean time since HIV diagnosis was 6.6 years (SD = 4.1), and since HAART onset, 5.1 years (SD = 3.3). More than 20% of the population presented intake above the recommendations for saturated fat, cholesterol and/or sodium, and below the recommendations for fiber. The recommended maximum tolerable sodium level was exceeded by 99% of the sample, and 86% of men and 94% of women did not reach the daily recommendations for calcium. Protein, carbohydrate and total fat intakes were adequate for the majority of the population. CONCLUSIONS A significant portion of the population presented inappropriate intake of saturated fat, sodium, fiber and calcium. Interventions aimed at improving PLHIV's dietary quality are needed