Sagittal Abdominal Diameter as the Best Predictor of Metabolic Syndrome in HIV-Infected Men on Antiretroviral Therapy


Cite item

Full Text

Abstract

Background:The interaction of human immunodeficiency virus (HIV), host and antiretroviral therapy (ART) causes a range of metabolic disorders that can be characterized as a metabolic syndrome (MetS) that increases the cardiovascular risk. MetS involves central obesity, which can be detected using different anthropometric parameters.

Objective:To assess the abilities of different anthropometric parameters in the prediction of MetS in HIV-infected men on ART.

Method:The study involved 92 male participants (mean age 44.46±10.38 years), divided into two groups: with and without MetS. All subjects underwent biochemical evaluation (triglycerides, HDL-cholesterol, fasting glucose), blood pressure measurement and anthropometric assessment: body mass, body height, body mass index (BMI), body fat mass, body circumferences (chest, upper arm, forearm, waist, hip, proximal and middle thigh and calf), sagittal abdominal diameter (SAD), skinfold thicknesses (subscapular, anterior and posterior upper arm, anterior and lateral forearm, abdominal, supraspinal, thigh and calf), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), waist-to-thigh ratio (WTR), sagittal abdominal diameter–to-body height ratio (SADH), body adiposity index (BAI) and conicity index. MetS was specified according to IDF criteria.

Results:Subjects with MetS had statistically significant higher values of all anthropometric parameters except middle thigh circumference, calf skinfold and body height. According to ROC analysis and Binary Logistic Regression, SAD has been shown as the best predictor of MetS with a predictive value of 21.40 cm (AUC:0.91), followed by WHR with a predictive value of 0.93.

Conclusion:Sagittal abdominal diameter is the strongest anthropometric indicator of MetS in HIV-infected patients on ART.

About the authors

Zorka Drvendžija

Department of Anatomy, Medical Facult, University of Novi Sad

Author for correspondence.
Email: info@benthamscience.net

Biljana Galić

Department of Anatomy, Medical Facult, University of Novi Sad

Email: info@benthamscience.net

Miloš Vujanović

Institut für Diagnostische und Interventionelle Radiologie/Neuroradiologie, Klinikum Passau

Email: info@benthamscience.net

Daniela Marić

Department of Anatomy, Medical Facult, University of Novi Sad

Email: info@benthamscience.net

Nina Jovanović

Department of Psychology, University of Novi Sad

Email: info@benthamscience.net

Snežana Brkić

Department of Anatomy, Medical Facult, University of Novi Sad

Email: info@benthamscience.net

Vesna Turkulov

Department of Anatomy, Medical Facult, University of Novi Sad

Email: info@benthamscience.net

Dalibor Ilić

Center for Radiology, University Clinical Center of Vojvodina

Email: info@benthamscience.net

References

  1. Daar ES. Novel approaches to HIV therapy. F1000 Res 2017; 6(F1000 Faculty Rev): 759.
  2. Maiese EM, Johnson PT, Bancroft T, Goolsby Hunter A, Wu AW. Quality of life of HIV-infected patients who switch antiretroviral medication due to side effects or other reasons. Curr Med Res Opin 2016; 32(12): 2039-46. doi: 10.1080/03007995.2016.1227776 PMID: 27552553
  3. Mellgren Å, Eriksson LE, Reinius M, Marrone G, Svedhem V. Longitudinal trends and determinants of patient-reported side effects on ART–a Swedish national registry study. PLoS One 2020; 15(12): e0242710. doi: 10.1371/journal.pone.0242710 PMID: 33362248
  4. Worm SW, Lundgren JD. The metabolic syndrome in HIV. Best Pract Res Clin Endocrinol Metab 2011; 25(3): 479-86. doi: 10.1016/j.beem.2010.10.018 PMID: 21663841
  5. American Heart Association. What is metabolic syndrome? 2022. Available from: https://www.heart.org/en/health-topics/metabolic-syndrome/about-metabolic-syndrome?fbclid=IwAR02mhwPCjqVdmk06nN-9c9uAt49NdL6cBwTtf6xnEoJgjjyKAXTwG_WkG4
  6. Worm SW, Friis-Møller N, Bruyand M, et al. High prevalence of the metabolic syndrome in HIV-infected patients: impact of different definitions of the metabolic syndrome. AIDS 2010; 24(3): 427-35. doi: 10.1097/QAD.0b013e328334344e PMID: 19910787
  7. Samaras K, Wand H, Law M, Emery S, Cooper D, Carr A. Prevalence of metabolic syndrome in HIV-infected patients receiving highly active antiretroviral therapy using International Diabetes Foundation and Adult Treatment Panel III criteria: associations with insulin resistance, disturbed body fat compartmentalization, elevated C-reactive protein, and corrected hypoadiponectinemia. Diabetes Care 2007; 30(1): 113-9. doi: 10.2337/dc06-1075 PMID: 17192343
  8. Bonfanti P, Giannattasio C, Ricci E, et al. HIV and metabolic syndrome: a comparison with the general population. J Acquir Immune Defic Syndr 2007; 45(4): 426-31. doi: 10.1097/QAI.0b013e318074ef83 PMID: 17514013
  9. Amirabdollahian F, Haghighatdoost F. Anthropometric indicators of adiposity related to body weight and body shape as cardiometabolic risk predictors in British young adults: superiority of waist-to-height ratio. J Obes 2018; 2018: 1-15. doi: 10.1155/2018/8370304 PMID: 30515323
  10. Saklayen MG. The global epidemic of the metabolic syndrome. Curr Hypertens Rep 2018; 20(2): 12. doi: 10.1007/s11906-018-0812-z PMID: 29480368
  11. World Health Organization. Obesity. 2022. Available from: https://www.who.int/health-topics/obesity#tab=tab_1
  12. The IDF consensus worldwide definition of the metabolic syndrome 2017. 2017. Available from: https://www.idf.org/e-library/consensusstatements/60-idfconsensus-worldwide-definitionof-the-metabolic-syndrome
  13. Bosho DD, Dube L, Mega TA, Adare DA, Tesfaye MG, Eshetie TC. Prevalence and predictors of metabolic syndrome among people living with human immunodeficiency virus (PLWHIV). Diabetol Metab Syndr 2018; 10(1): 10. doi: 10.1186/s13098-018-0312-y PMID: 29483948
  14. Jantarapakde J, Phanuphak N, Chaturawit C, et al. Prevalence of metabolic syndrome among antiretroviral-naive and antiretroviral-experienced HIV-1 infected Thai adults. AIDS Patient Care STDS 2014; 28(7): 331-40. doi: 10.1089/apc.2013.0294 PMID: 24914459
  15. Bune GT, Yalew AW, Kumie A. The extents of metabolic syndrome among Antiretroviral Therapy exposed and ART naïve adult HIV patients in the Gedeo-zone, Southern-Ethiopia: a comparative cross-sectional study. Arch Public Health 2020; 78(1): 40. doi: 10.1186/s13690-020-00420-3 PMID: 32399212
  16. Jain AK, Theengh DP, Yadav P, Nandy P. Assessment of metabolic syndrome in HIV-infected individuals. Indian J Sex Transm Dis AIDS 2017; 38(2): 152-6. doi: 10.4103/ijstd.IJSTD_55_16 PMID: 30148269
  17. Idiculla J, D’Souza , Ravindran GD, Singh G, Furruqh S. Diabetes mellitus, insulin resistance, and metabolic syndrome in HIV-positive patients in South India. Int J Gen Med 2011; 4: 73-8. doi: 10.2147/IJGM.S15818 PMID: 21403795
  18. Alvarez C, Salazar R, Galindez J, et al. Metabolic syndrome in HIV-infected patients receiving antiretroviral therapy in Latin America. Braz J Infect Dis 2010; 14(3): 256-63. doi: 10.1016/S1413-8670(10)70053-2 PMID: 20835509
  19. Bernal E, Masiá M, Padilla S, Martín-Hidalgo A, Gutiérrez F. Prevalence and characteristics of metabolic syndrome among HIV-infected patients from a Mediterranean cohort. Med Clin (Barc) 2007; 128(5): 172-5. doi: 10.1157/13098391 PMID: 17298778
  20. Beraldo RA, Meliscki GC, Silva BR, et al. Comparing the Ability of Anthropometric Indicators in Identifying Metabolic Syndrome in HIV Patients. PLoS One 2016; 11(2): e0149905. doi: 10.1371/journal.pone.0149905 PMID: 26919174
  21. Dimodi HT, Etame LS, Nguimkeng BS, et al. Prevalence of Metabolic Syndrome in HIV-Infected Cameroonian Patients. World J AIDS 2014; 4(1): 85-92. doi: 10.4236/wja.2014.41011
  22. Leal JA, Fausto MA, Carneiro M. Anthropometric Risk Factors for Metabolic Syndrome in HIV patients. MedicalExpress (São Paulo) 2016; 3(4): 160-5. doi: 10.5935/MedicalExpress.2016.04.05
  23. Clumeck N, Pozniak A, Raffi F. European AIDS Clinical Society (EACS) guidelines for the clinical management and treatment of HIV-infected adults. HIV Med 2008; 9(2): 65-71. doi: 10.1111/j.1468-1293.2007.00533.x PMID: 18257769
  24. Alberti KGMM, Zimmet P, Shaw J. The metabolic syndrome—a new worldwide definition. Lancet 2005; 366(9491): 1059-62. doi: 10.1016/S0140-6736(05)67402-8 PMID: 16182882
  25. Dimala CA, Ngu RC, Kadia BM, Tianyi FL, Choukem SP. Markers of adiposity in HIV/AIDS patients: Agreement between waist circumference, waist-to-hip ratio, waist-to-height ratio and body mass index. PLoS One 2018; 13(3): e0194653. doi: 10.1371/journal.pone.0194653 PMID: 29566089
  26. Öhrvall M, Berglund L, Vessby B. Sagittal abdominal diameter compared with other anthropometric measurements in relation to cardiovascular risk. Int J Obes 2000; 24(4): 497-501. doi: 10.1038/sj.ijo.0801186 PMID: 10805508
  27. Yim JY, Kim D, Lim SH, et al. Sagittal abdominal diameter is a strong anthropometric measure of visceral adipose tissue in the Asian general population. Diabetes Care 2010; 33(12): 2665-70. doi: 10.2337/dc10-0606 PMID: 20843976
  28. Risérus U, Ärnlöv J, Brismar K, Zethelius B, Berglund L, Vessby B. Sagittal abdominal diameter is a strong anthropometric marker of insulin resistance and hyperproinsulinemia in obese men. Diabetes Care 2004; 27(8): 2041-6. doi: 10.2337/diacare.27.8.2041 PMID: 15277437
  29. Risérus U, de Faire U, Berglund L, Hellénius ML. Sagittal abdominal diameter as a screening tool in clinical research: cutoffs for cardiometabolic risk. J Obes 2010; 2010: 1-7. doi: 10.1155/2010/757939 PMID: 20798888
  30. Møller G, Ritz C, Kjølbæk L, et al. Sagittal abdominal diameter and waist circumference appear to be equally good as identifiers of cardiometabolic risk. Nutr Metab Cardiovasc Dis 2021; 31(2): 518-27. doi: 10.1016/j.numecd.2020.09.032 PMID: 33223400
  31. Sampaio LR, Simões EJ, Assis AMO, Ramos LR. Validity and reliability of the sagittal abdominal diameter as a predictor of visceral abdominal fat. Arq Bras Endocrinol Metabol 2007; 51(6): 980-6. doi: 10.1590/S0004-27302007000600013 PMID: 17934666
  32. Pimentel GD, Moreto F, Takahashi MM, Portero-McLellan KC, Burini RC. Sagital abdominal diameter, but not waist circumference is strongly associated with glycemia, triacilglycerols and HDL-C levels in overweight adults. Nutr Hosp 2011; 26(5): 1125-9. PMID: 22072363
  33. Kahn HS, Gu Q, Bullard KM, Freedman DS, Ahluwalia N, Ogden CL. Population distribution of the sagittal abdominal diameter (SAD) from a representative sample of US adults: comparison of SAD, waist circumference and body mass index for identifying dysglycemia. PLoS One 2014; 9(10): e108707. doi: 10.1371/journal.pone.0108707 PMID: 25272003
  34. Kahn HS, Rissanen H, Bullard KM, Knekt P. The population distribution of the sagittal abdominal diameter ( SAD ) and SAD/height ratio among F innish adults. Clin Obes 2014; 4(6): 333-41. doi: 10.1111/cob.12078 PMID: 25826163
  35. Kruger M, Zyl L, Nell T Jnr. Sagittal Abdominal Diameter In HIV Show Strong Correlations In Body Fat Over Two Year HAART in a mixed ancestry HIV Population of South Africa. FASEB J 2015; 29(S1): 25-8. doi: 10.1096/fasebj.29.1_supplement.747.14 PMID: 25318479
  36. Tutunchi H, Ebrahimi-Mameghani M, Ostadrahimi A, Asghari-Jafarabadi M. What are the optimal cut-off points of anthropometric indices for prediction of overweight and obesity? Predictive validity of waist circumference, waist-to-hip and waist-to-height ratios. Health Promot Perspect 2020; 10(2): 142-7. doi: 10.34172/hpp.2020.23 PMID: 32296627
  37. Hassan MR, Ahmad N, Adam SIM, Nawi AM, Ghazi H. Abdominal obesity indicators: Waist circumference or waist-to-hip ratio in Malaysian adults population. Int J Prev Med 2016; 7(1): 82. doi: 10.4103/2008-7802.183654 PMID: 27330688
  38. Baioumi AYAA. Chapter 3 - Comparing Measures of Obesity: Waist Circumference, Waist-Hip, and Waist-Height Ratios. Ronald RW. Nutrition in the Prevention and Treatment of Abdominal Obesity. (2nd ed..). Academic Press 2019; pp. 29-40.
  39. Azarbad A, Aghnia T, Gharibzadeh A, et al. Cut-off points for anthropometric indices to screen for hypertension among Iranian adults of the Bandare-Kong cohort: a cross-sectional study. BMC Public Health 2022; 22(1): 2064. doi: 10.1186/s12889-022-14489-8 PMID: 36369024
  40. Hadigan C, Meigs JB, Wilson PWF, et al. Prediction of coronary heart disease risk in HIV-infected patients with fat redistribution. Clin Infect Dis 2003; 36(7): 909-16. doi: 10.1086/368185 PMID: 12652392
  41. Panel on antiretroviral guidelines for adults and adolescents. guidelines for the use of antiretroviral agents in adults and adolescents with HIV 2023. Available from: https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-arv
  42. Montessori V, Press N, Harris M, Akagi L, Montaner JS. Adverse effects of antiretroviral therapy for HIV infection. CMAJ 2004; 170(2): 229-38. PMID: 14734438
  43. Masenyetse LJ, Manda SOM, Mwambi HG. An assessment of adverse drug reactions among HIV positive patients receiving antiretroviral treatment in South Africa. AIDS Res Ther 2015; 12(1): 6. doi: 10.1186/s12981-015-0044-0 PMID: 25745501

Supplementary files

Supplementary Files
Action
1. JATS XML

Copyright (c) 2024 Bentham Science Publishers