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      Redistribuição de gordura corporal e alterações no metabolismo de lipídeos e glicose em pessoas vivendo com HIV/AIDS Translated title: Body fat redistribution and changes in lipid and glucose metabolism in people living with HIV/AIDS

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          Abstract

          RESUMO: Introdução: A síndrome da lipodistrofia do HIV é caracterizada por alterações no metabolismo e na composição corporal, que aumentam o risco cardiovascular de pessoas vivendo com HIV/AIDS (PVHA) em uso da terapia antirretroviral de alta potência (TARV). Objetivo: Avaliar a prevalência de lipodistrofia e de alterações do metabolismo de lipídios e glicose em PVHA em uso da TARV. Métodos: Para avaliação antropométrica foram aferidos peso, estatura e circunferência abdominal (CA). Para avaliação da lipodistrofia foi realizado o exame físico (subjetivo) e o exame (objetivo) de absortometria com raios X de dupla energia (DEXA) por meio da razão de massa gorda (RMG). Foram também realizados exames de lipidograma e glicemia de jejum e utilizados os critérios sugeridos pelo The National Cholesterol Education Program III para classificação de alterações metabólicas. Resultados: A amostra final consistiu em 262 pacientes com idade média de 44,3 ± 10,2 anos. A lipodistrofia, de acordo com o exame físico, esteve presente em 47,7% (IC95% 41,7 - 53,8) dos pacientes, enquanto pela RMG (DEXA) sua prevalência foi de 40,8% (IC95% 33,1 - 48,5). A maioria (53,0%; IC95% 47,0 - 59,1) dos pacientes apresentou aumento de adiposidade abdominal segundo a CA. As alterações metabólicas mais presentes foram o HDL reduzido (67,6%; IC95% 61,9 - 73,2) e a hipertrigliceridemia (55,7%; IC95% 49,7 - 61,7). Conclusões: A alta prevalência de lipodistrofia e alterações do metabolismo de lipídios e glicose evidenciam a importância da intervenção precoce nesse grupo de pacientes para prevenir complicações cardiovasculares.

          Translated abstract

          ABSTRACT: Introduction: The HIV lipodystrophy syndrome is characterized by changes in metabolism, and body composition that increase cardiovascular risk of people living with HIV/AIDS (PLWHA) using highly active antiretroviral therapy (HAART). Objective: To assess the prevalence of lipodystrophy and changes in lipid and glucose metabolism in PLWHA in use of HAART. Methods: For the anthropometric evaluation we measured weight, height and abdominal circumference (AC). For the lipodystrophy evaluation we conducted physical examination (subjective) and the (objective) examination of absorptiometry with X-ray dual energy (DEXA) by fat mass ratio (FMR). We also conducted lipid profile tests and fasting glucose and used the criteria suggested by The National Cholesterol Education Program III for metabolic disorders classification. Results: The final sample consisted of 262 patients with a mean age of 44.3 ± 10.2 years. Lipodystrophy, according to the physical examination, was present in 47.7% (95%CI 41.7 - 53.8) of patients, while the prevalence using FMR (DEXA) was 40.8% (95%CI 33.1 - 48.5). Most (53.0%; 95%CI 47.0 - 59.1) of the patients showed increased abdominal adiposity according to AC. The most prevalent metabolic alterations were reduced HDL (67.6%; 95%CI 61.9 - 73.2) and hypertriglyceridemia (55.7%; 95%CI 49.7 - 61.7). Conclusion: The high prevalence of lipodystrophy and changes in lipid and glucose metabolism show the importance of early intervention in this group of patients to prevent cardiovascular complications.

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          Leptin secretion from subcutaneous and visceral adipose tissue in women.

          Upper body obesity is a risk factor for type 2 diabetes. Little is known about the regulation of body fat distribution, but leptin may be involved. This study examined the secretion of leptin in subcutaneous and omental fat tissue in 15 obese and 8 nonobese women. Leptin secretion rates were two to three times higher in subcutaneous than in omental fat tissue in both obese and nonobese women (P < 0.0001 and P < 0.001, respectively). There was a positive correlation between BMI and leptin secretion rates in both subcutaneous (r = 0.87, P < 0.0001) and omental (r = 0.74, P < 0.0001) fat tissue. Furthermore, leptin secretion rates in subcutaneous and omental fat tissue correlated well with serum leptin levels (r = 0.84, P < 0.0001 and r = 0.73, P = 0.001, respectively), although in multivariate analysis, the subcutaneous leptin secretion rate was the major regressor for serum leptin (F = 42). Subcutaneous fat cells were approximately 50% larger than omental fat cells, and there was a positive correlation between fat cell size and leptin secretion rate in both fat depots (r = 0.8, P < 0.01). Leptin (but not gamma-actin) mRNA levels were twofold higher in subcutaneous than in omental fat tissue (P < 0.05). Thus the subcutaneous fat depot is the major source of leptin in women owing to the combination of a mass effect (subcutaneous fat being the major depot) and a higher secretion rate in the subcutaneous than in the visceral region, which in turn could be due to increased cell size and leptin gene expression.
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            Subdivisions of subcutaneous abdominal adipose tissue and insulin resistance.

            Whereas truncal (central) adiposity is strongly associated with the insulin resistant metabolic syndrome, it is uncertain whether this is accounted for principally by visceral adiposity (VAT). Several recent studies find as strong or stronger association between subcutaneous abdominal adiposity (SAT) and insulin resistance. To reexamine the issue of truncal adipose tissue depots, we performed cross-sectional abdominal computed tomography, and we undertook the novel approach of partitioning SAT into the plane superficial to the fascia within subcutaneous adipose tissue (superficial SAT) and that below this fascia (deep SAT), as well as measurement of VAT. Among 47 lean and obese glucose-tolerant men and women, insulin-stimulated glucose utilization, measured by euglycemic clamp, was strongly correlated with both VAT and deep SAT (r = -0.61 and -0.64, respectively; both P < 0.001), but not with superficial SAT (r = -0.29, not significant). Also, VAT and deep SAT followed a highly congruent pattern of associations with glucose and insulin area under the curve (75-g oral glucose tolerance test), mean arterial blood pressure, apoprotein-B, high-density lipoprotein cholesterol, and triglyceride. Superficial SAT had markedly weaker association with all these parameters and instead followed the pattern observed for thigh subcutaneous adiposity. We conclude that there are two functionally distinct compartments of adipose tissue within abdominal subcutaneous fat and that the deep SAT has a strong relation to insulin resistance.
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              HIV infection and cardiovascular disease.

              With the success of antiretroviral therapy (ART), non-human immunodeficiency virus (HIV)-related comorbidities like cardiovascular diseases (CVDs) are of increasing concern. We describe important recent research developments on the epidemiology of CVD in HIV infection, ART-related metabolic changes, and cardioprotective anti-inflammatory mechanisms, and summarize management strategies for CVD risk reduction. We systematically identified and analysed systematic reviews and most cited literature published in the last 3 years and supplemented findings with selected evidence based on clinical expertise. Among HIV-infected individuals, the prevalence of CVD risk factors and the risk for CVD is higher compared with HIV negatives. Antiretroviral drugs may induce dyslipidaemia, reduce insulin sensitivity, and promote body fat redistribution that additionally contributes to CVD risk. Some antiretroviral drugs may increase risk for CVD events, but the absolute risk increase is moderate and has to be put into perspective with the massive HIV-related benefits. Sustained HIV suppression reduces systemic inflammatory markers and is associated with a moderate reduction in CVD events. Regular CVD risk assessment and counselling to stop smoking must be regularly done in all HIV-infected individuals. Statins are effective for the treatment of dyslipidaemia in HIV infection, but drug interactions with ART need to be considered. Human immunodeficiency virus-infected individuals are at increased risk for CVD. Timely initiation of ART with consequent viral suppression is likely to reduce CVD events and to offset potential side effects from ART-induced metabolic changes. Reduction in smoking in HIV-infected individuals is a public health priority. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rbepid
                Revista Brasileira de Epidemiologia
                Rev. bras. epidemiol.
                Associação Brasileira de Saúde Coletiva (São Paulo, SP, Brazil )
                1415-790X
                1980-5497
                September 2017
                : 20
                : suppl 1
                : 526-536
                Affiliations
                [5] Ribeirão Preto orgnameUniversidade de São Paulo orgdiv1Escola de Enfermagem de Ribeirão Preto Brazil
                [4] Ribeirão Preto orgnameUniversidade de São Paulo orgdiv1Escola de Educação Física e Esporte de Ribeirão Preto Brazil
                [3] Franca São Paulo orgnameUniversidade de Franca Brazil
                [2] Ribeirão Preto orgnameUniversidade de São Paulo orgdiv1Escola de Enfermagem de Ribeirão Preto Brazil
                [1] Ribeirão Preto orgnameUniversidade de São Paulo orgdiv1Faculdade de Medicina de Ribeirão Preto orgdiv2Departamento de Clínica Médica Brazil
                Article
                S1415-790X2017000500526
                10.1590/1980-5497201700030014
                29160443
                329d35cb-7660-4918-b393-f037e5d58c58

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 23 February 2017
                : 15 June 2016
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 32, Pages: 11
                Product

                SciELO Public Health


                Dyslipidemia,Tecido adiposo,HIV,Dislipidemias,Prevalence,Lipodystrophy,Metabolic diseases,Body fat,Prevalência,Lipodistrofia,Doenças metabólicas

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