Dietary factors, metabolic abnormalities and fat redistribution
This report from the Steven Grinspoon Group at Harvard addresses dietary factors in lipodystrophy based on assessments in 85 consecutive HIV-infected patients with fat redistribution.
The analysis included dietary history, laboratory tests (fasting glucose, insulin, lipids, oral glucose tolerance), standard measurements (mean body mass index, waist-to-hip ratio), and relevant historical findings (PI use, kilocalorie intake, alcohol use, dietary fibre intake, and polyunsaturated-to-saturated fat ratio). The results showed that the following factors were positively associated with increased insulin AUC: increasing age, PI use, and polyunsaturated: saturated fat ratio. The factor that was inversely associated with insulin AUC was dietary fibre intake. The authors concluded that polyunsaturated fat, fibre, and alcohol were strongly associated with insulin resistance and were identified as important targets for dietary modification.
The authors point out that there is no consensus about the cause of lipodystrophy and there is scepticism about the notion that it is the product of a single process. Nevertheless, the most severe effects are associated with insulin resistance, which explains the emphasis on this component of the analysis. If this is correct, the authors have identified several potential targets for dietary modification, including increased dietary fibre and polyunsaturated fat, and decreased in intake of alcohol and cholesterol. This is one of the first major reports concerning the potential role of dietary modification in managing lipodystrophy.
Hadigan C et al. Modifiable dietary habits and their relation to metabolic abnormalities in men and women with human immunodeficiency virus infection and fat redistribution. Clin Infect Dis 2001;33:710-717.
John Hopkins AIDS Service