Potential use of niacin to reduce intra-abdominal fat

Simon Collins, HIV i-Base

Interesting results were presented by Fessel and colleagues from the Kaiser Permanente Care Programme in San Francisco on the use of open label high dose niacin (otherwise known as nicotinic acid or vitamin B3) for 48 weeks, to reverse intra-abdominal fat (IAF) accumulation.

As with the other studies reported above, the interest here is in a treatment which reports benefits for otherwise untreatable symptoms.

High dose niacin is not without serious toxicity risks itself although it increases HDL-C (high-density lipoprotein cholesterol) to a much greater extent than the statins. The ACTG panel recommends avoiding niacin because it may cause insulin resistance even in people without diabetes.

Nevertheless, this study reported decreases in IAF measured by single slice CT scan (L2) in 13/16 patients. Dosing was gradually increased over several weeks in order to reach optimal dose of 3000mg/day. Median baseline IAF was 227 (CI 173-266) and median duration of treatment was 364 days (294-400). IAF decreased in 13 and increased in 3 patients. Results reported were: overall in 16 patients IAF decreased by 16.9% (CI -33% to -0.8%) (p = 0.01). For those 13 in whom IAF decreased, the mean loss was 26.9% (CI -39.1% to -14.8%). Nine patients had decreased IAF >20% (mean 35.5%, CI -50.5% to -18.5%). Percentage decrease of IAF was associated with both the rise in HDL (p = 0.002) and decreased ratio of total cholesterol (TC/HDL (p = 0.003). Decrease of IAF was also associated with the duration of niacin treatment (p < 0.0001). Initial and final plasma lipids for all 16 patients were: TC, 258 and 235 mg/dL (NS); HDL, 35.4 and 43.1 mg/dL (p = 0.002); TC/HDL ratios, 7.3 and 5.6 (p = 0.008).

Side effects from high dose niacin include flushing (managed by 325 mg aspirin 20 minutes prior to niacin dosing). One patient experienced acanthosis nigricans – a black furry rash on the chest and underarms, which can result from insulin resistance, and which resolves after discontinuation/dose reduction. Diabetes can be exacerbated and require dose adjustments for diabetes medication. Liver function also requires careful monitoring. Niacin can also increase levels of growth hormone and this may explain some of the benefits seen in this study. Two patients entered the study with large buffalo humps and although not accurately measured, this was reported to soften and shrink considerably in one patient over the study period.

Niacin is reported to appear in human milk and may cause serious side effects in nursing infants.

Fessel J – Effects of Niacin upon Fat Expansion in HIV-Positive Patients Who Have the Fat Redistribution Syndrome (FRS). Abstract 703-T

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