Substance Use, Disordered Eating, and Weight Gain: Describing the Prevention and Treatment Needs of Incarcerated Women

Weight-related concerns are associated with women's substance use and treatment relapse. The prevalence of overweight, obesity, disordered eating behavior, and substance abuse history was assessed among female inmates incarcerated for 6 to 24 months at an Oregon state prison, using a self-administered survey and physical measurements. 

Average weight gain was 20 pounds, 87% of women were overweight (39%) or obese (48%), and 24% reported using one or more unhealthy strategies to lose weight in the past 6 months. Women who used tobacco and illicit substances before incarceration gained more weight. 

Integrating nutrition and weight gain issues into substance abuse treatment could benefit incarcerated women-both soon after entering prison to prevent weight gain and close to release to prevent relapse into substance use.

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By:  Drach LL1, Maher JE2, Braun MJ3, Murray SL4, Sazie E5.

• 1Program Design and Evaluation Services, Multnomah County Health Department and Oregon Public Health Division, Portland, OR, USA linda.drach@state.or.us.
• 2Program Design and Evaluation Services, Multnomah County Health Department and Oregon Public Health Division, Portland, OR, USA.
• 3Oregon Youth Authority, Portland, OR, USA Oregon Department of Corrections (formerly), Portland, OR, USA.
• 4Oregon Public Health Division, Portland, OR, USA.
• 5Oregon Department of Corrections (formerly), Portland, OR, USA. 
• J Correct Health Care. 2016 Apr;22(2):139-45. doi: 10.1177/1078345816634692.

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High Prevalence of Being Overweight and Obese HIV-Infected Persons, Before and After 24 Months on Early ART in the ANRS 12136 Temprano Trial

BACKGROUND:

HIV is usually associated with weight loss. World health Organization (WHO) recommends early antiretroviral (ART) initiation, but data on the progression of body mass index (BMI) in participants initiating early ART in Africa are scarce.

METHODS:

The Temprano randomized trial was conducted in Abidjan to assess the effectiveness of early ART and Isoniazid (INH) prophylaxis for tuberculosis in HIV-infected persons with high CD4 counts below 800 cells/mm(3) without any indication for starting ART. Patients initiating earlyART before December 2010 were included in this sub-study. BMI was categorized as: underweight (<18.5 kg/m(2)), normal weight (18.5-24.9 kg/m(2)), overweight (25-29.9 kg/m(2)) and obese (≥30 kg/m(2)). At baseline and after 24 months of ART, prevalence of being overweight orobese and factors associated with being overweight or obese were estimated using univariate and multivariate logistic regression.

RESULTS:

At baseline, 755 participants (78 % women; median CD4 count 442/mm(3), median baseline BMI 22 kg/m(2)) initiated ART. Among them, 19.7 % were overweight, and 7.2 % were obese at baseline. Factors associated with being overweight or obese were: female sex aOR 2.3 (95 % CI 1.4-3.7), age, aOR for 5 years 1.01 (95 % CI 1.0-1.2), high living conditions aOR 2.6 (95 % CI 1.5-4.4), High blood pressure aOR 4.3 (95 % CI 2.0-9.2), WHO stage 2vs1 aOR 0.7 (95 % CI 0.4-1.0) and Hemoglobin ≥95 g/dl aOR 3.0 (95 % CI 1.6-5.8). Among the 597 patients who attended the M24 visit, being overweight or obese increased from 20.4 to 24.8 % (p = 0.01) and 7.2 to 9.2 % (p = 0.03) respectively and factor associated with being overweight or obese was immunological response measured as an increase of CD4 cell count between M0-M24 (for +50 cells/mm(3): aOR 1.01; 95 % CI 1.05-1.13, p = 0.01).

CONCLUSION:

The weight categories overweight and obese are highly prevalent in HIV-infected persons with high CD4 cell counts at baseline, and increased over 24 months on ART in this Sub-Saharan African population.

Below:  Changes of BMI vs baseline (Mean and 95 % confidence intervals) according to initial BMI category, among 597 patients who attended the 24-month visit in the Temprano trial. N number, % percentage, BMI body mass index, underweight BMI <18.5 kg/m², normal BMI 18.5–24.9 kg/m², Overweight BMI 25–29.9 kg/m², Obese BMI >30 kg/m²

Full article at:   http://goo.gl/ZkLOjA

By:  Guehi C1, Badjé A2, Gabillard D3, Ouattara E4, Koulé SO1, Moh R5, Ekouevi D2, Ahibo H6, N'Takpé JB7, Menan GK7, Deschamps N7, Lecarrou J3, Eholié S5,Anglaret X4, Danel C2.

• 1Unité de Soins Ambulatoire et de Conseil (USAC), 18 BP, 1125 Abidjan 18, Côte d'Ivoire.
• 2Programme PACCI, ANRS research Site, Abidjan, Côte d'Ivoire ; Inserm U 1219, Bordeaux University, Bordeaux, France.
• 3Inserm U 1219, Bordeaux University, Bordeaux, France ; ISPED, Bordeaux University, Bordeaux, France.
• 4Programme PACCI, ANRS research Site, Abidjan, Côte d'Ivoire ; Inserm U 1219, Bordeaux University, Bordeaux, France ; ISPED, Bordeaux University, Bordeaux, France.
• 5Programme PACCI, ANRS research Site, Abidjan, Côte d'Ivoire ; Department of Infectious Diseases, Treichville Hospital, Abidjan, Côte d'Ivoire.
• 6Centre de Recherche et Diagnostic sur le SIDA, (Cedres) CHU de Treichville, Abidjan, Côte d'Ivoire.
• 7Programme PACCI, ANRS research Site, Abidjan, Côte d'Ivoire. 
• AIDS Res Ther. 2016 Feb 25;13:12. doi: 10.1186/s12981-016-0094-y. eCollection 2016.

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Comparing the Ability of Anthropometric Indicators in Identifying Metabolic Syndrome in HIV Patients

Background

Highly active antiretroviral therapy (HAART) can cause side effects in HIV patients, as the metabolic syndrome. Early identification of risk for development of cardiovascular diseases using available reliable and practical methods is fundamental. On this basis, the aim of this study was to compare the effectiveness of anthropometric indicators to identify metabolic syndrome in HIV patients on HAART.

Methods

It is a cross-sectional study. A number of 280 stable HIV patients were studied. It measured weight, height, waist circumference (WC), hip circumference (HP), thigh circumference (TC) and calculated body mass index (BMI), body adiposity index (BAI), waist to hip ratio (WHR) and waist to thigh ratio (WTR). There was also a performance of biochemical tests of lipid profile and fasting glucose. Systemic blood pressure was measured. The criteria proposed by the National Cholesterol Education Program III (NCEP-ATP III) to metabolic syndrome classification was used. Individuals were divided in groups with or without metabolic alterations and their anthropometric indicators were compared. Receiver operating characteristic (ROC) curves were designed for each anthropometric indicator using the metabolic syndrome classification to identify sensitivity and specificity.

Results

WC was a good tool to identify each metabolic disorder separately: total cholesterol (only females, p<0.05), triglycerides (only males, p<0.001), HDL cholesterol (p<0.05), LDL cholesterol (p<005) and fasting glycemic (p<005). WC also showed the best performance to identify metabolic syndrome in both genders (areas under the curve (AUCs): 0.79 and 0.76 for male and female, respectively), while BAI proved to be an inadequate indicator (AUCs: 0.63 and 0.67 for males and females), respectively, in this population.

Conclusions

The central adiposity measure (WC) had the best performance to identify metabolic syndrome, and it is a convenient, cheap and reliable tool that can be used in clinical practice routinely to prevent cardiovascular complications in HIV patients.

Below:  Receiver operating characteristic curves for the performance evaluations of anthropometric indicators in identifying metabolic syndrome

Full article at:   http://goo.gl/pUIfQT

By:  Rebeca Antunes Beraldo, Gabriela Cristina Meliscki, Bruna Ramos Silva, Anderson Marliere Navarro, Valdes Roberto Bollela, André Schmidt, Maria Cristina Foss-Freitas 

Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil

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Burden of Liver Disease among Community-Based People Who Inject Drugs (PWID) in Chennai, India

BACKGROUND AND OBJECTIVE:

We characterize the burden of liver disease in a cohort of PWID in Chennai, India, with a high prevalence of HCV.

MATERIALS AND METHODS:

1,042 PWID were sampled through community outreach in Chennai. Participants underwent fasting blood draw, questionnaire and an examination that included liver stiffness assessment using transient elastography (Fibroscan) and assessment of steatosis via ultrasound.

RESULTS:

The median age was 39 years, all were male, 14.8% were HIV infected and 35.6% were HCV antibody positive, of whom 78.9% were chronically infected (HCV RNA positive). Median liver stiffness was 6.2 kPA; 72.9% had no evidence of or mild stiffness, 14.5% had moderate stiffness, and 12.6% had evidence of severe stiffness/cirrhosis. Prevalence of severe stiffness/cirrhosis was significantly higher among persons who were older, had a longer duration of injecting drugs, higher body mass index, higher prevalence of insulin resistance, higher prevalence of steatosis, higher HCV RNA levels and evidence of alcohol dependence. An estimated 42.1% of severe stiffness/cirrhosis in this sample was attributable to HCV. 529 (53.0%) had some evidence of steatosis. Prevalence of steatosis was higher among those who had larger waist circumference, insulin resistance, higher HDL cholesterol and a history of antiretroviral therapy.

CONCLUSIONS:

We observed a high burden of liver disease in this relatively young cohort that was primarily driven by chronic HCV infection, metabolic factors (insulin resistance and steatosis) and heavy alcohol use. Interventions to improve access to HCV treatment and reduce alcohol use are needed to prevent further progression of liver disease.

Below:  Distribution of liver stiffness by HIV and HCV status

Below:  Population attributable fractions of severe liver stiffness/cirrhosis among total population and persons with chronic HCV infection

Full article at:  http://goo.gl/OKG7u6

By:  Solomon SS1,2,3, Srikrishnan AK3, McFall AM2, Kumar MS3, Saravanan S3, Balakrishnan P3, Solomon S3, Thomas DL1, Sulkowski MS1, Mehta SH2.

• 1Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America.
• 2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
• 3YR Gaitonde Centre for AIDS Research and Education, Chennai, India. 

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Body Mass Index Effects Sperm Quality: A Retrospective Study in Northern China

Excess weight and obesity have become a serious problem in adult men of reproductive age throughout the world. The purpose of this retrospective study was to assess the relationships between body mass index and sperm quality in subfertile couples in a Chinese Han population. 

Sperm analyses were performed and demographic data collected from 2384 male partners in subfertile couples who visited a reproductive medical center for treatment and preconception counseling. The subjects were classified into four groups according to their body mass index: underweight, normal, overweight, and obese. Of these subjects, 918 (38.3%) had a body mass index of >25.0 kg m-0 2 . No significant differences were found between the four groups with respect to age, occupation, level of education, smoking status, alcohol use, duration of sexual abstinence, or the collection time of year for sperm. The results clearly indicated lower sperm quality (total sperm count, sperm concentration, motile sperm, relative amounts of type A motility, and progressive motility sperm [A + B]) in overweight and obese participants than in those with normal body mass index. Normal sperm morphology and sperm volume showed no clear difference between the four groups. 

This study indicates that body mass index has a negative effect on sperm quality in men of subfertile couples in a Northern Chinese population. Further study should be performed to investigate the relationship between body mass index and sperm quality in a larger population.

Full article at:   http://goo.gl/PiWOj9

By:  Wang EY, Huang Y, Du QY, Yao GD, Sun YP1.

1Reproductive Medical Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China

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Daily Consumption of Ready-To-Use Peanut-Based Therapeutic Food Increased Fat Free Mass, Improved Anemic Status But Has No Impact on the Zinc Status of People Living with HIV/AIDS

BACKGROUND:

Food insecurity in sub-Saharan Africa and malnutrition constitute the main obstacles for successful treatment of people living with HIV/AIDS (PLWH). The aim of this study was to assess the effect of consuming daily 100 g RUTF (ready-to-use therapeutic food) as supplement, on body composition, anemia and zinc status of hospitalized PLWH in Senegal.

METHODS:

A Controlled clinical trial was conducted in 65 PLWH randomly allocated to receive either standard hospital diet alone (Control group: n = 33), or the standard diet supplemented with 100 g RUTF/day (RUTF group: n = 32). Supplementation was continued at home during 9 weeks. Individual dietary intakes were measured and compared to the Recommended Dietary Allowances. Body composition was determined using Bio-Impedance Analysis. Hemoglobin was measured by HemoCue and plasma zinc (PZ) concentration by atomic absorption spectrometry. PZ was adjusted to infection (CRP and α1-AGP). All measures were conducted on admission, discharge and after 9 weeks home-based follow up.

RESULTS:

34 and 24 % of the patients in RUTF and Control groups were suffering from severe malnutrition (BMI < 16 kg/m(2)), respectively. In both groups, more than 90 % were anemic and zinc deficiency affected over 50 % of the patients. Food consumed by the Control group represented 75, 14 and 55 % of their daily recommended intake (DRI) of energy, iron and zinc, respectively. When 100 g of RUTF was consumed with the standard diet, the DRI of energy and zinc were 100 % covered (2147 kcal, 10.4 mg, respectively), but not iron (2.9 mg). After 9 weeks of supplementation, body weight, and fat-free mass increased significantly by +11 % (p = 0.033), and +11.8 % (p = 0.033) in the RUTF group, but not in the Control group, while percentage body fat was comparable between groups (p = 0.888). In the RUTF group, fat free mass gain is higher in the patients on ART (+11.7 %, n = 14; p = 0.0001) than in those without ART (+6.2 %, n = 6; p = 0.032). Anemia decreased significantly with the supplementation, but zinc status, measured using plasma zinc concentration, remained unchanged.

CONCLUSION:

Improving PLWH' diet with 100 g RUTF for a long period has a positive impact on muscle mass and anemia but not on the zinc status of the patients.

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By:  Diouf A1, Badiane A2, Manga NM3, Idohou-Dossou N4, Sow PS5, Wade S6.

• 1Laboratoire de Nutrition, Département de Biologie Animale, Faculté des Sciences et Techniques, Université Cheikh Anta Diop de Dakar, Dakar, BP 5005, Dakar - Fann, Sénégal. adama.diouf@ucad.edu.sn.
• 2Laboratoire de Nutrition, Département de Biologie Animale, Faculté des Sciences et Techniques, Université Cheikh Anta Diop de Dakar, Dakar, BP 5005, Dakar - Fann, Sénégal. badiane21@yahoo.fr.
• 3Service des Maladies Infectieuses, Centre Hospitalier National Universitaire de Fann, Dakar, Sénégal. noelmagloiremanga@yahoo.fr.
• 4Laboratoire de Nutrition, Département de Biologie Animale, Faculté des Sciences et Techniques, Université Cheikh Anta Diop de Dakar, Dakar, BP 5005, Dakar - Fann, Sénégal. nicole.dossou@ucad.edu.sn.
• 5Service des Maladies Infectieuses, Centre Hospitalier National Universitaire de Fann, Dakar, Sénégal. papasalifsow@gmail.com.
• 6Laboratoire de Nutrition, Département de Biologie Animale, Faculté des Sciences et Techniques, Université Cheikh Anta Diop de Dakar, Dakar, BP 5005, Dakar - Fann, Sénégal. salimata.wade@ucad.edu.sn. 

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Rising Obesity Prevalence and Weight Gain among Adults Starting Antiretroviral Therapy in the United States and Canada

The proportion of overweight and obese adults in the United States and Canada has increased over the past decade, but temporal trends in body mass index (BMI) and weight gain on antiretroviral therapy (ART) among HIV-infected adults have not been well characterized. 

We conducted a cohort study comparing HIV-infected adults in the North America AIDS Cohort Collaboration on Research and Design (NA-ACCORD) to United States National Health and Nutrition Examination Survey (NHANES) controls matched by sex, race, and age over the period 1998 to 2010. Multivariable linear regression assessed the relationship between BMI and year of ART initiation, adjusting for sex, race, age, and baseline CD4(+) count. Temporal trends in weight on ART were assessed using a generalized least-squares model further adjusted for HIV-1 RNA and first ART regimen class. 

A total of 14,084 patients from 17 cohorts contributed data; 83% were male, 57% were nonwhite, and the median age was 40 years. Median BMI at ART initiation increased from 23.8 to 24.8 kg/m(2) between 1998 and 2010 in NA-ACCORD, but the percentage of those obese (BMI ≥30 kg/m(2)) at ART initiation increased from 9% to 18%. After 3 years of ART, 22% of individuals with a normal BMI (18.5-24.9 kg/m(2)) at baseline had become overweight (BMI 25.0-29.9 kg/m(2)), and 18% of those overweight at baseline had become obese. HIV-infected white women had a higher BMI after 3 years of ART as compared to age-matched white women in NHANES (p = 0.02), while no difference in BMI after 3 years of ART was observed for HIV-infected men or non-white women compared to controls. 

The high prevalence of obesity we observed among ART-exposed HIV-infected adults in North America may contribute to health complications in the future.

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By:   Koethe JR¹, Jenkins CA¹, Lau B², Shepherd BE¹, Justice AC^3,4, Tate JP^3,4, Buchacz K⁵, Napravnik S⁶, Mayor AM⁷, Horberg MA⁸, Blashill AJ⁹, Willig A¹⁰,Wester CW¹, Silverberg MJ¹¹, Gill J¹², Thorne JE², Klein M¹³, Eron JJ⁶, Kitahata MM¹⁴, Sterling TR¹, Moore RD²; North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD).

¹ Vanderbilt University School of Medicine , Nashville, Tennessee.

² Johns Hopkins University , Baltimore, Maryland.

³ Yale School of Medicine , New Haven, Connecticut.

⁴ VA Connecticut Healthcare System , West Haven, Connecticut.

⁵ Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia .

⁶6 University of North Carolina , Chapel Hill, North Carolina.

⁷7 Universidad Central del Caribe , Bayamon, Puerto Rico .

⁸8 Mid-Atlantic Permanente Research Institute , Rockville, Maryland.

⁹9 Harvard Medical School , Boston, Massachusetts.

¹⁰10 University of Alabama at Birmingham , Birmingham, Alabama.

¹¹11 Kaiser Permanente Northern California , Oakland, California.

¹²12 Alberta HIV Clinic , Sheldon M. Chumir Health Centre, Calgary, Alberta, Canada .

¹³13 McGill University Health Center , Montreal, Quebec, Canada .

¹⁴14 University of Washington , Seattle, Washington.

AIDS Res Hum Retroviruses. 2016 Jan;32(1):50-8. doi: 10.1089/aid.2015.0147. Epub 2015 Sep 9.

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Persistent HIV Viremia: Description of a Cohort of HIV Infected Individuals with ART Failure in Puerto Rico

The introduction of antiretroviral therapy (ART) has allowed human immunodeficiency virus (HIV) suppression in patients. We present data of a cohort of Puerto Rican patients with HIV who were under treatment with a steady regime of ART across a time horizon of eleven years. 

The time periods were categorized into four year stratums: 2000 to 2002; 2003 to 2005; 2006 to 2008 and 2009 to 2011. Socio-demographic profile, HIV risk factors, co-morbid conditions were included as study variables. One year mortality was defined. The p value was set at ≤0.05. The cohort consisted of 882 patients with 661 subjects presenting with persistent HIV viral load after a self-reported 12 month history of ART use. In this sub-cohort a higher viral load was seen across time (p < 0.05). Illicit drug use, IV drug use, alcohol use, loss of work were associated to having higher viral load means (p < 0.05). HIV viral load mean was lower as BMI increased (p < 0.001). 

It is imperative to readdress antiretroviral adherence protocols and further study ART tolerance and compliance.

Below:  Detectable vs. non-detectable viral load (% patients)

Full article at:  http://www.mdpi.com/1660-4601/13/1/50/htm

By:   Maldonado-Martínez G1, Hunter-Mellado RF2, Fernández-Santos D3, Ríos-Olivares E4.

• 1Data Management and Statistical Research Support Unit, Universidad Central del Caribe, Bayamón 00960, Puerto Rico. geronimo.maldonado@uccaribe.edu.
• 2Internal Medicine Department, Universidad Central del Caribe, Bayamón 00960, Puerto Rico. robert.hunter@uccaribe.edu.
• 3Data Management and Statistical Research Support Unit, Universidad Central del Caribe, Bayamón 00960, Puerto Rico. diana.fernandez@uccaribe.edu.
• 4Microbiology Department, Universidad Central del Caribe, Bayamón 00960, Puerto Rico. eddy.rios@uccaribe.edu. 
• Int J Environ Res Public Health. 2015 Dec 22;13(1). pii: E50. doi: 10.3390/ijerph13010050. 
• 
  
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Frailty, Food Insecurity & Nutritional Status in People Living with HIV

BACKGROUND:

Nutritional status and food insecurity are associated with frailty in the general U.S. population, yet little is known about this in the aging population of people living with HIV (PLWH).

OBJECTIVES:

Given the potential importance of nutrition and the amenability to intervention, we examined the association between nutritional status, food insecurity, and frailty in PLWH.

PARTICIPANTS:

50 PLWH, age ≥45 years, recruited from a cohort study examining risk factors for cardiovascular disease.

MEASUREMENTS:

Frailty, duration of HIV, use of antiretroviral therapy, disease history, food insecurity, physical function, and physical activity were assessed by questionnaire. Dietary intake was assessed using 3-day food records. Blood was drawn for CD4+ cell count, hemoglobin, hematocrit, and lipid levels. Physical measurements included height, weight, and skinfold thickness.

RESULTS:

The prevalence of frailty was 16% (n=8), 44% were pre-frail (n=22) and 40% were not frail (n=20). The number of reported difficulties with 20 activities of daily living was highest in frail (mean 10.4±3.9 SD), followed by pre-frail (6.5±4.6), and lowest in not frail participants (2.0±2.3). Seven (88%) of the frail PLWH lost weight with an average weight loss of 22.9 pounds; 6 (75%) reported unintentional weight loss, and all 6 of these met the frailty criteria for weight loss of 10 or more pounds. Nine (45%) of the not frail PLWH reported losing weight with an average weight loss of 6.2 pounds; 5 (23%) reported unintentional weight loss of <10 pounds. Frail PLWH were more likely to report being food insecure than not frail PLWH (63% vs. 10%, p=0.02), and tended to have lower energy intake than not frail PLWH.

CONCLUSION:

Research is needed on targeted interventions to improve food security and activities of daily living in PLWH for both the prevention and improvement of frailty.

Below:  Weight loss by frailty status

Full article at:   http://goo.gl/q62j5W

By:   E. SMIT,1 C. WANKE,2 K. DONG,2 A. GROTHEER,2 S. HANSEN,2 S. SKINNER,2 and A.M. TANG2

¹School of Biological and Population Health Sciences, Oregon State University, Corvallis, OR, USA

²Department of Public Health and Community Medicine, Tufts School of Medicine, Boston, MA, USA.

Corresponding author: Ellen Smit; School of Biological and Population Health Sciences, Oregon State University, Milam 135, Corvallis, OR 97331, USA. Phone: +1 (541) 737-3833; Email: ude.etatsnogero@timS.nellE 

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