Research Article: Metabolic syndrome and population attributable risk among HIV/AIDS patients: comparison between NCEP-ATPIII, IDF and AHA/NHLBI definitions

Date Published: October 4, 2012

Publisher: BioMed Central

Author(s): Paulo R Alencastro, Fernando H Wolff, Renato R Oliveira, Maria Letícia R Ikeda, Nêmora T Barcellos, Ajácio B M Brandão, Sandra C Fuchs.

http://doi.org/10.1186/1742-6405-9-29

Abstract

Metabolic Syndrome (MetS) is based on the same individual components, but has received several amendments to the original definition. In this study, we verified the prevalence of metabolic syndrome according to different criteria, and the impact of each component on the diagnostic.

This cross-sectional study enrolled HIV infected patients from a HIV/AIDS reference Center in southern Brazil. Metabolic syndrome was identified according to the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP-ATPIII), the International Diabetes Federation (IDF) and the American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI) criteria, and using a standardized questionnaire and blood testing.

A sample of 1240, out of 1295, HIV-infected patients was enrolled. Males were on average older, more educated, and had shorter time since the HIV diagnosis. The population attributable risk (PAR) for waist circumference explained 80% of the prevalence among men and women (AHA/NHLBI criteria). Triglycerides had the highest impact on prevalence of metabolic syndrome according to all criteria, independently of age, skin color and HAART use, among men.

In this large sample of HIV infected patients, the overall prevalence of metabolic syndrome, under either classification, was noticeable and the AHA/NHLBI definition accounted for the highest prevalence.

Partial Text

Metabolic syndrome (MetS) comprises a set of aggregated risk factors including hypertension, central obesity, abnormal fasting glucose, and dyslipidemia which increase the risk of cardiovascular disease [1-4] and type 2 diabetes mellitus [1-4]. Since the third report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP-ATPIII) several amendments have been incorporated in a working definition of MetS [5,6]. The International Diabetes Federation (IDF) criteria are based on the same components, but adopted racial/ethnic cutoffs for waist circumference. It have included waist circumference (WC) as a prerequisite for MetS and the treatment for previous conditions as additional criteria of abnormality [4,7].

This cross-sectional study enrolled HIV infected patients, aged 18 to 79 years, from a public health Center for AIDS Care and Treatment in Porto Alegre, southern Brazil. This hospital is one of three reference centers, which provide HIV treatment for patients living in the metropolitan area, other cities of the state or even from other states. A systematic consecutive sample of outpatients, attending to the center at the time of data collection, with confirmed HIV infection, was eligible. Those with mental retardation, restriction of freedom or pregnant women were excluded. The study was approved by the institutional review board of the Hospital de Clínicas de Porto Alegre- Comissão de Ética em Pesquisa, GPPG: 06-243, which is accredited by the Office of Human Research Protections. All participants signed a consent form.

A sample of 1240, out of 1295, HIV-infected patients was enrolled, 15 refused to participate and 40 fulfilled the exclusion criteria. Table 1 shows that participants were aged 38.6 ±10.1 years and mostly were whites. Males were on average older, completed more years at school, and the length of time since the HIV diagnosis was longer than for women. The use of protease inhibitors, on the other side, was more frequent among women.

In this large sample of HIV infected patients, the overall prevalence of metabolic syndrome, under either classification, was noticeable. The AHA/NHLBI definition accounted for higher prevalence of MetS than those observed in the NCEP-ATPIII and IDF, which is in accordance with lower cutoff and lacking of the obligatory abnormal waist circumference. The overall prevalence of most MetS components differed considerably among men and women, but the overall prevalence did not vary by sex. Even though the three definitions of MetS were based on the same components, the cutoffs for waist circumference differ markedly on NCEP-ATPIII and IDF, as well as the hierarchy of the central obesity.

In conclusion, the increasing number of antiretroviral agents, longer duration of HAART use, and ageing of the HIV population, might contribute to the growing prevalence of metabolic syndrome and to reduce the life expectancy of HIV-infected patients. This approach of measuring the impact of MetS components on PAR might be useful for comparing the effect of interventions targeting reduction of metabolic syndrome prevalence among HIV-infected populations.

MetS: Metabolic syndrome; PAR: Population attributable risk; NCEP-ATPIII: National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults; IDF: International Diabetes Federation; AHA/NHLBI: American Heart Association/National Heart, Lung and Blood Institute; WC: Waist circumference.

The authors declare that they have no conflict of interest.

All authors design the study. PA, RO, and MLI collected and analyzed the data. PA, FHW, AB, and NB wrote the manuscript. SF analyzed the data, made substantial contribution to the discussion, and reviewed the final version of the manuscript. All authors read and approved the final manuscript.

 

Source:

http://doi.org/10.1186/1742-6405-9-29

 

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