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Lipodystrophy and Inflammation Predict Grip Strength in HIV-Infected Men: the MACS Body Composition Sub-study
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Reported by Jules Levin
18th Intl AIDS Conference July 18-23 2010 Vienna Austria
KW Crawford1,X Li1 , X Xu1,A Abraham1, AS Dobs1, J Margolick1, FJ Palella2, LA Kingsley3, MD Witt4, TT Brown1
1 Johns Hopkins University, Baltimore MD; 2 Northwestern University, Chicago, IL; 3 University of Pittsburgh, Pittsburgh, PA; 4 University of Los Angeles, CA, USA
Background
Grip strength, a sensitive indicator of physical function, is associated with increased mortality in the general geriatric population, and declines with lower lean body mass (LBM), increased systemic inflammation, and increased central fat distribution.
However, the relationship between inflammation, regional adiposity, and grip strength in HIV-infected populations has not been studied to date.
We used data from the MACS Body Composition substudy to determine whether lipodystrophy status, changes in regional adiposity, and markers of systemic inflammation assessed in 2001-2002 were associated with lower grip strength in 2007.
Methods
RESULTS
Table 1. Comparison of demographic characteristics and anthropometric measurements across study subjects.
-- Mean BMI and extremity fat were lowest in LIPO+ mean, highest in the HIV- men, and intermediate in the LIPO- men
-- Mean lean mass followed the same pattern as BMI, but the differences were not statistically significant
-- VAT was similar among groups, especially between the LIPO+ and HIV- groups, despite markedly different BMI
-- Nadir and Current CD4 cell count was lower and the proportion of HAART-treated men was higher in the LIPO+ vs LIPO-
from Jules: notice visceral fat (VAT) is higher in HIV+LIPO+
Table 2. Markers of Inflammation in 2001-2002
-- sTNFαRII concentrations were higher in HIV+ men (combined) vs HIV- men, but other markers were similar
-- LIPO+ men had higher markers of inflammation compared to LIPO-
Fig.1. Grip Strength in 2007
-- LIPO+ had a lower median grip strength than LIPO- (35 vs. 41 kg, p=0.001)
-- HIV- men had a median grip strength which is intermediate between LIPO+ and LIPO- men
Table 3. Determinants of Grip Strength among HIV-infected men (Coefficients represent difference in grip strength (kg) per unit change in covariate)
Age and lower lean mass in 2002 associated with lower grip strength in 2007
Higher TNFαR II strongly associated with subsequent lower grip strength, independent of age and body composition; and not influenced by the degree of virologic suppression
LIPO+ had a lower grip strength than LIPO-, equivalent to ~ 10-20 years of age
The effect of mixed lipodystrophy on grip strength was only partially explained by increased VAT and decreased extremity fat
Nadir CD4 cell count, use of HAART, VL < 400 copies/mL were not associated with subsequent grip strength (p>0.05, data not shown)
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