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Waist-to-Hip Ratio Predicts Hepatic Steatosis in People With HIV
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HIV Drug Therapy, Glasgow 2018, October 28-31, 2018, Glasgow
Mark Mascolini
Waist-to-hip ratio proved a better predictor of hepatic steatosis than waist circumference alone in a London study of 338 people with HIV [1]. King's College London researchers urged colleagues to use this easily calculated ratio whenever possible to estimate steatosis risk.
Hepatic steatosis--liver fat buildup--remains highly prevalent in HIV populations and poses a threat of further liver damage and metabolic problems. Although Fibroscan and ultrasound can detect steatosis, those tests can be time-consuming and are not readily available in resource-poor areas. London collaborators hypothesized that easily made body measurements can predict steatosis in people with HIV.
Researchers selected an HIV study group to represent the demographics of three South London clinics. They used nonstretch tape to measures waist and hip circumference and calculated waist-to-hip ratio. They used standard criteria to define central obesity:
1. Waist size above 90 cm for male South/East Asians and Central/South Americans
2. Waist size above 94 cm for all other males
3. Waist size above 80 cm for women
4. Waist-to-hip ratio above 0.9 for men
5. Waist-to-hip ratio above 0.85 for women
The London collaborators diagnosed hepatic steatosis by Fibroscan or liver biopsy. They used univariate and binary logistic regression to identify factors contributing to steatosis risk. Receiver operator characteristic (ROC) curves estimated sensitivity and specificity of waist circumference and waist-to-hip ratio to identify steatosis. (Sensitivity is the ability of a test to single out people who have a certain condition. Specificity is the ability of that test to classify people who do not have that condition as negative.)
Among the 338 people studied, 71 (21%) had hepatic steatosis. Older age, higher body mass index, and abnormal glucose levels were all significantly associated with hepatic steatosis (P < 0.05 for all). ROC curve analysis confirmed that both waist-to-hip ratio and waist circumference were significantly associated with steatosis, though the association was stronger for waist-to-hip ratio (area under the curve 0.788, 95% confidence interval 0.722 to 0.855, P < 0.001) than for waist circumference (area under the curve 0.738, 95% confidence interval 0.662 to 0.813, P < 0.001).
A waist-to-hip ratio above 1.0 for men and 0.95 for women identified steatosis with a sensitivity of 0.761 and a specificity of 0.723. Sensitivity and specificity for waist circumference were 0.800 and 0.526 (for circumference above 105 cm for Asian and Central/South American men, above 101 cm for European and African men, and above 91 cm for women).
The researchers concluded that both waist-to-hip ratio and waist circumference "can effectively predict hepatic steatosis in people with HIV and may identify individuals suitable for further investigation." But waist-to-hip ratio is a better predictor. The London team reminded colleagues that these measurements "are non-invasive and can be done by any healthcare professional using standardised criteria."
Reference
1. Mok J, Goff L, Peters B, Duncan A. Waist-to-hip ratio is a predictive marker of hepatic steatosis in people living with HIV. HIV Drug Therapy, Glasgow 2018, October 28-31, 2018, Glasgow. Abstract P190.
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