Prevalence and risk factors for obesity among elderly patients living with HIV/AIDS in a low-resource setting

Abstract

Obesity is associated with detrimental changes in cardiovascular and metabolic parameters, including blood pressure, dyslipidemia, markers of systemic inflammation, and insulin resistance. In the elderly living with the human immunodeficiency virus (EPLHIV), and being treated with antiretroviral medications, the obesity complications escalate and expose the elderly to the risk of noncommunicable diseases. Given that over 3 million EPLHIV in sub-Sahara Africa, we assessed the prevalence of obesity and its associated factors among EPLHIV in a low-resource setting. This was a cross sectional study of EPLHIV aged 50 years and older, being treated with antiretroviral medications from 2004 to 2018. HIV treatment data collected from multiple treatment sites were analyzed. Baseline characteristics of the participants were described, and multivariable relative risk model was applied to assess the associations between obesity (body mass index [BMI] ≥30 kg/m 2 ) and the prespecified potential risk factors. Of the 134,652 in HIV cohort, 19,566 (14.5%) were EPLHIV: 12,967 (66.3%) were normal weight (18.5 ≤ BMI < 25), 4548 (23.2%) were overweight (25 ≤ BMI < 30), while 2,051 (10.5%) were obese (BMI ≥30). The average age the normal weight (57.1; standard deviation 6.6) and the obese (56.5; standard deviation 5.5) was similar. We observed that being an employed (relative risk [RR] 1.71; 95% confidence interval [CI] 1.48–2.00; P < .001), educated (RR 1.93; 95% CI 1.54–2.41; P < .001), and presence of hypertension (RR 1.78; 95% CI 1.44–2.20; P < .001), increased the risk of obesity. Also, being male (RR 0.38; 95% CI 0.33–0.44; P < .001), stages III/IV of the World Health Organization clinical stages of HIV (RR 0.58; 95% CI 0.50–0.68; P < .001), tenofovir-based regimen (RR 0.84; 95% CI 0.73–0.96, P < .001), and low CD 4 count (RR 0.56; 95% CI 0.44–0.71; P < .001) were inversely associated with obesity. This study demonstrates that multiple factors are driving obesity prevalence in EPLHIV. The study provides vital information for policy-makers and HIV program implementers in implementing targeted-interventions to address obesity in EPLHIV. Its findings would assist in the implementation of a one-stop-shop model for the management of HIV and other comorbid medical conditions in EPLHIV.

Bariatric Surgery and Vitamin D: Trends in Older Women and Association with Clinical Features and VDR Gene Polymorphisms

“…For some researchers, obesity is characterized as a systemic inflammatory disorder [ 10 ], complex and multifactorial [ 8 , 10 ], highly prevalent [ 7 , 8 , 10 ], and correlated with several chronic and cardiovascular diseases [ 8 , 9 , 10 , 11 ]. Physical inactivity [ 11 , 12 ], adipose tissue accumulation [ 11 , 12 , 13 ], consequences related to dietary factors [ 13 , 14 , 15 ], psychosocial aspects [ 13 , 14 , 15 ], genetic susceptibility [ 16 , 17 ], and obesogenic coefficients [ 18 ] are some of the phenomena related to obesity that negatively impact both health [ 13 , 14 , 15 , 19 ] and quality of life [ 14 , 16 ].…”

“…For other researchers, obesity and its comorbidities can cause complex commitments and limitations in older adults [ 12 , 15 ] regarding their life and existence, for example, in work performance [ 8 , 12 , 18 ], financial and economic activities, and participatory citizenship in society [ 12 , 18 ]. Among the various diseases and comorbidities related to obesity, we can mention arterial hypertension [ 11 , 20 ], coronary artery disease [ 20 ], diabetes mellitus [ 11 , 20 ], dyslipidemia [ 8 , 11 ], obstructive sleep apnea syndrome [ 8 , 11 ], steatohepatitis [ 18 ], various types of cancer [ 11 , 20 ], and the deterioration of lower limb torque [ 21 ], in addition to an increased risk of death on account of the comorbidities mentioned above [ 20 , 22 , 23 ].…”

Bariatric Surgery and Vitamin D: Trends in Older Women and Association with Clinical Features and <em>VDR </em>Gene Polymorphisms.

“…For some researchers, obesity is characterized as a systemic inflammatory disorder [9], complex and multifactorial [7,9], highly prevalent [6,7,9], and correlated with several chronic and cardiovascular diseases [7][8][9][10]. Physical inactivity [10,11], adipose tissue accumulation [10][11][12], consequences related to dietary factors [12][13][14], psychosocial aspects [12][13][14], genetic susceptibility [15,16], and obesogenic coefficients [17] are some of the phenomena related to obesity that negatively impact health [12][13][14]18]and quality of life [13,15].…”

“…For other researchers, obesity and its comorbidities can cause complex commitments and limitations in older adults [11,14]regarding their life and existence, for example, in work performance [7,11,17], financial and economic activities, and participatory citizenship in society [11,17]. Among the various diseases and comorbidities related to obesity, we can mention arterial hypertension [10,19], coronary artery disease [19], diabetes mellitus [10,19] dyslipidemia [7,10], obstructive sleep apnea syndrome [7,10], steatohepatitis [17], various types of cancer [10,19], deterioration of lower limb torque [20], in addition to an increased risk of death on account of the comorbidities mentioned above [19,21,22].…”

“…In contrast, several BS-related complications have been documented, such as malnutrition, chronic nausea and vomiting, acid reflux, inability to eat certain foods, and esophageal dilation [10,11]. Among these, malnourishment significantly threatens the health of patients subjected to bariatric surgery [12,18], as even purely restrictive surgeries can render about a 20-50% insufficiency of micronutrients [18].…”