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AIDS and Behavior

, Volume 22, Issue 6, pp 1972–1986 | Cite as

Body Mass Index and Waist Circumference in Patients with HIV in South Africa and Associated Socio-demographic, Health Related and Psychosocial Factors

  • Diana Huis in ’t Veld
  • Supa Pengpid
  • Robert Colebunders
  • Karl Peltzer
Original Paper

Abstract

A high body mass index (BMI) and high waist circumference are important health risk factors predisposing for cardiovascular and metabolic diseases and certain cancers. Historically, underweight was a diagnostic criterion of HIV-infection. In a cross-sectional study the prevalence of BMI-categories and high waist circumference and its associated factors in patients visiting three outpatient HIV clinics in South Africa were measured with anthropometric measurements and structured questionnaires regarding socio-demographic information, quality of life (QoL), AIDS-related stigma, symptoms of depression, alcohol use, HIV related information and level of adherence to ART. The median age of the 2230 included patients was 37 years, 66.5% were women and 88.6% received antiretroviral therapy. The prevalences of overweight, obesity and high waist circumference were 29.2, 21.9 and 44.6% respectively in women and 12.4, 4.0 and 3.9% respectively in men. Underweight was found in 18.2% of men and 6.3% of women. In multinomial regression analysis compared to a normal BMI, both overweight and obesity were associated with female gender, with being married or cohabiting and with a higher QoL score. Underweight was associated with male gender and tobacco use and negatively associated with being married or cohabiting and the physical domain of the QoL measure. A high waist circumference in men was associated with higher age and negatively associated with tobacco use and stigma score. In women it was negatively associated with never being married. A high prevalence of overweight and obesity was observed in HIV-clinics in South Africa, mainly in women. Since overweight and obesity are important health risk factors, effective weight reduction interventions are desirable.

Keywords

HIV BMI South Africa Psychosocial socio-demographic health related factors 

Notes

Funding

This study was funded by ABMRF, the Foundation for Alcohol Research and the Directorate Generale for Development Cooperation through the Flemish Interuniversity Council (VLIR-UOS).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    World Health Organization. Global health risks. Mortality and burden of disease attributable to selected major risks. 2009. ISBN 978 92 4 156387.Google Scholar
  2. 2.
    World Health Organization. Obesity and overweight. Fact sheet No 311. http://www.who.int/mediacentre/factsheets/fs311/en/index.html Accessed 16 Jan 2017.
  3. 3.
    World Health Organisation. Global Health Observatory data repository. Overweight/obesity by country. http://apps.who.int/gho/data/node.main.A896?lang=en, Accessed 16 Jan 2017.
  4. 4.
    Dahjio Y, Noubiap JJ, Azabji-Kenfack M, et al. Impact of a 12-week aerobic exercise training program on anthropometric and metabolic parameters in a group of type 2 diabetes Cameroonian women aged ≥50 years. Ann Transl Med. 2016;4(19):364.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Steenkamp L, Goosen A, Venter D, Beeforth M. Food insecurity among students living with HIV: strengthening safety nets at the Nelson Mandela Metropolitan University, South Africa. SAHARA J. 2016;13(1):106–12.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    McCormick CL, Francis AM, Iliffe K, et al. Increasing obesity in treated female HIV patients from Sub-Saharan Africa: potential causes and possible targets for intervention. Front Immunol. 2014;5:507.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Clark AE, Taylor JY, Wu CY, Smith JA. Alternative methods for measuring obesity in African American Women. Yale J Biol Med. 2013;86(1):29–39.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Kim DJ, Westfall AO, Chamot E, et al. Multimorbidity patterns in HIV-infected patients: the role of obesity in chronic disease clustering. J Acquir Immune Defic Syndr. 2012;61(5):600–5.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Haslam DW, James WP. Obesity. Lancet. 2005;366(9492):1197–209.CrossRefPubMedGoogle Scholar
  10. 10.
    Muhammad S, Sani MU, Okeahialam BN. Cardiovascular disease risk factors among HIV-infected Nigerians receiving highly active antiretroviral therapy. Niger Med J. 2013;54(3):185–90.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Hall V, Thormsen RW, Henriksen O, Lohse N. Diabetes in Sub Saharan Africa 1999-2011: epidemiology and public health implications. A systematic review. BMC Public Health. 2011;11:564.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Alberti KG, Zimmet P, Shaw J, for the IDF Epidemiology Task Force Consensus Group. The metabolic syndrome- a new worldwide definition. Lancet. 2005;366(9491):1059–62.CrossRefPubMedGoogle Scholar
  13. 13.
    Zhu S, Heymsfield SB, Toyoshima H, Wang Z, Pietrobelli A, Heshka S. Race-Ethnicity-specific waist circumference cutoffs for identifying cardiovascular disease risk factors. Am J Clin Nutr. 2005;81(2):409–15.CrossRefPubMedGoogle Scholar
  14. 14.
    Wang Y, Rimm EB, Stampfer MJ, Willett WC, Hu FB. Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men. Am J Clin Nutr. 2005;81(3):555–63.CrossRefPubMedGoogle Scholar
  15. 15.
    Goh LG, Dhaliwal SS, Welborn TA, Lee AH, Della PR. Anthropometric measurements of general and central obesity and the prediction of cardiovascular disease risk in women: a cross-sectional study. BMJ Open. 2014;4(2):e004138.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Huis in’t Veld D, Skaal L, Peltzer K, Colebunders R, Ndimande JV, Pengpid S. The efficacy of a brief intervention to reduce alcohol misuse in patients with HIV in South Africa: study protocol for a randomized controlled trial. Trials. 2012;13:190.CrossRefGoogle Scholar
  17. 17.
    Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. The Alcohol Use Disorders Identification Test Guidelines for Use in Primary Care. 2nd ed., WHO/MSD/MSB/01.6aGeneva: World Health Organization, Department of Mental Health and Substance Dependence; 2001.Google Scholar
  18. 18.
    Chan JM, Rimm EB, Colditz GA, Stampfer MJ, Willett WC. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care. 1994;17(9):961–9.CrossRefPubMedGoogle Scholar
  19. 19.
    WHOQOLHIV group. WHOQOL-HIV for quality of life assessment among people living with HIV and AIDS: results from the field test. AIDS Care. 2004;16(7):882–9.CrossRefGoogle Scholar
  20. 20.
    World Health Organization (WHO). WHOQOLHIV instruments user’s manual: scoring and coding for the WHOQOL-HIV instruments. Geneva 2002. http://www.who.int/mental_health/media/en/613.pdf.
  21. 21.
    Peltzer K, Friend-du Preez N, Ramlagan S, Anderson J. Antiretroviral treatment adherence among HIV patients in KwaZulu-Natal, South Africa. BMC Public Health. 2010;10:111.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Kalichman SC, Simbayi LC, Cloete A, Mthembuc PP, Mkhonta RN, Ginindza T. Measuring AIDS stigmas in people living with HIV/AIDS: the internalized AIDS-related stigma scale. AIDS Care. 2009;21(1):87–93.CrossRefPubMedGoogle Scholar
  23. 23.
    Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med. 1994;10(2):77–84.CrossRefPubMedGoogle Scholar
  24. 24.
    Zhang W, O’Brien N, Forrest JI, et al. Validating a shortened depression scale (10 item CES-D) among HIV-positive people in British Columbia, Canada. PLoS ONE. 2012;7(7):e40793.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Myer L, Smit J, Le Roux L, Parker S, Stein DJ, Seedat S. Common mental disorders among HIV-infected individuals in South Africa: prevalence, predictors and validation of brief psychiatric rating scales. AIDS Patient Care STDS. 2008;22(2):147–58.CrossRefPubMedGoogle Scholar
  26. 26.
    Mannheimer S, Thackeray L, Huppler Hullsiek K, et al. Community program for clinical research on AIDS. A randomized comparison of two instruments for measuring self-reported antiretroviral adherence. AIDS Care. 2008;20:161–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Maneesriwongul WL, Tulathong S, Fennie KP, Williams AB. Adherence to antiretroviral medication among HIV-positive patients in Thailand. J Acquir Immune Defic Syndr. 2006;43(Suppl. 1):S119–22.CrossRefPubMedGoogle Scholar
  28. 28.
    Sarna A, Luchters S, Geibel S, et al. Promoting Adherence through a directly administered antiretroviral therapy (DAART) strategy in Mombasa, Kenya. Horizons research update. Nairobi: Population Council; 2005.Google Scholar
  29. 29.
    Nunnally JC. Psychometric Theory. 2nd ed. New York: McGraw-Hill; 1978.Google Scholar
  30. 30.
    Amorosa V, Synnestvedt M, Gross R, et al. A tale of 2 epidemics: the intersection between obesity and HIV infection in Philadelphia. J Acquir Immune Defic Syndr. 2005;39(5):557–61.PubMedGoogle Scholar
  31. 31.
    Hamill MM, Ward KA, Pettifor JM, Norris SA, Prentice A. Bone mass, body composition and vitamin D status of ARV-naïve, urban, black South African women with HIV infection, stratified by CD4 count. Osteoporos Int. 2013;24(11):2855–61.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Sudfeld CR, Isanaka S, Mugusi FM, et al. Weight change at 1 mo of antiretroviral therapy and its association with subsequent mortality, morbidity and CD4 T cell reconstitution in a Tanzanian HIV-infected adult cohort. Am J Clin Nutr. 2013;97:1278–87.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Ogunmola OJ, Oladosu OY, Olamoyegun AM. Association of hypertension and obesity with HIV and antiretroviral therapy in a rural tertiary health center in Nigeria: a cross-sectional cohort study. Vasc Health Risk Manag. 2014;10:129–37.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Tesfaye DY, Kinde S, Medhin G, et al. Burden of metabolic syndrome among HIV-infected patients in Southern Ethiopia. Diabetes Metab Syndr. 2014;8(2):102–7.CrossRefPubMedGoogle Scholar
  35. 35.
    Mangili A, Polak JF, Skinner SC, et al. HIV infection and progression of carotid and coronary atherosclerosis: the CARE study. J Acquir Immune Defic Syndr. 2011;58(2):148–53.CrossRefPubMedGoogle Scholar
  36. 36.
    Micklesfield LK, Lambert EV, Hume DJ, et al. Socio-cultural, environmental and behavioural determinants of obesity in black South African women. Cardiovasc J Afr. 2013;24(9–10):369–75.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Govender L, Pillay K, Siwela M, Modi A, Mabhaudhi T. Food and nutrition insecurity in selected rural communities of KwaZulu-Natal, South Africa-Linking human nutrition and agriculture. Int J Environ Res Public Health. 2016;14(1):17. doi: 10.3390/ijerph14010017.CrossRefPubMedCentralGoogle Scholar
  38. 38.
    Puoane T, Fourie JM, Shapiro M, Rosling L, Tshaka NC, Oelefse A. ‘Big is beautiful’—an exploration with urban black community health workers in a South African township. S Afr J Clin Nutr. 2005;18(1):6–15.CrossRefGoogle Scholar
  39. 39.
    Averett SL, Stacey N, Wang Y. Decomposing race and gender differences in underweight and obesity in South Africa. Econ Hum Biol. 2014;15:23–40.CrossRefPubMedGoogle Scholar
  40. 40.
    Clausen T, Charlton KE, Holmboe-Ottesen G. Nutritional status, tobacco use and alcohol consumption of older persons in Botswana. J Nutr Health Aging. 2006;10(2):104–10.PubMedGoogle Scholar
  41. 41.
    Bjorntorp P. Visceral obesity: a “civilization syndrome”. Obes Res. 1993;1(3):206–22.CrossRefPubMedGoogle Scholar
  42. 42.
    Shuster A, Patlas M, Pinthus JH, Mourtzakis M. The clinical importance of visceral adiposity: a critical review of methods for visceral adipose tissue analysis. Br J Radiol. 1009;2012(85):1.Google Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Department of Epidemiology and Social MedicineUniversity of AntwerpAntwerpBelgium
  2. 2.FWO Research Foundation FlandersBrusselsBelgium
  3. 3.Department of Clinical SciencesInstitute of Tropical MedicineAntwerpBelgium
  4. 4.ASEAN Institute for Health DevelopmentMahidol UniversityNakhonpathomThailand
  5. 5.Department of Research and InnovationUniversity of LimpopoSovengaSouth Africa
  6. 6.HIV/AIDS, STIs & TB (HAST) Research ProgrammeHuman Sciences Research CouncilPretoriaSouth Africa
  7. 7.Department of PsychologyUniversity of LimpopoSovengaSouth Africa
  8. 8.Algemeen inwendige geneeskundeGhentBelgium

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