Effects of a lifestyle modification program in HIV-infected patients with the metabolic syndrome.
OBJECTIVE
A large percentage of HIV-infected patients receiving HAART develop the metabolic syndrome. In this study, we sought to determine whether lifestyle modification improves metabolic syndrome criteria, including waist circumference, blood pressure, fasting blood sugar, triglycerides, and HDL-cholesterol among HIV-infected patients with the metabolic syndrome.


METHODS
We conducted a randomized, 6-month study in HIV-infected patients with metabolic syndrome as defined by the National Cholesterol Education Program. Subjects were randomly assigned to an intensive lifestyle modification program, which included weekly one-on-one counseling sessions with a registered dietician, or observation (control group).


METHODS
Metabolic syndrome criteria and cardiovascular parameters, including blood pressure, body composition, submaximal stress testing, lipids and other biochemical parameters were determined.


RESULTS
Thirty-four patients were randomly assigned and 28 subjects completed the study. Compared with the control group, subjects randomly assigned to the lifestyle modification program demonstrated significant decreases in waist circumference (-2.6 +/- 1.1 versus 1.2 +/- 1.0 cm, P = 0.022), systolic blood pressure (-13 +/- 4 versus 4 +/- 4 mmHg, P = 0.008), hemoglobin A1C (-0.1 +/- 0.1 versus 0.2 +/- 0.1%, P = 0.017), lipodystrophy score (-1.2 +/- 0.3 versus 0.9 +/- 0.6, P = 0.006) and increased activity (17.7 +/- 14.3 versus -33.1 +/- 12.7 metabolic equivalents, P = 0.014) as measured by the Modifiable Activity Questionnaire, but lipid levels did not improve.


CONCLUSIONS
These data demonstrate that intensive lifestyle modification significantly improved important cardiovascular risk indices in HIV-infected patients with the metabolic syndrome. Lifestyle modification may be a useful strategy to decrease cardiovascular risk in this population.
Fitch
Kathleen V
KV
Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, MA 02114, USA.
Anderson
Ellen J
EJ
Hubbard
Jane L
JL
Carpenter
Sara J
SJ
Waddell
William R
WR
Caliendo
Angela M
AM
Grinspoon
Steven K
SK
D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure / Q000502:physiology; D049628:Body Size; D008076:Cholesterol, HDL / Q000097:blood; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D015658:HIV Infections / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D008019:Life Style; D008060:Lipodystrophy / Q000378:metabolism; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
D001786:Blood Glucose; D008076:Cholesterol, HDL; D006442:Glycated Hemoglobin; D014280:Triglycerides