title: Circulating fibroblast growth factor 23 (FGF23) levels are associated with metabolic disturbances and fat distribution but not cardiovascular risk in HIV-infected patients.
abstract: OBJECTIVE
  Dyslipidaemia, insulin resistance, metabolic syndrome and HIV/HAART-associated lipodystrophy syndrome (HALS) are common comorbidities in HIV-1-infected patients, which may increase cardiovascular risk. Fibroblast growth factor 23 (FGF23) is a bone-derived hormone with effects on metabolism and phosphate homeostasis. The aim of this study was to determine the relationship between FGF23 levels, metabolic alterations, fat distribution and cardiovascular risk.
  
  
  METHODS
  This was a cross-sectional study. Serum FGF23 levels were analysed in 152 patients and 34 healthy control individuals. Patients belonged to three groups: HIV-1-infected, antiretroviral-treated patients who have developed HALS (n = 60); HIV-1-infected, antiretroviral-treated patients without HALS (n = 43); and untreated (naive) HIV-1-infected patients (n = 49). Serum FGF23 levels were compared with lipid and glucose homeostasis parameters, fat distribution and cardiovascular risk.
  
  
  RESULTS
  Serum FGF23 levels were increased in HIV-1-infected patients, but the increase was most marked in those with HALS. FGF23 levels showed a strong positive correlation with age, indicators of dyslipidaemia (LDL cholesterol, polyunsaturated fatty acids and monounsaturated fatty acids), HALS parameters (trunk/appendicular fat ratio), insulin resistance (fasting insulin and homeostasis model assessment of insulin resistance) and C-reactive protein. FGF23 levels correlated with cardiovascular risk but correlation was lost after age adjustment.
  
  
  CONCLUSIONS
  FGF23 levels are increased in HIV-1-infected patients, especially in those with HALS, and this increase is associated with dyslipidaemia, insulin resistance, metabolic syndrome, fat distribution and parameters of inflammation. FGF23 is not associated with cardiovascular risk when age is taken into account.
authors.affiliation: Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain pdomingo@santpau.cat pere.domingo@uab.cat.
authors.forename: Pere
authors.initials: P
authors.lastname: Domingo
authors.affiliation: Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Maria Karuna
authors.initials: MK
authors.lastname: Lamarca
authors.affiliation: Departament de Bioquimica i Biologia Molecular and Institut de Biomedicina de la Universitat de Barcelona (IBUB), CIBER Fisiopatología de la Obesidad y Nutrición, Barcelona, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Gallego-Escuredo
authors.affiliation: Biostatistics and Data Management Core Facility, IDIBAPS, Hospital Clinic Barcelona, Barcelona, Spain Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Ferran
authors.initials: F
authors.lastname: Torres
authors.affiliation: Departament de Bioquimica i Biologia Molecular and Institut de Biomedicina de la Universitat de Barcelona (IBUB), CIBER Fisiopatología de la Obesidad y Nutrición, Barcelona, Spain.
authors.forename: Joan C
authors.initials: JC
authors.lastname: Domingo
authors.affiliation: Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain Departament de Bioquimica i Biologia Molecular and Institut de Biomedicina de la Universitat de Barcelona (IBUB), CIBER Fisiopatología de la Obesidad y Nutrición, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Villarroya
authors.affiliation: Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: M Del Mar
authors.initials: Mdel M
authors.lastname: Gutierrez
authors.affiliation: Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: M Gracia
authors.initials: MG
authors.lastname: Mateo
authors.affiliation: Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitari Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Vidal
authors.affiliation: Departament de Bioquimica i Biologia Molecular and Institut de Biomedicina de la Universitat de Barcelona (IBUB), CIBER Fisiopatología de la Obesidad y Nutrición, Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Villarroya
authors.affiliation: Departament de Bioquimica i Biologia Molecular and Institut de Biomedicina de la Universitat de Barcelona (IBUB), CIBER Fisiopatología de la Obesidad y Nutrición, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Giralt
mesh_terms: D000328:Adult; D050218:Body Fat Distribution; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood*; D015658:HIV Infections / Q000150:complications* / Q000473:pathology*; D006801:Humans; D008297:Male; D008659:Metabolic Diseases / Q000453:epidemiology*; D008875:Middle Aged; D018570:Risk Assessment
chemical_list: C000717427:FGF23 protein, human; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23
keywords: FGF23; HALS; MUFA; PUFA; cardiovascular risk; cholesterol; insulin resistance; metabolic syndrome; triglycerides