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. 2007 Jul;86(1):100-6.
doi: 10.1093/ajcn/86.1.100.

Independent associations of insulin resistance with high whole-body intermuscular and low leg subcutaneous adipose tissue distribution in obese HIV-infected women

Jeanine B Albu  1 , Sonjia Kenya, Qing He, Marsha Wainwright, Evan S Berk, Stanley Heshka, Donald P Kotler, Ellen S Engelson
Affiliations

Independent associations of insulin resistance with high whole-body intermuscular and low leg subcutaneous adipose tissue distribution in obese HIV-infected women

Jeanine B Albu et al. Am J Clin Nutr. 2007 Jul.

Abstract

Background: Obesity and insulin resistance are growing problems in HIV-positive (HIV+) women receiving highly active antiretroviral therapy (HAART).

Objective: The objective was to determine the contribution of adipose tissue (AT) enlargement and distribution to the presence of insulin resistance in obese HIV+ women.

Design: Whole-body intermuscular AT (IMAT), visceral AT (VAT), subcutaneous AT (SAT), and SAT distribution (leg versus upper body) were measured by whole-body magnetic resonance imaging. Insulin sensitivity (S(I)) was measured with an intravenous glucose tolerance test in obese HIV+ women recruited because of their desire to lose weight (n=17) and in obese healthy controls (n=32).

Results: The HIV+ women had relatively less whole-body SAT and more VAT and IMAT than did the controls (P<0.05 for all). A significant interaction by HIV status was observed for the relation of total SAT with S(I) (P<0.001 for the regression's slope interactions after adjustment for age, height, and weight). However, relations of IMAT, VAT, and SAT distribution (leg SAT as a percentage of total SAT; leg SAT%) with S(I) did not differ significantly between groups. For both groups combined, the best model predicting a low S(I) included significant contributions by both high IMAT and low leg SAT%, independent of age, height, and weight, and no interaction between groups was observed (overall r(2)=0.44, P=0.0003).

Conclusion: In obese HIV+ women, high whole-body IMAT and low leg SAT% distribution are independently associated with insulin resistance.

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Figures

FIGURE 1
FIGURE 1
Relation between residual insulin sensitivity (SI) and total subcutaneous adipose tissue (SAT) in HIV-positive (HIV+; △) and control (●) women. SI values were log transformed for normality. Residual SI is the difference between the observed and the expected values of SI, calculated through multiple regression as a function of age, height, and weight. SAT was measured by whole-body magnetic resonance imaging. P < 0.001 for interaction of slopes by HIV status. r = 0.64 (P = 0.006) for HIV+ women and r = −0.22 (P = 0.2) for control women.
FIGURE 2
FIGURE 2
Relation between residual insulin sensitivity (SI) and visceral adipose tissue (VAT) in HIV-positive (HIV+; △) and control (●) women. SI values were log transformed for normality. Residual SI is the difference between the observed and the expected values of SI, calculated through multiple regression as a function of age, height, and weight. VAT was measured by whole-body magnetic resonance imaging. P = 0.54 for interaction of slopes by HIV status.
FIGURE 3
FIGURE 3
Relation between residual insulin sensitivity (SI) and inter-muscular adipose tissue (IMAT) in HIV-positive (HIV+; △) and control (●) women. SI values were log transformed for normality. Residual SI is the difference between the observed and the expected values of SI, calculated through multiple regression as a function of age, height, and weight. IMAT was measured by whole-body magnetic resonance imaging. P = 0.25 for interaction of slopes by HIV status.
FIGURE 4
FIGURE 4
Relation between residual insulin sensitivity (SI) and sub-cutaneous adipose tissue (SAT) as a percentage of total SAT (leg SAT%) in HIV-positive (HIV+; △) and control (●) women. SI values were log transformed for normality. Residual SI is the difference between the observed and the expected values of SI, calculated through multiple regression as a function of age, height, and weight. Leg SAT (inferior to the greater trochanter) was measured by whole-body magnetic resonance imaging. P = .22 for interaction of slopes by HIV status.
FIGURE 5
FIGURE 5
Relation between residual insulin sensitivity (SI) and the ratio of visceral to subcutaneous adipose tissue (VAT:SAT) in HIV-positive (HIV+; △) and control (●) women. SI values were log transformed for normality. Residual SI is the difference between the observed and the expected values of SI, calculated through multiple regression as a function of age, height, and weight. VAT:SAT was measured by whole-body magnetic resonance imaging. P = 0.08 for interaction of slopes by HIV status.
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