Abstract
BackgroundWithout high-quality nutritional support, there is a risk that people infected with human immunodeficiency virus (HIV) will replace lost muscle mass with fat mass when initiating antiretroviral therapy (ART). We have shown that lipid-based nutrient supplements (LNS) with whey or soy considerably increases lean mass among Ethiopian people with HIV starting ART. Here, we aim to assess the effects of LNS on insulin function and glucose metabolism.MethodsThis is a secondary analysis of a randomized trial testing the effect of three-month supplementation with LNS containing whey (LNS/whey) or soy (LNS/soy) among people with HIV. LNS/whey and LNS/soy groups were combined and then were compared against the non-supplemented group. The outcomes were change in fasting plasma-glucose (FPG), and 30-min glucose and 120-min glucose after oral glucose tolerance test. We further assessed effect on glycated hemoglobin (HbA1c), fasting insulin, homeostatic model assessment index for beta-cell function (HOMA-B) and insulin resistance (HOMA-IR).ResultsOf the 318 patients enrolled, 268 (84.3%) had available FPG and HbA1c and included. After 3 months of ART, HbA1c tended to be 2 mmol/mol higher in the LNS supplemented group, most pronounced among those receiving whey as the protein source. LNS led to higher 30-min glucose (0.5 mmol/L, 95% CI 0.2, 0.8) and 120-min glucose (0.4 mmol/L, 95% CI 0.03, 0.8) and a > 50% increase in fasting insulin, HOMA-B and HOMA-IR compared to the non-supplemented.ConclusionAmong Ethiopian people with HIV initiating ART, short-term LNS intake increased glucose and insulin levels, and tended to increase HbA1c, potentially leading to more insulin resistance. Higher intake of carbohydrates with LNS could influence glycemic status. Whether these metabolic changes in early HIV treatment are beneficial or increase long-term risk of metabolic disorders needs to be explored.
Highlights
The human immunodeficiency virus (HIV) pandemic has widely affected Africa in the past 30 years, the care of HIV in Sub Saharan Africa has improved with the wide provision of antiretroviral therapy (ART) [1] and integration of HIV programs in the health care systems [2].The prevalence of metabolic syndrome and noncommunicable diseases (NCDs) is increasing in developing countries [3,4,5,6], and not least among adults with HIV [6]
Among adult Ethiopian with HIV starting ART, we found that concomitant lipid-based nutrient supplements (LNS) supplementation during the first 3 months of ART led to increase in Glycated hemoglobin (HbA1c), 30-min glucose, 120-min glucose, and fasting insulin compared to ART without supplementation
We studied the effect of 3 months concomitant LNS and ART intake on glucose and insulin metabolism and found that LNS led to more insulin resistance, higher glucose and HbA1c, which potentially could lead to metabolic disorders
Summary
The prevalence of metabolic syndrome and noncommunicable diseases (NCDs) is increasing in developing countries [3,4,5,6], and not least among adults with HIV [6]. Childhood under-nutrition leads to increased fat mass at the expense of lean mass and may increase the risk of NCDs [8]. In Ethiopia, the prevalence of obesity and smoking is low and malnutrition is high among the general population [10], but there is little knowledge of the nutritional impact on risk of diabetes among people with HIV. Without high-quality nutritional support, there is a risk that people infected with human immunodeficiency virus (HIV) will replace lost muscle mass with fat mass when initiating antiretroviral therapy (ART). We aim to assess the effects of LNS on insulin function and glucose metabolism
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