HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Free Full Text (PDF) Free All Versions of this Article: 95/3/1005    most recent 00366.2003v1 Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (15) Citing Articles via Google Scholar Google Scholar Articles by Torriani, M. Articles by Grinspoon, S. Search for Related Content PubMed PubMed Citation Articles by Torriani, M. Articles by Grinspoon, S.

Psoas muscle attenuation measurement with computed tomography indicates intramuscular fat accumulation in patients with the HIV-lipodystrophy syndrome

¹Division of Musculoskeletal Radiology and ²Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114

Submitted 11 April 2003 ; accepted in final form 22 May 2003

The human immunodeficiency virus (HIV)-lipodystrophy syndrome is characterized by abnormalities of lipid metabolism, glucose homeostasis, and fat distribution. Overaccumulation of intramuscular lipid may contribute to insulin resistance in this population. We examined 63 men: HIV positive with lipodystrophy (n = 22), HIV positive without lipodystrophy (n = 20), and age- and body mass index-matched HIV-negative controls (n = 21). Single-slice computed tomography was used to determine psoas muscle attenuation and visceral fat area. Plasma free fatty acids (FFA), lipid profile, and markers of glucose homeostasis were measured. Muscle attenuation was significantly decreased in subjects with lipodystrophy [median (interquartile range), 55.0 (51.0-58.3)] compared with subjects without lipodystrophy [57.0 (55.0-59.0); P = 0.05] and HIV-negative controls [59.5 (57.3-64.8); P < 0.01]. Among HIV-infected subjects, muscle attenuation correlated significantly with FFA (r = -0.38; P = 0.02), visceral fat (r = -0.49; P = 0.002), glucose (r = -0.38; P = 0.02) and insulin (r = -0.60; P = 0.0001) response to a 75-g oral glucose tolerance test. In forward stepwise regression analysis with psoas attenuation as the dependent variable, visceral fat (P = 0.02) and FFA (P < 0.05), but neither body mass index, subcutaneous fat, nor antiretroviral use, were strong independent predictors of muscle attenuation (r² = 0.39 for model). Muscle attenuation (P = 0.02) and visceral fat (P = 0.02), but not BMI, subcutaneous fat, FFA, or antiretroviral use, were strong independent predictors of insulin response (area under the curve) to glucose challenge (r² = 0.47 for model). These data demonstrate that decreased psoas muscle attenuation due to intramuscular fat accumulation may contribute significantly to hyperinsulinemia and insulin resistance in HIV-lipodystrophy patients. Further studies are needed to assess the mechanisms and consequences of intramuscular lipid accumulation in HIV-infected patients.

insulin resistance; protease inhibitor; acquired immunodeficiency syndrome; human immunodeficiency virus

This article has been cited by other articles:

				J. Fuller A 39-Year-Old Man With HIV-Associated Lipodystrophy JAMA, September 3, 2008; 300(9): 1056 - 1066. [Abstract] [Full Text] [PDF]

				L. A Kosmiski, D. H Bessesen, S. A Stotz, J. R Koeppe, and T. J Horton Short-term overfeeding increases resting energy expenditure in patients with HIV lipodystrophy Am. J. Clinical Nutrition, October 1, 2007; 86(4): 1009 - 1015. [Abstract] [Full Text] [PDF]

				T. Joy and S. K Grinspoon Adipose compartmentalization and insulin resistance among obese HIV-infected women: the role of intermuscular adipose tissue Am. J. Clinical Nutrition, July 1, 2007; 86(1): 5 - 6. [Full Text] [PDF]

				T. M Manini, B. C Clark, M. A Nalls, B. H Goodpaster, L. L Ploutz-Snyder, and T. B Harris Reduced physical activity increases intermuscular adipose tissue in healthy young adults Am. J. Clinical Nutrition, February 1, 2007; 85(2): 377 - 384. [Abstract] [Full Text] [PDF]

				M. Torriani, B. J. Thomas, R. B. Barlow, J. Librizzi, S. Dolan, and S. Grinspoon Increased intramyocellular lipid accumulation in HIV-infected women with fat redistribution J Appl Physiol, February 1, 2006; 100(2): 609 - 614. [Abstract] [Full Text] [PDF]

				C. Hadigan, D. Kamin, J. Liebau, S. Mazza, S. Barrow, M. Torriani, R. Rubin, S. Weise, A. Fischman, and S. Grinspoon Depot-specific regulation of glucose uptake and insulin sensitivity in HIV-lipodystrophy Am J Physiol Endocrinol Metab, February 1, 2006; 290(2): E289 - E298. [Abstract] [Full Text] [PDF]

				M. Torriani and S. Grinspoon Racial differences in fat distribution: the importance of intermuscular fat Am. J. Clinical Nutrition, April 1, 2005; 81(4): 731 - 732. [Full Text] [PDF]

				S. D. Driscoll, G. E. Meininger, K. Ljungquist, C. Hadigan, M. Torriani, A. Klibanski, W. R. Frontera, and S. Grinspoon Differential Effects of Metformin and Exercise on Muscle Adiposity and Metabolic Indices in Human Immunodeficiency Virus-Infected Patients J. Clin. Endocrinol. Metab., May 1, 2004; 89(5): 2171 - 2178. [Abstract] [Full Text] [PDF]

				M. Cesari, B. W. J. H. Penninx, F. Lauretani, C. R. Russo, C. Carter, S. Bandinelli, H. Atkinson, G. Onder, M. Pahor, and L. Ferrucci Hemoglobin Levels and Skeletal Muscle: Results From the InCHIANTI Study J. Gerontol. A Biol. Sci. Med. Sci., March 1, 2004; 59(3): M249 - M254. [Abstract] [Full Text] [PDF]