Combined use of waist and hip circumference to identify high-risk HIV-infected patients
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Objectives: To determine whether for a given waist circumference (WC), a larger hip circumference (HC) was associated with a reduced risk of insulin resistance, type 2 diabetes (T2D), hypertension and cardiovascular disease (CVD) in HIV-infected patients. A second objective was to determine whether, for a given WC, the addition of HC improved upon estimates of abdominal adiposity, in particular visceral adipose tissue (VAT), compared to those obtained by WC alone. Methods: HIV-infected men (N=1481) and women (N=841) were recruited between 2005 and 2009. WC and HC were obtained using standard techniques and abdominal adiposity was measured using computed tomography. Results: After control for WC and covariates, HC was associated with a lower risk of HOMA-IR (p<0.05) and T2D [Men: OR=0.91 (95% CI: 0.86-0.96); Women: OR=0.91 (95% CI: 0.84-0.98)]. For a given WC, HC was also associated with a lower risk of hypertension (p<0.05) and CVD [OR=0.94 (95% CI: 0.88-0.99)] in men, but not women. Although HC was negatively associated with VAT in men and women after control for WC (p<0.05), the addition of HC did not substantially improve upon the prediction of VAT compared to WC alone. Conclusions: The identification of high-risk HIV-infected individuals by WC alone is substantially improved by the addition of HC. Estimates of VAT by WC are not substantially improved by the addition of HC and thus variation in visceral adiposity may not be the conduit by which HC identifies increased health risk.