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J Acquir Immune Defic Syndr. 2018 Aug 15;78(5):579-588. doi: 10.1097/QAI.0000000000001722.

Body Mass Index and the Risk of Serious Non-AIDS Events and All-Cause Mortality in Treated HIV-Positive Individuals: D: A: D Cohort Analysis.

Author information

1
The Kirby Institute, UNSW Australia, Sydney, Australia.
2
Internal Medicine, New York Presbyterian/Weill Cornell Medical Center, New York, NY.
3
Institute for Global Health, UCL, London, United Kingdom.
4
CHIP, Department of Infectious Diseases, Section 2100, 2Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
5
Dipartimento di Scienze della Salute, Clinica di Malattie Infettive e Tropicali, Azienda Ospedaliera-Polo Universitario San Paolo, Milan, Italy.
6
Division of Infectious Diseases, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
7
Department of Public Health, Nice University Hospital, Nice, France.
8
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland.
9
Division of Infectious Diseases, Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
10
HIV Monitoring Foundation, Amsterdam, the Netherlands.
11
ICAP-Columbia University and Harlem Hospital, New York, NY.
12
ISPED, INSERM U1219, CHU de Bordeaux, Université de Bordeaux, Bordeaux, France.

Abstract

BACKGROUND:

The relationship between body mass index (BMI) [weight (kg)/height (m)] and serious non-AIDS events is not well understood.

METHODS:

We followed D:A:D study participants on antiretroviral therapy from their first BMI measurement to the first occurrence of the endpoint or end of follow-up (N = 41,149 followed for 295,147 person-years). The endpoints were cardiovascular disease (CVD); diabetes; non-AIDS-defining cancers (NADCs) and BMI-NADCs (cancers known to be associated with BMI in general population); and all-cause mortality. Using Poisson regression models, we analyzed BMI as time-updated, lagged by 1 year, and categorized at: 18.5, 23, 25, 27.5, and 30 kg/m.

RESULTS:

Participants were largely male (73%) with the mean age of 40 years (SD 9.7) and baseline median BMI of 23.3 (interquartile range: 21.2-25.7). Overall, BMI showed a statistically significant J-shaped relationship with the risk of all outcomes except diabetes. The relative risk (RR) for the BMI of <18.5 and >30 (95% confidence interval) compared with 23-25, respectively, was as follows: CVD: 1.46 (1.15-1.84) and 1.31 (1.03-1.67); NADCs: 1.78 (1.39-2.28) and 1.17 (0.88-1.54); and "BMI-NADCs": 1.29 (0.66-2.55) and 1.92 (1.10-3.36). For all-cause mortality, there was an interaction by sex (P < 0.001): RR in males: 2.47 (2.12-2.89) and 1.21 (0.97-1.50); and in females: 1.60 (1.30-1.98) and 1.02 (0.74-1.42). RR remained around 1 for intermediate categories of BMI. The risk of diabetes linearly increased with increasing BMI (P < 0.001).

CONCLUSIONS:

Risk of CVD, a range of cancers, and all-cause mortality increased at low BMI (<18.5) and then tended to increase only at BMI > 30 with a relatively low risk at BMI of 23-25 and 25-30. High BMI was also associated with risk of diabetes.

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