Psoas muscle attenuation measurement with computed tomography indicates intramuscular fat accumulation in patients with the HIV-lipodystrophy syndrome
Abstract
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 ( r 2= 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 ( r 2= 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.
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Lipid infiltration is an important determinant of insulin resistance in healthy and diseased patients; it is independent of visceral fat and is associated with decreased muscle strength and physical performance in older persons.
“As determined by the computerized tomography (CT) attenuation coefficient of muscle, lipid infiltration is an important determinant of insulin resistance in healthy (45) and diseased patients (46): it is independent of visceral fat and is associated with decreased muscle strength and physical performance in older persons (47).”
From Discovering pathways of sarcopenia in older adults: a role for insulin resistance on mitochondria dysfunction (2011) · cites this paper as [46]
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References 37 · Cited by 68
- Authors
- Torriani, M., Hadigan, C., Jensen, M. E., & Grinspoon, S.
- Affiliations
- Harvard University (US)
- Venue
- Journal of Applied Physiology
- Publisher
- American Physiological Society
- Published
- 2003-09
- Volume
- 95
- Issue
- 3
- Pages
- 1005-1010
- ISSN
- 0161-7567 (ISSN-L)
- 8750-7587
- 1522-1601
- OpenAlex
- W2163409343
- Cited by
- 68
- References
- 37
- Citations by year
- 2026: 2 · 2024: 3 · 2023: 2 · 2022: 2 · 2021: 2 · 2020: 4 · 2019: 4 · 2018: 3 · 2017: 2 · 2016: 3 · 2015: 1 · 2014: 3 · 2013: 5 · 2012: 1
- FWCI
- 4.86
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Applied Physiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK059535, DK 59535)
- National Center for Research Resources (RR 01066, RR-300088, M01RR001066)
- Topics
- Health Sciences › Medicine › Emergency Medicine › HIV-related health complications and treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Keywords
- HIV, insulin resistance, hyperinsulinemia, visceral fat, free fatty acids, glucose tolerance, lipid metabolism, antiretroviral therapy, sarcopenia, sarcopenic obesity, body fat distribution, HIV-associated lipodystrophy
- MeSH terms
- Adipose Tissue, Adult, Blood Glucose, Body Composition, Enzyme-Linked Immunosorbent Assay, Fatty Acids, Nonesterified, Hormones, Humans, Insulin Resistance, Lipids, Male, Middle Aged, Tomography, X-Ray Computed, Blotting, Western, Absorptiometry, Photon, Psoas Muscles, HIV-Associated Lipodystrophy Syndrome, Lipid Metabolism
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