Skip to main content

Advertisement

SpringerLink
Log in

Body Mass Index and Waist Circumference in Patients with HIV in South Africa and Associated Socio-demographic, Health Related and Psychosocial Factors

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

A high body mass index (BMI) and high waist circumference are important health risk factors predisposing for cardiovascular and metabolic diseases and certain cancers. Historically, underweight was a diagnostic criterion of HIV-infection. In a cross-sectional study the prevalence of BMI-categories and high waist circumference and its associated factors in patients visiting three outpatient HIV clinics in South Africa were measured with anthropometric measurements and structured questionnaires regarding socio-demographic information, quality of life (QoL), AIDS-related stigma, symptoms of depression, alcohol use, HIV related information and level of adherence to ART. The median age of the 2230 included patients was 37 years, 66.5% were women and 88.6% received antiretroviral therapy. The prevalences of overweight, obesity and high waist circumference were 29.2, 21.9 and 44.6% respectively in women and 12.4, 4.0 and 3.9% respectively in men. Underweight was found in 18.2% of men and 6.3% of women. In multinomial regression analysis compared to a normal BMI, both overweight and obesity were associated with female gender, with being married or cohabiting and with a higher QoL score. Underweight was associated with male gender and tobacco use and negatively associated with being married or cohabiting and the physical domain of the QoL measure. A high waist circumference in men was associated with higher age and negatively associated with tobacco use and stigma score. In women it was negatively associated with never being married. A high prevalence of overweight and obesity was observed in HIV-clinics in South Africa, mainly in women. Since overweight and obesity are important health risk factors, effective weight reduction interventions are desirable.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. World Health Organization. Global health risks. Mortality and burden of disease attributable to selected major risks. 2009. ISBN 978 92 4 156387.

  2. World Health Organization. Obesity and overweight. Fact sheet No 311. http://www.who.int/mediacentre/factsheets/fs311/en/index.html Accessed 16 Jan 2017.

  3. World Health Organisation. Global Health Observatory data repository. Overweight/obesity by country. http://apps.who.int/gho/data/node.main.A896?lang=en, Accessed 16 Jan 2017.

  4. Dahjio Y, Noubiap JJ, Azabji-Kenfack M, et al. Impact of a 12-week aerobic exercise training program on anthropometric and metabolic parameters in a group of type 2 diabetes Cameroonian women aged ≥50 years. Ann Transl Med. 2016;4(19):364.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Steenkamp L, Goosen A, Venter D, Beeforth M. Food insecurity among students living with HIV: strengthening safety nets at the Nelson Mandela Metropolitan University, South Africa. SAHARA J. 2016;13(1):106–12.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. McCormick CL, Francis AM, Iliffe K, et al. Increasing obesity in treated female HIV patients from Sub-Saharan Africa: potential causes and possible targets for intervention. Front Immunol. 2014;5:507.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Clark AE, Taylor JY, Wu CY, Smith JA. Alternative methods for measuring obesity in African American Women. Yale J Biol Med. 2013;86(1):29–39.

    PubMed  PubMed Central  Google Scholar 

  8. Kim DJ, Westfall AO, Chamot E, et al. Multimorbidity patterns in HIV-infected patients: the role of obesity in chronic disease clustering. J Acquir Immune Defic Syndr. 2012;61(5):600–5.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Haslam DW, James WP. Obesity. Lancet. 2005;366(9492):1197–209.

    Article  PubMed  Google Scholar 

  10. Muhammad S, Sani MU, Okeahialam BN. Cardiovascular disease risk factors among HIV-infected Nigerians receiving highly active antiretroviral therapy. Niger Med J. 2013;54(3):185–90.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hall V, Thormsen RW, Henriksen O, Lohse N. Diabetes in Sub Saharan Africa 1999-2011: epidemiology and public health implications. A systematic review. BMC Public Health. 2011;11:564.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Alberti KG, Zimmet P, Shaw J, for the IDF Epidemiology Task Force Consensus Group. The metabolic syndrome- a new worldwide definition. Lancet. 2005;366(9491):1059–62.

    Article  PubMed  Google Scholar 

  13. Zhu S, Heymsfield SB, Toyoshima H, Wang Z, Pietrobelli A, Heshka S. Race-Ethnicity-specific waist circumference cutoffs for identifying cardiovascular disease risk factors. Am J Clin Nutr. 2005;81(2):409–15.

    Article  PubMed  CAS  Google Scholar 

  14. Wang Y, Rimm EB, Stampfer MJ, Willett WC, Hu FB. Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men. Am J Clin Nutr. 2005;81(3):555–63.

    Article  PubMed  CAS  Google Scholar 

  15. Goh LG, Dhaliwal SS, Welborn TA, Lee AH, Della PR. Anthropometric measurements of general and central obesity and the prediction of cardiovascular disease risk in women: a cross-sectional study. BMJ Open. 2014;4(2):e004138.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Huis in’t Veld D, Skaal L, Peltzer K, Colebunders R, Ndimande JV, Pengpid S. The efficacy of a brief intervention to reduce alcohol misuse in patients with HIV in South Africa: study protocol for a randomized controlled trial. Trials. 2012;13:190.

    Article  Google Scholar 

  17. Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. The Alcohol Use Disorders Identification Test Guidelines for Use in Primary Care. 2nd ed., WHO/MSD/MSB/01.6aGeneva: World Health Organization, Department of Mental Health and Substance Dependence; 2001.

    Google Scholar 

  18. Chan JM, Rimm EB, Colditz GA, Stampfer MJ, Willett WC. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care. 1994;17(9):961–9.

    Article  PubMed  CAS  Google Scholar 

  19. WHOQOLHIV group. WHOQOL-HIV for quality of life assessment among people living with HIV and AIDS: results from the field test. AIDS Care. 2004;16(7):882–9.

    Article  Google Scholar 

  20. World Health Organization (WHO). WHOQOLHIV instruments user’s manual: scoring and coding for the WHOQOL-HIV instruments. Geneva 2002. http://www.who.int/mental_health/media/en/613.pdf.

  21. Peltzer K, Friend-du Preez N, Ramlagan S, Anderson J. Antiretroviral treatment adherence among HIV patients in KwaZulu-Natal, South Africa. BMC Public Health. 2010;10:111.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kalichman SC, Simbayi LC, Cloete A, Mthembuc PP, Mkhonta RN, Ginindza T. Measuring AIDS stigmas in people living with HIV/AIDS: the internalized AIDS-related stigma scale. AIDS Care. 2009;21(1):87–93.

    Article  PubMed  Google Scholar 

  23. Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med. 1994;10(2):77–84.

    Article  PubMed  CAS  Google Scholar 

  24. Zhang W, O’Brien N, Forrest JI, et al. Validating a shortened depression scale (10 item CES-D) among HIV-positive people in British Columbia, Canada. PLoS ONE. 2012;7(7):e40793.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. Myer L, Smit J, Le Roux L, Parker S, Stein DJ, Seedat S. Common mental disorders among HIV-infected individuals in South Africa: prevalence, predictors and validation of brief psychiatric rating scales. AIDS Patient Care STDS. 2008;22(2):147–58.

    Article  PubMed  Google Scholar 

  26. Mannheimer S, Thackeray L, Huppler Hullsiek K, et al. Community program for clinical research on AIDS. A randomized comparison of two instruments for measuring self-reported antiretroviral adherence. AIDS Care. 2008;20:161–9.

    Article  PubMed  CAS  Google Scholar 

  27. Maneesriwongul WL, Tulathong S, Fennie KP, Williams AB. Adherence to antiretroviral medication among HIV-positive patients in Thailand. J Acquir Immune Defic Syndr. 2006;43(Suppl. 1):S119–22.

    Article  PubMed  Google Scholar 

  28. Sarna A, Luchters S, Geibel S, et al. Promoting Adherence through a directly administered antiretroviral therapy (DAART) strategy in Mombasa, Kenya. Horizons research update. Nairobi: Population Council; 2005.

    Google Scholar 

  29. Nunnally JC. Psychometric Theory. 2nd ed. New York: McGraw-Hill; 1978.

    Google Scholar 

  30. Amorosa V, Synnestvedt M, Gross R, et al. A tale of 2 epidemics: the intersection between obesity and HIV infection in Philadelphia. J Acquir Immune Defic Syndr. 2005;39(5):557–61.

    PubMed  Google Scholar 

  31. Hamill MM, Ward KA, Pettifor JM, Norris SA, Prentice A. Bone mass, body composition and vitamin D status of ARV-naïve, urban, black South African women with HIV infection, stratified by CD4 count. Osteoporos Int. 2013;24(11):2855–61.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  32. Sudfeld CR, Isanaka S, Mugusi FM, et al. Weight change at 1 mo of antiretroviral therapy and its association with subsequent mortality, morbidity and CD4 T cell reconstitution in a Tanzanian HIV-infected adult cohort. Am J Clin Nutr. 2013;97:1278–87.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  33. Ogunmola OJ, Oladosu OY, Olamoyegun AM. Association of hypertension and obesity with HIV and antiretroviral therapy in a rural tertiary health center in Nigeria: a cross-sectional cohort study. Vasc Health Risk Manag. 2014;10:129–37.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Tesfaye DY, Kinde S, Medhin G, et al. Burden of metabolic syndrome among HIV-infected patients in Southern Ethiopia. Diabetes Metab Syndr. 2014;8(2):102–7.

    Article  PubMed  Google Scholar 

  35. Mangili A, Polak JF, Skinner SC, et al. HIV infection and progression of carotid and coronary atherosclerosis: the CARE study. J Acquir Immune Defic Syndr. 2011;58(2):148–53.

    Article  PubMed  Google Scholar 

  36. Micklesfield LK, Lambert EV, Hume DJ, et al. Socio-cultural, environmental and behavioural determinants of obesity in black South African women. Cardiovasc J Afr. 2013;24(9–10):369–75.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Govender L, Pillay K, Siwela M, Modi A, Mabhaudhi T. Food and nutrition insecurity in selected rural communities of KwaZulu-Natal, South Africa-Linking human nutrition and agriculture. Int J Environ Res Public Health. 2016;14(1):17. doi:10.3390/ijerph14010017.

    Article  PubMed Central  Google Scholar 

  38. Puoane T, Fourie JM, Shapiro M, Rosling L, Tshaka NC, Oelefse A. ‘Big is beautiful’—an exploration with urban black community health workers in a South African township. S Afr J Clin Nutr. 2005;18(1):6–15.

    Article  Google Scholar 

  39. Averett SL, Stacey N, Wang Y. Decomposing race and gender differences in underweight and obesity in South Africa. Econ Hum Biol. 2014;15:23–40.

    Article  PubMed  Google Scholar 

  40. Clausen T, Charlton KE, Holmboe-Ottesen G. Nutritional status, tobacco use and alcohol consumption of older persons in Botswana. J Nutr Health Aging. 2006;10(2):104–10.

    PubMed  CAS  Google Scholar 

  41. Bjorntorp P. Visceral obesity: a “civilization syndrome”. Obes Res. 1993;1(3):206–22.

    Article  PubMed  CAS  Google Scholar 

  42. Shuster A, Patlas M, Pinthus JH, Mourtzakis M. The clinical importance of visceral adiposity: a critical review of methods for visceral adipose tissue analysis. Br J Radiol. 1009;2012(85):1.

    Google Scholar 

Download references

Funding

This study was funded by ABMRF, the Foundation for Alcohol Research and the Directorate Generale for Development Cooperation through the Flemish Interuniversity Council (VLIR-UOS).

Author information

Author notes

    Authors and Affiliations

    1. Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium

      Diana Huis in ’t Veld & Robert Colebunders

    2. FWO Research Foundation Flanders, Brussels, Belgium

      Diana Huis in ’t Veld

    3. Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium

      Diana Huis in ’t Veld & Robert Colebunders

    4. ASEAN Institute for Health Development, Mahidol University, Nakhonpathom, Thailand

      Supa Pengpid & Karl Peltzer

    5. Department of Research and Innovation, University of Limpopo, Sovenga, South Africa

      Supa Pengpid

    6. HIV/AIDS, STIs & TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, South Africa

      Karl Peltzer

    7. Department of Psychology, University of Limpopo, Sovenga, South Africa

      Karl Peltzer

    8. Algemeen inwendige geneeskunde, De Pintelaan 185, 9000, Ghent, Belgium

      Diana Huis in ’t Veld

    Authors
    1. Diana Huis in ’t Veld
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Supa Pengpid
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Robert Colebunders
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Karl Peltzer
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Diana Huis in ’t Veld.

    Ethics declarations

    Conflict of interest

    The authors declare that they have no conflict of interest.

    Ethical approval

    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

    Informed consent

    Informed consent was obtained from all individual participants included in the study.

    Additional information

    Diana Huis in ’t Veld, Supa Pengpid, Robert Colebunders, and Karl Peltzer have contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Huis in ’t Veld, D., Pengpid, S., Colebunders, R. et al. Body Mass Index and Waist Circumference in Patients with HIV in South Africa and Associated Socio-demographic, Health Related and Psychosocial Factors. AIDS Behav 22, 1972–1986 (2018). https://doi.org/10.1007/s10461-017-1737-2

    Download citation

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s10461-017-1737-2

    Keywords

    Search

    Navigation