Skip to main content

Advertisement

Log in

Anthropometric measures and cognition in middle-aged HIV-infected and uninfected women. The Women’s Interagency HIV Study

  • Published:
Journal of NeuroVirology Aims and scope Submit manuscript

Abstract

This study aimed to explore the relationship of body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) with cognition in women with (HIV+) and without HIV (HIV−) infection. One thousand six hundred ninety participants (1,196 HIV+, 494 HIV−) in the Women’s Interagency HIV Study (WIHS) with data available on anthropometric measures comprise the analytical sample. Cross-sectional analyses using linear regression models estimated the relationship between anthropometric variables and Trails A, Trails B, Stroop interference time, Stroop word recall, Stroop color naming and reading, and Symbol Digit Modalities Test (SDMT) with consideration for age, HIV infection status, Wide Range Achievement Test score, CD4 count, insulin resistance, drug use, and race/ethnicity. Among HIV+ women, BMI < 18.5 kg/m2 was associated with poorer cognitive performance evidenced by longer Trails A and Trails B and shorter SDMT completion times. An obese BMI (30 kg/m2 or higher) was related to better performance on Trails B and worse performance on the Stroop interference test. Among HIV− women, an obese BMI was related to worse performance on the Stroop color naming test. Few and inconsistent associations were observed between WC, WHR, and cognition. Among women at mid-life with chronic (at least 10 years) HIV infection, common anthropometric measures, primarily BMI, were differentially related to cognitive test performance by cognitive domain. Higher levels of BMI were associated with better cognitive function. In this era of antiretroviral therapies, restoration of health evidenced as higher BMI due to effective antiretroviral therapies, may improve cognitive function in middle-aged HIV-infected women.

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

Access this article

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

  • Andrieu S, Aboderin I, Baeyens JP, Beard J, Benetos A, Berrut G, Brainin M, Cha HB, Chen LK, Du P, Forette B, Forette F, Franco A, Fratiglioni L, Gilette-Guyonnet S, Gold G, Gomez F, Guimaraes R, Gustafson D (2011) IAGG workshop: health promotion program on prevention of late onset dementia. J Nutr Health Aging 15:562–575

    Article  CAS  PubMed  Google Scholar 

  • Bacon MC, von Wyl V, Alden C, Sharp G, Robison E, Hessol N, Gange S, Barranday Y, Holman S, Weber K, Young MA (2005) The Women’s Interagency HIV Study: an observational cohort brings clinical sciences to the bench. Clin Diagn Lab Immunol 12:1013–1019

    CAS  PubMed Central  PubMed  Google Scholar 

  • Barkan SE, Melnick SL, Preston-Martin S, Weber K, Kalish LA, Miotti P, Young M, Greenblatt R, Sacks H, Feldman J (1998) The Women’s Interagency HIV Study. WIHS Collaborative Study Group. Epidemiology 9:117–125

    Article  CAS  PubMed  Google Scholar 

  • Becker JT, Kingsley L, Mullen J, Cohen B, Martin E, Miller EN, Ragin A, Sacktor N, Selnes OA, Visscher BR (2009) Vascular risk factors, HIV serostatus, and cognitive dysfunction in gay and bisexual men. Neurology 73:1292–1299

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Berger JR, Brew B (2005) An international screening tool for HIV dementia. AIDS 19:2165

    Article  PubMed  Google Scholar 

  • Bhaskaran K, Mussini C, Antinori A et al (2008) Changes in the incidence and predictors of human immunodeficiency virus-associated dementia in the era of highly active antiretroviral therapy. Ann Neurol 63:213

    Article  PubMed  Google Scholar 

  • Bozzette SA, Ake CF, Tam HK, Chang SW, Louis TA (2003) Cardiovascular and cerebrovascular events in patients treated for human immunodeficiency virus infection. N Engl J Med 348:702–710

    Article  CAS  PubMed  Google Scholar 

  • Capeau J, Bouteloup V, Katlama C, Bastard JP, Guiyedi V, Salmon-Ceron D, Protopopescu C, Leport C, Raffi F, Chene G (2012) Ten-year diabetes incidence in 1046 HIV-infected patients started on a combination antiretroviral treatment. AIDS 26:303–314

    Article  CAS  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention (2012a) Estimated HIV incidence among adults and adolescents in the United States, 2007–2010

  • Centers for Disease Control and Prevention (2012b) Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 U.S. dependent areas—2010. HIV Surveillance Supplemental Report 2012. Centers for Disease Control and Prevention: Atlanta

  • Cohen RA, Gongvatana A (2010) The persistence of HIV-associated neurocognitive dysfunction and the effects of comorbidities. Neurology 75:2052–2053

    Article  PubMed  Google Scholar 

  • Croft JB, Keenan NL, Sheridan DP, Wheeler FC, Speers MA (1995) Waist-to-hip ratio in a biracial population: measurement, implications, and cautions for using guidelines to define high risk for cardiovascular disease. J Am Diet Assoc 95:60–64

    Article  CAS  PubMed  Google Scholar 

  • Crystal HA, Weedon J, Holman S, Manly J, Valcour V, Cohen M, Anastos K, Liu C, Mack WJ, Golub E, Lazar J, Ho A, Kreek MJ, Kaplan RC (2011) Associations of cardiovascular variables and HAART with cognition in middle-aged HIV-infected and uninfected women. J Neurovirol 17:469–476

    Article  PubMed Central  PubMed  Google Scholar 

  • Currier J (2007) Report from the 14th Retrovirus Conference. Metabolic complications: lipoatrophy, lipohypertrophy, and cardiovascular risk. AIDS Clin Care 19:40–41

    PubMed  Google Scholar 

  • Fitzpatrick AL, Kuller LH, Lopez OL, Diehr P, O’Meara ES, Longstreth WT Jr, Luchsinger JA (2009) Midlife and late-life obesity and the risk of dementia: cardiovascular health study. Arch Neurol 66:336–342

    PubMed Central  PubMed  Google Scholar 

  • González-Scarano F, Martín’García J (2005) The neuropathogenesis of AIDS. Nat Rev Immunol 5:69

    Article  PubMed  Google Scholar 

  • Gustafson DR (2010) Adiposity hormones and dementia. J Neurosci 299:30–34

    CAS  Google Scholar 

  • Gustafson D, Skoog I (2009) Control of vascular risk factors. In: L-O Wahlund TE, Gauthier S (eds) Vascular dementia in clinical practice. Cambridge University Press, London

    Google Scholar 

  • Gustafson DR, Bäckman K, Waern M, Östling S, Guo X, Zandi PP, Mielke MM, Bengtsson C, Skoog I (2009a) Adiposity indicators and dementia over 32 years in Sweden. Neurology 73:1559–1566

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Gustafson DR, Bäckman K, Waern M, Östling S, Guo XX, Zandi P, Mielke MM, Bengtsson C, Skoog I (2009b) Adiposity indicators and dementia over 32 years in Sweden. Neurology 73:1559–1566

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Heaton RK, Clifford DB, Franklin DR Jr, Woods SP, Ake C, Vaida F, Ellis RJ, Letendre SL, Marcotte TD, Atkinson JH, Rivera-Mindt M, Vigil OR, Taylor MJ, Collier AC, Marra CM, Gelman BB, McArthur JC, Morgello S, Simpson DM, McCutchan JA, Abramson I, Gamst A, Fennema-Notestine C, Jernigan TL, Wong J, Grant I (2010) HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: CHARTER Study. Neurology 75:2087–2096

    Article  PubMed Central  PubMed  Google Scholar 

  • Heaton RK, Franklin DR, Ellis RJ, McCutchan JA, Letendre SL, Leblanc S, Corkran SH, Duarte NA, Clifford DB, Woods SP, Collier AC, Marra CM, Morgello S, Mindt MR, Taylor MJ, Marcotte TD, Atkinson JH, Wolfson T, Gelman BB, McArthur JC, Simpson DM, Abramson I, Gamst A, Fennema-Notestine C, Jernigan TL, Wong J, Grant I (2011) HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors. J Neurovirol 17:3–16

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Justman JE, Hoover DR, Shi Q, Tan T, Anastos K, Tien PC, Cole SR, Hyman C, Karim R, Weber K, Grinspoon S (2008) Longitudinal anthropometric patterns among HIV-infected and HIV-uninfected women. J Acquir Immune Defic Syndr 47:312–319

    Article  PubMed  Google Scholar 

  • Kaplan RC, Kingsley LA, Gange SJ, Benning L, Jacobson LP, Lazar J, Anastos K, Tien PC, Sharrett AR, Hodis HN (2008) Low CD4+ T-cell count as a major atherosclerosis risk factor in HIV-infected women and men. AIDS 22:1615–1624

    Article  PubMed Central  PubMed  Google Scholar 

  • Kivipelto M, Ngandu T, Fratiglioni L, Viitanen M, Kareholt I, Winblad B, Helkala EL, Tuomilehto J, Soininen H, Nissinen A (2005) Obesity and vascular risk factors at midlife and the risk of dementia and Alzheimer disease. Arch Neurol 62:1556–1560

    PubMed  Google Scholar 

  • Mansoor A, Althoff K, Gange S, Anastos K, Dehovitz J, Minkoff H, Kaplan R, Holman S, Lazar JM (2009) Elevated NT-pro-BNP levels are associated with comorbidities among HIV-infected women. AIDS Res Hum Retrovir 25:997–1004

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Mary-Krause M, Cotte L, Simon A, Partisani M, Costagliola D (2003) Increased risk of myocardial infarction with duration of protease inhibitor therapy in HIV-infected men. AIDS 17:2479–2486

    Article  PubMed  Google Scholar 

  • McArthur JC, Brew BJ (2010) HIV-associated neurocognitive disorders: is there a hidden epidemic? AIDS 24:1367–1370

    Article  PubMed  Google Scholar 

  • McCutchan JA, Marquie-Beck JA, Fitzsimons CA, Letendre SL, Ellis RJ, Heaton RK, Wolfson T, Rosario D, Alexander TJ, Marra C, Ances BM, Grant I (2012) Role of obesity, metabolic variables, and diabetes in HIV-associated neurocognitive disorder. Neurology 78:485–492

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Miller EN, Selnes OA, McArthur JC, Satz P, Becker JT, Cohen BA, Sheridan K, Machado AM, Van Gorp WG, Visscher B (1990) Neuropsychological performance in HIV-1-infected homosexual men: The Multicenter AIDS Cohort Study (MACS). Neurology 40:197–203

    Article  CAS  PubMed  Google Scholar 

  • Moroni M, Antinoria S (2003) HIV and direct damage of organs: disease spectrum before and during the highly active antiretroviral therapy era. AIDS 17:S51

    Article  PubMed  Google Scholar 

  • Robertson KR, Su Z, Margolis DM, Krambrink A, Havlir DV, Evans S, Skiest DJ (2010) Neurocognitive effects of treatment interruption in stable HIV-positive patients in an observational cohort. Neurology 74:1260–1266

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Saktor N (2002) The epidemiology of human immunodeficiency virus-associated neurological disease in the era of highly active antiretroviral therapy. J Neurovirol 8:115

    Article  Google Scholar 

  • Shah N, Braverman ER (2012) Measuring adiposity in patients: the utility of body mass index (BMI), percent body fat, and leptin. PLOS One 7:e33308

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Sobieszczyk ME, Hoover DR, Anastos K, Mulligan K, Tan T, Shi Q, Gao W, Hyman C, Cohen MH, Cole SR, Plankey MW, Levine AM, Justman J (2008) Prevalence and predictors of metabolic syndrome among HIV-infected and HIV-uninfected women in the Women’s Interagency HIV Study. J Acquir Immune Defic Syndr 48:272–280

    Article  CAS  PubMed  Google Scholar 

  • Whitmer RA, Gunderson EP, Barrett-Connor E, Quesenberry CP Jr, Yaffe K (2005) Obesity in middle age and future risk of dementia: a 27 year longitudinal population based study. BMJ 330:1360–1364

    Article  PubMed Central  PubMed  Google Scholar 

  • Whitmer RA, Gunderson EP, Quesenberry CP Jr, Zhou J, Yaffe K (2007) Body mass index in midlife and risk of Alzheimer disease and vascular dementia. Curr Alzheim Res 4:103–109

    Article  CAS  Google Scholar 

  • Whitmer RA, Gustafson DR, Barrett-Connor E, Haan MN, Gunderson EP, Yaffe K (2008) Central obesity and increased risk of dementia more than three decades later. Neurology 71:1057–1064

    Article  CAS  PubMed  Google Scholar 

  • Wright EJ, Grund B, Robertson K, Brew BJ, Roediger M, Bain MP, Drummond F, Vjecha MJ, Hoy J, Miller C, Penalva de Oliveira AC, Pumpradit W, Shlay JC, El-Sadr W, Price RW (2010) Cardiovascular risk factors associated with lower baseline cognitive performance in HIV-positive persons. Neurology 75:864–873

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

This study is supported in part by grants 1R01MH076537, 1R01MH079880, and IAID U01 318345. Data in this manuscript were collected by the Women’s Interagency HIV Study (WIHS) Collaborative Study Group with centers (Principal Investigators) at New York City/Bronx Consortium (Kathryn Anastos); Brooklyn, NY (Howard Minkoff, Deborah Gustafson); Washington DC, Metropolitan Consortium (Mary Young); The Connie Wofsy Study Consortium of Northern California (Ruth Greenblatt); Los Angeles County/Southern California Consortium (Alexandra Levine); Chicago Consortium (Mardge Cohen); and Data Coordinating Center (Stephen Gange). The WIHS is funded by the National Institute of Allergy and Infectious Diseases (UO1-AI-35004, UO1-AI-31834, UO1-AI-34994, UO1-AI-34989, UO1-AI-34993, and UO1-AI-42590) and by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (UO1-HD-32632). The study is co- funded by the National Cancer Institute, the National Institute on Drug Abuse, and the National Institute on Deafness and Other Communication Disorders. Funding is also provided by the National Center for Research Resources (UCSF-CTSI grant number UL1 RR024131). Dr. Gustafson received support from NIH/NIAID ARRA Supplement No. 54492, Swedish Research Council Diarienummer: 523-2005-8460, and the SUNY Research Foundation.

The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

We thank the women participating in WIHS for their time, cooperation, and support.

Conflict of interest

All authors, Deborah R. Gustafson, MS, PhD, Michelle M. Mielke, PhD, Phyllis C. Tien, MD, Victor Valcour, MD, Mardge Cohen, MD, Kathryn Anastos, MD, Chenglong Liu, MD, PhD, Leigh Pearce, PhD, Elizabeth T. Golub, PhD, Howard Minkoff, MD, and Howard A. Crystal, MD, have nothing to declare.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Deborah R. Gustafson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gustafson, D.R., Mielke, M.M., Tien, P.C. et al. Anthropometric measures and cognition in middle-aged HIV-infected and uninfected women. The Women’s Interagency HIV Study. J. Neurovirol. 19, 574–585 (2013). https://doi.org/10.1007/s13365-013-0219-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13365-013-0219-1

Keywords

Navigation