Exercise and diet can improve body fat changes

A structured exercise programme combined with a low fat, high fibre diet can

help reverse the body changes and metabolic disorders seen in HIV associated

lipodystrophy.

In a report published in the February edition of Clinical Infectious Diseases,

a team from Tufts University in the US have taken the unusual step of reporting the case of a 44 year old

white male taking HIV antiretrovirals with lipodystrophy, who reversed both

changes in his body shape and metabolism with a four month exercise

programme accompanied by a high fibre, low fat diet. The patient was the first individual to complete the full four month programme in a study currently underway at Tufts University.

"The patient...showed such dramatic improvement that we report the results here to show the potential efficacy of diet and exercise, without pharmacological management, as treatment for lipodystrophy" wrote the authors.

Given that the trend for structured treatment interruption was initially driven by a handful of patient case reports, the report is likely to be influential among people with HIV frustrated at the lack of progress towards treatment or explanation of the lipodystrophy syndrome.

The findings are also noteworthy because they provide the first evidence regarding the combined effect of exercise and diet. Roubenoff's group previously reported comparatively minor reductions in central fat accumulation from a programme of resistance exercise alone.

Exercise programme and diet

After two and a half years of treatment with d4T, 3TC and nevirapine the man

had achieved an undetectable viral load (below 400 copies m/L) and a stable

CD4 count, but had gained 12 kg in weight, and experienced a wasting of the

arms and legs, the accumulation of fat around the girth and on the breasts,

and had developed large bulging veins in the limbs.

Doctors prescribed an exercise programme lasting four months involving

stretching, 20 minutes of vigorous cardiovascular exercise and 40 minutes

weight training for the major muscle groups three times a week. At the same

time, the man was asked to consume at least 25 grams of dietary fibre daily

and follow a diet in which 15 per cent of his total caloric intake was

derived from protein and 30 per cent of his calories came from fat, with the

remainder derived from carbohydrates. During the study period, the proportion of calories that the man derived from saturated fat fell from 18% to 11% while his average daily calorie consumption increased by approximately 400 calories per day, to around 2800 calories.

Results

Body scans and blood tests were performed to determine his body composition

and levels of insulin resistance, fasting cholesterol, and triglycerides.

At the end of the four month programme, there had been a noticeable

improvement in the man's body shape, with the loss of over eight kilograms

of fat, a 10% reduction in waist to hip ratio and the disappearance of 62 cm² of visceral fat from the abdomen (as measured by CT scan).

There

had also been significant improvements in his metabolism, in particular

levels of LDL cholesterol had fallen by 30 per cent, fasting insulin was

down three and a half per cent and insulin resistance by over 15 per cent.

In addition, visceral fat which had accumulated around his internal organs

had fallen by 54 per cent. However, there had been no improvement in the

lipoatrophy in his limbs, although his body strength increased by over 50

per cent during the study.

The report authors conclude that their study shows that exercise and diet

are "capable of reversing much of the metabolic and body changes seen in

lipodystrophy", a condition which they believe to be "psychologically

catastrophic and physiologically dangerous."

However, they also acknowledge

the limitations of their study, most of all that it is based on the response

of one individual, who, although treated with antiretrovirals for over two

years had none of the other risk factors commonly seen in people with HIV-associated lipodystrophy. These include: long term HIV infection and

duration of treatment; dramatic changes in CD4 count and viral load; and a

family history of metabolic disorders.

A detailed discussion of the role of dietary adjustments in the management of lipodystrophy and cardiovascular risk factors in people with HIV, by Dr Graeme Moyle and dietitians Christine Baldwin and Michele Phillpot has been published recently by Medscape. A one off registration is required to view material on this site.

For further information on previous studies of the effect of exercise on lipodystrophy, and the impact of diet on the risk of developing lipodystrophy and metabolic changes, see Treating body fat and metabolic changes on this site.

New US guidelines on dietary management of diabetes were published this week. Click here for a related article on this site.