Associations between Dietary Carbohydrate Intakes, Fatty Acid Oxidation Rates, and Sites of Ectopic Fat Deposition Over Two Years in Persons with Treated HIV

• Published in: The Journal of nutrition Vol. 155; no. 9; pp. 3057 - 3065
• Main Authors: Koethe, John R, Widmer, Annaliese, Robles, Michelle E, Lillegard, Kate, Weeks, Jake, Esfandiari, Helia, Fan, Run, Ye, Fei, Bradshaw, Marques, Sirlin, Claude B, Silver, Heidi J
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2025; American Institute of Nutrition
• Subjects: Accumulation; Adipose tissue; Antiretroviral agents; Antiretroviral therapy; Body composition; Body fat; Body mass index; Body size; carbohydrate; Carbohydrates; Computed tomography; Density; Deposition; Diet; Dietary intake; ectopic fat; Fatty acids; Food intake; Health risks; HIV; Human immunodeficiency virus; imaging; Lipids; Magnetic resonance; Magnetic resonance imaging; Metabolism; obesity; Oxidation; Oxidation rate; Skeletal muscle; Statistical analysis; PWH; ART; ectopic fat; MR; SAT; VAT; INSTI; TVHS; SMD; imaging; carbohydrate; CT; body composition; HIV; obesity
• ISSN: 0022-3166; 1541-6100; 1541-6100
• DOI: 10.1016/j.tjnut.2025.07.003

Persons with human immunodeficiency virus (HIV) on long-term antiretroviral therapy (ART) have exaggerated accumulation of ectopic fat and cardiometabolic disease risk. The objective of this study was to characterize longitudinal changes in habitual diet and macronutrient oxidation in relation to changes in abdominal adipose tissue and ectopic fat sites using magnetic resonance and computed tomography imaging. A prospective cohort of 49 males with HIV had comprehensive assessments at baseline, 52 wk (year 1), and 104 wk (year 2). Linear mixed effects models accounted for the correlation structure in the data and estimated effects over time. Fixed effects included baseline value of the outcome, age, body mass index [BMI (in kg/m2)], time since HIV diagnosis, and duration of ART. The consumption of simple carbohydrates decreased over time (total and added sugars, P = 0.03) concomitant with increased ratio of fatty acid to carbohydrate oxidation (P = 0.01). The amount of abdominal subcutaneous adipose tissue decreased 15% (P < 0.0001), and the amount of visceral adipose tissue (VAT) decreased 7% (P = 0.009) simultaneously with improved subcutaneous adipose tissue and VAT densities. Improvement in VAT density is associated with reduced fat fraction of the liver (r = –0.28, P = 0.04) and thighs (r = –0.41, P = 0.03), indicating overall reduced ectopic fat accumulation. However, pancreas density decreased (P = 0.03), and no statistically significant change was observed in skeletal muscle density (P = 0.16), suggesting tissue-specific impacts. These findings support the relationship between dietary carbohydrate intake, fat oxidation rate, and fat mobilization to reduce ectopic lipid deposition in persons with HIV. Although modest changes in dietary intakes show potential for improving metabolic flexibility and body composition among individuals on long-term ART, some organs and tissues may not respond in tandem with other depots of ectopic fat.