Body Mass Index as a Predictor of Diabetes Mellitus, Hypertension and High Total Cholesterol among People Living with Human Immunodeficiency Virus in the Asia-Pacific Region and Cambodian General Population
Background: Non-Asian body mass index (BMI) classifications are commonly used to access risk factors of non-communicable diseases. We used Asian BMI classification to investigate the incidence and factors associated with high fasting blood glucose (FBG), hypertension (HTN), and high total cholesterol (TC) among people living with HIV (PLWH) in the Asia-Pacific region, and the prevalence and factor associated with type 2 diabetes mellitus (T2DM) among general adult Cambodians.Methods: PLWH enrolled in the TREAT Asia HIV observational database (TAHOD), receiving combined ART were included. In the Cambodian WHO STEPwise approach to Surveillance (STEPS) survey, non-pregnant participants were included. BMI was categorized using Asian BMI classifications: underweight (<18.5 kg/m2), normal (18.5-22.9 kg/m2), overweight (23-24.9 kg/m2), obese (≥25 kg/m2). We defined outcomes: high FBG: having single post-ART FBG measurement ≥126mg/dl, T2DM: having FBG measurement ≥126mg/dL, or random blood glucose ≥200mg/dL, or were taking diabetic medication, HTN: one measurement of systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, high TC: single result of fasting TC ≥200 mg/dL. Determinants of high FBG were analyzed using Cox regression models. Factors associated with HTN and high TC were determined using random effect Poisson regression models. Factors associated with T2DM were analyzed using logistic regression models. Results: Among Asia-Pacific PLWH, the incidence rate of high FBG was 1.14 per 100 person-years (/100pys) with being obese, older age, having prior-AIDS defining illnesses, and hyperlipidemia as associated factors. The incidence rate of HTN and high TC were 12.44 and 14.49/100pys respectively. Besides traditional risk factors, HIV mode of exposure, having prior AIDS-defining illnesses, low baseline CD4 cell, high baseline TC, high baseline chronic kidney disease stage, and shorter duration on ART associated with increased rate of HTN. HIV mode of exposure, high baseline triglyceride, high baseline HDL, and shorter duration on ART associated with increased rate of high TC. Among adult Cambodians, the prevalence of T2DM was 5% with older age, being hypertensive, and having high TC as associated factors. Conclusion: Higher BMI under Asian classification was significantly associated with an increased risk of high FBG, increased rate of HTN and high TC, and higher prevalence of T2DM.