The effect of Methadone maintenance treatment on body mass index and lipid profile among clients attending MMT clinic at Muhimbili National Hospital in Dar es salam, Tanzania

Abstract

ABSTRACT Background: Methadone, a full mu-opioid receptor agonist, reduces illicit drug use and the spread of infections such as HIV and HBV, which are common among drug abusers due to injection sharing. However, it is also associated with changes in body mass index and lipid profile, an area with limited studies in Tanzania. Objective: The objective of this study was to examine the effect of methadone maintenance treatment on body mass index and lipid profile among clients who visit MMT clinic in MNH at Dar es Salaam, Tanzania. Materials and Methods: This was a retrospective cohort study with a cross-sectional element included 100 clients from an MMT clinic at MNH. Body weight and height were measured during data collection to calculate post-treatment BMIs, while baseline BMIs were determined from baseline data collected from treatment files. Fasting blood samples were collected for lipid analysis. The BMI before and after MMT and lipid profiles were determined and analyzed by age, sex and prior heroine use using t-test analyzing approach. Results: Ninety-two percent of participants were male, the mean age of study participants was 42 ± 9.3 years and 73% had education below secondary level. Paired t-test analysis showed a significant increase in mean BMI from 19.3 ± 2.6 kg/m2before treatment to 20.3 ± 3.10 kg/m2 after treatment), p<0.0001, t (100) = 4.35 (2-tailed), 95% CI= 0.56 to 1.50kg/m2. We noticed that participants on MMT for more than 24 months had significantly higher mean BMI (21.28±2.5 kg/m2) compared to those on MMT for less or equal to 24 months (20.05±2.5 kg/m2),p=0.0480, t=2.00, two tailed, 95%CI =0.01075 to 2.443 kg/m2. The mean (± SEM) increase in BMI was 1.227 ± 0.6128 kg/m2, indicating that on average BMI is more likely to increase by 1.227kg/m2 after two years of methadone treatment. Overall, 54% had one or more abnormal lipid levels. Decreased levels of HDL were most prevalent, rating 40% followed by elevated levels of TG, rating 21%.

Conclusions: Methadone use is associated with an increase in BMI, with longer durations of therapy leading to higher BMI. Over 50 percent of participants had abnormal lipid profile, particularly HDL (low) and TG (high). Recommendation: Because of benefits of MMT we recommend expansion of MMT clinics to other urban centers in Tanzania, consider determining lipid profile of clients at enrolment and during follow up, conducting a follow-up study comprising of large sample size for a longer period to investigate the long effects of methadone on lipid profile.