Dietary intake in human immunodeficiency virus-infected adults: a comparison of dietary assessment methods

Total diet, individual meals, and their association with gastroesophageal reflux disease

Background: To identify the association of total diet and individual meals with gastroesophageal reflux disease (GERD).

Methods: This age- and sex-matched case-control study was carried out among 217 subjects (106 cases and 111 controls). Data were collected using a demographic questionnaire and a GERD checklist and a 3-day food record.

Results: Cases consumed more fat (median: 26.3 [3.2-71.5] g vs. 21.8 [4.3-58.1] g; P=0.04)and more energy percent form carbohydrates (median: 72.5 [0-100] vs. 69.0 [0-100]; P=0.02)at lunch, and less energy (median: 129.5 kcal [0-617.6] vs. 170.5 kcal [0-615.7]; P=0.01) and protein (2.4 [0-19.4] g vs. 3.1 [0-21.8] g; P=0.01) at evening snack, compared to controls.The volume of food was significantly different between the two group only at lunch (median:516 [161-1292] g vs. 468 [198-1060] g; P=0.02). The percentage of energy from total dietary protein showed a significant association with GERD after adjusting for confounders (odds ratio[OR]=0.89; 95% CI: 0.81-0.98). Regarding the individual meals, amount of fat consumed at lunch (OR=1.02; 95% CI: 1.00-1.05), and amount of protein intake at evening snack (OR=0.92;95% CI: 0.85-1.00) were significantly associated with GERD. Meanwhile, caloric density and meal frequency did not differ significantly between the two groups.

Conclusion: Amount of fat consumed at lunch is positively associated with GERD, whereas the percentage of energy from total protein and amount of protein intake at evening snack are more likely to be inversely associated with GERD.

Effectiveness of Mindfulness-Based Cognitive Therapy on the Quality of Life, Emotional Status, and CD4 Cell Count of Patients Aging with HIV Infection

Long-term diagnosed and treated HIV-infected patients have to cope with a wide range of challenges that threaten their ability to age successfully. We report the results of a randomized controlled trial testing the effects of a mindfulness-based cognitive therapy (MBCT) program on quality of life (QoL), emotional status, and immune status over a 3-month period. Forty HIV-infected patients diagnosed prior to 1996 and on cART for a minimum of 5 years were randomized to follow an MBCT program (n = 20) or remain as controls (routine follow-up) (n = 20). A regression analysis was performed, and the measurement of effect size was estimated using Cohen's d. QoL, psychological stress, depressive symptoms, and anxiety symptoms improved in the MBCT group compared with the control group. During follow-up, patients in the MBCT group had a significantly increased CD4 cell count. Effect sizes for MBCT on the variables assessed were large (d = 0.8). The findings suggest that this program may help to promote successful aging in these patients.

Development of an online database of typical food portion sizes in Irish population groups

The Irish Food Portion Sizes Database (available at www.iuna.net) describes typical portion weights for an extensive range of foods and beverages for Irish children, adolescents and adults. The present paper describes the methodologies used to develop the database and some key characteristics of the portion weight data contained therein. The data are derived from three large, cross-sectional food consumption surveys carried out in Ireland over the last decade: the National Children's Food Survey (2003-2004), National Teens' Food Survey (2005-2006) and National Adult Nutrition Survey (2008-2010). Median, 25th and 75th percentile portion weights are described for a total of 545 items across the three survey groups, split by age group or sex as appropriate. The typical (median) portion weights reported for adolescents and adults are similar for many foods, while those reported for children are notably smaller. Adolescent and adult males generally consume larger portions than their female counterparts, though similar portion weights may be consumed where foods are packaged in unit amounts (for example, pots of yoghurt). The inclusion of energy under-reporters makes little difference to the estimation of typical portion weights in adults. The data have wide-ranging applications in dietary assessment and food labelling, and will serve as a useful reference against which to compare future portion size data from the Irish population. The present paper provides a useful context for researchers and others wishing to use the Irish Food Portion Sizes Database, and may guide researchers in other countries in establishing similar databases of their own.

Psychological stress is associated with high levels of IL-6 in HIV-1 infected individuals on effective combined antiretroviral treatment

This study explores the role of psychological stress in the circulating levels of interleukin-6 (IL-6) in a group of HIV-1 infected individuals on effective cART. We developed a cross-sectional study with 50 individuals with confirmed diagnosis of HIV-1 infection ≥1 and ≤8 years, on continuous cART for >1 and <8 years and with plasma viral load <50 copies/mL for at least 1 year. Clinical, behavioral and psychological variables were collected to control their possible indirect contribution in the relationship between psychological stress and IL-6. Pearson correlation and univariate/multivariate logistic regressions were performed. Eighty-eight percent of the subjects were male: median (IQR) age: 39.0 (32.7-42.2), years since HIV-1 infection: 3.4 (2.1-7.0), years on cART: 2.5 (1.6-5.7), CD4 cell count: 709.0 (573.5-881.0) cell/mm(3), plasma levels of IL-6: 7.0 (0-12.2) pg/ml. A strong correlation between IL-6 and psychological stress was found (r=.81). Psychological stress (coef: 0.49; SD: 0.05), anxiety/depression (0.37; 0.08) and unhealthy diet (2.94; 1.38) were associated with higher levels of IL-6. In the multivariate model psychological stress remained strongly associated with IL-6 (R(2): 59%). In conclusion, individuals with psychological stress presented high levels of IL-6 and psychological stress was the only variable which remained strongly associated with IL-6. This strong relationship suggests evidence for a mechanism through which psychological stress might contribute to the health's impairment of HIV-infected individuals on effective cART.

Dietary calcium, dairy food intake and metabolic abnormalities in HIV-infected individuals

BACKGROUND

Epidemiological data suggest that calcium intake may influence lipid metabolism. It is unknown whether this influence also occurs in individuals with HIV/AIDS. The present study aimed to assess the relationship between dietary calcium, dairy food intake and metabolic parameters in individuals with HIV/AIDS.

METHODS

A cross-sectional study was conducted with 100 individuals with HIV/AIDS. Calcium intakes and food group consumption were determined by a food 24-h dietary recall and a food frequency questionnaire, respectively. The level of physical activity was determined with the international physical activity questionnaire and metabolic syndrome (MS) was defined by National Cholesterol Education Program Adult Treatment Panel III (2001). Student's t-test, one-way analysis of variance and chi-square were used to compare the groups.

RESULTS

The mean (SD) calcium intake was 559.5 (298.84) mg day(-1) and dairy food consumption was 1.73 (0.78) servings per day. Dietary calcium intake below 700 mg day(-1) had greater waist circumference, body mass index (BMI) but not significant and higher systolic blood pressure (SBP) (P < 0.05) and diastolic blood pressure (DBP) (P = 0.07). Dairy food consumers (>2 servings per day) showed lower BMI (P < 0.01), waist circumference (P = 0.05), SBP and DBP (P < 0.05). There was a significant association between calcium intake, MS and hypertension. The odds ratio for MS was 2.0 [95% confidence interval (CI) = 1.23-3.32] and for hypertension was 2.25 (95% CI = 1.44-4.44). Only 21% of the individuals were categorised in the moderate/intense physical activity level.

CONCLUSIONS

The results obtained suggest that a dietary pattern with higher proportion of calcium and fruits/vegetables may protect against abdominal obesity and hypertension in HIV-infected individuals.

Risco cardiovascular: marcadores antropométricos, clínicos e dietéticos em indivíduos infectados pelo vírus HIV

OBJETIVO: Descrever marcadores antropométricos, clínicos e dietéticos associados ao risco cardiovascular em indivíduos infectados pelo vírus HIV. MÉTODOS: Realizou-se um estudo transversal com 100 indivíduos, adultos, com HIV/Aids, da cidade do Rio de Janeiro. O risco cardiovascular foi estimado pelo escore de risco de Framingham. O consumo alimentar foi avaliado por meio de um recordatório de 24 horas e de uma lista de frequência de consumo de alimentos. Para comparar variáveis, foram utilizados o teste t de Student e o teste Qui-quadrado. RESULTADOS: Dentre os indivíduos avaliados, 63% eram homens, com idade média de 41,8, DP=9,6 anos, 77% faziam uso de antirretrovirais. Escore de risco de Framingham >10% foi identificado em 53% dos indivíduos. Os principais fatores de risco cardiovascular potencialmente modificáveis identificados foram: lipoproteína de alta densidade baixo (70%), hipercolesterolemia (35%), hipertensão arterial (35%), seguidos de tabagismo (23%) e glicose alta (21%). Indivíduos com escore de risco de Framingham >10% apresentavam uma tendência para consumir dietas mais ricas em colesterol (p=0,720), em sódio (p=0,898), em açúcares/doces (p=0,032) e pobres em fibras (p=0,273), associadas a um maior consumo de bebidas alcoólicas (p=0,053). A avaliação dos hábitos de vida revelou maior prevalência de tabagismo e maior nível de sedentarismo no grupo com escore de risco de Framingham >10, porém não significativos. CONCLUSÃO: Os resultados deste estudo mostram que pacientes com HIV/Aids sob terapia Highly Active Antiretroviral Therapy e com mais altos escore de risco de Framingham não seguem as medidas preventivas contra doenças cardiovasculares e devem ser permanentemente encorajados a fazer escolhas alimentares saudáveis, parar de fumar e aumentar a atividade física.

Dietary patterns and health and nutrition outcomes in men living with HIV infection

BACKGROUND

Nutritional status is an important determinant of HIV outcomes.

OBJECTIVE

We assessed the association between dietary patterns identified by cluster analysis and change in body mass index (BMI; in kg/m(2)), CD4 count, and viral load (VL).

DESIGN

HIV-positive adult male subjects (n = 348) with a BMI >or= 20.5 were evaluated by biochemical, body composition, and dietary data. Cluster analysis was performed on 41 designated food groups derived from 3-d food records. Dietary clusters were compared for sociodemographic, nutrient intake, and clinical outcomes. Multivariate linear regression assessed associations between dietary clusters and change in BMI, CD4 count, and VL.

RESULTS

We observed 3 dietary patterns: juice and soda; fast food and fruit drinks; and fruit, vegetable, and low-fat dairy. Subjects in the fast food and fruit drinks pattern had the lowest fiber intake, highest VL, and lowest CD4 count and had a lower income than did subjects in the other 2 clusters. Subjects in the fruit, vegetable, and low-fat dairy diet pattern had higher intakes of protein, fiber, and micronutrients and the highest BMI and CD4 count. Subjects in the juice and soda pattern had higher energy intakes and lowest BMI. On average, the fast food and fruit drinks cluster and fruit, vegetable, and low-fat dairy cluster gained 0.33 (P = 0.06) and 0.42 (P = 0.02), respectively, more in BMI than the juice and soda cluster across the study interval in a multivariate model.

CONCLUSIONS

In a cohort of HIV-positive men, we identified 3 distinct dietary patterns; each pattern was associated with specific nutrition, demographic, and HIV-related variables.

Self-reported changes in dietary calcium and energy intake predict weight regain following a weight loss diet in obese women

This study examined relationships between changes in dietary calcium intake, energy intake, and body weight following a weight loss diet. One hundred three overweight or obese women lost weight over 22 wk. Dietary calcium and energy intake were assessed using the Block 98 FFQ (Block) and 5-d food records (FR) at intervention end and 6- and 18-mo follow-up. Pearson correlations were used to relate changes in dietary calcium to energy intake. We used regression analyses to examine relationships between changes in dietary calcium, energy intake, and weight regain. Changes in dietary calcium and energy intake were correlated (r = 0.32; P = 0.033), but neither variable alone predicted weight regain. From 6- to 18-mo follow-up, greater dietary calcium intake inversely predicted weight regain when controlling for changes in energy intake (P = 0.048 Block and 0.025 FR), whereas higher energy intake positively predicted weight regain when controlling for changes in dietary calcium intake (P = 0.009 Block and 0.049 FR) (combined R(2) = 0.153 Block and 0.178 FR). Dietary calcium may oppose weight regain, reducing the effect of greater energy intake. Our results encourage future research on the potential relationship between dietary calcium and weight loss maintenance and suggest that controlling for dietary calcium may increase the ability of energy intake to predict weight change.

Obesity in HIV-infection: dietary correlates

OBJECTIVE

To describe the prevalence of obesity among a cohort of individuals living with HIV infection, and to determine differences in dietary intake among those subjects who are normal weight, overweight, and obese.

DESIGN

A cross-sectional study among participants enrolled in the Nutrition for Healthy Living (NFHL) study.

SETTING

Eligible participants included HIV-positive adults living in the greater Boston, MA and Providence, RI, areas. Subjects and Measures of Outcome: In total, 321 (265 males, 56 females) subjects were studied. Body composition measurements, demographic and health data, and fasting blood samples were analyzed. Dietary intake was assessed by three-day food records. Statistical analyses were performed using Statistical Package for Social Science (SPSS).

RESULTS

13% of males and 29% females were found to be obese. Energy intake per kilogram decreased by body mass index (BMI) category for both men and women (p <0.05). Although not different between groups, mean total fat and saturated fat intakes were above recommendations for both men and women in all BMI categories, while total grams dietary fiber decreased as BMI increased. Individuals in all BMI groups had micronutrient intakes below the Dietary Reference Intakes. Serum markers of insulin resistance were significantly different by BMI category among men and women, as well as triglycerides and total cholesterol for the males.

CONCLUSIONS

Obesity and diet in individuals living with HIV-infection needs to be addressed, as quality of dietary intake may have future implications regarding cardiovascular disease, metabolic syndrome, and other health risks associated with overweight and obesity.

Dietary glycemic index of human immunodeficiency virus-positive men with and without fat deposition

This study focused on dietary glycemic index because insulin resistance can be important in the pathogenesis of fat deposition in human immunodeficiency virus (HIV). We evaluated differences in past dietary glycemic intake between men with HIV who developed fat deposition and those who did not. This was a nested case-control study consisting of 37 cases and 37 controls from the Nutrition for Healthy Living cohort. Food records from 6 to 24 months prior to development of fat deposition in cases were analyzed and compared with controls. Cases were defined as men with a waist-to-hip ratio >0.95 and body mass index (calculated as kg/m(2)) between 23 and 26. Controls were matched by age, race, body mass index, highly active antiretroviral therapy use, and CD4 count. Food records were analyzed using t tests for normally distributed nutrients and Wilcoxon rank-sum tests for nutrients with skewed distributions. Glycemic index was calculated for each meal and day. There was no significant difference in glycemic index for meals and day between participants with or without fat deposition. Both groups had a moderate dietary glycemic index intake. This study showed no association between dietary glycemic index and development of fat deposition in HIV. Instead, results of this study depict the potential benefits associated with eating high-quality diets, primarily adequate fiber and protein intake. Diet can be important in preventing development of fat deposition in patients with HIV.