Nutritional Counseling Can Help Prevent Blood Fat Abnormalities in HIV Patients

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Nutritional Counseling Can Help Prevent Blood Fat Abnormalities in HIV Patients on HAART

By Liz Highleyman

Saturated fats are found in animal products such as butter, cheese, whole milk, ice cream, and oils such as coconut, palm, and palm kernel oil.

Research indicates that dietary consumption of fat contributes to elevated blood lipid levels in people with HIV. Elevated blood lipids are a concern because they may increase the risk of cardiovascular disease.Most experts believe that lifestyle changes -- improved diet and increased exercise -- should be the first-line approach to managing abnormal blood fat levels, before resorting to lipid-lowering drugs. However, there has been little study of the effect of dietary changes on blood fat levels in people with HIV taking antiretroviral therapy, which can lead to metabolic abnormalities.As reported at the recent 4th International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention in Sydney, Australia (July 22-25, 2007), Brazilian researchers conducted a study to evaluate the effects of a dietary intervention involving nutritional counseling on blood lipid levels in HIV positive individuals starting HAART.In this trial, 90 HIV-infected patients starting antiretroviral therapy for the first time were randomly assigned to either receive or not receive 20-minute dietary counseling sessions, based on guidelines of the National Cholesterol Education Program (NCEP), every 3 months for 1 year. Participants were urged to eat less saturated and trans fats and simple carbohydrates like sugars, and to eat more complex carbohydrates and fiber. The control group only received nutrition information once, at the start of the study.Baseline characteristics were similar in the 2 groups. About two-thirds were women, the median age was about 38 years, about 27% were smokers, and the median CD4 count was about 180 cells/mm3.Before and after each intervention session, 24-hour food records, BMI, waist-to-hip ratio, and lipid profiles were assessed. Data were analyzed by intention-to-treat, using mixed-effects models. Dyslipidemia (abnormal blood lipid levels) were defined according to NCEP guidelines. The investigators presented data from 80 individuals (42 in the intervention group and 38 control subjects) who completed the full 1-year study period and maintained undetectable HIV viral loads at 6 and 12 months. Results

· Dietary intervention was associated with a reduction in total calorie intake, from a mean 2655 to 2289 Kcal/day.· Percentage fat intake also decreased in the intervention group, from 31% to 21% of total calories.· In the control group, in contrast, total calorie intake increased (from 2600 to 2814 Kcal/day), with no change in percentage of fat intake. · BMI and waist-to-hip ration remained unchanged in the intervention group, but increased in the control group (BMI from 23 to 26 kg/m2; waist-to-hip ratio from 0.86 to 0.91).· Similarly, plasma total cholesterol and low-density lipoprotein (LDL or “badâ€) cholesterol were unchanged in the intervention group but increased in the control group (total cholesterol from 150 to 189 mg/dL; LDL from 85 to 106 mg/dL).

· Plasma triglycerides decreased in the dietary intervention group (from 134 to 101 mg/dL), but increased in the control group (from 134 to 158 mg/dL).

· After 1 year of follow-up, 17% of patients who received dietary counseling developed dyslipidemia, compared with 50% in the control group (P < 0.05).

ConclusionThis randomized trial shows that dietary intervention is able to prevent an elevation in lipids blood levels (total cholesterol and LDL cholesterol) or even a decrease (triglycerides) in individuals who start HAART independently of drug regimen,†the researchers concluded. They added that, “This simple approach is safe and should be incorporated into clinical care.†Hospital de Clinicas, Porto Alegre, Brazil.

08/17/07

References R Lazzaretti, J Pinto-Ribeiro, R Kummer, and others. Dietary intervention when starting HAART prevents the increase in lipids independently of drug regimen: a randomized trial. 4th International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention. Sydney, Australia, July 22-25, 2007. Abstract WEAB3

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