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Sneij A, Campa A, Huffman F, George F, Trepka MJ, Sales Martinez S, Baum M. Effectiveness of a 6-Month Nutrition Intervention in People Living with HIV and Prediabetes Progressing through Stages of Change towards Positive Health Behavior. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14675. [PMID: 36429394 PMCID: PMC9690930 DOI: 10.3390/ijerph192214675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
UNLABELLED The prevalence of prediabetes in people living with human immunodeficiency virus (HIV) is two to three times higher than that of the general population. The aim of this study was to assess the effectiveness of an intervention in guiding low-income people living with HIV (PLWH) and prediabetes through the stages of change and promote self-efficacy of positive health behavior. METHODS A 6- month randomized, controlled intervention was conducted where participants (N = 38) were randomized into the intervention group (n = 20) or the control group (n = 18). The participants' stages of change, nutrition knowledge, and self-efficacy were assessed using questionnaires. Participants were recruited in August 2017-December 2018, were HIV seropositive, had undetectable viral load, were prediabetic, and not currently receiving glucose-altering medications. Participants randomized into the intervention group received medical nutrition therapy/counseling and nutrition education; participants randomized into the control group received educational material related to nutrition, HIV, and prediabetes at baseline. Primary outcome measures were progression through the stages of change as measured by the transtheoretical ("stages of change") model, improvements in nutrition knowledge, and self-efficacy of the participants. RESULTS Significant improvement in stage of behavioral change was observed in the intervention group for physical activity, fruit/vegetable intake, fiber intake as well as nutrition knowledge and self-efficacy; however, no significant changes were observed in the control group. CONCLUSIONS A nutrition intervention was effective in promoting positive health behavior by progressing participants through the stages of behavioral change in low-income people living with HIV and prediabetes.
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Affiliation(s)
- Alicia Sneij
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Adriana Campa
- Department of Dietetics and Nutrition, Florida International University, Miami, FL 33199, USA
| | - Fatma Huffman
- Department of Dietetics and Nutrition, Florida International University, Miami, FL 33199, USA
| | - Florence George
- Department of Mathematics and Statistics, Florida International University, Miami, FL 33199, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Florida International University, Miami, FL 33199, USA
| | - Sabrina Sales Martinez
- Department of Dietetics and Nutrition, Florida International University, Miami, FL 33199, USA
| | - Marianna Baum
- Department of Dietetics and Nutrition, Florida International University, Miami, FL 33199, USA
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Maeda SS, Albergaria BH, Szejnfeld VL, Lazaretti-Castro M, Arantes HP, Ushida M, Domiciano DS, Pereira RMR, Marin-Mio RV, de Oliveira ML, de Mendonça LMC, do Prado M, de Souza GC, Palchetti CZ, Sarni ROS, Terreri MT, de Castro LCG, Artoni SMB, Amoroso L, Karcher DE, Prado CM, Gonzalez MC, de Medeiros Pinheiro M. Official Position of the Brazilian Association of Bone Assessment and Metabolism (ABRASSO) on the evaluation of body composition by densitometry-part II (clinical aspects): interpretation, reporting, and special situations. Adv Rheumatol 2022; 62:11. [PMID: 35365246 DOI: 10.1186/s42358-022-00240-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To present an updated and evidence-based guideline for the use of dual-energy x-ray absorptiometry (DXA) to assess body composition in clinical practice. MATERIALS AND METHODS This Official Position was developed by the Scientific Committee of the Brazilian Association of Bone Assessment and Metabolism (Associação Brasileira de Avaliação Óssea e Osteometabolismo, ABRASSO) and experts in the field who were invited to contribute to the preparation of this document. The authors searched current databases for relevant publications in the area of body composition assessment. In this second part of the Official Position, the authors discuss the interpretation and reporting of body composition parameters assessed by DXA and the use of DXA for body composition evaluation in special situations, including evaluation of children, persons with HIV, and animals. CONCLUSION This document offers recommendations for the use of DXA in body composition evaluation, including indications, interpretation, and applications, to serve as a guiding tool in clinical practice and research for health care professionals in Brazil.
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Affiliation(s)
- Sergio Setsuo Maeda
- Discipline of Endocrinology, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), Rua Estado de Israel, 639, São Paulo, SP, CEP: 04022-001, Brazil.
| | - Ben-Hur Albergaria
- Department of Epidemiology, Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil
| | - Vera Lúcia Szejnfeld
- Discipline of Rheumatology, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Marise Lazaretti-Castro
- Discipline of Endocrinology, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), Rua Estado de Israel, 639, São Paulo, SP, CEP: 04022-001, Brazil
| | - Henrique Pierotti Arantes
- School of Medicine, Instituto Master de Ensino Presidente Antônio Carlos (IMEPAC), Uberlândia, MG, Brazil
| | - Marcela Ushida
- Discipline of Rheumatology, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Diogo Souza Domiciano
- Discipline of Rheumatology, Department of Medicine, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | | | - Rosângela Villa Marin-Mio
- Discipline of Endocrinology, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), Rua Estado de Israel, 639, São Paulo, SP, CEP: 04022-001, Brazil
| | - Mônica Longo de Oliveira
- Discipline of Endocrinology, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), Rua Estado de Israel, 639, São Paulo, SP, CEP: 04022-001, Brazil
| | | | | | | | - Cecília Zanin Palchetti
- Department of Nutrition, School of Public Health, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Roseli Oselka Saccardo Sarni
- Discipline of Allergy, Clinical Immunology, and Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Maria Teresa Terreri
- Section of Pediatric Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | | | - Lizandra Amoroso
- School of Agricultural and Veterinary Sciences, Universidade Estadual de São Paulo (UNESP), Jaboticabal, SP, Brazil
| | - Débora Emy Karcher
- School of Agricultural and Veterinary Sciences, Universidade Estadual de São Paulo (UNESP), Jaboticabal, SP, Brazil
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, Division of Human Nutrition, University of Alberta, Edmonton, Canada
| | - Maria Cristina Gonzalez
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas (UCPel), Pelotas, RS, Brazil.,Postgraduate Program in Nutrition and Food, Universidade Federal de Pelotas (UFPel), Pelotas, RS, Brazil
| | - Marcelo de Medeiros Pinheiro
- Discipline of Rheumatology, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Kusuma MTPL, Kidd T, Muturi N, Procter SB, Yarrow L, Hsu WW. The Symbolic Meaning of HIV: Understanding Lecturers' Ambivalence over Teaching HIV to Dietetic Students. J Int Assoc Provid AIDS Care 2021; 19:2325958220939755. [PMID: 32662324 PMCID: PMC7361481 DOI: 10.1177/2325958220939755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Responding to the increasing reports of health students and professionals demonstrating stigmatized attitudes toward people living with HIV (PLHIV), this article examined the learning process that takes place during their academic training. Using symbolic interactionism as a theoretical framework, we studied the way lecturers in dietetic schools in Indonesia make meaning of their understanding and experience of HIV in relation to their teaching conduct. We found that the current curriculum does not provide adequate opportunities for students to learn and interact with PLHIV. Participants described HIV discussion is mainly limited to the clinical aspects and essential treatment as they were uncomfortable discussing HIV with the students. The ostensible symbolic meaning of HIV among dietetic lecturers in Indonesia was compounded with limitations and restrictions affecting their teaching practices and attitudes to PLHIV. Future intervention is required to help lecturers recognize their degree of awareness and personal values about HIV.
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Affiliation(s)
- Mutiara Tirta Prabandari Lintang Kusuma
- Department of Nutrition and Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia.,Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, KS, USA
| | - Tandalayo Kidd
- Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, KS, USA
| | - Nancy Muturi
- A.Q. Miller School of Journalism and Mass Communications, College of Arts and Sciences, Kansas State University, Manhattan, KS, USA
| | - Sandra Butin Procter
- Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, KS, USA
| | - Linda Yarrow
- Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, KS, USA
| | - Wei-Wen Hsu
- Department of Statistics, College of Arts and Sciences, Kansas State University, Manhattan, KS, USA
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Abba A, Fokam J, Kamgaing RS, Yimga JF, Ka’e AC, Nka AD, Tchouaket MCT, Chenwi CA, Semengue ENJ, Ndjolo A, Sosso SM. Correlation between the immuno-virological response and the nutritional profile of treatment-experienced HIV-infected patients in the East region of Cameroon. PLoS One 2021; 16:e0229550. [PMID: 33983976 PMCID: PMC8118549 DOI: 10.1371/journal.pone.0229550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/21/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND HIV management remains concerning and even more challenging in the frame of comorbidities like malnutrition that favors disease progression and mortality in resource-limited settings (RLS). OBJECTIVE To describe the nutritional parameters of antiretroviral therapy (ART) recipients (without nutritional support) with respect to CD4 count and virological failure. METHODS A cross-sectional study was conducted from October to December 2018 among 146 consenting participants enrolled in two health facilities of the East-Region of Cameroon. Socio-demographic data, basic clinical information and treatment history were collected; blood samples were collected by venipuncture for laboratory analysis (HIV-1 viral load, CD4 Tcells measurement and biochemical analysis) performed at the "Chantal Biya" International Reference Center", Yaounde, Cameroon. The nutritional profile was assessed by using anthropometric and biochemical parameters. Data were analyzed using Excel 2016, Graph pad prism version 6; Spearman correlation and Kruskal-Wallis test were used; with p<0.05 considered statistically significant. RESULTS Median [IQR] age was 42 [33-51] years, 76.0% (111/146) were female and median [IQR] duration on ART was 54 [28-86] months. Of these participants, 11.6% (17/146) were underweight based on the body mass index and 4.7% (7/146) were at the stage of advanced weight loss. According to immunovirological responses, 44.5% (65/146) were immunocompromised (CD4<500 cell/μl) and 75.3% (110/146) had an undetectable viremia (<40 copies/mL). CD4 count inversely correlated with total protein concentration (r = -0.18, p = 0.005**). Viremia was inversely correlated with albumin (r = -0.21; p = 0.047*), nutritional risk index (r = -0.28; p = 0.013*), total cholesterol (r = -0.27; p = 0.007**), and positively correlated with total protein (r = 0.27; p<0.001**) concentrations. CONCLUSION In this RLS, with patients having about five years of ART-experience, malnutrition appears to be driven mainly by a poor BMI, indicating that about one of ten patients falls within this severe condition. However, the largely normal nutritional profiles should be interpreted with caution, considering local realities and food support programs in place. The present outcomes highlight the need for monitoring nutritional status of people receiving ART in RLS, toward the design of optimal food interventions.
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Affiliation(s)
- Aissatou Abba
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
- * E-mail: (AA); (JF)
| | - Joseph Fokam
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé I, Yaoundé, Cameroon
- * E-mail: (AA); (JF)
| | - Rachel Simo Kamgaing
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
| | - Junie Flore Yimga
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
| | - Aude Christelle Ka’e
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
| | - Alex Durand Nka
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
| | - Michel Carlos Tommo Tchouaket
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Collins Ambe Chenwi
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
| | | | - Alexis Ndjolo
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé I, Yaoundé, Cameroon
| | - Samuel Martin Sosso
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
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Patel F, Kennedy C. Metabolic Changes in Pediatric HIV-Positive Patients and Potential Lifestyle Interventional Strategies. Cureus 2021; 13:e14556. [PMID: 34026373 PMCID: PMC8133514 DOI: 10.7759/cureus.14556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Metabolic changes in the HIV population have been well-studied, particularly after the advent of antiretroviral therapy. More notably, the emergence of the metabolic syndrome within the HIV population, due to prolonged survival, has led to an increasing rate of cardiovascular occurrence and mortality within the population in adult life. Importance of early intervention in HIV children, particularly lifestyle modifications, is necessary to reduce cardiovascular disease (CVD) risk and mortality in adulthood. Potential clinical interventions include routine anthropometric measurements as a measure of CVD risk, a low saturated fat and high fiber diet, and vigorous aerobic exercise have been shown to decrease CVD risk in the HIV population. The literature review found multiple knowledge gaps due to minimal studies completed on the HIV population and even less on HIV-positive children. Overall, a standardized protocol was required to better care for HIV-positive children and potential future CVD mortality.
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Affiliation(s)
- Falguni Patel
- Internal Medicine/Pediatrics, Alabama College of Osteopathic Medicine, Dothan, USA
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Kusuma MTPL, Kidd T, Muturi N, Procter SB, Yarrow L, Hsu WW. HIV knowledge and stigma among dietetic students in Indonesia: implications for the nutrition education system. BMC Infect Dis 2020; 20:663. [PMID: 32907539 PMCID: PMC7487527 DOI: 10.1186/s12879-020-05379-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 08/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies have demonstrated that health care students and practitioners are not immune to stigma towards people living with HIV (PLHIV). This attitude could lead to poor quality of care if it remains uncorrected. However, little is known about dietetic students' acceptance of PLHIV despite their substantial role in treatment. This study aimed to measure the extent of knowledge and stigma towards PLHIV among dietetic students and to determine the associated factors using the attribution theory. METHODS Students from three dietetics schools in Indonesia (n = 516) were recruited to participate in this cross-sectional study. Survey questions covered demographic information, interaction with PLHIV, access to information sources, cultural values, and beliefs as predictor variables. The outcome variables were comprehensive knowledge of HIV, HIV and nutrition-specific knowledge, and attitudes. Analyses with linear regression and the stepwise selection were performed to determine factors related to the outcome. RESULTS The levels of HIV comprehensive knowledge and HIV-nutrition specific knowledge among dietetic students were low, as indicated by the average score of 19.9 ± 0.19 (maximum score = 35) and 8.0 ± 0.11 (maximum score = 15), respectively. The level of negative attitudes towards PLHIV was high, with 99.6% of participants reported having a high stigma score. Types of university affiliation (public or private), beliefs and values, exposure to HIV discourse, access to printed media, and years of study were significantly related to HIV comprehensive knowledge (p < 0.05). Nutrition-specific knowledge was also correlated with university affiliation, beliefs and values, participation in HIV discussion, and years of study (p < 0.05). HIV comprehensive knowledge, university affiliation, discussion participation, and ethnicities were associated with attitudes (p < 0.05). CONCLUSIONS Awareness and acceptance of PLHIV must be further improved throughout dietetic training to ensure patients' quality of care since students represent future dietary care providers. Considering the consistent findings that affiliation to education institution correlates with HIV knowledge and attitude, some examinations concerning the curriculum and teaching conduct might be necessary.
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Affiliation(s)
- Mutiara Tirta Prabandari Lintang Kusuma
- Department of Nutrition and Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia. .,Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, Kansas, USA.
| | - Tandalayo Kidd
- Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Nancy Muturi
- A.Q. Miller School of Journalism and Mass Communications, College of Arts and Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Sandra B Procter
- Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Linda Yarrow
- Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Wei-Wen Hsu
- Department of Statistics, College of Arts and Sciences, Kansas State University, Manhattan, Kansas, USA
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Schreiner N, Perazzo J, Digennaro S, Burant C, Daly B, Webel A. Associations between symptom severity and treatment burden in people living with HIV. J Adv Nurs 2020; 76:2348-2358. [PMID: 32643309 DOI: 10.1111/jan.14461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/04/2020] [Accepted: 05/26/2020] [Indexed: 12/15/2022]
Abstract
AIM To examine the association between symptoms severity and treatment burden in people living with HIV. DESIGN Correlational, secondary analysis of data from participants diagnosed with HIV enrolled in a descriptive, cross-sectional study examining physical activity patterns. METHODS We analysed data from 103 men and women using self-report data collected between March 2016 - February 2017. Our primary statistical analyses consisted of explanatory multivariate modelling with individual PROMIS-29 scores representing symptom severity and treatment burden measured using the Treatment Burden Questionnaire-13. RESULTS Greater symptom severity was associated with higher levels of cumulative treatment burden as well as higher levels of task-specific medication and physical activity burden. Multivariate regression analyses revealed that fatigue was a risk factor of cumulative treatment burden as well as task-specific medication and physical activity treatment burden. Effect sizes of multivariate models ranged from small (0.11) to medium (0.16). Additionally, post hoc analyses showed strong correlations between fatigue and other measured symptoms. CONCLUSION Findings support extant treatment burden literature, including the importance of addressing symptom severity in conjunction with treatment burden screening in the clinical setting. Results also suggest clinical interventions focused on the reduction of fatigue could reduce treatment burden in people living with HIV. Strong correlations between fatigue and other symptoms indicate the potential for reducing fatigue by addressing other highly clustered symptoms, such as depression. IMPACT People living with HIV exhibiting higher levels of fatigue are at high risk for treatment burden and poorer self-management adherence. Clinicians should consider incorporating symptom and treatment burden assessments when developing, tailoring and modifying interventions to improve self-management of HIV and other co-morbid conditions.
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Affiliation(s)
- Nathanial Schreiner
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
| | | | - Sarah Digennaro
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
| | - Christopher Burant
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
| | - Barbara Daly
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
| | - Allison Webel
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
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Factors associated with insufficient weight gain among Mexican pregnant women with HIV infection receiving antiretroviral therapy. PLoS One 2020; 15:e0233487. [PMID: 32442181 PMCID: PMC7244146 DOI: 10.1371/journal.pone.0233487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 05/06/2020] [Indexed: 11/30/2022] Open
Abstract
Objective We identified clinical, dietary, and socioeconomic factors associated with insufficient gestational weight gain among Mexican pregnant women with human immunodeficiency virus (HIV) infection. Methods This was a cross-sectional study involving 112 pregnant women with HIV infection receiving antiretroviral therapy (ART). Data including viral load, complete blood analysis, and CD4 counts were extracted from medical records. An inquiry form was used to collect data on socioeconomic status and frequency of food intake. Pre-gestational weight was calculated based on pregnancy weight to obtain the body mass index (BMI) and weight gain for gestational age according the US Institute of Medicine. Of the study population, 68.7% were in consensual union, 31.3% were single, and 33.9% belonged to the two lowest socioeconomic strata. The median age and CD4 count were 27 (interquartile range [IQR]: 23–32) years and 418 (IQR: 267–591), respectively. The adequacy of energy was 91.8% (IQR: 74.1–117.7). The median energy intake from protein was 13.5% (IQR: 12.2–14.9) and from lipids, 35.5% (IQR: 31.1–40.3). Pregnant women with gastrointestinal symptoms and CD4 count <350 were seven times more likely to have folate deficiency (odds ratio [OR] 7.8, 95% confidence interval [CI] 1.6–38.1; p = 0.009) and six times more likely to have poor zinc intake (OR 6.7, 95% CI 1.3–36.8; p = 0.014). In all, 42.9% of the pregnant women consumed iron and folic acid supplements and 54.4% consumed multivitamin supplements. Moreover, 45.5% had a normal pre-gestational BMI, 41.1% were classified overweight, and 13.4% had obesity, whereas 62.5% showed insufficient gestational weight gain, and 18.8% experienced weight loss. The variables associated with insufficient weight gain were consensual union (OR 5.3, 95% CI 1.9–15.0; p = 0.002) and belonging to the lowest socioeconomic stratum (E) (OR 3.1, 95% CI 1.0–9.2; p = 0.046). Conclusion Dietary strategies to improve gestational weight gain for Mexican women with HIV infection receiving ART must consider clinical and socioeconomic factors.
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Gonçalves JL, Silva MCA, Roma EH, Grinsztejn B, de Lemos ADS, Gorni N, Cruz AM, de Almeida CF, Quintana MDSB, Bonecini-Almeida MDG, de Brito PD. Iron intake is positively associated with viral load in antiretroviral naïve Brazilian men living with HIV. Mem Inst Oswaldo Cruz 2020; 114:e190350. [PMID: 32022169 PMCID: PMC6996494 DOI: 10.1590/0074-02760190350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/19/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Iron homeostasis contribute for the human immunodeficiency virus (HIV) pathogenesis. OBJECTIVES We assessed the iron intake pattern in antiretroviral naïve Brazilian men living with HIV correlating with clinical and nutritional parameters. METHODS The iron consumption mean was estimated according to a food frequency questionnaire (FFQ), and a 3-day food record (3dFR) submitted to the patients. HIV viral load, CD4+ T cell counts, serum iron, haematological and anthropometrics parameters were recorded. FINDINGS Fifty-one HIV-infected adult men naïve for antiretroviral therapy (ART) were enrolled. The mean age of participants was 35 (SEM ± 1.28) years old, with mean time of HIV-1 infection of 1.78 (0-16.36, min-max) years. Majority (41.18%) had complete secondary, and 21.57% had tertiary educational level. The income was around 1x (54.90%) to 2x (41.18%) minimum wage. Fifty-four percent showed normal weight, while 40% were overweight. The patients showed normal mean values of haematological parameters, and mean serum iron was 14.40 µM (SEM ± 0.83). The FFQ showed moderate correlation with the 3dFR (ρ = 0.5436, p = 0.0009), and the mean values of iron intake were 10.55(± 0.92) mg/day, recorded by FFQ, and 15.75(± 1.51) mg/day, recorded by 3dFR. The iron intake, recorded by FFQ, negatively correlated with serum iron (ρ = -0.3448, p = 0.0132), and did not have influence in the CD4+ T cell counts [e.B 0.99 (0.97-1.01, 95% confidence interval (CI), p = 0.2]. However, the iron intake showed a positive effect in HIV viral load [e.B 1.12 (1.02-1.25, 95%CI), p < 0.01]. MAIN CONCLUSIONS This study draws attention for the importance of iron intake nutritional counseling in people living with HIV. However, more studies are required to clarify the association between high iron intake and HIV infection and outcome.
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Affiliation(s)
- Juliana Lauar Gonçalves
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Serviço de Nutrição, Rio de Janeiro, RJ, Brasil
| | - Maria Clara Amorim Silva
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Serviço de Nutrição, Rio de Janeiro, RJ, Brasil
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Imunologia e Imunogenética em Doenças Infecciosas, Rio de Janeiro, RJ, Brasil
| | - Eric Henrique Roma
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Imunologia e Imunogenética em Doenças Infecciosas, Rio de Janeiro, RJ, Brasil
| | - Beatriz Grinsztejn
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em DST e AIDS, Rio de Janeiro, RJ, Brasil
| | - Alberto dos Santos de Lemos
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Centro Hospitalar, Rio de Janeiro, RJ, Brasil
| | - Nathalia Gorni
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Serviço de Nutrição, Rio de Janeiro, RJ, Brasil
| | - Adele Moura Cruz
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Serviço de Nutrição, Rio de Janeiro, RJ, Brasil
| | - Cristiane Fonseca de Almeida
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Serviço de Nutrição, Rio de Janeiro, RJ, Brasil
| | - Marcel de Souza Borges Quintana
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Plataforma de Pesquisa Clínica, Rio de Janeiro, RJ, Brasil
| | - Maria da Gloria Bonecini-Almeida
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Imunologia e Imunogenética em Doenças Infecciosas, Rio de Janeiro, RJ, Brasil
| | - Patrícia Dias de Brito
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Serviço de Nutrição, Rio de Janeiro, RJ, Brasil
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10
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Silveira EA, Falco MO. [Nutritional diagnosis of people living with HIV/AIDS: a review of national and international protocols]. CIENCIA & SAUDE COLETIVA 2019; 25:5003-5016. [PMID: 33295518 DOI: 10.1590/1413-812320202512.36262018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/15/2019] [Indexed: 11/21/2022] Open
Abstract
HIV infection is a predictor of several metabolic and body composition alterations, in addition to malnutrition, anemia, and hypovitaminosis. There are thus specificities of diagnosis and treatment depending on the stage of the disease and the outpatient or hospital environment. The scope of this narrative review was to update the conceptual and theoretical framework regarding the nutritional diagnosis of people living with HIV/AIDS. Current national and international scientific evidence published in scientific articles, recent books, protocols, consensuses, and guidelines were analyzed. The nutritional diagnosis encompasses several clinical aspects and abilities and specific knowledge about HIV/AIDS, such as: clinical history and current clinical situation, food consumption, anthropometric data, body composition, and biochemistry, blood pressure and physical examination. The nutritional diagnosis process was demonstrated in order to provide subsidies for the health teams in the identification of parameters that make it possible to establish a plan for nutritional care to promote, prevent and recuperate the alterations detected in people living with HIV/AIDS.
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Affiliation(s)
- Erika Aparecida Silveira
- Programa de Pós-Graduação Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Goiás. Av. Primeira Avenida s/n, Setor Leste Universitário. 74605-050 Goiânia GO Brasil.
| | - Marianne Oliveira Falco
- Programa de Pós-Graduação Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Goiás. Av. Primeira Avenida s/n, Setor Leste Universitário. 74605-050 Goiânia GO Brasil.
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11
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Bello TK, Gericke GJ, MacIntyre UE. Development, Implementation, and Process Evaluation of a Theory-Based Nutrition Education Programme for Adults Living With HIV in Abeokuta, Nigeria. Front Public Health 2019; 7:30. [PMID: 30931289 PMCID: PMC6424023 DOI: 10.3389/fpubh.2019.00030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 02/05/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction: Healthy diets play a role in the management and care for adults living with HIV/AIDS (ALH). Appropriate nutrition education (NE) is necessary to equip ALH with relevant knowledge and skills for healthy eating. A needs assessment identified the need for a nutrition education programme (NEP) as part of the nutrition service for ALH in Abeokuta, Nigeria. The aim of this study was to design a theory-based NEP and to evaluate the implementation process among ALH attending selected federal and state hospitals in Abeokuta as out-patients. Materials and Methods: An exploratory descriptive needs assessment in the qualitative and quantitative domains was conducted among a convenient sample of ALH (N = 243) at the selected hospitals. The quantitative needs assessment identified needs for improvement in the primary outcome [quality of life (QoL)] and the secondary outcomes [quality of dietary intake, nutrition knowledge, attitudes, and practice (KAP), and anthropometric status]. Participants' perceptions of the NEP were obtained using an interviewer administered questionnaire among 70 ALH who attended the implementation of the NEP and process evaluation thereof at the intervention hospital. Results: The qualitative results identified a lack of knowledge on planning varied meals with limited resources. The identified needs, existing guidelines and literature were integrated with appropriate constructs of the Social Cognitive Theory (SCT) and the Health Belief Model (HBM) into the NEP. The NE manual, participant's work book, flipcharts, and the brochure were tailored to address the identified challenges. Discussion: The process evaluation showed that the NEP was implemented as planned and that the participants' perceptions were positive. The use of the NE manual, participant's work book, flipcharts, and brochure demonstrated the practicality of incorporating behavioral theories in NE for ALH.
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Affiliation(s)
| | | | - Una E. MacIntyre
- Department of Human Nutrition, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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12
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Dietary patterns and nutritional status of HIV-infected children and adolescents in El Salvador: A cross-sectional study. PLoS One 2018; 13:e0196380. [PMID: 29763418 PMCID: PMC5953455 DOI: 10.1371/journal.pone.0196380] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 04/12/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction The present study aimed to assess the nutritional status, the dietary patterns and its associated factors in the HIV-infected population of children and adolescents on antiretroviral treatment at the El Salvador reference center for pediatric HIV care (CENID). Methods A cross-sectional survey was carried out between December 2010 and December 2011. Socio-demographic and clinical characteristics were collected from 307 children and adolescents aged 2–18 years and receiving antiretroviral therapy. Nutritional status was assessed by height-for-age, weight-for-height and body mass index-for-age. Dietary data was collected through a 24 hour recall, and through a weekly food frequency questionnaire. Dietary patterns were identified by principal component analysis. Bivariate and multivariable statistical methods were used to assess the factors associated with “high adherence” to the “healthy diet” pattern. Results More than a third of the study group (33.2%) were stunted, 3.3% were identified as being wasted, and 10% were overweight or obese. Their diets were predominantly based on a high consumption of cereals, beans, eggs and processed foods and a low consumption of fruits, vegetables and dairy products. Three dietary patterns were identified: “healthy diet”, “high fat/sugar diet” and “low diversity diet”. Being female (OR: 1.63; 95%CI: 0.97–2.75), younger (OR: 2.37; 95%CI: 1.28–4.36) and institutionalized (OR: 14.5; 95%CI: 5.35–39.50) increased the odds to adhere to the “healthy diet” pattern. Conclusion Our findings reveal a high prevalence of stunting and overweight in HIV-infected children in El Salvador. Institutionalized children were more likely to adhere to a healthy dietary pattern whereas children in poverty were more likely to have less varied and healthy diets. These results highlight the need to assess the dietary patterns of HIV-infected children and adolescents in order to guide public policies to design healthy life style interventions for this population at risk.
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13
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López JD, Shacham E, Gilliland J, Szopiak E. Urban farming: an innovative intervention to enhance engagement in HIV care. Int J STD AIDS 2018; 29:623-625. [PMID: 29623815 DOI: 10.1177/0956462418765839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Julia D López
- 1 Department of Environmental Health, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA
| | - Enbal Shacham
- 1 Department of Environmental Health, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA
| | - Jake Gilliland
- 1 Department of Environmental Health, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA
| | - Erin Szopiak
- 2 Department of Nutrition and Dietetics, Doisy College of Health Sciences, Saint Louis University, Saint Louis, MO, USA
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14
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Thuppal SV, Jun S, Cowan A, Bailey RL. The Nutritional Status of HIV-Infected US Adults. Curr Dev Nutr 2017; 1:e001636. [PMID: 29955683 PMCID: PMC5998784 DOI: 10.3945/cdn.117.001636] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/30/2017] [Accepted: 09/27/2017] [Indexed: 12/31/2022] Open
Abstract
Background: Nutrition is critical to HIV mortality and morbidity. Improved treatment modalities have increased life expectancy of HIV-infected individuals. More than 1 million US adults are living with HIV, but little is known about their nutritional status. Objective: We aimed to characterize the nutritional status of those living with HIV with the use of the NHANES 2003-2014. Methods: The NHANES is a nationally representative, cross-sectional survey of the US population and includes a household interview, medical examination, and two 24-h dietary recalls; survey weights are applied to make the data nationally representative. HIV antibodies were ascertained initially by immunoassay and confirmed with Western blot. NHANES 2003-2014 data were analyzed for HIV-positive (n = 87) and HIV-negative (n = 15,868) US adults (aged 19-49 y). Body mass index (BMI), waist circumference, dietary intakes, and nutritional biomarkers were estimated and compared by HIV status, stratified by sex. Results: HIV-infected men and women had higher serum protein, lower serum albumin, and lower serum folate than did non-HIV-infected adults. HIV-positive women had significantly higher BMI, prevalence of overweight or obesity, and waist circumference risk and substantially lower serum 25-hydroxyvitamin D concentrations (44 compared with 65 nmol/L) than did HIV-negative women. When compared with HIV-negative women, HIV-positive women had lower intakes of some key nutrients such as fiber, vitamin E, vitamin K, magnesium, and potassium but had higher intakes of protein and niacin. Conclusions: The NHANES data suggest that HIV infection is associated with poorer markers of some nutritional status indicators; however, the US population prevalence of HIV is <0.5%. Given the small sample size, not only in this study but also in the United States, much more targeted research is needed to better understand the multitude of factors that influence the nutritional status among those living with HIV in the United States, especially among women.
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Affiliation(s)
| | - Shinyoung Jun
- Department of Nutrition Science, Purdue University, West Lafayette, IN
| | - Alexandra Cowan
- Department of Nutrition Science, Purdue University, West Lafayette, IN
| | - Regan L Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, IN
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15
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Whitfield KC, Wozniak R, Pradinuk M, Karakochuk CD, Anabwani G, Daly Z, MacLeod SM, Larson CP, Green TJ. Anthropometric measures are simple and accurate paediatric weight-prediction proxies in resource-poor settings with a high HIV prevalence. Arch Dis Child 2017; 102:10-16. [PMID: 27073160 DOI: 10.1136/archdischild-2015-309645] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 03/12/2016] [Accepted: 03/17/2016] [Indexed: 11/04/2022]
Abstract
RATIONALE Accurate weight measurements are essential for both growth monitoring and drug dose calculations in children. Weight can be accurately measured using calibrated scales in resource-rich settings; however, reliable scales are often not available in resource-poor regions or emergency situations. Current age and/or length/height-based weight-prediction equations tend to overestimate weight because they were developed from Western children's measures. OBJECTIVE To determine the accuracy of several proxy measures for children's weight among a predominately HIV-positive group of children aged 18 months to 12 years in Botswana. DESIGN Weight, length/height, ulna and tibia lengths, mid-upper arm circumference (MUAC) and triceps skinfold were measured on 775 children recruited from Gaborone, Botswana, between 6 July and 24 August 2011. RESULTS Mean (95% CI) age and weight were 7.8 years (7.5 to 8.4) and 21.7 kg (21.2 to 22.2), respectively. The majority of children were HIV-positive (n=625, 81%) and on antiretroviral treatment (n=594, 95%). The sample was randomly divided; a general linear model was used to develop weight-prediction equations for one half of the sample (n=387), which were then used to predict the weight of the other half (n=388). MUAC and length/height, MUAC and tibia length and MUAC and ulna length most accurately predicted weight, with an adjusted R2 of 0.96, 0.95 and 0.93, respectively. Using MUAC and length/height, MUAC and tibia length and MUAC and ulna length equations, ≥92% of predicted weight fell within 15% of actual weight, compared with <55% using current equations. CONCLUSION The development of nomograms using these equations is warranted to allow for rapid and accurate weight prediction from these simple anthropometric measures in HIV-endemic, resource-constrained settings.
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Affiliation(s)
- Kyly C Whitfield
- Food, Nutrition and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Roberta Wozniak
- Food, Nutrition and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mia Pradinuk
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Crystal D Karakochuk
- Food, Nutrition and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gabriel Anabwani
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
| | - Zachary Daly
- Food, Nutrition and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stuart M MacLeod
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles P Larson
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Timothy J Green
- Food, Nutrition and Health, University of British Columbia, Vancouver, British Columbia, Canada.,South Australian Health and Medical Research Institute, and the Women's and Children's Health Research Institute, Adelaide, South Australia, Australia
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Martinez SS, Campa A, Bussmann H, Moyo S, Makhema J, Huffman FG, Williams OD, Essex M, Marlink R, Baum MK. Effect of BMI and fat mass on HIV disease progression in HIV-infected, antiretroviral treatment-naïve adults in Botswana. Br J Nutr 2016; 115:2114-21. [PMID: 27087233 PMCID: PMC5830121 DOI: 10.1017/s0007114516001409] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
An obesity paradox has been proposed in many conditions including HIV. Studies conducted to investigate obesity and its effect on HIV disease progression have been inconclusive and are lacking for African settings. This study investigated the relationship between overweight/obesity (BMI≥25 kg/m2) and HIV disease progression in HIV+ asymptomatic adults not on antiretroviral treatment (ART) in Botswana over 18 months. A cohort study in asymptomatic, ART-naïve, HIV+ adults included 217 participants, 139 with BMI of 18·0-24·9 kg/m2 and seventy-eight participants with BMI≥25 kg/m2. The primary outcome was time to event (≥25 % decrease in cluster of differentiation 4 (CD4) cell count) during 18 months of follow-up; secondary outcomes were time to event of CD4 cell count<250 cells/µl and AIDS-defining conditions. Proportional survival hazard models were used to compare hazard ratios (HR) on time to events of HIV disease progression over 18 months. Higher baseline BMI was associated with significantly lower risk of an AIDS-defining condition during the follow-up (HR 0·218; 95 % CI 0·068, 0·701; P=0·011). Higher fat mass at baseline was also significantly associated with decreased risk of AIDS-defining conditions during the follow-up (HR 0·855; 95 % CI 0·741, 0·987; P=0·033) and the combined outcome of having CD4 cell count≤250/µl and AIDS-defining conditions, whichever occurred earlier (HR 0·918; 95 % CI 0·847, 0·994; P=0·036). All models were adjusted for covariates. Higher BMI and fat mass among the HIV-infected, ART-naïve participants were associated with slower disease progression. Mechanistic research is needed to evaluate the association between BMI, fat mass and HIV disease progression.
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Affiliation(s)
- S. S. Martinez
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33186, USA
| | - A. Campa
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33186, USA
| | - H. Bussmann
- Botswana Harvard AIDS Initiative Partnership, Gaborone, Botswana
| | - S. Moyo
- Botswana Harvard AIDS Initiative Partnership, Gaborone, Botswana
| | - J. Makhema
- Botswana Harvard AIDS Initiative Partnership, Gaborone, Botswana
| | - F. G. Huffman
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33186, USA
| | - O. D. Williams
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33186, USA
| | - M. Essex
- Harvard School of Public Health, Boston, MA 02115, USA
| | - R. Marlink
- Harvard School of Public Health, Boston, MA 02115, USA
| | - M. K. Baum
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33186, USA
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Sneij A, Campa A, Martinez SS, Stewart T, Baum M. Lower Plasma Zinc Levels in Hyperglycemic People Living with HIV in the MASH cohort. JOURNAL OF AIDS & CLINICAL RESEARCH 2016; 7:542. [PMID: 27182454 PMCID: PMC4866606 DOI: 10.4172/2155-6113.1000542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Zinc deficiency is prevalent in HIV and hyperglycemic patients. Antiretroviral therapy (ART) is a treatment to control HIV progression; however it increases the risk for hyperglycemia. The objective of this study was to assess the plasma zinc levels in hyperglycemic people living with HIV (PLWH). METHODS Secondary analysis was conducted on the data from the Miami Adult Studies in HIV (MASH) cohort in Florida. Patients were categorized into hyperglycemic group (fasting blood glucose ≥100 mg/dL) and normal group (<100 mg/dL). RESULTS Plasma zinc status and CD4 levels were lower in the hyperglycemic group, however the difference was not significant. There was a greater percentage of plasma zinc deficiency in the hyperglycemic group (69%) compared to the normoglycemic group (64%). DISCUSSION Although not statistically significant, related biomarkers such as plasma zinc levels and CD4 levels were lower in the hyperglycemic group. This may be due to the role zincplays in the immune system. Due to the fact that there was a higher percentage of plasma zinc deficiency in the hyperglycemic group (69%) compared to the normoglycemic group (64%), it is important to monitor and manage blood glucose levels to minimize complications. Our findings along with previous findings suggest that zinc supplementation may benefit hyperglycemic PLWH.
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Affiliation(s)
- Alicia Sneij
- Florida International University, Florida, USA
- Center for Research on US Latino HIV/AIDS and Drug Abuse (Crusada), USA
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18
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Cunha JD, Maselli LMF, Stern ACB, Spada C, Bydlowski SP. Impact of antiretroviral therapy on lipid metabolism of human immunodeficiency virus-infected patients: Old and new drugs. World J Virol 2015; 4:56-77. [PMID: 25964872 PMCID: PMC4419122 DOI: 10.5501/wjv.v4.i2.56] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/15/2015] [Accepted: 03/09/2015] [Indexed: 02/05/2023] Open
Abstract
For human immunodeficiency virus (HIV)-infected patients, the 1990s were marked by the introduction of highly active antiretroviral therapy (HAART) representing a new perspective of life for these patients. The use of HAART was shown to effectively suppress the replication of HIV-1 and dramatically reduce mortality and morbidity, which led to a better and longer quality of life for HIV-1-infected patients. Apart from the substantial benefits that result from the use of various HAART regimens, laboratory and clinical experience has shown that HAART can induce severe and considerable adverse effects related to metabolic complications of lipid metabolism, characterized by signs of lipodystrophy, insulin resistance, central adiposity, dyslipidemia, increased risk of cardiovascular disease and even an increased risk of atherosclerosis. New drugs are being studied, new therapeutic strategies are being implemented, and the use of statins, fibrates, and inhibitors of intestinal cholesterol absorption have been effective alternatives. Changes in diet and lifestyle have also shown satisfactory results.
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Ziegler TR, McComsey GA, Frediani JK, Millson EC, Tangpricha V, Eckard AR. Habitual nutrient intake in HIV-infected youth and associations with HIV-related factors. AIDS Res Hum Retroviruses 2014; 30:888-95. [PMID: 24953143 DOI: 10.1089/aid.2013.0282] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Few studies have evaluated habitual nutrient intake among HIV-infected youth in the United States, even though diet may influence disease progression and risk of comorbidities. This study determined habitual micronutrient and macronutrient intake in HIV-infected youth. HIV-infected subjects and healthy controls 1-25 years old were prospectively enrolled. Nutrient intake was assessed via 24-h dietary recalls performed every 3 months for 1 year and compared to recommended intake from the U.S. Dietary Reference Intakes (DRIs) and Acceptable Macronutrient Distribution Ranges (AMDRs). Subjects with two or more food recalls were analyzed (175 HIV(+) and 43 healthy controls). Groups were similar in age, race, sex, body mass index, and kilocalorie intake. In both groups, intake of several micronutrients was below the DRI. In addition, HIV(+) subjects had a lower percentage DRI than controls for vitamins A, D, E, pantothenic acid, magnesium, calcium, folate, and potassium. HIV(+) subjects' percentage caloric intake from fat was above the AMDR and was higher than controls. Caloric intake was negatively correlated with current and nadir CD4 count. Zinc, riboflavin, and magnesium percentage DRI were positively associated with current CD4 count. In HIV(+) subjects not on antiretroviral therapy, HIV-1 RNA levels were negatively correlated with protein intake. HIV(+) youth have an inadequate dietary intake of several essential nutrients and poorer dietary intake compared to controls. Intake of some nutrients was associated with important HIV-related factors. Further investigation is warranted to determine the impact of dietary intake of specific nutrients on HIV progression and chronic complication risk in this population.
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Affiliation(s)
| | - Grace A. McComsey
- Rainbow Babies & Children's Hospital and Case Western Reserve University, Cleveland, Ohio
| | | | | | | | - Allison Ross Eckard
- Emory University School of Medicine, Atlanta, Georgia
- Children's Healthcare of Atlanta, Atlanta, Georgia
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20
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Winter FS, Emakam F, Kfutwah A, Hermann J, Azabji-Kenfack M, Krawinkel MB. The effect of Arthrospira platensis capsules on CD4 T-cells and antioxidative capacity in a randomized pilot study of adult women infected with human immunodeficiency virus not under HAART in Yaoundé, Cameroon. Nutrients 2014; 6:2973-86. [PMID: 25057105 PMCID: PMC4113773 DOI: 10.3390/nu6072973] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 05/24/2014] [Accepted: 07/07/2014] [Indexed: 12/22/2022] Open
Abstract
Dietary supplements are often used to improve the nutritional status of people living with HIV/AIDS (PLHIV). Arthrospira platensis (Asp), also known as Spirulina, is a cyanobacterium rich in proteins and micronutrients. Cell and animal trials described immune-modulating, antiretroviral and antioxidant activities. This pilot study describes the effects of the supplementation of 5 g/day of Asp on a pre-highly-active antiretroviral therapy (pre-HAART), HIV-infected, adult female population. It was conducted as a three-month randomized controlled trial (RCT) that compared a cup supplementation of five grams/day of Asp with a placebo of equal protein content and energy. The study included 73 HIV-infected women. The immediate outcome variables were CD4 T-cells, viral load and immune activation by CD8 T-cells expressing CD38. The antioxidant status was assessed by way of the total antioxidant capacity of the serum (TAOS). The renal function was documented by way of creatinine, urea and the calculated glomerular filtration rate. Statistical analyses were carried out with non-parametric tests, and the effect size of each interaction was calculated. No differences in the immunological and virological markers between the Asp and the placebo group could be observed. In the placebo group, 21 of 30 patients (70%) developed concomitant events, while in the Asp group, only 12 of 28 patients (43%) did. Both groups registered a significant weight increase; 0.5 kg (p < 0.05) in the Asp group and 0.65 kg (p < 0.05) in the placebo group. The antioxidant capacity increase of 56 (1-98) µM for Asp was significantly different from the decrease observed in the placebo group (p < 0.001). A slight increase in the creatinine level of 0.1 g/dL (p < 0.001) was observed in the Asp group, and no effect was observed in the urea levels. The improvement of the antioxidant capacity under Asp, shown for the first time on PLHIV, could become a focus for future research on the nutritional and health effects of Spirulina. The observed slight, but significant increase of serum creatinine needs further evaluation, especially with varying doses of Asp.
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Affiliation(s)
| | - Francois Emakam
- Institute of Nutritional Sciences, University of Giessen, Giessen D-35392, Germany.
| | - Anfumbom Kfutwah
- Laboratory of Virology, Centre Pasteur Cameroun, Yaoundé 00237, Cameroon.
| | - Johannes Hermann
- Institute of Nutritional Sciences, University of Giessen, Giessen D-35392, Germany.
| | - Marcel Azabji-Kenfack
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé 00237, Cameroon.
| | - Michael B Krawinkel
- Institute of Nutritional Sciences, University of Giessen, Giessen D-35392, Germany.
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Capili B, Anastasi JK, Chang M, Ogedegbe O. Barriers and facilitators to engagement in lifestyle interventions among individuals with HIV. J Assoc Nurses AIDS Care 2014; 25:450-7. [PMID: 24630628 DOI: 10.1016/j.jana.2014.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 01/15/2014] [Indexed: 01/17/2023]
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Abstract
HIV-associated lipodystrophy syndrome (HALS), comprising metabolic and morphological alterations, is a known side effect of highly active antiretroviral therapy (HAART). Evidence for the role of nutrition in the management of the systemic parameters of HALS is currently limited. In the present paper we review the current knowledge base surrounding HALS, focusing particularly on the role of nutrition in mitigating the systemic parameters of the syndrome. Reported prevalence of HALS was found to vary from 9 to 83 % due to lack of a standardised definition, as well as variations in assessment methods and in the study population used. HALS is associated with both morphological (lipoatrophy, lipohypertrophy) and metabolic (dyslipidaemia, glucose intolerance, diabetes, hypertension, endothelial dysfunction and atherosclerosis) alterations, which may occur singly or in combination, and are associated with an increased risk of CVD. HAART-induced adipocyte inflammation, oxidative stress and macrophage infiltration, as well as altered adipocyte function and mitochondrial toxicity, have been shown to be central to the development of HALS. The adipocyte, therefore, represents a plausible target for treatment. Pharmacological and surgical treatment interventions have shown effect. However, their use is associated with numerous adverse effects and complications. Targeted lifestyle interventions may provide a useful alternative for managing HALS owing to their safety and tolerability. A Mediterranean-style diet has been found to be effective in improving the systemic parameters of HALS. Furthermore, the effects of n-3 PUFA supplementation are encouraging and future randomised controlled trials investigating the beneficial effects of n-3 PUFA in HALS are justified.
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Bansah AK, Holben DH, Basta T. Food Insecurity is Associated with Household Utility Insecurity among Individuals Living with HIV/AIDS in Rural Appalachia. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2013. [DOI: 10.1080/19320248.2013.786662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Botros D, Somarriba G, Neri D, Miller TL. Interventions to address chronic disease and HIV: strategies to promote exercise and nutrition among HIV-infected individuals. Curr HIV/AIDS Rep 2013; 9:351-63. [PMID: 22933247 DOI: 10.1007/s11904-012-0135-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Food insecurity, micronutrient deficits, dyslipidemia, insulin resistance, obesity, cardiovascular disease, and bone disorders complicate the treatment of HIV infection. Nutrition and exercise interventions can be effective in ameliorating these symptoms that are associated with HIV and antiretroviral therapy (ART). In this literature review, we examine the most recent nutrition and exercise interventions for HIV-infected patients. Macronutrient supplementation can be useful in treating malnutrition and wasting. Multivitamin (vitamin B complex, vitamin C, and vitamin E) supplements and vitamin D may improve quality of life and decrease morbidity and mortality. Nutritional counseling and exercise interventions are effective for treating obesity, fat redistribution, and metabolic abnormalities. Physical activity interventions improve body composition, strength, and fitness in HIV-infected individuals. Taken collectively, the evidence suggests that a proactive approach to nutrition and physical activity guidance and interventions can improve outcomes and help abrogate the adverse metabolic, cardiovascular, and psychological consequences of HIV and its treatments.
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Affiliation(s)
- Diana Botros
- Division of Pediatric Clinical Research, Department of Pediatrics (D820), University of Miami, Miller School of Medicine, Batchelor Children's Research Institute, PO Box 016820, Miami, FL 33101, USA.
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Trepka MJ, Niyonsenga T, Maddox L, Lieb S, Lutfi K, Pavlova-McCalla E. Community poverty and trends in racial/ethnic survival disparities among people diagnosed with AIDS in Florida, 1993-2004. Am J Public Health 2013; 103:717-26. [PMID: 23409892 DOI: 10.2105/ajph.2012.300930] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We described the racial/ethnic disparities in survival among people diagnosed with AIDS in Florida from 1993 to 2004, as the availability of highly active antiretroviral therapy (HAART) became widespread. We determined whether these disparities decreased after controlling for measures of community-level socioeconomic status. METHODS We compared survival from all causes between non-Hispanic Blacks and non-Hispanic Whites vis-a-vis survival curves and Cox proportional hazards models controlling for demographic, clinical, and area-level poverty factors. RESULTS Racial/ethnic disparities in survival peaked for those diagnosed during the early implementation of HAART (1996-1998) with a Black-to-White hazard ratio (HR) of 1.72 (95% confidence interval [CI] = 1.62, 1.83) for males and 1.40 (95% CI = 1.24, 1.59) for females. These HRs declined significantly to 1.48 (95% CI = 1.35, 1.64) for males and nonsignificantly to 1.25 (95% CI = 1.05, 1.48) for females in the 2002 to 2004 diagnosis cohort. Disparities decreased significantly for males but not females when controlling for baseline demographic factors and CD4 count and percentage, and became nonsignificant in the 2002 to 2004 cohort after controlling for area poverty. CONCLUSIONS Area poverty appears to play a role in racial/ethnic disparities even after controlling for demographic factors and CD4 count and percentage.
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Affiliation(s)
- Mary Jo Trepka
- Department of Epidemiology and Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA.
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Purnomo J, Jeganathan S, Begley K, Houtzager L. Depression and dietary intake in a cohort of HIV-positive clients in Sydney. Int J STD AIDS 2012; 23:882-6. [DOI: 10.1258/ijsa.2012.012017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This cross-sectional study aimed to compare dietary intake in people living with HIV (PLHIV) experiencing symptoms of depression with those not reporting depression. The Centre for Epidemiologic Studies Depression Scale (CES-D10) was used to classify the risk of depression. Dietary nutrient intake was determined using the diet history and food frequency questionnaire. Depressed ( n = 21) compared with non-depressed ( n = 37) subjects had significantly lower mean intake of fibre (16.1 versus 25.4 g/day), vitamin A (801.5 versus 1524.8 mg/day), magnesium (299.8 versus 380.0 mg/day) and folate (264.8 versus 402.9 μg/day). The proportion of subjects achieving the recommended intake of these nutrients, with the exception of folate was also found to be lower in the depressed group compared with non-depressed group. The study found that depressive symptomatology in PLHIV was associated with poorer dietary nutrient intake. A multidisciplinary model of care that includes a nutrition assessment is recommended for the management of PLHIV with depression to reduce the risk of associated nutritional problems.
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Affiliation(s)
- J Purnomo
- The Albion Centre, Prince of Wales Hospital, Sydney
| | - S Jeganathan
- The Albion Centre, Prince of Wales Hospital, Sydney
| | - K Begley
- The Albion Centre, Prince of Wales Hospital, Sydney
- Department of Psychology, Macquarie University, Sydney
| | - L Houtzager
- The Albion Centre, Prince of Wales Hospital, Sydney
- School of Molecular and Microbial Biosciences, University of Sydney, Sydney
- Faculty of Health, University of Canberra, Canberra, Australia
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Yager JE, Kadiyala S, Weiser SD. HIV/AIDS, food supplementation and livelihood programs in Uganda: a way forward? PLoS One 2011; 6:e26117. [PMID: 22022530 PMCID: PMC3192151 DOI: 10.1371/journal.pone.0026117] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 09/19/2011] [Indexed: 11/18/2022] Open
Abstract
Background Over the last decade, health, nutrition and policy experts have become increasingly aware of the many ways in which food insecurity and HIV infection negatively impact and reinforce one another. In response, many organizations providing HIV care began supplying food aid to clients in need. Food supplementation, however, was quickly recognized as an unsustainable and incomplete intervention. Many HIV care organizations therefore developed integrated HIV and livelihood programs (IHLPs) to target the root causes of food insecurity. Methods and Findings We conducted a qualitative study using in-depth interviews with 21 key informants who worked at seven organizations providing HIV care, food aid, or IHLPs in Kampala, Uganda in 2007-2008 to better understand the impact of IHLPs on the well-being of people living with HIV and AIDS (PLWHAs) and the challenges in transitioning clients from food aid to IHLPs. There was strong consensus among those interviewed that IHLPs are an important intervention in addressing food insecurity and its adverse health consequences among PLWHAs. Key informants identified three main challenges in transitioning PLWHAs from food supplementation programs to IHLPs: (1) lack of resources (2) timing of the transition and (3) logistical considerations including geography and weather. Factors seen as contributing to the success of programs included: (1) close involvement of community leaders (2) close ties with local and national government (3) diversification of IHLP activities and (4) close integration with food supplementation programs, all linked through a central program of HIV care. Conclusion Health, policy and development experts should continue to strengthen IHLPs for participants in need. Further research is needed to determine when and how participants should be transitioned from food supplementation to IHLPs, and to determine how to better correlate measures of food insecurity with objective clinical outcomes so as to better evaluate program results.
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Affiliation(s)
- Jessica E Yager
- Department of Medicine, Division of Infectious Diseases, University of Washington, Seattle, Washington, United States of America.
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Anjos EMD, Pfrimer K, Machado AA, Cunha SFDC, Salomão RG, Monteiro JP. Nutritional and metabolic status of HIV-positive patients with lipodystrophy during one year of follow-up. Clinics (Sao Paulo) 2011; 66:407-10. [PMID: 21552663 PMCID: PMC3071999 DOI: 10.1590/s1807-59322011000300007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Accepted: 11/17/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The aim of this prospective study was to compare changes in lipid metabolism and nutritional status after either 6 and 12 months of follow-up in subjects with lipodystrophy syndrome after traditional lifestyle therapy with or without fibric acid analogue intervention (bezafibrate and clofibrate). METHODS Food intake, alterations in body composition and metabolic abnormalities were assessed in subjects with lipodystrophy syndrome at the beginning of the study. The nutritional status and metabolic alterations of the subjects were monitored, and the subjects received nutritional counseling each time they were seen. The subjects were monitored either two times over a period no longer than six months (Group A; n = 18) or three times over a period of at least 12 months (Group B; n = 35). All of the subjects underwent nutrition counseling that was based on behavior modification. The fibric acid analogue was only given to patients with serum triglyceride levels above 400 mg/dL. RESULTS After six months of follow-up, Group A showed no alterations in the experimental parameters. After twelve months, there was a decrease in serum triglyceride levels (410.4 ± 235.5 vs. 307.7 ± 150.5 mg/dL, p < 0.05) and an increase in both HDLc levels (37.9 ± 36.6 vs. 44.9 ± 27.9 mg/dL, p,0.05) and lean mass (79.9 ± 7.8 vs. 80.3 ± 9.9 %, p < 0.05) in Group B. CONCLUSION After one year of follow-up (three sessions of nutritional and medical counseling), the metabolic parameters of the subjects with lipodystrophy improved after traditional lifestyle therapy with or without fibric acid analogue intervention.
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Affiliation(s)
- Eloísa Marchi Dos Anjos
- Department of Pediatrics, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Georgiou NA, Garssen J, Witkamp RF. Pharma-nutrition interface: the gap is narrowing. Eur J Pharmacol 2010; 651:1-8. [PMID: 21114994 DOI: 10.1016/j.ejphar.2010.11.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 11/03/2010] [Accepted: 11/04/2010] [Indexed: 12/29/2022]
Abstract
The interaction between pharmacology and nutrition science is on the rise. Nutritional status is considered one of the important determinants of health and disease and several diseases of our time have a clear link with lifestyle factors including the diet. There is also increasing realization that a continuum between health and disease often exists without strict boundaries. Understanding the subtle interactions between genes, environment and homeostatic processes is the key in finding effective ways to prevent, treat or manage disease. Both pharmacologists and nutritionists are recognizing that most of the low hanging fruit has been picked, and that the one disease-one target-one drug (or nutrient) concept will provide fewer successes than it did in the past. Instead, complex multi-factorial diseases require multi-pathway understanding and multi-targeting approaches which will often result in compound combinations. Therapeutic synergy between foods and drugs does not necessarily mean that both have the same primary target. There are also examples of nutritional products that effectively contribute to the therapeutic regimen by improving the patients' general condition or by reducing side-effects of drugs. Examples of conditions and diseases that are highlighted in this review include the metabolic syndrome with its co-morbidities, immune-related diseases and HIV. With the aging population there are other fields emerging, including CNS-related diseases and cancer, where we will likely see an increased synergy between the two disciplines that seemed to have lost contact since the times of Hippocrates.
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Affiliation(s)
- Niki A Georgiou
- Danone Research, Centre for Specialised Nutrition, Wageningen, The Netherlands
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