Dietary fat intake and relationship to serum lipid levels in HIV-infected patients with metabolic abnormalities in the HAART era

Abstract

Objective: To evaluate dietary intake and its relationship to lipid parameters in HIV-infected patients with metabolic abnormalities.

Method: We prospectively determined dietary intake (4-day food records or 24-h recall) in 356 HIV-infected patients and 162 community-derived HIV-negative controls evaluated for metabolic studies between 1998-2005. Differences in dietary intake between HIV-infected patients and non-HIV-infected controls, in relation to the established 2005 USDA (United States Department of Agriculture) Recommended Dietary Guidelines, were determined. The relationship between dietary fat intake and serum lipid levels among HIV-infected individuals was also evaluated.

Results: Assessment of dietary intake in this group of HIV-infected patients demonstrated increased intake of total dietary fat (P < 0.05), saturated fat (P = 0.006), and cholesterol (P = 0.006) as well as a greater percentage of calories from saturated fat (P = 0.002) and from trans fat (P = 0.02), despite similar caloric intake to the control individuals. A significantly higher percentage of HIV-infected patients were above the 2005 USDA Recommended Dietary Guidelines for saturated fat (> 10%/day) (76.0% HIV vs. 60.9% controls, P = 0.003), and cholesterol (> 300 mg/day) (49.7% HIV vs. 37.9% controls, P = 0.04). Saturated fat intake was strongly associated with triglyceride level [triglyceride level increased 8.7 mg/dl (parameter estimate) per gram of increased saturated fat intake, P = 0.005] whereas total fat was inversely associated with triglyceride level [triglyceride level decreased 3.0 mg/dl (parameter estimate) per gram of increased total fat intake, P = 0.02] among HIV-infected individuals.

Conclusions: Increased intake of saturated fat is seen and contributes to hypertriglyceridemia among HIV-infected patients who have developed metabolic abnormalities. Increased saturated fat intake should be targeted for dietary modification in this population.

Figure 1A. A: Percentage of Total Calories From Macronutrients

Results are expressed as mean ± standard deviation. The white bar denotes HIV-infected subjects while the dark gray bar denotes non-HIV-infected controls. * p values for the differences between HIV-infected and control subjects derived from a mixed effects ANOVA model with adjustment for age, race, gender, BMI, insurance status, use of lipid-lowering agents, method of dietary assessment, and income quartile, with each study assigned a random effect B: Percentage of Total Calories from Fat Components Results are expressed as mean ± standard deviation. The white bar denotes HIV-infected subjects while the dark gray bar denotes non-HIV-infected controls. * p values for the differences between HIV-infected and control subjects derived from a mixed effects ANOVA model with adjustment for age, race, gender, BMI, insurance status, use of lipid-lowering agents, method of dietary assessment, and income quartile, with each study assigned a random effect Abbreviations: SFA, Saturated Fatty Acids; MUFA, Monounsaturated Fatty Acids; PUFA, Polyunsaturated Fatty Acids C: Percentage of Subjects Exceeding Recommended Dietary Guidelines‡ The white bar denotes HIV-infected subjects while the dark gray bar denotes non-HIV-infected controls. * p values for the differences between HIV-infected and control subjects derived from a mixed effects ANOVA model with adjustment for age, race, gender, BMI, insurance status, use of lipid-lowering agents, method of dietary assessment, and income quartile, with each study assigned a random effect ‡ based on the USDA Dietary Guidelines for Americans 2005[31]

Figure 1A. A: Percentage of Total Calories From Macronutrients

Results are expressed as mean ± standard deviation. The white bar denotes HIV-infected subjects while the dark gray bar denotes non-HIV-infected controls. * p values for the differences between HIV-infected and control subjects derived from a mixed effects ANOVA model with adjustment for age, race, gender, BMI, insurance status, use of lipid-lowering agents, method of dietary assessment, and income quartile, with each study assigned a random effect B: Percentage of Total Calories from Fat Components Results are expressed as mean ± standard deviation. The white bar denotes HIV-infected subjects while the dark gray bar denotes non-HIV-infected controls. * p values for the differences between HIV-infected and control subjects derived from a mixed effects ANOVA model with adjustment for age, race, gender, BMI, insurance status, use of lipid-lowering agents, method of dietary assessment, and income quartile, with each study assigned a random effect Abbreviations: SFA, Saturated Fatty Acids; MUFA, Monounsaturated Fatty Acids; PUFA, Polyunsaturated Fatty Acids C: Percentage of Subjects Exceeding Recommended Dietary Guidelines‡ The white bar denotes HIV-infected subjects while the dark gray bar denotes non-HIV-infected controls. * p values for the differences between HIV-infected and control subjects derived from a mixed effects ANOVA model with adjustment for age, race, gender, BMI, insurance status, use of lipid-lowering agents, method of dietary assessment, and income quartile, with each study assigned a random effect ‡ based on the USDA Dietary Guidelines for Americans 2005[31]

Figure 1A. A: Percentage of Total Calories From Macronutrients

Results are expressed as mean ± standard deviation. The white bar denotes HIV-infected subjects while the dark gray bar denotes non-HIV-infected controls. * p values for the differences between HIV-infected and control subjects derived from a mixed effects ANOVA model with adjustment for age, race, gender, BMI, insurance status, use of lipid-lowering agents, method of dietary assessment, and income quartile, with each study assigned a random effect B: Percentage of Total Calories from Fat Components Results are expressed as mean ± standard deviation. The white bar denotes HIV-infected subjects while the dark gray bar denotes non-HIV-infected controls. * p values for the differences between HIV-infected and control subjects derived from a mixed effects ANOVA model with adjustment for age, race, gender, BMI, insurance status, use of lipid-lowering agents, method of dietary assessment, and income quartile, with each study assigned a random effect Abbreviations: SFA, Saturated Fatty Acids; MUFA, Monounsaturated Fatty Acids; PUFA, Polyunsaturated Fatty Acids C: Percentage of Subjects Exceeding Recommended Dietary Guidelines‡ The white bar denotes HIV-infected subjects while the dark gray bar denotes non-HIV-infected controls. * p values for the differences between HIV-infected and control subjects derived from a mixed effects ANOVA model with adjustment for age, race, gender, BMI, insurance status, use of lipid-lowering agents, method of dietary assessment, and income quartile, with each study assigned a random effect ‡ based on the USDA Dietary Guidelines for Americans 2005[31]