Dietary Patterns and Physical Activity Correlate With Total Cholesterol Independently of Lipid-Lowering Drugs and Antiretroviral Therapy in Aging People Living With Human Immunodeficiency Virus

Abstract

Background: Hypercholesterolemia is a well established risk factor for coronary heart disease and is highly prevalent among human immunodeficiency virus (HIV)-positive persons. Antiretroviral therapy (ART) can both directly modify total cholesterol and have drug-drug interactions with statins. This makes investigating modifiable behavioral predictors of total cholesterol a pertinent task.

Methods: To explore the association between diet and physical activity with cross-sectionally measured total cholesterol, we administered a validated Food-Frequency-Questionnaire to participants of the Swiss HIV Cohort Study ≥45 years old. Linear mixed-effects models were applied to explore the associations between dietary patterns and physical activity with total cholesterol, after adjustment for clinical and demographic covariates.

Results: In total, 395 patients were included. Forty percent (158 of 395) had elevated total cholesterol (>5.2 mmol/L), and 41% (164 of 395) were not regularly physically active. In multivariable analysis, 2 factors were positively associated with total cholesterol; female sex (β = 0.562; 95% confidence interval [CI], 0.229-0.896) and the combined consumption of meat, refined/milled grains, carbonated beverages, and coffee (β = 0.243; 95% CI, 0.047-0.439). On the other hand, regular physical activity (β = -0.381; 95% CI, -0.626 to -0.136), lipid-lowering drugs (β = -0.443; 95% CI -0.691 to -0.196), ART containing tenofovir (β = -0.336; 95% CI -0.554 to -0.118), and black ethnicity (β = -0.967; 95% CI -1.524 to -0.410) exhibited a negative association.

Conclusions: We found independent associations between certain dietary patterns and physical activity with total cholesterol. Increasing physical activity might achieve cardiovascular and other health benefits in HIV-positive individuals. The clinical relevance of the identified dietary patterns requires further investigation in prospective cohort studies and randomized controlled trials.

Keywords: HIV; aging; diet; physical activity; total cholesterol.

Figure 1.

Four main dietary patterns as determined by hierarchical clustering.

Figure 2.

Correlation matrix of the examined food items. Squares with “X” are not statistically significant after adjustment for multiple testing.

Figure 3.

Boxplot of total daily consumption stratified by dietary patterns. Pattern I: meat, refined/milled grains, carbonated beverages, coffee. Pattern II: organ meats, poultry, fish/seafood, alcohol. Pattern III: whole grains, dairy products, eggs, leafy green vegetables, other vegetables (raw and cooked), legumes/nuts/seeds, potatoes, boiled/mashed, pickled food, fruits, tea (black/green). Pattern IV: pizza, deep fried foods, salty snacks, ice cream/pudding, desserts/sweet snacks, confectionary sugars/syrups, fruit juice/drinks.

Figure 4.

Factors that correlate with total cholesterol, univariable and 2 linear mixed-effect models. Model I was adjusted for all the covariates in the figure. Model II was adjusted for all covariates in the figure and additionally for ethnicity, university education, living alone, smoking, depression, diabetes, hypertension, number of years on antiretroviral therapy, recent dietary change, multivitamin supplement, Omega 3 supplement, protein powder supplement. Dietary patterns consumption frequencies were ln(x+1) transformed. Pattern I: meat, refined/milled grains, carbonated beverages, coffee. Pattern II: organ meats, poultry, fish/seafood, alcohol. Pattern III: whole grains, dairy products, eggs, leafy green vegetables, other vegetables (raw and cooked), legumes/nuts/seeds, potatoes, boiled/mashed, pickled food, fruits, tea (black/green). Pattern IV: pizza, deep fried foods, salty snacks, ice cream/pudding, desserts/sweet snacks, confectionary sugars/syrups, fruit juice/drinks. Abbreviations: ART, antiretroviral therapy; HET, heterosexual; IDU, injecting drug users; INTI, integrase inhibitor; MSM, men who have sex with men; NNRTI, nonnucleoside reverse-transcriptase inhibitor; NRTI, nucleoside reverse-transcriptase inhibitor; NTRTI, nucleotide reverse-transcriptase inhibitor; PI, protease inhibitor.