Dietary intake is associated with neuropsychological impairment in women with HIV

Abstract

Background: Diet is a modifiable risk factor that may influence cognition in people with HIV.

Objectives: We examined the association between dietary intake and cognition in women with HIV (WWH) and HIV-seronegative women.

Methods: An 18-item dietary National Cancer Institute screener was completed by 729 WWH and 346 HIV-seronegative Women's Interagency HIV Study participants. Daily intake frequencies of processed meats, sweet beverages, fish, whole milk, and vegetables were calculated. Participants completed biennial neuropsychological (NP) testing. NP domains included attention/working memory, executive function, processing speed, memory, learning, fluency, and motor function. NP impairment was defined as demographically adjusted T-scores (mean = 50; SD = 10) ≤40 at ≥1 visit after completing the dietary screener. Multivariable logistic regression, stratified by HIV serostatus, examined associations between intake frequency tertile (referent = lowest intake) and NP performance.

Results: Dietary intake frequencies of individual food line items were similar between WWH and HIV-seronegative women, except for sweet beverages, for which HIV-seronegative women reported higher intake frequencies than WWH (P values < 0.05). In WWH, multivariable-adjusted models indicated higher odds of NP impairment with higher intake frequencies of processed meat [P = 0.006; ORupper tertile = 1.91 (95% CI: 1.23-2.95; P = 0.003); ORmiddle tertile = 1.66 (95% CI: 1.14-2.42; P = 0.01)], sweet beverages [P = 0.02; ORupper tertile = 1.75 (95% CI: 1.17-2.64; P = 0.007)], fish [P = 0.01; ORupper tertile = 1.70 (95% CI: 1.10-2.64; P = 0.02)], and whole milk [P = 0.029; ORupper tertile = 1.66 (95% CI: 1.14-2.42; P = 0.008)]. Lower odds of NP impairment [P = 0.005; ORupper tertile = 0.65 (95% CI: 0.45-0.95; P = 0.02); ORmiddle tertile = 0.42 (95% CI: 0.24-0.73; P = 0.002)] were associated with higher vegetable intakes. In HIV-seronegative women, multivariable-adjusted models did not show associations between food line items/diet quality score and NP outcomes.

Conclusions: Intakes of processed meat, sweet beverages, whole milk, fish, and vegetables may be associated with NP functions among WWH. Associations among WWH are not directly comparable to those among HIV-seronegative women, because models were conducted on each group separately given controls for HIV-specific covariates in WWH. Further studies are needed using more rigorous dietary assessment methods and lengthier longitudinal follow-ups.

Keywords: HIV; cohort studies; diet; food; neuropsychological assessment; nutrition; risk factors in epidemiology.

FIGURE 1

Dietary intake frequencies of (A) processed meats, (B) sweet beverages, (C) fish, (D) whole milk, and (E) vegetables and the odds of subsequent 2–4-year NP impairment among women with HIV (n = 729). *P < 0.05; **P < 0.01; ***P < 0.001; †P = 0.06; ‡P = 0.07; ¤ P = 0.08; þ P = 0.09. Multivariable logistic regression models were adjusted for: clinic site; annual household income; CES-D score ≥ 16; recent tobacco, marijuana, crack, cocaine, and/or heroin use; and HIV-specific clinical factors [history of any prior AIDS-defining illness, current CD4+ T-cell count (cells/mL), and years on ART]. Abbreviations: ART, antiretroviral therapy; CES-D, Center for Epidemiology Studies, Depression; NP, neuropsychological; PS, processing speed; WM, working memory.

FIGURE 2

Diet quality score (higher score denoting less quality) and odds of subsequent 2–4-year NP impairment among (A) WWH (n = 729) and (B) HIV-seronegative women (n = 346). *P < 0.05; **P < 0.01; †P = 0.08. Multivariable logistic regression models were adjusted for: clinic site; annual household income; CES-D score ≥ 16; recent tobacco, marijuana, crack, cocaine, and/or heroin use; and, among WWH only, HIV-specific clinical factors [history of any prior AIDS-defining illness, current CD4+ T-cell count (cells/mL), and years on ART]. Abbreviations: ART, antiretroviral therapy; CES-D, Center for Epidemiology Studies, Depression; NP, neuropsychological; PS, processing speed; WM, working memory; WWH, women with HIV.