Background: Dyslipidemia, defined as abnormal concentrations of serum lipid and lipoprotein concentrations, is prevalent in the Human Immunodeficiency Virus (HIV)-infected population. This condition is caused by the virus, antiretroviral drugs, and traditional risk factors. Public health is concerned with dyslipidemia due to its proatherogenic properties, the rising number of cardiac events in this population, permanence of viral infection, and use of pharmacological treatments necessary to sustain life. Lifestyle interventions, such as diet are recommended for initial treatment and prevention of dyslipidemia, yet few studies have measured dietary intake against the accepted dietary guidelines.
Objective: This study sought to examine determinants of dyslipidemia, assess dietary intake of macromolecules that comprise a diet to control plasma lipid concentrations and maintain an ideal plasma lipid profile, identify correlates with macromolecule intake, and measure association of individual macromolecules with dyslipidemia.
Methods: This sample comprised a national representation of persons living with HIV in the United States (US) measured in the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2012. Only persons with results from validated laboratory tests used to obtain HIV status and dyslipidemia status were included in the study. Subject’s daily dietary intake was compared to the guidelines of the therapeutic lifestyle changes diet in the Third Report of the National Cholesterol and Education Program on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adults Treatment Panel III) [NCEP/ATP III]. Diet was collected through one self-reported 24-hour recall of the previous day’s food consumption. Recalled foods were entered into a database to calculate daily dietary intake of macromolecules. Chi-square tests examined statistically significant differences in the proportion of dyslipidemics across subjects’ demographics. Crude logistic regression models measured the effect of every 10% increase in the natural log of daily intake of a macromolecule on odds of dyslipidemia. Missing data were excluded from analyses.
Results: Of the 37 subjects that met inclusion criteria, 52.3% were dyslipidemic, and the majority were overweight, male, non-Hispanic black, and not taking antiretroviral agents. Average age was 37.1 years (±1.3). Statistically significant differences in the proportion of dyslipidemics were observed for race-ethnicity (p=0.01) and antiretroviral drug use (p=0.04). Sex was marginally significant (p=0.06). Results of dietary analyses represent 32 of the 37 subjects, and macromolecules with caloric value were reported as percentage of total energy intake. Overall, subjects met dietary guidelines for total fat (30.1%, ±1.5), monounsaturated fat (10.9%, ±0.7), polyunsaturated fat (6.1%, ±0.4), protein (15.5%, ±1.1), and carbohydrate (48.2, ±2.2), exceeded guidelines for cholesterol (255.5 mg, ±25.7) and saturated fat (9.5%, ±0.7), and did not meet guidelines for fiber (13.0 g, ±1.7) and fruit and vegetable intake (beta-carotene=0.9 g, ±0.3). When distinguishing by dyslipidemia status, daily dietary intakes were met, and similar, for most macromolecules; however, daily dietary intake of cholesterol for those without dyslipidemia was less compared to those with dyslipidemia (227.2 mg, ±41.3 and 287.7 mg, ±30.7, respectively). Use of antiretroviral drugs [odds ratio (OR) = 5.16, 95% confidence interval (CI) = 1.016, 26.25) and not identifying as non-Hispanic black [OR = 7.11, 95% CI = 1.51, 33.37) significantly increased odds of dyslipidemia. Each crude model for macromolecules of the therapeutic lifestyle changes diet indicated that all were insignificant predictors of dyslipidemia (p >0.05).
Conclusions: Dyslipidemia is prevalent in the HIV-infected population. Subjects' demographics were associated with dyslipidemia status, while dietary factors were not. Compared to dietary guidelines in the therapeutic lifestyle changes diet of NCEP/ATP III, subjects with and without dyslipidemia met daily dietary for most of macromolecules. Those infected with HIV, regardless of dyslipidemia status, consume an insufficient daily quantity of fiber and fruits and vegetables, while exceeding daily dietary intakes for saturated fat and cholesterol. However, the large difference in cholesterol intake among those with and without dyslipidemia may implicate this macromolecule as a factor altering plasma lipid and lipoprotein levels. Targeting dietary intervention to antiretroviral users and all other race-ethnicities aside from non-Hispanic black, and stressing adequate intakes of fiber, cholesterol, and fruit and vegetables may alleviate the increased risk of dyslipidemia . This study was the first to assess diet utilizing cross-sectional data of a representative sample of those with HIV residing in the US. Validity of dietary recall is limited due to misreporting, and one 24-hour recall may not reflect typical dietary intakes of macromolecules. Due to the small sample size, estimates that measure associations of factors related to dyslipidemia status were calculated with less than ideal precision and may be unstable. Future studies recruiting a larger sample size, while still representative of the target population, are needed to assess the therapeutic lifestyle changes diet on plasma lipid and lipoprotein concentrations, and to measure if dietary intakes differ among sub-populations of those living with HIV.