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People With HIV Infection Eat Too Much Saturated Fat
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Mark Mascolini
February 27, 2007
14th Conference on Retroviruses and Opportunistic Infections
Los Angeles
Most protease inhibitors, some nucleosides, and HIV itself get blamed for out-of-line lipids, but Harvard researchers found another problem in a case-control study: People with HIV get too many calories from saturated fat.
Comparing 356 HIV-infected people with 162 healthy controls, Hester Keogh and colleagues found that marginally more people in the HIV group were taking lipid-lowering drugs (12.1% versus 9.9%, P = 0.18) and had significantly lower CD4 counts (average 444 versus 871 cells, P < 0.0001). Infected study participants had HIV for an average 8.5 years, and two thirds were taking a protease inhibitor. The researchers determined dietary intake from 4-day food records and diet history.
HIV "cases" and non-HIV "controls" had similar proportions of men (55.3% of cases, 45.1% of controls) and women (44.7% of cases, 54.9% of controls), whites (56.3% of cases, 61.1% of controls), African Americans (28.4% of cases, 25.3% of controls), and Hispanics (9.9% of cases, 6.2% of controls). Income quartiles correlated in the two groups, and the average age was 41 to 42 years.
People without HIV infection had bigger appetites than infected people, downing an average 2235 kcal per day versus 2065 in the HIV group, a difference that fell just short of statistical significance (P = 0.08). The non-HIV group did consume significantly more fat than HIV-infected people (87 versus 79 grams/day, P = 0.02), including more saturated fat (31 versus 27 grams/day, P = 0.004), and monounsaturated fat (33 versus 30 grams/day, P = 0.04). The non-HIV group also munched marginally more trans fats (5 versus 3 grams/day, P = 0.09) and ingested significantly more cholesterol (342 versus 294 mg/day, P = 0.004). People with HIV drank significantly more alcohol than controls (7 versus 3 grams/day, P = 0.02).
Because HIV-infected people consumed fewer calories daily than the non-HIV group, they got significantly more calories from saturated fatty (P = 0.002) and trans fats (P = 0.02) and marginally more calories from monounsaturated fat (P = 0.11). Furthermore, significantly more HIV-infected people exceeded 2005 USDA daily recommendations for saturated fat (P = 0.003) and cholesterol (P = 0.04), and marginally more people with HIV exceeded guidelines for total fat (P = 0.10). Statistical analysis tied saturated fat intake in the HIV group to higher triglycerides (P = 0.005). Male gender correlated with a higher triglyceride reading (P = 0.001).
Although non-HIV controls had significantly thicker hips (average 107.4 versus 99.8 cm, adjusted P = 0.02), slimmer waists in the HIV group meant they had a wider average waist-to-hip ratio (0.95 versus 0.90, adjusted P < 0.0001). Visceral-to-subcutaneous adipose tissue ratio also proved significantly higher in the HIV group (0.82 versus 0.43, adjusted P = 0.002). As earlier studies found, arm and leg fat was significantly lower in the HIV group than in non-HIV controls (8.3 versus 12.4 kg, adjusted P = 0.0008), and people with HIV also had a significantly higher trunk-to-extremity fat ratio (1.5 to 1.0, adjusted P < 0.0001).
HIV-infected people had significantly worse average total cholesterol (196 versus 178 mg/dL, adjusted P = 0.003), triglycerides (230 versus 130 mg/dL, adjusted P < 0.0001), "good" high-density lipoprotein cholesterol (41 versus 48 mg/dL, adjusted P < 0.0001), glucose area under the curve (16,980 versus 15,224 mg/dL x 120 min, adjusted P = 0.02), and fasting insulin (13 versus 12 microIU/mL, adjusted P = 0.03). Significantly more people with HIV met criteria for the metabolic syndrome (32.3% versus 22.1%, adjusted P = 0.02).
The Harvard researchers concluded that overindulgence in saturated fats contributes to high triglycerides in people with HIV who have other metabolic abnormalities. They urged clinicians to target saturated fat intake when modifying diets in people with HIV.
Reference
1. Keogh H, Joy T, Hadigan C, et al. Increased fat and cholesterol intake and relationship to serum lipid levels among HIV-infected patients in the current era of HAART. 14th Conference on Retroviruses and Opportunistic Infections. February 25-28, 2007. Los Angeles. Abstract 813.
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