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CROI: High dietary fat and cholesterol contribute to serum lipid levels in people with HIV
Derek Thaczuk, Friday, March 09, 2007
High dietary levels of saturated fats contribute significantly to elevated blood levels of lipids and cholesterol among HIV-positive individuals, according to a study presented at the Fourteenth Conference on Retroviruses and Opportunistic Infections in Los Angeles last week.

The study, conducted through the Massachusetts General Hospital, Harvard Medical School, and US National Institutes of Health, investigated the relationship between dietary composition and metabolic parameters in HIV-positive participants and HIV-negative controls. Participants were recruited at Massachusetts General Hospital between 1998 and 2005: 356 HIV-positive participants and 162 HIV-negative controls were enrolled.

The HIV-positive and HIV-negative groups were demographically similar (average age 42 vs. 41 years, 56.3% vs. 61.1% Caucasian, 55.3% vs. 45.1% male). Compared to the controls, HIV-positive participants had higher mean triglyceride levels (230 vs. 130 mg/dl, p<0.0001), lower HDL cholesterol levels (41 vs. 48 mg/dl, p<0.0001), more peripheral lipoatrophy (total extremity fat, 8.3 vs. 12.4 kg, p=0.0008) and higher fasting insulin levels (13 vs. 12 μIU/ml, p=0.03).

The HIV-positive group had average CD4 cell counts of 444 cells/mm3, viral loads of 400 copies/ml, and duration of HIV infection of 8.5 years; 88.8% were taking antiretrovirals.

Participants reported the specifics of their food intake through four-day diaries and 24-hour recall. Overall caloric intake was roughly similar between the groups (2,235 vs. 2,065 kilocalories/day, HIV-positive vs. HIV-negative), as were the levels of dietary carbohydrates and proteins.

However, the dietary fats varied significantly: compared to controls, HIV-positive participants had higher levels of total dietary fat (87 vs. 79 g/day, p<0.05), saturated fat (31 vs. 27 g/day, p=0.006), and cholesterol (342 vs. 294 g/day, p=0.006) as well as a greater percentage of calories from saturated fat (p=0.002) and from trans fat (p=0.02). Significantly more HIV-positive people consumed more than the 2005 USDA Recommended Dietary Guidelines for saturated fat (>10%/day: 76.0% vs. 60.9%, p=0.003), and cholesterol (> 300 mg/day: 49.7% vs. 37.9%, p=0.04).

Elevated blood triglyceride levels were strongly associated with the dietary levels of saturated fat in HIV-positive participants. While a great deal of research has focused on HIV infection and antiretroviral use as factors in blood fat and cholesterol levels in people with HIV, this research team concluded that “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.”

Reference
Keogh H et al. Increased fat and cholesterol intake and relationship to serum lipid levels among HIV-infected patients in the current era of HAART. Fourteenth Conference on Retroviruses and Opportunistic Infections, Los Angeles, abstract 813, 2007.