CROI: High dietary fat and cholesterol contribute to serum lipid levels in people with HIV

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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

Glossary

cholesterol

A waxy substance, mostly made by the body and used to produce steroid hormones. High levels can be associated with atherosclerosis. There are two main types of cholesterol: low-density lipoprotein (LDL) or ‘bad’ cholesterol (which may put people at risk for heart disease and other serious conditions), and high-density lipoprotein (HDL) or ‘good’ cholesterol (which helps get rid of LDL).

triglycerides

A blood fat (lipid). High levels are associated with atherosclerosis and are a risk factor for heart disease.

 

p-value

The result of a statistical test which tells us whether the results of a study are likely to be due to chance and would not be confirmed if the study was repeated. All p-values are between 0 and 1; the most reliable studies have p-values very close to 0. A p-value of 0.001 means that there is a 1 in 1000 probability that the results are due to chance and do not reflect a real difference. A p-value of 0.05 means there is a 1 in 20 probability that the results are due to chance. When a p-value is 0.05 or below, the result is considered to be ‘statistically significant’. Confidence intervals give similar information to p-values but are easier to interpret. 

metabolism

The physical and chemical reactions that produce energy for the body. Metabolism also refers to the breakdown of drugs or other substances within the body, which may occur during digestion or elimination.

opportunistic infection (OI)

An infection that occurs more frequently or is more severe in people with weakened immune systems, such as people with low CD4 counts, than in people with healthy immune systems. Opportunistic infections common in people with advanced HIV disease include Pneumocystis jiroveci pneumonia; Kaposi sarcoma; cryptosporidiosis; histoplasmosis; other parasitic, viral, and fungal infections; and some types of cancer. 

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, p10%/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.”

References

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.