By Michael Smith, North American Correspondent, MedPage Today
Published: March 05, 2012
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston.
The right diet can prevent the weight gain, fat changes, and dyslipidemia associated with treatment for HIV, researchers reported.
In a prospective randomized trial, patients who followed a diet aimed at reducing total and low-density lipoprotein cholesterol avoided the changes often linked to highly active anti-retroviral therapy (HAART), according to Jorge Ribeiro, MD, SCD, and colleagues at the Hospital de Clínicas de Porto Alegre in Porto Alegre, Brazil.
After a year of follow-up, just 21% of those in the diet group had a lipid profile compatible with dyslipidemia, compared with 68% of the control group, Ribeiro and colleagues reported in the March 13 issue of the Journal of the American College of Cardiology.
The study is the first to try to isolate the effect of diet in people just starting HAART, the researchers said. Previous controlled studies, looking at diet and exercise together in people already on treatment, found little benefit, they noted.
"These findings indicate that nutritional intervention should be considered for all patients who start HAART," the researchers concluded.
Ribeiro and colleagues analyzed outcomes for 81 patients who started treatment from March 2004 to April 2006. All were asked about their current diet during assessment for the study, and after entry all were given dietary counseling.
Those in the diet group, however, were given more detailed instruction, including individualized diets with 25% of the total calories in lipids, 15% in proteins, and 60% in carbohydrates, including 30 g/day of fiber and 200 mg dietary cholesterol.
They also got nutritional guidance, based on the National Cholesterol Education Program, from a registered dietitian four times during the year-long trial.
Analysis showed:
- Nine of the 38 patients analyzed in the diet group had alterations in their lipid profile compatible with dyslipidemia, compared with 26 of the 43 in the control group.
- The diet reduced the percentage of calories from fat from 31% on average to 21%, but there was no change among controls.
- Total cholesterol was unchanged in the diet group, but rose from 151 to 190 mg/dL among controls.
- Similarly, low-density lipoprotein cholesterol levels were unchanged among those on the diet, but increased by a mean of 85 to 106 mg/dL among controls.
- Plasma triglycerides were reduced by diet from 135 to 101 mg/dL on average, but increased from 134 to 160 mg/dL among controls.
- Body mass index was stable in the diet group, but increased among those in the control group, from 23.2 to 26.2, by the end of the trial.
- All the differences were significant at P<0.001.
The researchers cautioned that the study did not have an exercise component, so the findings don't eliminate the possibility that a broader intervention might have different results.
The lipid changes that were observed are clinically relevant, according to James Stein, MD, of the University of Wisconsin School of Medicine and Public Health in Madison, Wisc.
The 15% difference between the groups in total cholesterol "would be expected" to yield a long-term reduction in the risk of cardiovascular disease of about 25% to 30%, Stein said in an accompanying editorial.
But he noted that all participants at the start of the study consumed markedly more total cholesterol than a typical American, which might have "accentuated the reductions" among those who started the diet.
Nonetheless, he argued, the findings are "an important addition to the literature and re-emphasize that dietary interventions can be as effective as low-dose statin therapy for preventing and treating dyslipidemia associated with HAART."
The study had support from the Brazilian National Council for Scientific and Technological Development, the Rio Grande do Sul Research Foundation, and the Fund for Incentive in Research of the Hospital de Clínicas de Porto Alegre.
The journal said the authors reported that they have no relevant relationships to disclose.
The journal said Stein reported being on data and safety monitoring committees for Abbott, Lilly, and Takeda.
Primary source: Journal of the American College of Cardiology
Source reference:
Lazzaretti RK, et al "Dietary intervention prevents dyslipidemia associated with highly active antiretroviral therapy in human immunodeficiency virus type 1–infected individuals: a randomized trial" J Am Coll Cardiol 2012; 59: 979–88.
Additional source: Journal of the American College of Cardiology
Source reference:
Stein JH "Nutritional therapy to prevent dyslipidemia in patients starting antiretroviral therapy for human immunodeficiency virus" J Am Coll Cardiol 2012; 59: 989-990.
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