Marianne de Oliveira Falco

Overweight and abdominal obesity in adults living with HIV/AIDS

OBJECTIVE To investigate the prevalence of overweight, abdominal obesity and associated factors in people living with HIV/AIDS (PLWHA). METHOD Cross-sectional study with 270 PLWHA. A questionnaire was applied to investigate sociodemographic, clinical and lifestyle characteristics. Weight, height and waist circumference were measured. BMI ≥25 kg/m2 was considered overweight, while abdominal obesity referred to waist circumference ≥102 cm for men and ≥88 cm for women. The authors used multiple Poisson regression with 5% significance level. RESULTS The prevalence of overweight and abdominal obesity was 33.7% and 12.6%, respectively, referring to 37.9% of women and 5.7% of men (p<0.001). Overweight was associated with age of 40-49 years and ≥50 years, non-use of ARV therapy, and lower tertile of consumption of risk foods. Abdominal obesity was associated with: female gender, age of 40-49 years and ≥50 years, income greater than four times the minimum wage, and CD4+ lymphocyte count >350 cells/mm3. CONCLUSION There was a high prevalence of overweight and abdominal obesity associated with sociodemographic and clinical conditions, and consumption of risk foods. This scenario indicates the need for reorientation of the health care focus in this population.

Terapia nutricional nas alterações metabólicas em pessoas vivendo com HIV/aids

OBJETIVO: Analizar el efecto del tratamiento nutricional sobre las alteraciones metabolicas provocadas por el uso de la terapia antirretroviral en adultos viviendo con VIH/Sida. METODOS: Revision sistematica de literatura en el PubMed, Lilacs y Cochrane, entre 1996 y 2010, del tipo ensayo clinico, controlado, aleatorio, crossover, adultos, viviendo con VIH/Sida en uso de terapia antirretroviral y sin enfermedades oportunistas. La intervencion de interes fue suplementacion nutricional via oral y/o cambio de estilo de vida por tratamiento dietoterapico especifico: dislipidemia, resistencia insulinica, lipodistrofia e hipertension arterial sistemica. Se utilizo la escala de Jadad para clasificacion cualitativa de los articulos. RESULTADOS: Se localizaron 385 articulos y siete fueron incluidos. Las intervenciones utilizadas en estos estudios fueron: dieta, dieta mas ejercicio fisico, dieta mas suplemento y solamente suplementos. Dislipidemia fue el resultado evaluado en todos los estudios. Los estudios que evaluaron suplementacion con omega 3 encontraron reduccion significativa de los trigliceridos. La dieta especifica mas suplementacion de omega 3 mostro aumento de HDL-colesterol. Suplementacion con nicotinato de cromo no tuvo efecto sobre la dislipidemia. La modificacion de estilo de vida, incluyendo dieta y actividad fisica, redujo significativamente la circunferencia de la cintura, lipodistrofia y presion arterial sistolica. CONCLUSIONES: La reduccion de trigliceridos por la suplementacion con omega 3 fue la intervencion nutricional con mayores evidencias cientificas. La prescripcion de dieta especifica parece ser la intervencion mas adecuada para aumentar HDL-colesterol. No es posible hacer inferencias sobre el tratamiento nutricional del colesterol total, LDL-colesterol y resistencia insulinica. Las modificaciones en el estilo de vida pueden promover mejoria de la lipodistrofia y presion arterial.OBJECTIVE To analyze the effect of nutritional treatment on metabolic changes caused by the use of antiretroviral therapy in adults with HIV/AIDS. METHODS A systematic review of literature was conducted in the PubMed, Lilacs and Cochrane databases, between 1996 and 2010, including crossover and randomized controlled clinical trials performed in adults with HIV/AIDS using antiretroviral therapy and without opportunistic diseases. The intervention of interest was oral nutritional supplementation and/or a change in lifestyle due to specific dietary treatment: dyslipidemia, insulin resistance, lipodystrophy and systemic arterial hypertension. The Jadad scale was used for a qualitative classification of articles. RESULTS A total of 385 articles were found, of which seven were included. The interventions used in these studies were as follows: diet, diet and physical exercises, diet and supplementation, and only supplementation. Dyslipidemia was the outcome assessed in all studies. Studies that assessed omega-3 supplementation found a significant reduction in triglycerides. The specific diet with omega-3 supplementation showed an increase in HDL-cholesterol. Chrome nicotinate supplementation did not have an effect on dyslipidemia. Changing ones lifestyle, including diet and physical activity, significantly reduced waist circumference, lipodystrophy and systolic blood pressure. CONCLUSIONS Reduction in tryglicerides with omega-3 supplementation was the nutritional intervention with the strongest scientific evidence. Prescribing a specific diet appeared to be the most adequate intervention to increase HDL-cholesterol. Inferences could not be made about the nutritional treatment of total cholesterol, LDL-cholesterol and insulin resistance. Changes in lifestyle can promote an improvement in lipodystrophy and blood pressure.

Nutritional therapy in metabolic changes in individuals with HIV/AIDS

OBJETIVO: Analizar el efecto del tratamiento nutricional sobre las alteraciones metabolicas provocadas por el uso de la terapia antirretroviral en adultos viviendo con VIH/Sida. METODOS: Revision sistematica de literatura en el PubMed, Lilacs y Cochrane, entre 1996 y 2010, del tipo ensayo clinico, controlado, aleatorio, crossover, adultos, viviendo con VIH/Sida en uso de terapia antirretroviral y sin enfermedades oportunistas. La intervencion de interes fue suplementacion nutricional via oral y/o cambio de estilo de vida por tratamiento dietoterapico especifico: dislipidemia, resistencia insulinica, lipodistrofia e hipertension arterial sistemica. Se utilizo la escala de Jadad para clasificacion cualitativa de los articulos. RESULTADOS: Se localizaron 385 articulos y siete fueron incluidos. Las intervenciones utilizadas en estos estudios fueron: dieta, dieta mas ejercicio fisico, dieta mas suplemento y solamente suplementos. Dislipidemia fue el resultado evaluado en todos los estudios. Los estudios que evaluaron suplementacion con omega 3 encontraron reduccion significativa de los trigliceridos. La dieta especifica mas suplementacion de omega 3 mostro aumento de HDL-colesterol. Suplementacion con nicotinato de cromo no tuvo efecto sobre la dislipidemia. La modificacion de estilo de vida, incluyendo dieta y actividad fisica, redujo significativamente la circunferencia de la cintura, lipodistrofia y presion arterial sistolica. CONCLUSIONES: La reduccion de trigliceridos por la suplementacion con omega 3 fue la intervencion nutricional con mayores evidencias cientificas. La prescripcion de dieta especifica parece ser la intervencion mas adecuada para aumentar HDL-colesterol. No es posible hacer inferencias sobre el tratamiento nutricional del colesterol total, LDL-colesterol y resistencia insulinica. Las modificaciones en el estilo de vida pueden promover mejoria de la lipodistrofia y presion arterial.OBJECTIVE To analyze the effect of nutritional treatment on metabolic changes caused by the use of antiretroviral therapy in adults with HIV/AIDS. METHODS A systematic review of literature was conducted in the PubMed, Lilacs and Cochrane databases, between 1996 and 2010, including crossover and randomized controlled clinical trials performed in adults with HIV/AIDS using antiretroviral therapy and without opportunistic diseases. The intervention of interest was oral nutritional supplementation and/or a change in lifestyle due to specific dietary treatment: dyslipidemia, insulin resistance, lipodystrophy and systemic arterial hypertension. The Jadad scale was used for a qualitative classification of articles. RESULTS A total of 385 articles were found, of which seven were included. The interventions used in these studies were as follows: diet, diet and physical exercises, diet and supplementation, and only supplementation. Dyslipidemia was the outcome assessed in all studies. Studies that assessed omega-3 supplementation found a significant reduction in triglycerides. The specific diet with omega-3 supplementation showed an increase in HDL-cholesterol. Chrome nicotinate supplementation did not have an effect on dyslipidemia. Changing ones lifestyle, including diet and physical activity, significantly reduced waist circumference, lipodystrophy and systolic blood pressure. CONCLUSIONS Reduction in tryglicerides with omega-3 supplementation was the nutritional intervention with the strongest scientific evidence. Prescribing a specific diet appeared to be the most adequate intervention to increase HDL-cholesterol. Inferences could not be made about the nutritional treatment of total cholesterol, LDL-cholesterol and insulin resistance. Changes in lifestyle can promote an improvement in lipodystrophy and blood pressure.

Gastrointestinal Symptoms in HIV-Infected Patients: Female Sex and Smoking as Risk Factors in an Outpatient Cohort in Brazil

This study aimed to estimate the incidence of gastrointestinal symptoms (GIS) and associated factors in an outpatient cohort of people living with HIV/AIDS (PLWHA) followed between October 2009 and July 2011. We evaluated nausea and/or vomiting, dyspepsia, heartburn, diarrhea, constipation, and flatulence. The outcome variable was the presence of three or more GIS. Sociodemographic (sex, skin color, age, income, years of schooling), lifestyle (smoking status, alcohol consumption, physical activity level), clinical (antiretroviral therapy, time of HIV infection, CD4 lymphocyte count, viral load), and anthropometric (nutritional status and waist circumference) variables were investigated. Data on sociodemographic and lifestyle variables were collected through a pre-tested and standardized questionnaire. CD4 count was determined by flow cytometry and viral load by branched DNA (bDNA) assays for HIV-1. All variables were analyzed at a p<0.05 significance level. Among 290 patients, the incidence of three or more GIS was 28.8% (95% CI 23.17 to 33.84) and 74.48% presented at least one symptom. Female gender (IR 2.29, 95% CI 1.63 to 3.22) and smoking status (IR 1.93, 95% CI 1.30 to 2.88) were risk factors for the presence of three or more GIS after multivariate Poisson regression. A high incidence of gastrointestinal symptoms was found among PLWHA, and it was significantly associated with female sex and tobacco use. Those results reinforce the relevance of investigating the presence of GIS in PLWHA as it may affect treatment adherence.

Association of physical inactivity with hypertension and low educational level in people living with HIV / AIDS

ABSTRACT The aim of this study was to determine the prevalence of physical inactivity and whether it is associated with sociodemographic, lifestyle, clinical, anthropometric, and body composition variables in people living with HIV/AIDS (PLWHA). This study makes use of data from a cohort of 288 adults aged ≥19 years, conducted between October 2009 and July 2011. The variables studied were sex, age, education, income, skin color, tobacco use, alcohol intake, body mass index, body fat percentage, waist circumference, and waist-hip ratio, length of HIV/AIDS diagnosis, use of antiretroviral therapy and length of its use, CD4, hypertension (HT) and diabetes mellitus. Physical inactivity was defined as a score below 600 metabolic equivalent minutes/week according to the International Physical Activity Questionnaire – Short Version. Poisson multiple regression was applied in the multivariate analysis with a significance level of 5%. The prevalence of physical inactivity was 44.1%. Education of ≤4 years of study (prevalence ratio [PR]: 1.71) and HT (PR: 1.49) were associated with physical inactivity. Physical inactivity was highly prevalent in PLWHA and associated with low educational level and HT. We highlight the simultaneous association between two cardiometabolic risk factors, HT and physical inactivity.

Nutrition Therapy for Adults with HIV on ART

This chapter presents evidence on nutrition therapy for adults human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) who are receiving antiretroviral therapy (ART) and all the ramifications and targets of this intervention for their complex health status, which includes metabolic abnormalities, cardiovascular risk, gastrointestinal disorders, dyslipidemia, vitamin D deficiency, bone health, immune response, changes in body composition, and lipodystrophy. The effects of dietary intervention and supplementation with a variety of micronutrients such as zinc, selenium, probiotics, vitamins A and D, and multivitamins, among others, with regard to the side effects of ART or the complications of the disease itself are addressed. The results of interventions depend on the stage of disease progression, nutritional status, and ART regimen for each intervention and its dosage. Along with aspects of recent research, the paths to an even more effective nutritional and clinical management are discussed.

Nutritional Treatment Approach for Children with HIV Receiving ART

Estimates indicate that about 3.3 million HIV-positive children aged to 14 years worldwide. The use of antiretroviral therapy (ART) reduces infectious complications and increases the survival of children with HIV, although there is an increase in metabolic abnormalities caused by exposure to ART. Thus, the nutritional therapy should be part of every treatment protocol for HIV-positive children receiving ART and to women exposed to ART during pregnancy, even if they are HIV negative. This chapter discusses the evidence and recommendations for the weaning process, nutritional status, food intake, and use of multivitamins and micronutrients with the aim of maintaining health status and reducing the risk of cardiovascular disease. Along with a small number of specific research studies on the topic, this chapter will be helpful in thinking about approaches for clinical nutrition, consideration of public policies and actions for the prevention of health issues, and the direction of future research to increase quality of life for this group of children.

Chapter 7 – Nutrition Therapy for HAART-Naïve HIV-Infected Patients

In this chapter, some proposals for nutritional therapy for ART-naive HIV-infected adults are presented and discussed as basic therapeutic support, especially in the context of malnutrition, diarrhea, and micronutrient deficiency. Despite the widespread distribution of ART in certain regions of the world, there are still thousands of people who do not have access to this treatment, mainly in sub-Saharan Africa and resource-limited settings. Thus, this chapter aims to highlight recent studies that indicate conclusive results (or not) regarding the use of multivitamins, minerals such as zinc, selenium, and calcium, vitamins A and D, and even probiotics, bringing ideas and suggestions for advancing knowledge of intervention in HIV/AIDS.

Nutritional Treatment Approach for ART-Naïve HIV-Infected Children

Currently, 90% of children with human immunodeficiency virus (HIV) live in areas of food insecurity. Depletion of the immune system is caused by inadequate nutritional status, opportunistic infections, and HIV disease progression. Breastfeeding is one approach for minimizing frequent and numerous morbidities, and it should be encouraged even in areas of food insecurity and regions where access to ART is scarce. To facilitate proper treatment of malnutrition or weaning, some formulas are used alone or in addition to daily intake. Vitamins, minerals, and trace elements supplementation are also common strategies for nutritional status recovery, prevention, and treatment of morbidity and immune function improvement. There have been attempts to advance the reproduction of the benefits of breast milk via supplementation with probiotics. Nutritional treatment is the major agent for helping HIV-infected children who exhibit dietary deficiencies.

Terapia nutricional en las alteraciones metabólicas en personas viviendo con VIH/Sida

OBJETIVO: Analizar el efecto del tratamiento nutricional sobre las alteraciones metabolicas provocadas por el uso de la terapia antirretroviral en adultos viviendo con VIH/Sida. METODOS: Revision sistematica de literatura en el PubMed, Lilacs y Cochrane, entre 1996 y 2010, del tipo ensayo clinico, controlado, aleatorio, crossover, adultos, viviendo con VIH/Sida en uso de terapia antirretroviral y sin enfermedades oportunistas. La intervencion de interes fue suplementacion nutricional via oral y/o cambio de estilo de vida por tratamiento dietoterapico especifico: dislipidemia, resistencia insulinica, lipodistrofia e hipertension arterial sistemica. Se utilizo la escala de Jadad para clasificacion cualitativa de los articulos. RESULTADOS: Se localizaron 385 articulos y siete fueron incluidos. Las intervenciones utilizadas en estos estudios fueron: dieta, dieta mas ejercicio fisico, dieta mas suplemento y solamente suplementos. Dislipidemia fue el resultado evaluado en todos los estudios. Los estudios que evaluaron suplementacion con omega 3 encontraron reduccion significativa de los trigliceridos. La dieta especifica mas suplementacion de omega 3 mostro aumento de HDL-colesterol. Suplementacion con nicotinato de cromo no tuvo efecto sobre la dislipidemia. La modificacion de estilo de vida, incluyendo dieta y actividad fisica, redujo significativamente la circunferencia de la cintura, lipodistrofia y presion arterial sistolica. CONCLUSIONES: La reduccion de trigliceridos por la suplementacion con omega 3 fue la intervencion nutricional con mayores evidencias cientificas. La prescripcion de dieta especifica parece ser la intervencion mas adecuada para aumentar HDL-colesterol. No es posible hacer inferencias sobre el tratamiento nutricional del colesterol total, LDL-colesterol y resistencia insulinica. Las modificaciones en el estilo de vida pueden promover mejoria de la lipodistrofia y presion arterial.OBJECTIVE To analyze the effect of nutritional treatment on metabolic changes caused by the use of antiretroviral therapy in adults with HIV/AIDS. METHODS A systematic review of literature was conducted in the PubMed, Lilacs and Cochrane databases, between 1996 and 2010, including crossover and randomized controlled clinical trials performed in adults with HIV/AIDS using antiretroviral therapy and without opportunistic diseases. The intervention of interest was oral nutritional supplementation and/or a change in lifestyle due to specific dietary treatment: dyslipidemia, insulin resistance, lipodystrophy and systemic arterial hypertension. The Jadad scale was used for a qualitative classification of articles. RESULTS A total of 385 articles were found, of which seven were included. The interventions used in these studies were as follows: diet, diet and physical exercises, diet and supplementation, and only supplementation. Dyslipidemia was the outcome assessed in all studies. Studies that assessed omega-3 supplementation found a significant reduction in triglycerides. The specific diet with omega-3 supplementation showed an increase in HDL-cholesterol. Chrome nicotinate supplementation did not have an effect on dyslipidemia. Changing ones lifestyle, including diet and physical activity, significantly reduced waist circumference, lipodystrophy and systolic blood pressure. CONCLUSIONS Reduction in tryglicerides with omega-3 supplementation was the nutritional intervention with the strongest scientific evidence. Prescribing a specific diet appeared to be the most adequate intervention to increase HDL-cholesterol. Inferences could not be made about the nutritional treatment of total cholesterol, LDL-cholesterol and insulin resistance. Changes in lifestyle can promote an improvement in lipodystrophy and blood pressure.