The impact of different dietary patterns on nutritional status and metabolic integrity in asymptomatic people living with HIV infection in South Africa

Abstract

Adequate nutritional status promotes optimal structure and function. In PLWH, few studies on the impact of dietary intake on nutritional and metabolic status have been undertaken. This cross-sectional secondary data analysis examined how different dietary patterns influenced nutritional and metabolic integrity in asymptomatic PLWH in the North-West Province of South Africa. Dietary data were collected using validated QFFQ. Data analysis was by SPSS version 14. Dietary and nutrient patterns were generated using Principal Component Analysis. Though asymptomatic, marked biochemical differences depicting altered metabolism and inflammation were observed in PLWH compared to the uninfected. PLWH also showed an anthropometric profile that depicted altered body composition and abnormal fat distribution. Four dietary patterns: animal-based, ‘recommended’, staple, and the Carbohydrate, Vegetable and Legumes (CVL) based were observed in both PLWH and the uninfected with slight differences. In PLWH, the animal-based similar to the CVL pattern was associated with better overall nutrient intake (r=0.5, p<0.001) and selected nutrients, including energy (r=0.3, p<0.001), protein (r=0.6, p<0.001), iron (r=0.5, p<0.001), zinc (r=0.6, p<0.001) and vitamin A (r=0.5, p<0.001), compared to the other dietary patterns. The animal based dietary pattern also predicted higher BMI (OR=2.2, 95% CI=0.9-5.0), LBM (3.6, 1.3-10.4), serum albumin (1.5, 0.9-2.4) and lower liver enzymes AST (0.5, 0.3-0.8) and ALT (0.6, 0.4-0.9). Using Graphical Chain Modelling, higher intake of the animal-based but lower staple-based dietary patterns were associated with better overall nutrient intake, serum vitamins A, E, lipid score, albumin, BMI and LBM suggesting that intake of this diet may provide better nutrient quality, enhancing nutritional status and metabolic proficiency, which may ultimately influence disease progression. The findings have implications for dietary guidelines for this population but further research is required. However, if these findings are true, then a predominantly animal-based diet may be ‘recommended’ for this population. Moreover, the longer term implications of high fat intake associated with the animal based dietary pattern on obesity and associated risks should be considered. This poses a challenge to imperatively weigh up the longer term risks of the overall population profile crucial for public health.

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