Annan, Reginald Adjetey
The impact of different dietary patterns on nutritional status and metabolic integrity in asymptomatic people living with HIV infection in South Africa
University of Southampton, School of Medicine,
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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