Adherence to Mediterranean diet is favorably associated with metabolic parameters in HIV-positive patients with the highly active antiretroviral therapy–induced metabolic syndrome and lipodystrophy

Abstract

Objective-To investigate whether closer adherence to a Mediterranean dietary pattern is associated with metabolic aspects of the Highly Active Antiretroviral Therapy (HAART)-induced metabolic syndrome (fat redistribution, insulin resistance, dyslipidemia) in HIV positive patients. Design-Cross sectional study.Methods-227 HIV-infected patients were evaluated during a single outpatient visit to the General Clinical Research Center of Beth Israel Deaconess Medical Center. Usual dietary intake and physical activity habits were evaluated; the Mediterranean Diet Score (MedDietScore) was calculated. Dualenergy x-ray absorptiometry, CT findings anthropometrics and data from the study interviews and questionnaires were used for the assessment of body composition using specific criteria. A complete metabolic profile was available for all subjects.Results-In the entire study sample, a weak inverse association was found between insulin resistance, estimated using the homeostasis model (HOMA-IR), and MedDietScore (standardized β= -0.15, p = 0.03). Interaction models revealed that this was largely driven by an inverse association in patients with fat redistribution (FR) (standardized β = -0.13, p = 0.02). Moreover, MedDietScore was positively correlated with HDL-cholesterol (standardized β = 0.15, p = 0.01) and marginally negatively associated with circulating triglyceride levels (standardized β = -0.16, p = 0.13) in this group of patients. Conflicts of interest: NoneAuthors' contributions: Dr. Mantzoros designed this study. Drs. Tsiodras, Chimienti and Wadhwa collected the data. Ms. Poulia and Dr. Yannakoulia analyzed the dietary information, performed the statistical analysis and drafted the paper. Drs Mantzoros and Tsiodras contributed to subsequent revisions of the paper and to the responses to the reviewers' comments. Drs. Karchmer and Mantzoros secured funding for this study. All authors critically revised the manuscript and approved the final version submitted.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptMetabolism. Author manuscript; available in PMC 2010 June 1.

Metabolic Complications and Glucose Metabolism in HIV Infection: A Review of the Evidence

“…They observed a positive association between kilocalories from sweets intake and higher insulin resistance as measured by the homeostatic model assessment of insulin resistance (HOMA-IR). [42] Investigations with self-reported dietary intake that evaluated the Mediterranean dietary pattern with biomarker profiles for diabetes and cardiovascular disease risk present equivocal results,[43–45] while an upcoming study will directly measure the impact of a Mediterranean diet intervention on metabolic biomarkers in PLWH. [46] However, these studies have been conducted in predominately male, white cohorts.…”

Lipodystrophies: adipose tissue disorders with severe metabolic implications

“…In a cross-sectional study of 136 patients with at least 1 year of exposure to HAART, those individuals that reported moderate to high adherence to Mediterranean diet had lower frequency of lipodystrophy [51]. Another study showed that in lipodystrophic patients under HAART, adherence to Mediterranean diet was associated with lower insulin resistance (assessed by HOMA-IR), increased HDL cholesterol and reduced blood triglycerides levels [50]. Combined, these results suggest that Mediterranean diet may have protective effects on both HAART-induced lipodystrophy and its metabolic complications.…”

Congenital Lipodystrophies and Dyslipidemias

“…In addition, high consumption of carbohydrate (especially fructose) should also be avoided. The beneficial effect of a Mediterranean diet, enriched in n−3 polyunsaturated fatty acids (PUFAs), on metabolic parameters has been demonstrated in HIV-positive patients with highly active antiretroviral therapy (HAART)-induced metabolic syndrome [82]. Additional studies are warranted to determine whether this Mediterranean diet is equally effective in patients with inherited lipodystrophies.…”