高效抗逆转录病毒治疗（HAART）时代，合并代谢异常的HIV感染患者的膳食脂肪摄入量及其与血脂水平的关系
Dietary fat intake and relationship to serum lipid levels in HIV-infected patients with metabolic abnormalities in the HAART era.
作者信息
Joy Tisha, Keogh Hester M, Hadigan Colleen, Lee Hang, Dolan Sara E, Fitch Kathleen, Liebau James, Lo Janet, Johnsen Stine, Hubbard Jane, Anderson Ellen J, Grinspoon Steven
机构信息
Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
出版信息
AIDS. 2007 Jul 31;21(12):1591-600. doi: 10.1097/QAD.0b013e32823644ff.
OBJECTIVE
To evaluate dietary intake and its relationship to lipid parameters in HIV-infected patients with metabolic abnormalities.
METHOD
We prospectively determined dietary intake (4-day food records or 24-h recall) in 356 HIV-infected patients and 162 community-derived HIV-negative controls evaluated for metabolic studies between 1998-2005. Differences in dietary intake between HIV-infected patients and non-HIV-infected controls, in relation to the established 2005 USDA (United States Department of Agriculture) Recommended Dietary Guidelines, were determined. The relationship between dietary fat intake and serum lipid levels among HIV-infected individuals was also evaluated.
RESULTS
Assessment of dietary intake in this group of HIV-infected patients demonstrated increased intake of total dietary fat (P < 0.05), saturated fat (P = 0.006), and cholesterol (P = 0.006) as well as a greater percentage of calories from saturated fat (P = 0.002) and from trans fat (P = 0.02), despite similar caloric intake to the control individuals. A significantly higher percentage of HIV-infected patients were above the 2005 USDA Recommended Dietary Guidelines for saturated fat (> 10%/day) (76.0% HIV vs. 60.9% controls, P = 0.003), and cholesterol (> 300 mg/day) (49.7% HIV vs. 37.9% controls, P = 0.04). Saturated fat intake was strongly associated with triglyceride level [triglyceride level increased 8.7 mg/dl (parameter estimate) per gram of increased saturated fat intake, P = 0.005] whereas total fat was inversely associated with triglyceride level [triglyceride level decreased 3.0 mg/dl (parameter estimate) per gram of increased total fat intake, P = 0.02] among HIV-infected individuals.
CONCLUSIONS
Increased intake of saturated fat is seen and contributes to hypertriglyceridemia among HIV-infected patients who have developed metabolic abnormalities. Increased saturated fat intake should be targeted for dietary modification in this population.
目的
评估合并代谢异常的HIV感染患者的饮食摄入情况及其与血脂参数的关系。
方法
我们前瞻性地测定了1998年至2005年间接受代谢研究评估的356例HIV感染患者和162例社区来源的HIV阴性对照者的饮食摄入情况（4天食物记录或24小时回顾）。根据2005年美国农业部（USDA）既定的《膳食指南》，确定HIV感染患者与未感染HIV的对照者在饮食摄入方面的差异。同时还评估了HIV感染者饮食脂肪摄入量与血脂水平之间的关系。
结果
对这组HIV感染患者的饮食摄入评估显示，尽管其热量摄入与对照个体相似，但总膳食脂肪（P<0.05）、饱和脂肪（P = 0.006）和胆固醇（P = 0.006）的摄入量增加，并且来自饱和脂肪（P = 0.002）和反式脂肪（P = 0.02）的热量百分比更高。高于2005年美国农业部饱和脂肪推荐膳食指南（>10%/天）的HIV感染患者比例显著更高（HIV感染者为76.0%，对照者为60.9%，P = 0.003），高于胆固醇推荐膳食指南（>300毫克/天）的比例也更高（HIV感染者为49.7%，对照者为37.9%，P = 0.04）。在HIV感染者中，饱和脂肪摄入量与甘油三酯水平密切相关[饱和脂肪摄入量每增加1克，甘油三酯水平升高8.7毫克/分升（参数估计值），P = 0.005]，而总脂肪摄入量与甘油三酯水平呈负相关[总脂肪摄入量每增加1克，甘油三酯水平降低3.0毫克/分升（参数估计值），P = 0.02]。
结论
在已出现代谢异常的HIV感染患者中，可见饱和脂肪摄入量增加，且这会导致高甘油三酯血症。该人群应针对增加的饱和脂肪摄入量进行饮食调整。
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