Policarpo Sara, Valadas Emilia, Rodrigues Teresa, Moreira Ana Catarina
Nutrition and Dietetics Department, University Hospital of Santa Maria, Lisbon, Portugal.
Infectious Diseases Department, University Hospital of Santa Maria, Lisbon, Portugal.
J Int AIDS Soc. 2014 Nov 2;17(4 Suppl 3):19727. doi: 10.7448/IAS.17.4.19727. eCollection 2014.
Metabolic syndrome (MS) is common in HIV-infected individuals and it is associated with higher cardiovascular risk (CVR). Mediterranean diet has been associated with a better metabolic control and lower CVR.
From December 2013 to May 2014, individuals between 18 and 65 years of age, who attended the outpatient HIV Clinic at the University Hospital Santa Maria, Lisbon, were selected. Adherence to Mediterranean diet was evaluated with MedDietScore, a scale from 0 to 55 that punctuates 11 food items according to the frequency of intake. Higher scores represent higher adherence. CVR was assessed using D.A.D tool (classified as low, moderate or high risk). We excluded individuals with opportunistic disease, hospitalized in the past three months or with renal disease diagnosis. All participants gave written informed consent.
In the 571 HIV patients included, 67.1% (n=383) were male, 91.6% (n=523) Caucasian, with a mean age of 46.5±8.9 years. Patients were divided in two groups: naïve (7.5%; n=43) or on antiretroviral treatment (ART) (92.5%; n=528). Mean length of HIV diagnosis was 6.7±6.5 years (naïve) and 13.3±6.1 years (ART); TCD4+ counts were above 500 cel/mm3 in 55.8% (n=24) and 67.6% (n=357) of the patients, respectively. MS was present in 33.9% (n=179) of patients in ART group and 16.3% (n=7) in naïve group. Presence of MS was associated with ART group (OR=2.7; p=0.018). MS was also associated with older age in this group (p=0.000). Overall, mean MedDietScore was 27.3±5.5. Higher score was associated with older age (r=0.319; p=0.000). Naïve patients presented a trend to higher adherence to Mediterranean diet (65.1% vs 51.7% in naïve group; p=0.090). No relation between MS and Mediterranean diet was found. Higher CVR was associated with the presence of MS in the ART group (p=0.001). In this group, individuals with moderate CVR presented higher rates of adherence to Mediterranean diet (p=0.036) when compared to low and high CVR score.
In this cross-sectional study, naïve individuals presented a trend to higher adherence to Mediterranean diet. On the ART group, higher adherence to Mediterranean diet was found in individuals with moderate CVR score. We think that this might suggest that this group of patients adopt this diet only in the presence of metabolic alterations or perceived CVR. Prospective studies in HIV patients are required to determine the impact of adherence to Mediterranean diet on the reduction of CVR.
代谢综合征（MS）在HIV感染者中很常见，并且与较高的心血管风险（CVR）相关。地中海饮食与更好的代谢控制及更低的CVR相关。
2013年12月至2014年5月，选取了在里斯本圣玛丽亚大学医院门诊HIV诊所就诊的18至65岁个体。采用地中海饮食评分（MedDietScore）评估对地中海饮食的依从性，该评分从0到55，根据11种食物的摄入频率进行打分。分数越高表示依从性越高。使用D.A.D工具评估CVR（分为低、中或高风险）。我们排除了患有机会性疾病、在过去三个月内住院或被诊断患有肾脏疾病的个体。所有参与者均签署了书面知情同意书。
在纳入的571例HIV患者中，67.1%（n = 383）为男性，91.6%（n = 523）为白种人，平均年龄为46.5±8.9岁。患者分为两组：初治患者（7.5%；n = 43）或接受抗逆转录病毒治疗（ART）的患者（92.5%；n = 528）。HIV诊断的平均时长在初治患者中为6.7±6.5年，在接受ART治疗的患者中为13.3±6.1年；患者的TCD4 +细胞计数分别在55.8%（n = 24）和67.6%（n = 357）的患者中高于500个细胞/mm³。接受ART治疗组的患者中有33.9%（n = 179）患有MS，初治组中有16.3%（n = 7）患有MS。MS的存在与ART治疗组相关（OR = 2.7；p = 0.018）。在该组中，MS也与年龄较大相关（p = 0.000）。总体而言，平均地中海饮食评分为27.3±5.5。分数越高与年龄越大相关（r = 0.319；p = 0.000）。初治患者表现出对地中海饮食依从性较高的趋势（初治组为65.1%，接受ART治疗组为51.7%；p = 0.090）。未发现MS与地中海饮食之间存在关联。在接受ART治疗组中，较高的CVR与MS的存在相关（p = 0.001）。在该组中，与低CVR和高CVR评分相比，中度CVR的个体对地中海饮食的依从率更高（p = 0.036）。
在这项横断面研究中，初治个体表现出对地中海饮食依从性较高的趋势。在接受ART治疗组中，中度CVR评分的个体对地中海饮食的依从性更高。我们认为这可能表明这组患者仅在存在代谢改变或察觉到CVR时才采用这种饮食。需要对HIV患者进行前瞻性研究，以确定坚持地中海饮食对降低CVR的影响。
