The cardiometabolic profile and related dietary intake of Ugandans living with HIV and AIDS

Tonny Kiyimba, Fred Kigozi, Peter Yiga, Barbara Mukasa, Patrick Ogwok, Bart Van der Schueren, Christophe Matthys, Tonny Kiyimba, Fred Kigozi, Peter Yiga, Barbara Mukasa, Patrick Ogwok, Bart Van der Schueren, Christophe Matthys

Abstract

Introduction: Suboptimal diet and physical inactivity downgrade the putative benefits of Antiretroviral Therapy (ART) among People Living with HIV (PLWH). However, there is paucity of literature on dietary intake and cardiometabolic profiles of PLWH in Uganda.

Methods: A cross-sectional study among PLWH in Uganda was conducted. Dietary intake was assessed using a 24h recall method of 2 non-consecutive days. The short International Physical Activity Questionnaire assessed participants' physical activity. Fasted blood samples were analyzed for Fasting Blood Glucose (FBG), total cholesterol, LDL-c, HDL-c and triglycerides. Blood pressure and anthropometric measurements were performed following step 2 of the WHO STEPS.

Results: 253 patients completed in this study. A high prevalence of low HDL-c (31.9%), abdominal obesity (44.5%), high BMI (51.6%), raised FBG (45.3%), high SBP (31.5%), elevated triglycerides (26.4%) and metabolic syndrome (28%) was found. More women were identified with metabolic syndrome (31.5%) than men (19.2%). Low prevalence of high LDL-c (4.7%) and total cholesterol (9.8%) was found. Diets had a high carbohydrate (65.8 ± 10.4) E% and fiber intake (30.1 ± 12.7) g with minimal PUFA (6.1 ± 2.3) E%, fruits and vegetables (1.4 servings). High proportions were found of unmet intake for vitamin A (38.2%), B1(48.8%), B2 (29.6%), B12 (29%), folate (61.4%), Ca (76%), Zn (53.1%) and Mg (41.7%). Mean MET min was 6,700 ± 5,509 and over 68% of the participants had >3,000 MET min.

Conclusion: Our findings reveal a high prevalence of metabolic disturbances among PLWH in Uganda and further highlight that their diets are suboptimal with low fruits and vegetable intake.

Keywords: AIDS; HIV; cardiometabolic; dietary intake; metabolic syndrome; polyphenol.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Kiyimba, Kigozi, Yiga, Mukasa, Ogwok, Van der Schueren and Matthys.

Figures

Figure 1
Figure 1
Prevalence of metabolic syndrome and its components. WC, waist circumference; FBG, Fasting Blood Glucose; HDL, High Density Lipoproteins.
Figure 2
Figure 2
Energy contribution per macronutrient per eating meal.
Figure 3
Figure 3
Energy distribution per eating occasion.

References

    1. UNAIDS . Fact sheet–World AIDS Day. (2021). Available online at: .
    1. Avert Organisation. HIV and AIDS in Uganda. (2019). Available online at: August
    1. Karamchand S, Leisegang R, Schomaker M, Maartens G, Walters L, Hislop M, et al. . Risk factors for incident diabetes in a cohort taking first-line nonnucleoside reverse transcriptase inhibitor-based antiretroviral therapy. Medicine. (2016) 95:e2844. 10.1097/MD.0000000000002844
    1. Crum-Cianflone N, Roediger MP, Eberly L, Headd M, Marconi V, Ganesan A, et al. . Increasing rates of obesity among HIV-infected persons during the HIV epidemic. PLoS ONE. (2010) 5:e10106. 10.1371/journal.pone.0010106
    1. Muyanja D, Muzoora C, Muyingo A, Muyindike W, Siedner MJ. High prevalence of metabolic syndrome and cardiovascular disease risk among people with HIV on stable ART in southwestern Uganda. AIDS Patient Care STDS. (2016) 30:4–10. 10.1089/apc.2015.0213
    1. Nguyen KA, Peer N, Mills EJ, Kengne AP. A meta-analysis of the metabolic syndrome prevalence in the global HIV-infected population. PLoS OnE. (2016) 11:e0150970. 10.1371/journal.pone.0150970
    1. Schulte-Hermann K, Schalk H, Haider B, Hutterer J, Gmeinhart B, Pichler K, et al. . Impaired lipid profile and insulin resistance in a cohort of Austrian HIV patients. J Infect Chemother. (2016) 22:248–53. 10.1016/j.jiac.2016.01.007
    1. Mondy K, Overton ET, Grubb J, Tong S, Seyfried W, Powderly W, et al. . Metabolic syndrome in HIV-infected patients from an urban, midwestern US outpatient population. Clin Infect Dis. (2007) 44:726–34. 10.1086/511679
    1. Ddamulira C, Nsereko N, Musoke M, Kiyingi FP. Community based non communicable disease services as a predictor of improved quality of life of people living with HIV in Uganda: a randomized controlled trial. J Environ Sci Public Health. (2020) 4:304–17. 10.26502/jesph.96120102
    1. Jericó C, Knobel H, Montero M, Ordoñez-Llanos J, Guelar A, Gimeno JL, et al. . Metabolic syndrome among HIV-infected patients: prevalence, characteristics, and related factors. Diabetes Care. (2005) 28:132–7. 10.2337/diacare.28.1.132
    1. National Cholesterol Education Program (US) . Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults. Third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III): The Program (2002).
    1. Todowede OO, Mianda SZ, Sartorius B. Prevalence of metabolic syndrome among HIV-positive and HIV-negative populations in sub-Saharan Africa—a systematic review and meta-analysis. Syst Rev. (2019) 8:4. 10.1186/s13643-018-0927-y
    1. Kazooba P, Kasamba I, Mayanja BN, Lutaakome J, Namakoola I, Salome T, et al. . Cardiometabolic risk among HIV-POSITIVE Ugandan adults: prevalence, predictors and effect of long-term antiretroviral therapy. Pan African Med J. (2017) 27:40. 10.11604/pamj.2017.27.40.9840
    1. Mann J, Truswell AS. Essentials of Human Nutrition. Oxford: Oxford University Press; (2017).
    1. Wakiso District Local Government District Health Profile 2020 17.12.2021 Available online at: (accessed December 17, 2021).
    1. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects . JAMA. (2013) 310:2191–4. 10.1001/jama.2013.281053
    1. Dickey RA, Bartuska D, Bray GW, Callaway CW, Davidson ET, Feld S, et al. . AACE/ACE Position statement on the prevention, diagnosis, and treatment of obesity (1998 revision). Endocr Pract. (1998) 4:297–350.
    1. The IDF Consensus Worldwide Definition of the Metabolic Syndrome (2006) .
    1. World Health Organization . WHO STEPS Surveillance Manual: the WHO STEPwise Approach to Chronic Disease Risk Factor Surveillance. World Health Organization; (2005). Report No.: 9241593830.
    1. Hagströmer M, Oja P, Sjöström M. The international physical activity questionnaire (IPAQ): a study of concurrent and construct validity. Public Health Nutr. (2006) 9:755–62. 10.1079/PHN2005898
    1. Saunders JB, Aasland OG, Babor TF, De la Fuente JR, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction. (1993) 88:791–804. 10.1111/j.1360-0443.1993.tb02093.x
    1. Non-Communicable Disease Risk Factor Survey Uganda Report (2014). Available online at:
    1. Etter J-F, Le Houezec J, Perneger TV. A self-administered questionnaire to measure dependence on cigarettes: the cigarette dependence scale. Neuropsychopharmacology. (2003) 28:359–70. 10.1038/sj.npp.1300030
    1. Wallace TC. Dietary Supplements in Health Promotion. Florida: CRC Press; (2015).
    1. Anono E, Walsh H, Kanerva N, Mubasu D, Okoth V, Clinton B, et al. . Photographic Food Atlas for Kenyan Adolescents (9–14 Years). Kanerva, FN, Ed. Nairobi: KENFIN-EDURA; (2018).
    1. Harvest, Plus,. Available online at:
    1. Haytowitz D, Ahuja J, Wu X, Khan M, Somanchi M, Nickle M, et al. . USDA National Nutrient Database for Standard Reference, Legacy. USDA National Nutrient Database for Standard Reference (2018).
    1. Haubrock J, Nöthlings U, Volatier J-L, Dekkers A, Ocké M, Harttig U, et al. . Estimating usual food intake distributions by using the multiple source method in the EPIC-Potsdam calibration study. J Nutr. (2011) 141:914–20. 10.3945/jn.109.120394
    1. Institute of Medicine Standing Committee on the Scientific Evaluation of Dietary Reference Intakes: Applications in Dietary Assessment (2000) .
    1. Trumbo P Schlicker S Yates A Poos M Food Food and Nutrition Board of the Institute of Medicine The The National Academies . Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. J Am Diet Assoc. (2002) 102:1621–30. 10.1016/S0002-8223(02)90346-9
    1. Lifestyle UT. Can Lifestyle Modifications Using Therapeutic Lifestyle Changes (TLC) Reduce Weight and the Risk for Chronic Disease?
    1. FAO/WHO U. FAO/WHO GIFT. Global Individual Food consumption data Tool. Available online at:
    1. Neveu V, Perez-Jiménez J, Vos F, Crespy V, du Chaffaut L, Mennen L, et al. . Phenol-Explorer: an online comprehensive database on polyphenol contents in foods. Database. (2010) 2010:bap024. 10.1093/database/bap024
    1. Cornier M-A, Despres J-P, Davis N, Grossniklaus DA, Klein S, Lamarche B, et al. . Assessing adiposity: a scientific statement from the American heart association. Circulation. (2011) 124:1996–2019. 10.1161/CIR.0b013e318233bc6a
    1. Uganda Demographic and Health Survey 2016 . In: Kampala U, editor. Uganda Bureau of Statistics. Rockville, MD: The DHS Program ICF; (2018).
    1. Ben-Yacov L, Ainembabazi P, Stark AH, Kizito S, Bahendeka S. Prevalence and sex-specific patterns of metabolic syndrome in rural Uganda. BMJ Nut Prev Health. (2020) 3:11. 10.1136/bmjnph-2019-000050
    1. Clark SJ, Gómez-Olivé FX, Houle B, Thorogood M, Klipstein-Grobusch K, Angotti N, et al. . Cardiometabolic disease risk and HIV status in rural South Africa: establishing a baseline. BMC Public Health. (2015) 15:1–9. 10.1186/s12889-015-1467-1
    1. Njelekela MA, Mpembeni R, Muhihi A, Mligiliche NL, Spiegelman D, Hertzmark E, et al. . Gender-related differences in the prevalence of cardiovascular disease risk factors and their correlates in urban Tanzania. BMC Cardiovasc Disord. (2009) 9:1–8. 10.1186/1471-2261-9-30
    1. Sodjinou R, Agueh V, Fayomi B, Delisle H. Obesity and cardio-metabolic risk factors in urban adults of Benin: relationship with socio-economic status, urbanisation, and lifestyle patterns. BMC Public Health. (2008) 8:1–13. 10.1186/1471-2458-8-84
    1. Klassen K, Goff L. Dietary intakes of HIV-infected adults in urban UK. Eur J Clin Nutr. (2013) 67:890–3. 10.1038/ejcn.2013.109
    1. Pourcher G, Costagliola D, Martinez V. Obesity in HIV-infected patients in France: prevalence and surgical treatment options. J Visc Surg. (2015) 152:33–7. 10.1016/j.jviscsurg.2014.12.001
    1. Yiga P, Seghers J, Tafiire H, Tonny K, Muluta SN, Ogwok P, et al. . Tackling the Health Beauty Paradox Through a Lifestyle Intervention Among Women of Reproductive Age in Urban Uganda, A Randomised Control Trial. unpublished.
    1. Yiga P, Ogwok P, Achieng J, Auma MD, Seghers J, Matthys C. Determinants of dietary and physical activity behaviours among women of reproductive age in urban Uganda, a qualitative study. Public Health Nutr. (2021) 24:3624–36. 10.1017/S1368980020003432
    1. Gissing SC, Pradeilles R, Osei-Kwasi HA, Cohen E, Holdsworth M. Drivers of dietary behaviours in women living in urban Africa: a systematic mapping review. Public Health Nutr. (2017) 20:2104–13. 10.1017/S1368980017000970
    1. Okop KJ, Mukumbang FC, Mathole T, Levitt N, Puoane T. Perceptions of body size, obesity threat and the willingness to lose weight among black South African adults: a qualitative study. BMC Public Health. (2016) 16:1–13. 10.1186/s12889-016-3028-7
    1. Draper CE, Davidowitz KJ, Goedecke JH. Perceptions relating to body size, weight loss and weight-loss interventions in black South African women: a qualitative study. Public Health Nutr. (2016) 19:548–56. 10.1017/S1368980015001688
    1. Pedro MN, Rocha GZ, Guadagnini D, Santos A, Magro DO, Assalin HB, et al. . Insulin resistance in HIV-patients: causes and consequences. Front Endocrinol. (2018) 9:514. 10.3389/fendo.2018.00514
    1. Dillon DG, Gurdasani D, Riha J, Ekoru K, Asiki G, Mayanja BN, et al. . Association of HIV and ART with cardiometabolic traits in sub-Saharan Africa: a systematic review and meta-analysis. Int J Epidemiol. (2013) 42:1754–71. 10.1093/ije/dyt198
    1. WHO . Policy Brief: Update of Recommendations on First-And Second-Line Antiretroviral Regimens. World Health Organization; (2019).
    1. Bosch B. DTG and Weight Gain (2020).
    1. Keene CM, Griesel R, Zhao Y, Gcwabe Z, Sayed K, Hill A, et al. . Virologic efficacy of tenofovir, lamivudine and dolutegravir as second-line antiretroviral therapy in adults failing a tenofovir-based first-line regimen. AIDS. (2021) 35:1423–32. 10.1097/QAD.0000000000002936
    1. Grinspoon S, Carr A. Cardiovascular risk and body-fat abnormalities in HIV-infected adults. N Engl J Med. (2005) 352:48–62. 10.1056/NEJMra041811
    1. Grunfeld C, Pang M, Doerrler W, Shigenaga J, Jensen P, Feingold K. Lipids, lipoproteins, triglyceride clearance, and cytokines in human immunodeficiency virus infection and the acquired immunodeficiency syndrome. J Clin Endocrinol Metabol. (1992) 74:1045–52.
    1. Sander LD, Newell K, Ssebbowa P, Serwadda D, Quinn TC, Gray RH, et al. . Hypertension, cardiovascular risk factors and antihypertensive medication utilisation among HIV-infected individuals in R akai, U ganda. Trop Med Int Health. (2015) 20:391–6. 10.1111/tmi.12443
    1. Szablowski CJ, Mercer KR, Manalang M, Suscha E, Moskowitz K, Anderson JH, et al. . Differences between point-of-care blood glucose analyzers in identifying prediabetes. Diabetes. (2018) 67 (Supplement_1):2370–PUB. 10.2337/db18-2370-PUB
    1. Duvivier BM, Schaper NC, Bremers MA, Van Crombrugge G, Menheere PP, Kars M, et al. . Minimal intensity physical activity (standing and walking) of longer duration improves insulin action and plasma lipids more than shorter periods of moderate to vigorous exercise (cycling) in sedentary subjects when energy expenditure is comparable. PLoS ONE. (2013) 8:e55542. 10.1371/journal.pone.0055542
    1. Stephen AM, Champ MM-J, Cloran SJ, Fleith M, van Lieshout L, Mejborn H, et al. . Dietary fibre in Europe: current state of knowledge on definitions, sources, recommendations, intakes and relationships to health. Nutr Res Rev. (2017) 30:149–90. 10.1017/S095442241700004X
    1. Onyango AC, Walingo MK, Mbagaya G, Kakai R. Assessing nutrient intake and nutrient status of HIV seropositive patients attending clinic at Chulaimbo Sub-District Hospital, Kenya. J Nutr Metab. (2012) 2012:306530. 10.1155/2012/306530
    1. WHO Study Group on Diet Prevention of Noncommunicable Diseases World Health Organization . Diet, Nutrition, and the prevention of chronic diseases: report of a WHO study group. World Health Organ Tech Rep Ser. (1990) 797:1–204.
    1. Isabirye N, Ezeamama AE, Kyeyune-Bakyayita R, Bagenda D, Fawzi WW, Guwatudde D. Dietary micronutrients and gender, body mass index and viral suppression among HIV-infected patients in Kampala, Uganda. Int J MCH AIDS. (2020) 9:337–49. 10.21106/ijma.362
    1. Lovegrove JA, Lovegrove SS, Lesauvage SV, Brady LM, Saini N, Minihane AM, et al. . Moderate fish-oil supplementation reverses low-platelet, long-chain n– 3 polyunsaturated fatty acid status and reduces plasma triacylglycerol concentrations in British Indo-Asians. Am J Clin Nutr. (2004) 79:974–82. 10.1093/ajcn/79.6.974
    1. Jiamton S, Pepin J, Suttent R, Filteau S, Mahakkanukrauh B, Hanshaoworakul W, et al. . A randomized trial of the impact of multiple micronutrient supplementation on mortality among HIV-infected individuals living in Bangkok. AIDS. (2003) 17:2461–9. 10.1097/00002030-200311210-00008
    1. Rawat R, McCoy SI, Kadiyala S. Poor diet quality is associated with low CD4 count and anemia and predicts mortality among antiretroviral therapy–naive HIV-positive adults in Uganda. J Acquir Immune Defic Syndr. (2013) 62:246–53. 10.1097/QAI.0b013e3182797363
    1. Lacey CJ, Murphy ME, Sanderson MJ, Monteiro EF, Vail A, Schorah CJ, et al. . Antioxidant-micronutrients and HIV infection. Int J STD AIDS. (1996) 7:485–9. 10.1258/0956462961918554
    1. Kanter AS, Spencer DC, Steinberg MH, Soltysik R, Yarnold PR, Graham NM. Supplemental vitamin B and progression to AIDS and death in black South African patients infected with HIV. J Acquir Immune Defic Syndr. (1999) 21:252–3. 10.1097/00126334-199907010-00011
    1. Tang AM, Graham NM, Kirby AJ, McCall LD, Willett WC, Saah AJ. dietary micronutrient intake and risk of progression to acquired immunodeficiency Syndrome (AIDS) in human immunodeficiency virus type 1 (HlV-1)-infected homosexual men. Am J Epidemiol. (1993) 138:937–51. 10.1093/oxfordjournals.aje.a116814
    1. Abrams B, Duncan D, Hertz-Picciotto I. A prospective study of dietary intake and acquired immune deficiency syndrome in HIV-seropositive homosexual men. J Acquir Immune Defic Syndr. (1993) 6:949–58.
    1. Audain KA, Zotor FB, Amuna P, Ellahi B. Food supplementation among HIV-infected adults in Sub-Saharan Africa: impact on treatment adherence and weight gain. Proc Nutr Soc. (2015) 74:517–25. 10.1017/S0029665115000063
    1. dos Santos Ferreira CE, França CN, Correr CJ, Zucker ML, Andriolo A, Scartezini M. Clinical correlation between a point-of-care testing system and laboratory automation for lipid profile. Clinica Chimica Acta. (2015) 446:263–6. 10.1016/j.cca.2015.04.036
    1. Akbar R, Khawaja KI, Mahmood S, Goon IY, Chambers JC, Sarwar S, et al. editors. Use of point-of-care cholesterol testing in population based non-communicable disease surveillance: caveats and challenges. Proceedings. (2020). 10.47489/p000s343z7541-9mc
    1. Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U, et al. . Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet. (2012) 380:247–57. 10.1016/S0140-6736(12)60646-1

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa