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HIV-infected US youth are at high risk of obesity and poor diet quality: A challenge for improving short- and long-term health outcomes

https://doi.org/10.1016/j.jada.2004.07.031Get rights and content

Abstract

Objective

To examine the relationships among dietary quality, weight status, and human immunodeficiency virus (HIV) infection in US adolescents and young adults.

Design

This cross-sectional study was embedded in the Reaching for Excellence in Adolescent Care and Health cohort study of HIV-infected and HIV-uninfected, at-risk youth. Biochemical, clinical, and sociodemographic data were available. Dietary intake was collected using the Block Food Frequency Questionnaire and a modified Healthy Eating Index was calculated to measure diet quality.

Subjects/Setting

Participants included 264 HIV-infected and 127 HIV-uninfected youth 13 to 23 years old (75.2% women, 67.3% African American/non-Hispanic, 20.5% Hispanic, 12.3% other) at 14 clinic sites.

Statistical analyses performed

Determinants of obesity and the modified Healthy Eating Index were tested using logistic and generalized linear regression.

Results

About half (51.7%) of participants were overweight or obese. Obesity was positively associated with being a woman, living independently, watching television ≥3 hours per day, previous dieting, and being from the northeastern or southern United States. Youth who were HIV uninfected or HIV infected with CD4+ T cells ≥500 cells/μL had similar obesity rates; overweight (25%) and obesity (20%) was prevalent among women even with CD4+ T cells <200 cells/μL. The modified Healthy Eating Index score was 56.2±0.6, reflecting a diet needing improvement. HIV infection, watching television ≥3 hours/day, and being from the Chicago, IL, area were associated with a lower-quality diet.

Conclusions

Obesity is a common nutrition problem for both HIV-infected and uninfected youth; however, HIV-infected youth are at increased risk of developing metabolic abnormalities. Culturally appropriate, client-focused nutrition education will help youth improve their diet and increase physical activity to reduce health consequences associated with both obesity and HIV infection.

Section snippets

Study population

The Reaching for Excellence in Adolescent Care and Health study was a prospective cohort study of the progression of HIV infection in adolescents in 15 US clinical sites (14, 15). A standardized data collection protocol was developed through the Adolescent Medicine HIV/AIDS Research Network. Between March 1996 and November 1999, 325 adolescents between 12 and 18 years of age who had acquired HIV infection through sexual activity or intravenous drug use were recruited. In addition, a comparison

Participant characteristics

Compared to HIV-uninfected participants, HIV-infected youth were older (19.4±0.1 vs 20.0±0.1 years, respectively; P<.001), more likely to live on their own, and less likely to have completed or be enrolled in high school or a general equivalency diploma program (Table 1). Almost half (46.2%) of the HIV-infected group was not on antiretroviral therapy. Of those taking antiretroviral therapy, 34.5% were taking a monotherapy or combination therapy without a protease inhibitor; 19.3% were taking a

Discussion

The prevalence of obesity in this study population was twice as high as that reported among US adolescents (1). Researchers have reported that African-American, HIV-infected women were more likely to want a larger body size while white, HIV-infected women wanted to lose weight, independent of stage of illness or history of opportunistic infections (10). While the strong association of obesity with past weight-loss attempts seen in our subjects may argue against intentional weight gain, previous

Conclusions

To our knowledge, this is the first study to examine the prevalence of overweight and obesity and diet quality in youth with HIV. Practicing dietetics professionals should consider the following:

  • HIV-infected adolescent and young adult patients may have a higher prevalence of overweight and obesity than the general youth population.

  • Diet quality is often poor among HIV-infected youth.

  • Obese persons with HIV infection may be at even greater risk of developing metabolic abnormalities associated

L. A. Kruzich is dietetic internship practicum coordinator and G. S. Marquis is an associate professor in the Department of Food Science and Human Nutrition, Iowa State University,

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    L. A. Kruzich is dietetic internship practicum coordinator and G. S. Marquis is an associate professor in the Department of Food Science and Human Nutrition, Iowa State University,

    Ames. C. M. Wilson is a professor in the Department of Pediatrics and Medicine, University of Alabama at Birmingham.

    C. B. Stephensen is a research scientist with the US Department of Agricul-ture, Western Human Nutrition Research Center, Department of Nutrition, Davis, CA.

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