HIV affects nutritional status from the onset of infection and in all stages of the disease11,12
. Most patients with HIV tend to lose weight due to a variety of causes like nausea, anorexia, opportunistic diseases and inadequate dietary intake. One study linked time of death to a point in time when the body weight reaches two-thirds of the ideal value2
. A major goal of nutritional management is to intervene early and preserve lean body weight to prevent wasting. Increasingly, data suggest that depletion of nutrients affects the ability of the body to mount and sustain an immune response11,13
. Early nutritional intervention in patients infected with HIV improves immune function. Of the various causes of undernutrition in these individuals, dietary inadequacy is an often-neglected but important cause. As HIV infection becomes a more chronic disease and the management of HIV becomes increasingly sophisticated, the ability to ensure HIV-infected individuals have access to high-quality, nutritious food choices that promote optimal dietary patterns, rather than just sufficient quantities of food, will also be increasingly important.
In this study, almost all food consumed by the participants was considered in the analysis, capturing total diet. Standard calibrated instruments were used to calculate weight and height of each participant. There was no statistically significant correlation between BMI and CD4 cell count. Although 24 h analysis may not reflect the dietary habits over a longer period of time but shows the dietary intake over previous 24 h. n0 utritional status amongst the study participants was generally below the normal standards. This justifies a need for nutritional intervention among HIV individuals for improved quality of life. Nutritional management is an essential but often neglected element in HIV care. AIDS patients experience a myriad of disease-related nutritional complications, including weight loss, lipodystrophy, malabsorption and micronutrient deficiencies14
. Anorexia and other gastrointestinal symptoms such as nausea, vomiting, diarrhoea and malabsorption may occur due to HIV, opportunistic infections or drugs, and may prevent adequate nutritional intake or absorption leading to continued weight loss, vitamin deficiencies and poor nutritional status. Low socio-economic status and poor income can limit access to adequate dietary intake. Opportunistic infections are associated with increased resting energy expenditure15
. However, one large study by Macallan et al16
concluded that reduced energy intake, rather than elevated energy expenditure, is the prime determinant of HIV-associated weight loss. The resulting malnutrition can itself contribute to an increased immunocompromised state17
. Malnutrition and wasting should be treated as grave complications in the course of HIV infection because the timing of death in these patients may be related more closely to the extent of wasting than to any secondary infection18
. Any HIV-infected person should be considered at risk for malnutrition, with nutritional assessment focused on factors that may promote or contribute to the potential for malnutrition. Focus on improving nutrition in HIV-infected patients is important because it optimizes existing immune system function, can help alleviate the burden of HIV-related complications, might reduce the overall cost of medical care and improves the patient's quality of life. Dworkin et al18
assessed the potential role of dietary intake in the development and persistence of malnutrition in patients with HIV and AIDS and found that 88 per cent patients were ingesting less than 50 per cent of the RDA for at least one nutrient. Kim et al19
performed a cross-sectional study of 633 subjects in Boston and Rhode Island to determine the correlates of inadequate dietary intake among HIV-infected adults, and found that inadequate energy intake occurred in 38 per cent of this population and that female sex was independently associated with less energy and protein intake. Protein intake was also less in those without a caregiver adult in the family20
It is pertinent to note that all these studies have been conducted in populations that have reasonable access to food, unlike our study, which was performed in an already impoverished population. In our study the energy intake was less than RDA values. Similar pattern of a significantly low protein intake by patients was also noted. On the contrary, the fat intake for both males and females was significantly higher than the daily recommendations. Studies indicate that diets consumed by lower socio-economic groups contain cheap, concentrated energy derived mostly from fat, sugar, cereals, potatoes and low-cost meat products20,21
. Increased fat intake and obesity have been seen to occur disproportionately in patients with limited resources. People on the lower end of the income scale, in an attempt to cut food cost, have been seen to consume less expensive but more energy- and fat-dense foods. The recommended dietary intake of nutrients is different in various countries. This might make interpretation of findings dependent on reference range used. However, the fact that the recommended nutrient intake for most nutrients is lower in India than in developed countries makes the findings of the study all the more pertinent.
Dietary food records collected prospectively may provide a more accurate assessment of dietary behaviour than do patients’ recollection of the preceding day. However, 24-hour and multiple-day dietary recall have been found to be comparable22
. Generally, at least three days of diet data are required for the most stable macronutrients and for the percentage of calories from fat. Micronutrients, such as vitamin C, require many more days. Also, recent changes may have been made by patients in their dietary habits in response to changes in body composition and economic constraints brought on by the onset of HIV-related expenses. The proportion of females was smaller in this study, probably due to the socio-cultural milieu in India, with lack of access to healthcare facilities for females seen across a spectrum of diseases. However, this could also make the results more significant in view of the generally higher nutrient intake amongst males compared to females.
In conclusion, our study showed that energy intake was significantly lower than the recommended intake in HIV infected individuals. With malnutrition imposing additional immunosuppressive burden on an already immunocompromised patient, it is imperative that more efforts are directed at tackling food insecurity, and all HIV-infected persons be considered at risk for malnutrition and nutritional counselling should play a major role in management of HIV disease.