HIV-infected US youth at risk for obesity

Nutrition Research Newsletter, Nov, 2004

Adolescents and young adulthood are critical periods, during which eating and lifestyle behaviors are established. Overweight teenagers have an immediate increased risk of hypertension, hyperlipidemia, and type 2 diabetes. They are also more likely to be overweight as adults and have increased morbidity and mortality later in life. Although the general risks of obesity are fairly well understood, little is known about obesity among youth infected with human immunodeficiency virus (HIV). Obtaining a balance between a healthful weight and high dietary quality among HIV-infected youth may be even more of a challenge than among adults. The purpose of this study was to examine the relationships among weight status, dietary quality, and HIV infection among US youth to improve nutrition counseling for this high-risk 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. 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 group of 171 HIV-uninfected adolescents were recruited from the same clinic sites; participation selection was made by choosing persons who matched as closely as possible the risk-behavior profiles and demographic characteristics of the HIV-infected persons. This article describes a supplemental cross-sectional stud of dietary intake that was conducted during one study visit between January and October 2000. Among the 436 participants active in the 14 Reaching for Excellence in Adolescent Care and Health network site at the time of the dietary intake study, 391 agreed to participate (264 HIV-infected and 127 HIV-uninfected adolescents).

Anthropometric measurements were taken in the clinics. Weight at the previous 6-month visit was compared to current weight for assessment of weight change. The Block Food Frequency Questionnaire was used to estimate usual dietary patterns during the past year. A modified US Department of Agriculture Healthy Eating Index (HEI) scale was used to measure diet quality. HIV serum antibody status was verified annually on all HIV-uninfected subjects.

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

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.

L Kruzich, G Marquis, C Wilson, C Stephensen. HIV-Infected US youth are at high risk of obesity and poor diet quality: a challenge for improving short- and long-term health outcomes. JADA 104:1554-1560 (October 2004) [Correspondence: Laurie A. Kruzich, MS, RD, Department of Food Science and Human Nutrition, 220 MacKay Hall, Iowa State University, Ames, IA 50011. E-mail: Ikruzich@iastate.edu].