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‘Best Foods For your heart’: A pilot randomised controlled trial of dietary intervention to reduce cardiovascular risk in HIV dyslipidaemia
Abstracts / Atherosclerosis 255 (2016) e1ee5
shellfish. In addition, home ground cafetiaire coffee was consumed in excess. A stringent low saturated fat diet and reduction of coffee and switch in preparation was advised. After 2 months strict adherence, the new fat diet proved too challenging and an agreed more relaxed diet with introduction of some eggs, offal and shellfish. A 4-day dietary record with serial biochemistry were undertaken on first consultation and after each diet phase (table 1).
e5
Methods: Sixty adults with stable HIV infection on ART and LDL-cholesterol >3mmol/l were recruited from three UK HIV centres. Participants were randomised (1:1) to receive dietary advice to reduce saturated fat intake to <10% of energy intake (diet1), or to adopt the Mediterranean Portfolio Diet (diet2) with additional cholesterol-lowering foods (nuts, stanols, soya, oats, pulses) for 6 months. An average of 3 blood pressure readings, taken seated at rest, and diet quality (using 14-point Mediterranean Diet Score) were measured at baseline and month 6. Between-group changes of blood pres-
Table 1
Total fat
Saturated fat
Dietary cholesterol/day
Fibre %
Coffee intake (cups)
Initial High fat Diet
Chol 14.9 HDL 2.11
62%
22.4%
873.1 mg
1.8%
5+ unfiltered
Low saturated fat Diet
Chol 6.8 HDL 2.04
53%
11.6%
326 mg
6.4%
<2 filtered
Lower but relaxed saturated fat Diet
Chol 8.8 HDL 2.12
52%
13.3%
548.3 mg
5.0%
~2 filtered
Total fat remained high but reduced due to high intake of olive oil, avocados, nuts and seeds; MUFA intake ~24%. SAFA was reduced by 50% by omitting full fat dairy products and eggs, excess strong boiled coffee was switched to filter preparation. Brewing coffee beans directly liberates a fat soluble substance Cafestol which is negligible in filtered coffee. Dietary fibre was increased with vegetables, pulses and fruit. Overall the modified diet remained low in carbohydrates but increased from 9% to 14%. There was no decrease in minerals and vitamin intake e vitamin E was seen to increase. Body weight reduced from 60 kg to 57.5 kg. Conclusions A hyper-responsive diet-induced lipid change is uncommon and may reflect skills of the expert assessing and tailoring specific advice to key dietary factors, patient compliance and motivation to change and genetic variability.
14/. ‘BEST FOODS FOR YOUR HEART’: A PILOT RANDOMISED CONTROLLED TRIAL OF DIETARY INTERVENTION TO REDUCE CARDIOVASCULAR RISK IN HIV DYSLIPIDAEMIA Clare Stradling 1,2, *, Neil Thomas 1, Steve Taylor 2, Satyajit Das 4, Jonathan Ross 5, Shahrad Taheri 3. 1 University of Birmingham, UK; 2 Heart of England NHS Foundation Trust, UK; 3 Weill Cornell Medicine in Qatar, Qatar; 4 Coventry Partnership NHS Trust, UK; 5 University Hospitals Birmingham NHS Foundation Trust, UK
sure (BP) and 14-point Mediterranean Diet Score (MDS) were assessed using ANCOVA, with adjustments for baseline values of the dependent variables. Analysis was by intention to treat. Ethical approval was granted (13/WM/ 0225). Results: This is an interim analysis of 60 participants (mean age 42 yrs, 50% female, 50% black African, 40% White European, 65% non-smokers) who completed 6 months. The groups were comparable for age, gender, smoking status, and lipid profile. After 6 months the difference between group changes in Mediterranean Diet Score was 3.7 points (95%CI 2.3 to 5.2, p < 0.001), with significant improvement in the Diet2 group. Systolic blood pressure was 7.2mmHg lower (95%CI 1.6 to 12.8, p < 0.001) in Diet2 participants, compared to the increase observed in Diet1.
Diet1 (n ¼ 31)
Diet2 (n ¼ 29)
Baseline Month 6 Change 0 to 6m
Baseline Month 6 Change 0 to 6m
MDS
6.8 (2.4)
6.6 (2.9)
0.3 6.0 (1.3 to 0.8) (2.3)
9.5 (2.2)
3.5 (2.5 to 4.5)
Systolic BP
123 (15)
126 (17)
3.5 (0.0 to 7.0)
121 (10)
3.7 (8.2 to 0.8)
Diastolic BP 78 (12)
79 (10)
2.0 78 (1.4 to 5.5) (9)
78 (8)
0.4 (2.8 to 3.6)
125 (14)
All expressed as Mean (SD), except within group change Mean (95%CI).
Background: The risk of cardiovascular disease is increased in the HIV population, potentially due to the additional burdens of infection, inflammation and antiretroviral treatment (ART). The effects of dietary intervention on cardiovascular risk (CVR) in HIV have not been well defined. Aim: to examine the effect of two dietary interventions on blood pressure (BP) in HIV dyslipidaemia.
Conclusions: Dietetic advice to follow a Mediterranean diet containing plant stanols, nuts, oily fish and soya protein resulted in a greater improvement in diet quality and systolic BP than standard guidelines to reduce saturated fat intake.
shellfish. In addition, home ground cafetiaire coffee was consumed in excess. A stringent low saturated fat diet and reduction of coffee and switch in preparation was advised. After 2 months strict adherence, the new fat diet proved too challenging and an agreed more relaxed diet with introduction of some eggs, offal and shellfish. A 4-day dietary record with serial biochemistry were undertaken on first consultation and after each diet phase (table 1).
e5
Methods: Sixty adults with stable HIV infection on ART and LDL-cholesterol >3mmol/l were recruited from three UK HIV centres. Participants were randomised (1:1) to receive dietary advice to reduce saturated fat intake to <10% of energy intake (diet1), or to adopt the Mediterranean Portfolio Diet (diet2) with additional cholesterol-lowering foods (nuts, stanols, soya, oats, pulses) for 6 months. An average of 3 blood pressure readings, taken seated at rest, and diet quality (using 14-point Mediterranean Diet Score) were measured at baseline and month 6. Between-group changes of blood pres-
Table 1
Total fat
Saturated fat
Dietary cholesterol/day
Fibre %
Coffee intake (cups)
Initial High fat Diet
Chol 14.9 HDL 2.11
62%
22.4%
873.1 mg
1.8%
5+ unfiltered
Low saturated fat Diet
Chol 6.8 HDL 2.04
53%
11.6%
326 mg
6.4%
<2 filtered
Lower but relaxed saturated fat Diet
Chol 8.8 HDL 2.12
52%
13.3%
548.3 mg
5.0%
~2 filtered
Total fat remained high but reduced due to high intake of olive oil, avocados, nuts and seeds; MUFA intake ~24%. SAFA was reduced by 50% by omitting full fat dairy products and eggs, excess strong boiled coffee was switched to filter preparation. Brewing coffee beans directly liberates a fat soluble substance Cafestol which is negligible in filtered coffee. Dietary fibre was increased with vegetables, pulses and fruit. Overall the modified diet remained low in carbohydrates but increased from 9% to 14%. There was no decrease in minerals and vitamin intake e vitamin E was seen to increase. Body weight reduced from 60 kg to 57.5 kg. Conclusions A hyper-responsive diet-induced lipid change is uncommon and may reflect skills of the expert assessing and tailoring specific advice to key dietary factors, patient compliance and motivation to change and genetic variability.
14/. ‘BEST FOODS FOR YOUR HEART’: A PILOT RANDOMISED CONTROLLED TRIAL OF DIETARY INTERVENTION TO REDUCE CARDIOVASCULAR RISK IN HIV DYSLIPIDAEMIA Clare Stradling 1,2, *, Neil Thomas 1, Steve Taylor 2, Satyajit Das 4, Jonathan Ross 5, Shahrad Taheri 3. 1 University of Birmingham, UK; 2 Heart of England NHS Foundation Trust, UK; 3 Weill Cornell Medicine in Qatar, Qatar; 4 Coventry Partnership NHS Trust, UK; 5 University Hospitals Birmingham NHS Foundation Trust, UK
sure (BP) and 14-point Mediterranean Diet Score (MDS) were assessed using ANCOVA, with adjustments for baseline values of the dependent variables. Analysis was by intention to treat. Ethical approval was granted (13/WM/ 0225). Results: This is an interim analysis of 60 participants (mean age 42 yrs, 50% female, 50% black African, 40% White European, 65% non-smokers) who completed 6 months. The groups were comparable for age, gender, smoking status, and lipid profile. After 6 months the difference between group changes in Mediterranean Diet Score was 3.7 points (95%CI 2.3 to 5.2, p < 0.001), with significant improvement in the Diet2 group. Systolic blood pressure was 7.2mmHg lower (95%CI 1.6 to 12.8, p < 0.001) in Diet2 participants, compared to the increase observed in Diet1.
Diet1 (n ¼ 31)
Diet2 (n ¼ 29)
Baseline Month 6 Change 0 to 6m
Baseline Month 6 Change 0 to 6m
MDS
6.8 (2.4)
6.6 (2.9)
0.3 6.0 (1.3 to 0.8) (2.3)
9.5 (2.2)
3.5 (2.5 to 4.5)
Systolic BP
123 (15)
126 (17)
3.5 (0.0 to 7.0)
121 (10)
3.7 (8.2 to 0.8)
Diastolic BP 78 (12)
79 (10)
2.0 78 (1.4 to 5.5) (9)
78 (8)
0.4 (2.8 to 3.6)
125 (14)
All expressed as Mean (SD), except within group change Mean (95%CI).
Background: The risk of cardiovascular disease is increased in the HIV population, potentially due to the additional burdens of infection, inflammation and antiretroviral treatment (ART). The effects of dietary intervention on cardiovascular risk (CVR) in HIV have not been well defined. Aim: to examine the effect of two dietary interventions on blood pressure (BP) in HIV dyslipidaemia.
Conclusions: Dietetic advice to follow a Mediterranean diet containing plant stanols, nuts, oily fish and soya protein resulted in a greater improvement in diet quality and systolic BP than standard guidelines to reduce saturated fat intake.