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Principles of Nutrition for Persons with HIV & AIDS
by James A Zachary MD
Nutrition for persons with HIV infection and AIDS is very similar to that for persons with good health as well as for those with other chronic diseases. In a healthy person with HIV infection, the goal of the diet and any supplements is to acquire all the nutrients necessary for maintenance of health including achieving a healthy body weight, supporting tissue health (including muscles, nervous system, blood, bone, teeth, hair, skin, liver, and kidneys,) and optimization of fats (lipids) in the bloodstream for good heart health. Once again for someone with HIV infection who is "healthy" the best way to take nutrients is in food and NOT in supplements or pills. Studies of nutritional supplementation (e.g., vitamins) in healthy persons have not shown any significant benefits UNLESS there is a dietary deficiency of a specific nutrient or nutrients. Indeed the main problem in healthy individuals in the United States is not deficiency of nutrients but an EXCESS of nutrients which results in weight gain. In turn weight gain may result in cosmetic problems, an increased tendency toward diabetes, high blood pressure, and high cholesterol levels. In fact studies of vitamin supplementation in persons who are not known to be vitamin deficient have shown that there may be a small risk of harm.
Body Weight, Body Mass
Index (BMI), and Body Composition
The best or optimal or most healthy weight is based on the gender of the individual, the person's age, their height, and also on something called body composition. Men should be a little heavier for a given height and as people age, their weight should slightly increase also. Body composition is really an alternative to measuring just weight. Body weight is obviously just one number which may not give accurate information about the health of an individual due to body composition differences. For example, a man who is 5 foot 6 inches, weighs 180 pounds, and has a 44 inch waistline has very different health issues from a 5 foot 6 inch man who weighs 180 pounds and has a 31 inch waist. This latter person spends 3 hours per day at the gym and can run on a treadmill for 2 hours and lift a car off the ground. The first man is obese and his excess weight is composed of fat tissue; his risks of hypertension, diabetes, and heart disease are elevated. The second man's description might be "hypermuscular," because his extra weight is composed of muscle. The second man's risk of disease is very different from the first man's. Current technology makes it possible to relatively easily estimate the composition of a person's body weight. One technique is body impedance analysis (BIA), and another would be an imaging procedure such as MRI. Body impedance analysis (BIA) provides a easy, rapid means of estimating the fat, lean body mass, and water composition of an individual. More importantly BIA allows one to follow changes over time. There are also techniques involving immersion of the body in fluid and measurement of weight differences that can estimate body composition. BMI or body mass index is a quick way of analyzing body weight versus height versus age versus gender into different health categories. You can go to the National Institute of Health's BMI calculator HERE.
To understand why your weight is changing, think about your body as a box. If more food or calories goes in the box than you use in your activities (calories expended), then the box gets bigger. If you are using more food calories than you are taking in, then the box will shrink. Inactivity and the aging process result in less calories being used so that over time as you get older, your body will need less food than when you were younger. Infections, trauma, surgery, and high HIV viral loads will tend to use more calories. Fat in foods has twice the number of calories per unit weight than either protein or carbohydrate foods; therefore, when you eat a fatty food you are getting a concentrated amount of calories compared to other foods. Unless you are exercising regularly and vigorously, your body tends to store extra calories from whatever source in the form of fat tissue. Unfortunately this excesive fat tissue may predispose you to other problems, and, generally fat is cosmetically unappealing. Cancer, diabetes (uncontrolled blood sugar), high blood pressure, heart disease, and wear & tear arthritis are associated with being overweight or obese. If you exercise, your body may store the extra calories as muscle which is a much healthier form of tissue.
Protein, Fat, and Carbohydrates in the Diet
The Fat Components of the Blood and Problems with Them (High Cholesterol and Hyperlipidemia)
Fat Redistribution (see HERE)
3.14.2005 under construction
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