Effects of At‐Risk and Recent Alcohol Use on Diet Quality among People Living with HIV (PLWH)

Abstract

People living with HIV (PLWH) have increased rates of alcohol use, increased survival rates with the use of ARTs and are at an increased risk for the development of metabolic comorbidities, including obesity and insulin resistance. Alcohol use is associated with decreased diet quality and individuals consuming large quantities of alcohol often have the poorest diet quality and overconsume calories. The goal of this study was to test the hypothesis that at-risk alcohol use, as well as recent alcohol use, is associated with poor diet quality in PLWH. Diet quality was determined in a subset of adult, in-care PLWH enrolled in the New Orleans Alcohol Use in HIV (NOAH) Study (n=222). Participants completed a single 24-hour dietary recall using the Automated Self-Administered 24-hour (ASA-24) Dietary Recall Tool and values were compared to the U.S. Dietary Guidelines and Dietary Reference Intakes. At-risk alcohol use was determined by the Alcohol Use Disorders Identification Test (AUDIT). An AUDIT score ≥ 8 was defined as at-risk alcohol use (n=67) and an AUDIT score of < 8 (n=155) was considered low-risk. Recent alcohol use was determined by Timeline Followback (TLFB), which assessed the previous 30-day alcohol intake. PLWH with at-risk alcohol use had lower body mass index (BMI), consumed a lower percentage of calories from carbohydrates, consumed more total calories, more calories from protein, more cholesterol and sodium and had a higher total calorie/body weight (kg) than PLWH with low-risk alcohol use. PLWH with at-risk alcohol use also consumed more calories from alcohol than PLWH with low-risk alcohol use. Calories from alcohol accounted for the difference in total caloric intake between the two groups. Cured meat intake (oz. equivalent) was higher in PLWH with at-risk alcohol use, which likely contributed to the increased sodium, cholesterol and protein intake in this group. AUDIT score and recent alcohol use (TLFB) were positively correlated with each other and total caloric consumption and calories from alcohol. Additionally, recent alcohol use (TLFB) was positively correlated with calories consumed from protein, fat, and carbohydrates. Both AUDIT score and recent alcohol use (TLFB) were negatively correlated with BMI and waist circumference. Overall, PLWH consumed lower than recommended dietary amounts of carbohydrates (43.6% ± 11.2) and higher than recommended amounts of fat (36.0% ± 9.1). The Healthy Eating Index (HEI), a measure of diet quality based on Dietary Guidelines for Americans was not affected by alcohol use in PLWH, however average HEI in PLWH was 44.5/100, compared to the national average in adults, 59/100. These preliminary analyses suggest that at-risk and recent alcohol use significantly affect diet quality in PLWH and that overall, PLWH in this South Louisiana cohort are not meeting U.S Dietary Guidelines. The development and implementation of nutritional and alcohol-reducing interventions may be appropriate strategies to improve food selection and diet quality and decrease the risk of developing metabolic comorbidities in PLWH.