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Dieta mediterrânica e risco cardiovascular em indivíduos infectados pelo Vírus da Imunodeficiência Humana : 5 anos de follow-up
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Resumo(s)
A infecção pelo Vírus da Imunodeficiência Humana (VIH) é uma doença crónica cuja terapêutica anti-retroviral (TARc) permitiu o aumento da esperança média de vida. Contudo, a sua utilização pode reduzir a qualidade de vida ao ser responsável pelo aumento da prevalência de comorbilidades das quais resistência à insulina, diabetes, dislipidémia, doença cardiovascular (DCV), síndrome metabólica (SM) e lipodistrofia.
O risco cardiovascular (RCV) nas pessoas que vivem com VIH (PVVIH) é superior ao documentado para a população que não está infectada, destacando a importância de intervenções no estilo de vida nestes indivíduos.
As recomendações alimentares com base nas guidelines europeias para PVVIH são semelhantes ao padrão alimentar da Dieta Mediterrânica (DM), que já foi demonstrado apresentar um papel protector na DCV. Para além disso, a actividade física (AF) também pode influenciar de forma positiva o estilo de vida desta população. Os objectivos deste estudo foram determinar o RCV actual e a adesão à DM, numa coorte de 571 doentes previamente avaliados há 5 anos, comparar estes factores com os dados de há 5 anos, e quantificar o nível de AF.
Após 5 anos, dos 476 indivíduos com evolução ponderal documentada, verificou-se um aumento do peso em 252 indivíduos, destacando-se o ano de 2016 com o maior número de indivíduos na categoria da obesidade (14,6%; n=67). No estudo actual, incluíram-se 149 indivíduos com uma média de 52,0±9,3 anos, sendo maioritariamente do género masculino (61,7%; n=92), de raça Caucasiana (91,9%; n=137), com um tempo médio de infecção de 17,9±6,9 anos e uma carga viral indetectável em 91,2% (n=135) dos indivíduos; 6,7% (n=10) apresentou DCV nos últimos 5 anos. Verificou-se uma prevalência de 10,1% (n=15) de diabetes, 26,2% (n=39) de dislipidémia, 24,2% (n=36) de hipertensão arterial (HTA) e 50,8% (n=62) de SM. Mais de metade da amostra é eutrófica (52,0%; n=77) e apresenta um perímetro de cintura (PC) aumentado (57,0%; n=85). A adesão à DM apresentou um score médio de 28,9±5,2 pontos, superior a 2014. A estimativa de RCV actual mostrou que 54,7% da amostra se encontra numa estimativa de RCV muito elevado, apesar da estimativa calculada em 2014 demonstrar que os indivíduos deveriam encontrar-se num risco baixo a moderado. Não se verificou qualquer associação entre o RCV e a DM. Verifica-se que 77,6% da amostra tem um nível de AF moderado e passa uma média de 244,4±173,9 minutos diários sentado.
A evidência demonstra inúmeros benefícios associados à DM e à prática de AF. Ainda que não se tenham verificado associações entre o RCV, a DM e a AF, torna-se essencial actuar na prevenção e perceber que factores poderão estar associados a uma maior ou menor adesão à DM e à prática de AF.
Human Immunodeficiency Virus (HIV) infection is a chronic disease whose antiretroviral therapy (cART) has increased the average life expectancy. However, its use can possibly reduce quality of life by being responsible for the increased prevalence of comorbidities including insulin resistance, diabetes, dyslipidemia, cardiovascular disease (CVD), metabolic syndrome (MS) and lipodystrophy. Cardiovascular risk (CVR) in people living with HIV (PLWHIV) is higher than documented in the uninfected population, highlighting the importance of lifestyle interventions for these individuals. Dietary recommendations based on European guidelines for PLWHIV are similar to the dietary pattern of the Mediterranean diet (MD), which has been demonstrated to have a protective role against CVD. In addition, physical activity (PA) can also positively influence the lifestyle of this population. The main goals of this study were to determine the current CVR and adherence to MD, in a cohort of 571 individuals evaluated 5 years ago, compare them with previously data and to quantify the level of PA. After 5 years, of the 476 individuals with weight evolution, there was an increase in weight in 252 individuals, highlighting the year 2016 regarding the percentage of individuals with obesity (14,6%; n=67). In the current study, a total of 149 individuals with a mean age of 52,0±9,3 years were included, mostly male (61,7%; n=92), Caucasian (91,9%; n=137), with an average infection time of 17,9±6,9 years and an undetectable viral load in 91,2% (n=135) of the individuals; 6,7% (n=10) had CVD in the last 5 years. There was a prevalence of 10,1% (n=15) of diabetes, 26,2% (n=39) of dyslipidemia, 24,2% (n=36) of hypertension and 50,8% (n=62) of MS. More than half of the sample is eutrophic (52,0%; n=77) and has an increased waist circumference (WC) (57,0%; n=85). Adherence to MD had an average score of 28,9±5,2 points, higher than 2014. It was found that 77,6% of the sample had a moderate level of PA and spends an average of 244,4±173,9 daily minutes sitting. The current risk estimate showed that 54,7% of the sample is at very high CVR, although the estimate calculated in 2014 shows that individuals should be at low to moderate risk. The evidence demonstrates numerous benefits associated with MD and PA. Although there are no associations between CVR, MD and PA, it is essential to act on prevention and to understand which factors may be associated with higher or lesser adherence to MD and PA.
Human Immunodeficiency Virus (HIV) infection is a chronic disease whose antiretroviral therapy (cART) has increased the average life expectancy. However, its use can possibly reduce quality of life by being responsible for the increased prevalence of comorbidities including insulin resistance, diabetes, dyslipidemia, cardiovascular disease (CVD), metabolic syndrome (MS) and lipodystrophy. Cardiovascular risk (CVR) in people living with HIV (PLWHIV) is higher than documented in the uninfected population, highlighting the importance of lifestyle interventions for these individuals. Dietary recommendations based on European guidelines for PLWHIV are similar to the dietary pattern of the Mediterranean diet (MD), which has been demonstrated to have a protective role against CVD. In addition, physical activity (PA) can also positively influence the lifestyle of this population. The main goals of this study were to determine the current CVR and adherence to MD, in a cohort of 571 individuals evaluated 5 years ago, compare them with previously data and to quantify the level of PA. After 5 years, of the 476 individuals with weight evolution, there was an increase in weight in 252 individuals, highlighting the year 2016 regarding the percentage of individuals with obesity (14,6%; n=67). In the current study, a total of 149 individuals with a mean age of 52,0±9,3 years were included, mostly male (61,7%; n=92), Caucasian (91,9%; n=137), with an average infection time of 17,9±6,9 years and an undetectable viral load in 91,2% (n=135) of the individuals; 6,7% (n=10) had CVD in the last 5 years. There was a prevalence of 10,1% (n=15) of diabetes, 26,2% (n=39) of dyslipidemia, 24,2% (n=36) of hypertension and 50,8% (n=62) of MS. More than half of the sample is eutrophic (52,0%; n=77) and has an increased waist circumference (WC) (57,0%; n=85). Adherence to MD had an average score of 28,9±5,2 points, higher than 2014. It was found that 77,6% of the sample had a moderate level of PA and spends an average of 244,4±173,9 daily minutes sitting. The current risk estimate showed that 54,7% of the sample is at very high CVR, although the estimate calculated in 2014 shows that individuals should be at low to moderate risk. The evidence demonstrates numerous benefits associated with MD and PA. Although there are no associations between CVR, MD and PA, it is essential to act on prevention and to understand which factors may be associated with higher or lesser adherence to MD and PA.
Descrição
Tese de mestrado, Nutrição Clínica, Universidade de Lisboa, Faculdade de Medicina, 2020
Palavras-chave
Infecção por VIH Dieta mediterrânica Risco cardiovascular Actividade física Nutrição Teses de mestrado - 2020