Over a third of childbearing women with HIV would like to breastfeed: A UK survey of women living with HIV.

The World Health Organisation advice for post-partum women living with HIV (WLHs) in low- and middle-income countries is to breastfeed on suppressive antiretroviral treatment and use infant postnatal prophylaxis. In resource-rich settings, where formula feeding is safe, avoidance of breastfeed is advised. A questionnaire was created to survey attitudes to breastfeeding in WLHs in the United Kingdom. This was offered to all eligible pregnant women in the third trimester or within 3 months post-partum who attended HIV outpatient clinics from 2017 to 2018. Ninety-four women completed the questionnaire, 69% were Black African and 92% had an undetectable HIV viral load. Thirty eight percent stated they would like to breastfeed and 89% said they would breastfeed if they were HIV negative. Sixty two percent had community members question why they did not breastfeed, and 66% felt forced to invent a reason why they were not breastfeeding. Current UK guidelines recommend formula feeding, proposing a harm reduction approach to support women with suppressed HIV who wish to breastfeed. Over a third of respondents said they would like to breastfeed because stigma and secrecy remain an issue for WLHs. This suggests that over time more women may choose this option.

Randomized parallel-group pilot trial (Best foods for your heart) comparing the effects of a Mediterranean Portfolio diet with a low saturated fat diet on HIV dyslipidemia.

BACKGROUND & AIMS: Mediterranean diets reduce the risk of cardiovascular disease (CVD). However, the effect is unknown in people living with HIV, who have an increased risk potentially due to the additional burdens of infection, inflammation and antiretroviral treatment (ART). We examined the feasibility of a 6-month dietary intervention in adults with HIV dyslipidemia using a sample size adequate to detect differences in LDL-cholesterol. METHODS: Sixty adults with stable HIV infection on ART and LDL-cholesterol >3 mmol/l were recruited. Participants were randomized (1:1) to receive dietary advice to reduce saturated fat intake to <10% of energy intake (Diet1), or supported to adopt the Mediterranean Portfolio Diet (Diet2) with additional cholesterol-lowering foods (nuts, stanols, soya, oats, beans) for 6 months. Recruitment, retention and intervention fidelity were monitored. Measurements were conducted at baseline, 6 and 12 months. A secondary analysis examined between group differences in CVD risk factors at month 6 adjusted for baseline values and potential confounders. RESULTS: Rates of recruitment, participation and attrition were 35%, 91%, and 12% respectively. Reported dietary adherence was 68% to Mediterranean foods and 59% to Portfolio components. At 6 months Diet2 participants (n = 29) had a significantly lower LDL-cholesterol (mean difference adjusted for baseline -0.4 mmol/l, 95%CI -0.7 to -0.1, P = 0.01), and systolic blood pressure (-7 mmHg, 95%CI -2 to -12, P = 0.008) compared to those in Diet1 (n = 31). These effects were not sustained at 1 year (LDL-cholesterol -0.05 mmol/l, 95%CI -0.33 to 0.23, P = 0.7; systolic blood pressure -3.5 mmHg, 95%CI -9.4 to 2.5, P = 0.2). CONCLUSION: We showed the feasibility of adopting a Mediterranean Portfolio diet in people living with HIV. Our findings suggest this intervention might equate to short term improvements in diet quality, blood pressure, and LDL-cholesterol. Further definitive evaluations are required to determine if this is a viable strategy to facilitate cardiovascular risk reduction. CLINICAL TRIAL REGISTRY: ISRCTN32090191 Best Foods For your heart trial.

Randomised controlled pilot study to assess the feasibility of a Mediterranean Portfolio dietary intervention for cardiovascular risk reduction in HIV dyslipidaemia: a study protocol.

INTRODUCTION: HIV drug treatment has greatly improved life expectancy, but increased risk of cardiovascular disease remains, potentially due to the additional burdens of infection, inflammation and antiretroviral treatment. The Mediterranean Diet has been shown to reduce cardiovascular risk and mortality in the general population, but no evidence exists for this effect in the HIV population. This study will explore the feasibility of a randomised controlled trial (RCT) to examine whether a Mediterranean-style diet that incorporates a portfolio of cholesterol-lowering foods, reduces cardiovascular risk in people with HIV dyslipidaemia. METHODS AND ANALYSIS: 60 adults with stable HIV infection on antiretroviral treatment and low-density lipoprotein cholesterol >3 mmol/L will be recruited from 3 West Midlands HIV services. Participants will be randomised 1:1 to 1 of 2 dietary interventions, with stratification by gender and smoking status. Participants allocated to Diet1 will receive advice to reduce saturated fat intake, and those to Diet2 on how to adopt the Mediterranean Portfolio Diet with additional cholesterol-lowering foods (nuts, stanols, soya, oats, pulses). Measurements of fasting blood lipids, body composition and arterial stiffness will be conducted at baseline, and month 6 and 12 of the intervention. Food intake will be assessed using the Mediterranean Diet Score, 3-day food diaries and metabolomic biomarkers. Questionnaires will be used to assess quality of life and process evaluation. Qualitative interviews will explore barriers and facilitators to making dietary changes, and participant views on the intervention. Qualitative data will be analysed using the Framework Method. Feasibility will be assessed in terms of trial recruitment, retention, compliance to study visits and the intervention. SD of outcomes will inform the power calculation of the definitive RCT. ETHICS: The West Midlands Ethics Committee has approved this study and informed consent forms. This trial is the first to test cholesterol-lowering foods in adults with HIV. TRIAL REGISTRATION NUMBER: ISRCTN32090191; Pre-results.

A review of dietary influences on cardiovascular health: part 2: dietary patterns.

Dietary recommendations are key to cardiovascular disease (CVD) management. The underpinning evidence is generally based on data generated from single nutrient or food types. However, food is not consumed in such a manner, and components may interact synergistically or antagonistically depending on the dietary composition. Analyses of dietary patterns have attempted to address these important issues. The aim of this review is to present the current evidence on three major dietary patterns and their relationship with CVD. The most widely reported is the Mediterranean diet, which is characterised by abundant use of olive oil, and plant-based foods, moderate consumption of fish, dairy products, alcohol with meals, and a relatively low intake of red meat. The strongest evidence of causality has been established for the Mediterranean diet and unlike other dietary patterns has been shown to significantly reduce major CVD events. The Dietary Approach to Stop Hypertension (DASH), emphasising fruit, vegetables and low fat dairy products, has successfully been shown to lower blood pressure and cholesterol levels. However, its true effects on CVD under freeliving conditions have yet to be fully explored. The available evidence is encouraging for CVD prevention, but long-term effectiveness is unclear. Very low-carbohydrate diets appear to exert their favourable effect on CVD risk factors via weight loss. However, longterm effectiveness and safety remains unclear. The available evidence supports the role of the DASH and Mediterranean diets in the prevention of CVD.

A review of dietary influences on cardiovascular health: part 1: the role of dietary nutrients.

BACKGROUND: Lifestyle modification, including diet, is a key strategy for prevention and regression of cardiovascular disease (CVD), a leading cause of death worldwide. Traditionally, the study of the relationship between diet and CVD has focused on the analysis of single nutrients, or foods, in relation to CVD risk. OBJECTIVE: In part one of this review, we present current epidemiologic and clinical evidence on nutrition and cardiovascular health with regards to specific foods and nutrients aimed at preventing CVD. METHODS: The Cochrane Library database between 2006 and 2012 was searched for studies on effects of dietary factors on cardiovascular health. DISCUSSION: Evidence is presented on soy protein, fats, fish, nuts, fruit, vegetables, electrolytes, vitamins, and carbohydrate including fibre, glycaemic index, and wholegrains. Evidence from specific foods underpins current dietary CVD prevention guidelines, that advise on replacing saturated with unsaturated fat, consuming carbohydrate foods that are wholegrain or of low glycaemic index, increased consumption of fruit, vegetables (particularly cruciferous), nuts, and oily fish. Other nutrients (such as soya protein, or reducing sodium intake) reduce CVD risk via favourable effects on disease contributors (such as LDL-cholesterol or blood pressure), but also infer/promote dietary change that impacts other nutrients (using less animal or processed foods, resulting in saturated fat reduction). The complexity and limitations of interpreting dietary epidemiologic studies is reviewed. With the general ineffectiveness of nutrient-based intervention, recently the shift has been towards the examination of associations between dietary patterns and cardiovascular health, which will be examined in the second part of this review.

The effects of dietary intervention on HIV dyslipidaemia: a systematic review and meta-analysis.

BACKGROUND: Efficacy of dietary intervention for treatment and prevention of HIV-related lipid disturbances has not been well established. METHODS: We conducted a systematic search of electronic databases supplemented with manual searches and conference abstracts, without language restriction. All randomised controlled trials (RCTs) with blood lipid outcomes, involving dietary intervention or supplementation for the treatment or prevention of adult HIV dyslipidaemia, versus no or other intervention were included. Two authors using predefined data fields, including study quality indicators, extracted data independently. RESULTS: Eighteen studies (n = 873) met our inclusion criteria. Seven RCTs for omega-3 supplementation (n = 372), and four RCTs for dietary intervention (n = 201) were meta-analysed using random-effects models. Mild statistical heterogeneity was observed. Dietary intervention reduced triglyceride levels by -0·46 mmol/l (95%CI: -0·85 to -0·07 mmol/l) compared to control. Omega-3 supplementation reduced triglyceride levels by -1.12 mmol/l, (95%CI: -1·57 to -0·67 mmol/l) and total cholesterol, -0·36 mmol/l (95%CI: -0·67 to -0·05 mmol/l) compared to placebo/control. CONCLUSIONS: Both omega-3 supplementation and dietary intervention reduced triglyceride level, with the latter possibly to a smaller extent. While dietary interventions are beneficial, more stringent dietary approaches may be necessary to fully address lipid disturbances in HIV patients. TRIAL REGISTRATION: PROSPERO 2011:CRD42011001329.