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首页> 外文期刊>Journal of human nutrition and dietetics >A study of dietary advice and care provided to HIV positive patients referred for lipid lowering: as part of a service improvement initiative.
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A study of dietary advice and care provided to HIV positive patients referred for lipid lowering: as part of a service improvement initiative.

机译：一项针对HIV阳性患者的饮食建议和护理研究，旨在降低血脂：这是一项改善服务计划的一部分。

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Background: Combination antiretroviral therapy (ART) has dramatically reduced mortality in HIV-infected patients. As life expectancy of HIV infected patients has increased, concerns about the long-term effects of treatment grow (Sax, 2006). HIV positive patients have a greater risk of myocardial infarction (MI) and ART has been associated with a 26% increase in the rate of MI per year of exposure (DAD Study Group, 2003). The aim of this study was to evaluate provision of dietetic care to patients referred for lipid lowering advice and identify potential areas for service improvement. Methods: Departmental activity statistics identified 117 new clients referred for lipid lowering advice in the previous 11 months. The biochemical data and dietetic record cards were screened, of the initial sample 30 were excluded as they did not have follow up biochemistry after their dietetic consultation and a further seven were excluded as they were seen primarily for other conditions. The remaining cards (n = 80) hadtheir dietetic record cards audited to check dietary topics discussed, risk factors identified length before follow up and clinical outcomes. Results: There were 68 men and 12 women in this sample with a mean age of 46 years and mean body mass index (BMI) of 25.4 kg m(-2) (3.7 kg m(-2)). Of the clients referred, only 48.8% of the sample had high density lipoprotein (HDL): cholesterol ratios taken to calculate cardiovascular risk and most patients were seen an average of 30.7 days (35.3 days) after high was identified. Following their dietetic consultation, 77% of clients had a reduction in their cholesterol levels and 61% had a reduction in triglyceride levels. This sample's average percentage change in cholesterol was -10% (16%) and triglyceride was -6% (32%).The most popular dietary advice was reducing saturated fat intake (90%), increasing fibre intake (76%), benefits of plant stanols (40%), importance of regular meals (29%), exercise (26%) and benefits of omega three (11%). Additional risk factors identified 11% of clients seen were smokers, however most records (66%) did not have documentation on whether smoking behaviour was discussed. Only 20% of clients had a follow up appointments and not all were seen within 3 months with average time between follow up being 14.9 weeks (13.2 weeks). Discussion: Improvement in biochemical results were comparable to a study by Henry et al., (1998) which showed that in HIV infected clients receiving ART, diet modification and increased exercise were successful in reducing cholesterol levels by 11% and triglyceride levels by 21%. The level of smoking was considerably lower than other studies (DAD Study Group, 2003) which reported 56% of HIV positive clients to be smokers. A large number of clients were lost to follow up and were not seen within 3 months. Lazzaretti et al., (2007) showed in a randomized trial that seeing patients at regular 3 month intervals for dietary intervention prevented an increase in lipid blood levels in individuals who start ART. Conclusions:Not all clients are having their cardiovascular risk calculated before referral for dietary advice. Clients are not being seen at regular intervals by dietitians, some are lost to follow up and smoking status is not regularly documented during dietetic consultation. References Data Collection on Adverse Events of Anti-HIV Drugs (DAD) Study Group. (2003) Combination antiretroviral therapy and the risk of myocardial infarction. N. Engl. J. Med.349, 1993-2003. Friis-Moller, N., Weber, R., Reiss, P., Thiebaut, R., Kirk, O., d'Arminio, M.A. et al. (2003) Cardiovascular disease risk factors in HIV patients' association with antiretroviral therapy. Results from the DAD study. AIDS17, 1179-1193. Henry, K., Melroe, H., Huebesch, J., Hermundson, J. & Simpson, J. (1998) Atorvastatin and gemfibrozil for protease inhibitor-related lipid abnormalities. Lancet352, 1031-1032. Sax, P.E. (2006)Strategies for management and treatment of dyslipidem
机译：背景：联合抗逆转录病毒疗法（ART）大大降低了HIV感染患者的死亡率。随着HIV感染患者的预期寿命的增加，人们对治疗的长期效果的担忧日益增加（Sax，2006）。 HIV阳性患者罹患心肌梗死（MI）的风险更高，而ART与每年暴露的MI率增加26％有关（DAD研究小组，2003年）。这项研究的目的是评估为降脂建议转诊的患者提供饮食护理，并确定可能改善服务的领域。方法：部门活动统计数据确定了在过去11个月中有117位新客户接受降脂建议。筛选了生化数据和饮食记录卡，排除了最初的30个样本，因为他们在饮食咨询后没有进行后续的生化检查，另外排除了7个样本，因为主要是在其他情况下才发现它们。其余的卡（n = 80）已审核了他们的饮食记录卡，以检查所讨论的饮食主题，危险因素确定了随访前的时长以及临床结果。结果：该样本中有68名男性和12名女性，平均年龄为46岁，平均体重指数（BMI）为25.4 kg m（-2）（3.7 kg m（-2））。在所介绍的客户中，只有48.8％的样本具有高密度脂蛋白（HDL）：胆固醇比值，以计算心血管疾病的风险，大多数患者被确认为平均30.7天（35.3天）。在进行饮食咨询后，77％的客户胆固醇水平降低，61％的甘油三酸酯水平降低。该样本的胆固醇平均变化百分比为-10％（16％），甘油三酸酯为-6％（32％）。最受欢迎的饮食建议是减少饱和脂肪摄入（90％），增加纤维摄入（76％），有益效果植物甾烷醇（40％），常规餐点的重要性（29％），运动（26％）和欧米茄3的益处（11％）。识别出的其他风险因素中有11％的患者是吸烟者，但是大多数记录（66％）没有关于是否讨论吸烟行为的文档。只有20％的客户进行了随访预约，并且在3个月内未见到全部患者，平均随访时间为14.9周（13.2周）。讨论：生化结果的改善与亨利等人（1998年）的研究相当，该研究表明，接受抗逆转录病毒疗法的艾滋病毒感染者，饮食调整和增加运动成功地将胆固醇水平降低了11％，甘油三酸酯水平降低了21％ 。吸烟水平大大低于其他研究（DAD研究小组，2003年），该研究报告56％的HIV阳性感染者为吸烟者。大量客户流失了跟进服务，三个月之内未见到他们。 Lazzaretti等人（2007年）在一项随机试验中显示，每隔3个月定期进行饮食干预的患者，可以阻止开始接受抗逆转录病毒治疗的个体的血脂水平升高。结论：并非所有的患者在转介饮食建议之前都已计算出其心血管风险。营养师不会定期去看病人，有些人会失去跟进，饮食咨询期间也不会定期记录吸烟状况。关于抗艾滋病毒药物不良事件研究组的参考数据收集。 （2003）联合抗逆转录病毒疗法和心肌梗塞的风险。 N. Engl。 J.Med.349，1993-2003。 Friis-Moller，N.，Weber，R.，Reiss，P.，Thiebaut，R.，Kirk，O.，d'Arminio，M.A.等。 （2003）HIV患者的心血管疾病危险因素与抗逆转录病毒疗法的关联。 DAD研究的结果。 AIDS17，1179-1193。 Henry，K.，Melroe，H.，Huebesch，J.，Hermundson，J.＆Simpson，J.（1998）阿托伐他汀和吉非贝齐治疗蛋白酶抑制剂相关的脂质异常。柳叶刀352，1031-1032。萨克斯（P.E.） （2006）血脂异常的管理和治疗策略

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