Healthy Diet May Improve Adherence in Diabetes, HIV

Comprehensive nutrition could improve the overall health of patients with chronic diseases.

Following a healthy diet can improve medication adherence and mental health of patients with HIV and/or type 2 diabetes, according to a study published in the Journal of Urban Health.

The investigators sought to evaluate whether helping individuals get medically appropriate, comprehensive nutrition would improve their overall health.

The study included 52 participants, who picked up meals and snacks twice per week. The meals were based on the Mediterranean diet, and included lean proteins, healthy fats, whole grains, and fresh fruits and vegetables. Additionally, the food was low in refined sugars and saturated fats.

After 6 months, the results of the study showed that participants consumed fewer fats, and increased their consumption of fruits and vegetables. Overall, participants had fewer symptoms of depression and were less likely to binge drink.

For participants with HIV, the investigators found that adherence to antiretroviral therapy increased from 47% to 70%. Participants with diabetes consumed less sugar and lost weight.

“We saw significant improvements in food security and in outcomes related to all 3 mechanisms through which we posited food insecurity may affect HIV and diabetes health—–nutritional, mental health, and behavioral,” said co-first author Kartika Palar, MD. “For example, we saw dramatic improvements in depression, the distress of having diabetes, diabetes self-management, trading-off between food and health care, and HIV medication adherence.”

The meals and snacks fulfilled 100% of daily caloric requirements, according to the authors. The average energy requirements used to design the daily meals were 1800 to 2000 kcal for individuals with HIV, and 1800 kcal for those with type 2 diabetes.

The threshold evolved to account for varied energy requirements of participants of different sizes and metabolic needs, according to the study.

“This study highlights the vital role that community-based food support organizations can play in supporting health and well-being of chronically ill populations who struggle to afford basic needs,” said senior author Sheri Weiser, MD.

The study was too small to conclusively show whether providing nutritious food to people with diabetes resulted in better long-term control of their blood sugar, or reduced hospitalizations or emergency department (ED) visits. However, it did find an increase in the amount of people with diabetes who achieved optimal blood sugar control, and a decrease in hospitalizations or ED visits; however, the changes did not reach statistical significance.

During the 6-month study, the cost to feed each participant was $6.58 per day, or $1194 for the entire duration of the study.

The majority of study participants were receiving federal disability payments (SSI and/or SSDI), and approximately 20% were receiving food stamps. Compared with participants living with HIV, patients with type 2 diabetes were more likely to be older, female, African American, employed, and receiving food stamps.

The investigators plan to do a 6-month follow-up study of 200 HIV-positive individuals in San Francisco and Alameda counties in California.