Barriers to Nutrition Counseling with a Registered Dietitian (RD) and Its Association with Dietary Intake, Nutrition Status, Disease Outcomes and Substance Abuse in People Living with HIV (PLWH).
Doctor of Philosophy (PhD)
Dietetics and Nutrition
First Advisor's Name
First Advisor's Committee Title
Second Advisor's Name
Fatma G. Huffman
Second Advisor's Committee Title
Third Advisor's Name
Third Advisor's Committee Title
Fourth Advisor's Name
Fourth Advisor's Committee Title
HIV; barriers to healthcare; nutrition counseling; alternate healthy eating index; cardiovascular disease
Date of Defense
The relationship between nutrition and HIV is multifactorial. Nutrition counseling provided by a Registered Dietitian (RD) has the potential for improving disease risk outcomes for PLWH. To determine barriers to access nutritional counseling with an RD in PLWH, and evaluate the relationship of this counseling on dietary intake, nutritional status, cardiovascular disease (CVD), and HIV-disease outcomes.
This is a cross-sectional study of a consecutive convenience sample of 130 PLWH on stable ART from the MASH cohort. After consenting, participants completed a survey on types and frequency of nutritional services received in the last 12 months, and on barriers to access these services. Participants were assigned to groups according to their responses. Demographics, anthropometries, dietary intake, medical history and laboratory information were obtained. The Alternative Healthy Eating Index (AHEI) scores were calculated after obtaining two 24-hour dietary recalls, and Nutribase and SPSS 20 were used for analyses.
Mean age was 47.7 years, 62.0% were male and 77.0% were Black; 48% percent were seeing an RD, with 48.3% of those visiting an RD³4 times within the year. Frequently identified barriers to nutritional services were difficulty in keeping appointments (33.8%) location (24.6%) and lack of referrals (23.8%) by medical personnel. Lack of referral was associated with lower CD4 cell count (r=-0.2, P=0.029). Compared to those who did not visit an RD, participants who did had higher AHEI scores (34.7 vs. 29.2, P < 0.001), lower waist circumference (35.5 vs. 38.5 in., P=0.003), and BMI (26.0 vs. 28.8 kg/m2, P=0.019), with higher proportion of participants within the normal range of BMI (48% vs. 25%, P=0.017). The group consulting an RD had significantly lower risk factors for CVD, with better lipid profiles for all biomarkers, and lower waist circumference (35.5 vs. 38.5 inches, P = 0.003) and systolic blood pressure (114.8 vs. 127.9 mmHg, P < 0.001). Other CVD risk factors such as ART and substance abuse, common in this population, were not significantly different between the groups. Our findings suggest that consulting with an RD is associated with better nutritional status, dietary intake and lower risk factors for CVD.
Fleetwood, Christina D., "Barriers to Nutrition Counseling with a Registered Dietitian (RD) and Its Association with Dietary Intake, Nutrition Status, Disease Outcomes and Substance Abuse in People Living with HIV (PLWH)." (2015). FIU Electronic Theses and Dissertations. 2181.
In Copyright. URI: http://rightsstatements.org/vocab/InC/1.0/
This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s).