Nutrition, Metabolism and GI Research in HIV - CFAR Centers for AIDS Research

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Low cholesterol diet foodsDietary Analysis

What is Dietary Assessment?

Dietary assessment allows researchers to analyze the patterns, quantity, and quality of food consumed by individuals or a population. Dietary assessment can measure total energy (calories) specific amounts of nutrients, and diversity. Dietary assessment can also be used by researchers to determine the quality of dietary intake from theoretical or empirical analyses methods to try to associate dietary intake with risk for disease-related outcomes.

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Why is Dietary Assessment Important?

Dietary assessment is important to understand the types and amounts of macro- and micronutrients consumed by an individual or population in order to assess susceptibility for specific nutrition-related diseases or deficiencies and/or excesses. If nutrient deficiencies or excesses are identified then further interventions, programs, or policies can be developed to improve dietary intake in the affected populations.

Around the Globe:

Obesity: As global incomes have risen and the food supply chain has morphed to include excess processed foods, obesity and the dietary choices that can lead to obesity have become a focus of dietary analysis. Dietary analysis has been used to determine the excess caloric intake of obese individuals and populations, as well as the nutrient deficiency that results from a processed food based diet.

Obesity Risk Index 2013

In 2008, 1.4 billion people were identified globally as overweight. This has led to approximately 2.8 million deaths per year due to obesity related diseases (World Health Organization 2014).

Malnourishment: Although, obesity has become a global problem, another global population still cannot access enough food. These individuals are malnourished. Most individuals who are identified as malnourished live in resource poor countries, however malnourished populations still exist in the industrialized world, as you can see in the map below.

2013 Global Hunger Index


Approximately 842 million people around the globe cannot access enough food to remain healthy. 827 million of these people live in resource poor countries (World Food Program 2013).

This global dietary intake problem (whether it be related to malnutrition or obesity) makes it imperative that researchers understand the caloric and nutrient limitations of their study population to fully understand how to best impact them.

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Why is Dietary Analysis important in HIV/AIDS?

Several studies have supported the role of nutrition for the management of HIV/AIDS either due to unintentional weight loss/gain or to reduce the risk of cardiovascular disease, diabetes, or other co-morbidities. Early nutrition intervention may prevent or delay progression of HIV due to declining nutritional status.

In 2003, the World Health Organization stated that PLWHA (People Living with HIV/AIDS) require an increased energy intake in order to maintain the same body weight.

Dietary Analysis is necessary to understand if patients are able to follow the WHO recommendations.

Researchers have also determined that supplemental nutrients can have a positive impact on HIV patients. For instance, patients with a higher fiber intake developed less fat deposition then patients with lower fat deposition. (Hendricks 2003)

HIV/AIDS Impacts Dietary Intake:

  • Symptoms associated with ART can alter dietary intake:
  • HIV can lead to metabolic abnormalities:

Dietary Analysis and HIV Research:

Dietary Intake has recently been recognized as an important factor in the success of HIV/AIDS care and treatment.

  • Measurements have been completed to better understand the impact of dietary intake on the success rates of ARTs.
  • Measurements have been completed to understand the impact of macronutrient and micronutrient supplements on the health of PLWHA.

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How can you use Dietary Analysis?

Dietary analysis can come in the form of food log that is analyzed by a nutritional specialist or a survey.

Analysis based on a Food Log:

  • 24 Hour Recall: This nutritional tool requires individuals to recall all of the food and drink that they consumed in a 24 hour time period.
  • Detailed Food Record (72 hours): This nutritional tool requires an individual to write down all of the food and drink that they consume in a 72 hour time period. The record is self-administered, than reviewed by a nutritional expert.
  • Healthy Eating Index: This index is a way to measure dietary quality of an individual or a population.

Analysis based on a Survey:

  • Dietary Diversity Score: This score is calculated from a survey to show the diversity of foods that a household consumes or an individual consumes.
  • Food Frequency Questionnaire: This questionnaire attempts to identify the frequency which an individual eats a certain type of food. ex. fruit, vegetables, alcohol, vitamins, minerals, etc.

Which measure should I use?


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Scales: Analysis, Examples, and Research using each Scale

1. 24 Hour Recall:

  • Analysis of Data: Use the ASA 24 Hour recall online which was developed by the National Cancer Institute. Researchers can create their own 24 Hour recall online and ASA 24 will analyze the data for you. 24 Recall Analysis

  • Example of 24 Hour Recall Sheet: 24 Hour Recall Example from Tufts.

  • Research Using Recall:

Example of Research that uses the 24 Hour Recall: National

Dowshen N, Kuhns LM, Johnson A, Holoyda BJ and Garofalo R. Improving Adherance to Antiretroviral Therapy for Youth Living with HIV/AIDS: A Pilot Study Using Personalized, Interactive, Daily Text Message Reminders. Journal for Medical Internet Research. 2012; 14(2):e51.

Examples of Research that uses the 24 Hour Recall: International

Giudici, KV, Duran AC and Jaime PC. Inadequate food intake among adults living with HIV. Sao Pablo Medical Journal. 2013; 131(3):145-52.

Tang AM, Bhatnagar T, Ramachandran R, Dong K, Skinner S, Kumar MS and Wanke C. Malnutrition in population of HIV-positive and HIV-negative drug users living in Chennai, South India. Drug Alcohol Depend. 2011; 118(1): 73-77.

2. Detailed Food Record (72 Hours):

  • Analysis of Data: The Minnesota Nutrition Data System contains all information necessary for analyzing dietary intake. However you must purchase a license to access this information. Information about how to access a license is available on their website Minnesota Nutriton Data System Website.

  • Example of Detailed Food Record: Detailed Food Record 3 Days

  • Research Using Food Record:

Examples of Research that uses the Detailed Food Record: National

Forrester JE, Tucker KL, and Gorbach SL. Dietary intake and body mass index in HIV-positive and HIV-negative drug abusers of Hispanic ethnicity. Public Health Nutrition. 2004; 7(7): 863-870.

Hendricks KM, Dong KR, Tang AM, Ding B, Spiegelman D, Woods MN, and Wanke CA. High-fiber diet in HIV-positive men is associated with lower risk of developing fat deposition. American Journal of Clinical Nutrition. 2003; 78:790-5.

3. Healthy Eating Index:

  • Analysis of Data: Guidance for analysis can be found on the HEI website Health Eating Index Analysis.

  • Example of Healthy Eating Index (Analysis): This chart compares the different between HEI 2005 vs 2010.

  • Research Using Index: This process map explains how HEI can be used in research

4. Food Frequency Questionnaire:

Examples of Research that uses the Food Frequency Questionnaire: National

Smit E, Graham N, Tang A, Flynn C, Solomon L, and Vlahov D. Dietary Intake of Community Based HIV-Seropositive and Seronegative Injecting Drug Users. Nutrition. 1996; 12: 496-501.

Hendricks K, Tang A, Spiegelman D, Skinner S, and Woods M. Dietary Intake in Human Immunodeficiency Virus-Infected Adults: A Comparison of Dietary Assessment Methods. Journal of the American Dietetic Association. 2005; 105(4): 532-539.

Examples of Research that uses the Food Frequency Questionnaire: International

Hattingh Z, Walsh CM, Veldman FJ, and Bester CJ. Macronutrient intake of HIV-seropositive women in Mangaung, South Africa. Nutritional Research. 2006; 26:53-58.

Lukmanji Z, Hertzmark E, Spiegleman D, and Fawzi WW. Dietary Patterns, Nutrient Intake and Sociodemographic Characteristics in HIV-Infected Tanzanian Pregnant Women. Ecology of Food and Nutrition. 2013; 52:34-62.

5. Dietary Diversity Score:

Analysis of Data: FANTA provides all necessary information to analyze and administer the DDS in their DDS indicator guide DDS Indicator Guide.

Example of Dietary Diversity Score: Dietary Diversity Score

Research Using Score:

Examples of Research that uses the Dietary Diversity Score: National

Arimond M and Ruel MT. Dietary diversity is associated with child nutritional status: evidence from 11 demographic and health surveys. The Journal of Nutrition. 2004; 134(10): 2579-2585.

Examples of Research that uses the Dietary Diversity Score: International

Mpontshane N, Van den Broeck J, Chhagan M, Luabeya KKA, Johnson A, and Bennish ML. HIV Infection if Associated with Decreased Dietary Diversity in South African Children. The Journal of Nutrition. 2008; 138(9): 1705-1711.

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Food Frequency Questionnaires. Accessed July 20, 2014.

Hendricks K, Tang A, Spiegelman D, Skinner S, and Woods M. Dietary Intake in Human Immunodeficiency Virus-Infected Adults: A Comparison of Dietary Assessment Methods. J Am Diet Assoc. 2005; 105: 532-540.

Kennedy G, Ballard T and Dop M. Guidelines for Measuring Household and Individual Dietary Diversity. Published by Nutrition and Consumer Protection Division, Food and Agriculture Organization of the United Nations. 2013.

Schroder H, Covas MI, Marrugat J, Vila J, Pena A, Alcantara M, et al. Use of a three-day estimated food record, a 72-hour recall and a food-frequency questionnaire for dietary assessment in a Mediterranean Spanish population. Clinical Nutrition. 2001; 20 (5): 429-437.

Swindle A and Bilinsky P. Household Dietary Diversity Score (HDDS) for Measurement of Household Food Access: Indicator Guide. September 2006.

Tien PC, Benson C, Zolopa AR, Sidney S, Osmond D, and Grunfeld C. The Study of Fat Redistribution and Metabolic Change in HIV Infection (FRAM): Methods, Design, and Sample Characteristics. Am J Epidemiol. 2006: 163(9): 860-869.

USDA. Procedures for collecting 24-hour food recalls. Accessed June 24, 2014.

Woods MN. Nutrition Assessment I & II. Published by Tufts University School of Medicine. Accessed July 16, 2014.

World Food Program. Hunger Statistics. 2013.

World Health Organizations. Obesity and Overweight. Reviewed May 2014.


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For information on our Nutrition, Metabolism & GI Core services,
please contact Chris Wanke, MD ( or
Tamsin Knox, MD (

Lifespan/Tufts/Brown CFAR is funded by the National Institutes of Health.
Please remember to cite the LTB CFAR (Grant P30 AI042853)
in all publications that have benefited from the Center's Core services.