• Number Eighteen
• Number Seventeen
• Number Sixteen
• Number Fifteen
• Number Fourteen
• Number Thirteen
• Number Twelve
• Number Eleven
• Number Ten
• Number Nine
• Number Eight
• Number Seven
• Number Six
• Number Five
• Number Four
• Number Three
• Number Two
• Number One

HIV ReSources Web Site - April 30, 2004

The HIV ReSources has been updated. 

New Pages: 
Heart Disease

New Links: 
Nutrition-Related Conditions

Hepatitis Information
 

BSE Information and Resources--Updated

There are now updated resources on BSE and Avian Influenza including technical briefings, fact sheets, notices, FAQs, and more from APHIS, FSIS, FAS, DHHS, FDA, CDC, and the WHO. As people with depressed immune systems may be more vulnerable to such conditions a review of these diseases are prudent. 

The CDC published "Interim Recommendations for Persons with Possible Exposure to Avian Influenza During Outbreaks Among Poultry in the United States" (updated link 2/23/05). Outbreaks of avian influenza A occur among U.S. poultry flocks from time to time and this year avian influenza outbreaks have been reported in several locations in the United States. 

For recent reports on emerging infectious diseases refer to the "Emerging Infectious Diseases Journal. 

New Consumer Mercury Advisory

Many people living with HIV follow the advice of health care professionals to eat more fish. Learning more about possible ill effects resulting from excessive fish consumption helps us to find a balance between good and harmful dietary habits. We know that tuna or swordfish more than once a week may be harmful in some regions of the U.S. because of increased mercury content (HIV ReSource Review Issue 13 and Issue 16). Tuna steaks and canned albacore tuna generally contain higher levels of mercury than canned light tuna. More than once a week consumption of certain fish found in the Florida Everglades may also contain increased amounts of mercury. Consumers can check with their state or local health department to see if there are special advisories on fish caught locally through the Environmental Protection Agency (EPA) web site. 

The joint Food and Drug Administration (FDA) and EPA “Revised Consumer Advisory on Methylmercury in Fish” addressing fish and shellfish is now available on the Internet. The advisory contains information on consumption of both commercial and locally caught fish. Pregnant women, nursing mothers, and women of childbearing age who may become pregnant should not eat shark, swordfish, king mackerel or tilefish. Besides the fetus, young children and people with decreased immune systems are most at risk from high methylmercury levels in fish. 

FDA recommends that consumers eat a balanced diet, choosing a variety of foods that are low in trans fat and saturated fat and rich in high fiber grains, fruits and vegetables. Fish and shellfish can be an important part of a balanced diet and people can safely eat about 12 ounces per week of cooked fish species not listed on the FDA advisory. 

For more information and links to other resources about the risks of mercury in fish and shellfish visit: 
* Link 1
* Link 2
* Link 3
* Link 4
* Link 5

Employment Opportunity

Project Angel Heart was hiring a full-time Client Services Coordinator to coordinate the delivery of home-delivered meals to people living with HIV/AIDS, cancer and other life- threatening illnesses. In addition to other responsibilities, the Client Services Coordinator performs functions related to client eligibility, manages a client database, coordinates the dissemination of information to clients, and conducts research relevant to diet, nutrition and illness. This position also assists the Director of Client Services with program evaluation and other aspects of the program and covers the Client Services Assistant position as needed. 

This position has been filled. 
 

Sugar

A discussion of sugar that adds to information in the Nutrition Forum column of the current HIV Nutrition Update Issue 47 newszine is at the Center for Science in the Public Interest (CSPI) web site. Articles list "added sugars" and offer information on how they affect the human body. A recent article in the American Journal of Clinical Nutrition notes the consumption of high-fructose corn syrup in beverages such as soft drinks may play a role in the development of obesity. It's important to point out that the digestion, absorption, and metabolism of fructose differs from that of glucose and fructose does not stimulate insulin secretion or enhance leptin production. As noted in Issue 23 of the HIV ReSource Review, people may have an “addiction like” pattern for colas and coffee with sugar. Sugar in the form of whole fruits and complex carbohydrates are a better food choice instead of refined sugar and simple carbohydrates. 

Reference
1. Bray GA, Nielsen SJ, Popkin BM. Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. Am J Clin Nutr 2004;79(4):537-543. 

Obituary

With a heavy heart we announce the passing of Dean Allen DeLong who helped 'behind the scenes' with the tasks of publishing our newsletters and keeping up the web site. Dean passed on I-95 shortly after a motorcycle accident. For further information visit the Dean Allen DeLong Web Site.

Conference News

Mercury: Medical and Public Health Issues will be held on April 28, 2004- April 30, 2004 in Tampa, Fl. The program will focus on medical and public health aspects of mercury exposure. For more information, visit the EPA web site.
 

HIV ReSources Web Site Update

New Pages:
HIV Nutrition Update Issue 47

New Links:
Nutrition And HIV

Recursos de nutricion

HIV Nutrition Newsletter Gateway
 

Substance Abuse

The National Institute on Drug Abuse (NIDA) recently released a revised edition of "Drug Use Among Racial/Ethnic Minorities", which compliments information in Issue 24 and Issue 25 of the HIV ReSource Review. The NIDA resource is for researchers, health administrators, policymakers, program leaders, and others looking for information on illegal drug use among minority populations. Of particular importance, the NIDA report notes that estimates of illegal drug use among minorities may under- represent the extent of illegal drug use. Attention to the issues of illegal drug use may become increasingly vital as the prevalence of HIV among minorities continues to rise. 

Recalls And Warnings

Food and Drug Administration (FDA) Recalls: 
* Grand Prix Trading Corp., 75A Onderdonk Avenue, Ridgewood, New York 11385 is recalling it's 136-gram, 4.8- ounce packages of "E. Wedel, Delicje Soft Biscuits Topped with Fine Chocolate and Delicious Filling", due to the presence of undeclared milk allergens.  People who have allergens to milk run the risk of serious or life-threatening allergic reaction if they consume this product. 

* Aloe Commodities International, Inc., in Carrollton, Texas, is recalling 1600 bottles of Solutions IE Ageless Formula II, Lot numbers P2207 and P2221 because they contain a significantly higher-than-labeled level of vitamin D3. (Approximately 188,640 International Units (IU) are present in each serving size of 6 capsules instead of the intended level of 400 IU). The product is distributed by Solutions International, Inc., Orem, UT. If you have been taking the supplements and have symptoms of vitamin D toxicity such as weakness, tiredness, headache, flu-like symptoms, nausea and diarrhea you should seek medical attention immediately. For more information visit: the FDA web site.

Visit the FDA web site for further information on other product
recalls, market withdrawals and safety alerts from the FDA. 

* The Canadian government asked more than 1,000 people to get tested for HIV and hepatitis because Canadian acupuncturists reportedly used inadequate sterilization. Visit the following Canadian and American web sites for further information.

HIV Nutrition Update - Newszine Issue 47

The March/April 2004 HIV Nutrition Update Newszine issue is now available. The feature article in this issue, "Examining the Role for Conjugated Linoleic Acid in HIV/AIDS - Part I: In Vitro and Animal Studies" is by John Babish, Ph.D. Dr. Babish is a molecular biologist who served as a tenured Associate Professor of Pharmacology and Toxicology at Cornell University for 17 years. He has authored or co-authored over one hundred peer-reviewed scientific articles, eight position papers, and two book chapters. The inventor of 14 U.S. and world patents, he is the Chairperson of Bionexus® Ltd. located in Ithaca, New York, the makers of NutriVir®. Dr. Babish also served as a member of the Macronutrients, Micronutrients, and Non- Essential Dietary Supplements sub-group of the National HIV Nutrition Guidelines Working Group. The group's work did not include a review of Conjugated inoleic Acid (CLA). As with many dietary supplements, numerous inconsistencies in the results of CLA research make it difficult to interpret published studies. The principle reason for this is the number of variables inherent in any single study, making it difficult to compare results from one publication to another. 

In the next HIV Nutrition Update issue, Dr. Babish will report on the Bionexus clinical trial entitled, “A Double-Blinded, Placebo- Controlled Study of the Dietary Supplement BION493 in HIV patients exhibiting ART/HAART-associated lipodystrophy.” Patients with morphological changes such as fat redistribution, including buffalo hump, central and visceral fat accumulation, facial and limb fat atrophy and lipomatosis and those with either high cholesterol, high triglycerides or insulin resistance are enrolled in the phase I study. 

Issue 47 also includes: 
* Program Spotlight column on the Regional Internal Medicine Clinic in Spartanburg, SC; 
* Nutrition Forum column on sugar; 
* Book Reviews of Know Your Fats: The Complete Primer for Understanding the Nutrition of Fats, Oils, and Cholesterol and the Natural Medicines Comprehensive Database; 
* Med Watch column on Emtricitabine (Emtriva); 
* Editor Thanks to periodic HIV Nutrition Update and HIV ReSource Review editors. 
 

Conference Updates

* The Third Cannabis Therapeutics Conference "Cannabis Use Throughout the Life Span" was held on May 20-22, 2004, at the Charlottesville Omni Hotel in Charlottesville, VA. The conference was sponsored by Patients Out of Time with the University of Virginia School of Nursing, the Pain Clinic of the University of Virginia's Health System, the Virginia Nurses Association and the University of Virginia School of Law. Press and journalists can contact Al Byrne through email or visit the Web Site for more information. 

* The Eighth Annual HIV Update was held on June 3-5, 2004 at the Seaport Hotel & World Trade Center in Boston, MA. Visit the Harvard Medical School web site for information on future conferences. 

* The International Society of Sports Nutrition (ISSN) First Annual Conference was held June 18-19, 2004. Visit the web site for further information. 

* The International Research Conference on Food, Nutrition and Cancer was at the Capital Hilton Hotel in Washington, DC on July 15-16, 2004. For further information, visit the web site. 

Energy Requirements

Recent information on energy requirements compliments articles published in Issue 8 of the HIV ReSource Review and the NUMEDX Journal Fall/Winter 2003 issue. 

A study of several equations for predicting resting metabolic rate against measured (by indirect calorimetry) values revealed the Mifflin calculation as the most accurate for calculating resting metabolic rate in adults. (1) Investigators suggest clinicians consider using the Mifflin calculation as the standard for calculating resting metabolic rate. Using the Atwater energy equivalents to measure metabolizable energy intake, researchers recently learned that in older people these energy equivalent values may overestimate the actual metabolizable energy intake. (2) 

References
1. Frankenfield DC, Rowe WA, Smith JS, Cooney RN. Validation of several established equations for resting metabolic rate in obese and nonobese people. J Am Diet Assoc 2003;103 (9):1152-1159.
2. Kruskall LJ, Campbell WW, Evans WJ. The Atwater Energy Equivalents Overestimate Metabolizable Energy Intake in Older Humans: Results from a 96-Day Strictly Controlled Feeding Study. J Nutr 2003;133:2581-2584.
 

Nutrition Counseling and Assessment

Throughout the years we have learned of many issues to onsider when counseling people living with HIV. Effective nutrition counseling is vital to help patients realize lifestyle changes that will help them increase their quality of life and decrease morbidity and mortality. (1) Effective nutrition counseling and assessment is especially important for people living with HIV/ AIDS. Proactive nutrition intervention can result in fewer complications, leading to a reduced cost of care and increased quality of life. To allow maximum benefit and cost effectiveness, nutritional intervention and education should
start at the time of initial HIV-positive diagnosis and continue throughout the disease process. Review Tufts University Nutrition and HIV Research.

Recent articles report on the potential of primary care physicians to offer effective nutrition counseling. (1, 2) Variables such as time constraints of primary care practice require nutrition counseling to be brief. To meet the need for effective nutrition counseling, two new tools are now available for physicians and other health care providers. The weight, activity, variety and excess (WAVE) tool and a brief validated questionnaire should help providers perform brief assessments of diet and physical activity (rapid eating and activity assessment for patients -REAP) to facilitate nutrition assessment and counseling. The REAP and WAVE tools offer providers an opportunity to discuss nutrition with patients in only 1-9 minutes. Knowing when to refer appropriate patients to qualified nutrition professionals is vital to be effective enough to help patients realize lifestyle changes that will help them increase their quality of life, decrease morbidity and mortality. 

View the Nutrition Curriculum Guide For Training Physicians. 

References
1. Eaton CB, McBride PE, Gans KA, Underbakke GL. Teaching Nutrition Skills to Primary Care Practitioners. J Nutr 2003;133:563S-566S. 
2. Gans KM, Ross E, Barner CW, Wylie-Rosett J, et al. REAP and WAVE: New Tools to Rapidly Assess/Discuss Nutrition with Patients. J Nutr 2003;133:556S-562S.

Warnings And Food Recalls

* The Food and Drug Administration (FDA) recently warned consumers not to buy or use the herbal 'Green Hornet' product. The product is an unapproved liquid promoted as an herbal version of the illegal street drug Ecstasy. Reports of severe adverse reactions in four teenagers who took the drug prompted the warning as the liquid contains undeclared ingredients found in over-the-counter drugs. Visit the FDA web site for more information. 

* The Department of Health and Human Services (HHS) is cracking down on distributors of steroid-like androstenedione (Andro) products sold as dietary supplements. Although these products are promoted to enhance athletic performance the FDA says they are a potential health risk. 

* The Food and Drug Administration recently announced a recall of Adco USA uneviscerated fish due to possible contamination with Clostridium botulinum spores. ADCO USA, Inc. in Brooklyn, NY is recalling 200 packages of Coral Brand Steamed Indian Mackerel uneviscerated fish because it may be contaminated with Clostridium botulinum Spores, which can cause Botulism, a serious and potentially fatal food-borne illness. Symptoms of botulism include blurred or double vision, general weakness, poor reflexes, difficulty swallowing and respiratory paralysis. 

The recalled product was sold in Florida, South Carolina and Wisconsin. Consumers who have Coral Brand Steamed Indian Mackerel are advised not to eat it, but should return it to the place of purchase. 

* A Georgia firm recently announced a recall of fully cooked boneless ham for possible listeria contamination. Four Star Meat Products Company Inc. is voluntarily recalling approximately 713 pounds of the ham that may be contaminated with Listeria monocytogenes. The product was shipped to a warehouse in Chattanooga, Tennessee and the company reports that all of the product is being held at that location. 

Consumers with food safety questions can phone the toll-free USDA Meat and Poultry Hotline at 888/MPHotline. The hotline is available in English and Spanish and can be reached from 10 a.m. to 4 p.m. (Eastern Time) Monday through Friday. Recorded food safety messages are available 24 hours a day. 

Access news releases and other information at the FSIS Web site. For a listing of recalls, market withdrawals, and safety alerts visit the FDA web site.
 

More on Diabetes

Recent publications add to the glucose abnormalities information presented in previously published HIV ReSource Review (Issue 27 and Issue 28) and HIV Nutrition Update newszines (Issue 45). New research also compliments the discussion of cognitive decline in HIV-positive people in a 1996 HIV ReSource Review issue. 

New data from the Agency for Healthcare Research and Quality highlights a relationship between diabetes, obesity, and chronic disease. And the National Diabetes Education Program offers recent information on the link between diabetes and heart disease. 

Researchers at the U.S. Department of Veterans Affairs Medical Center in Portland, Oregon report that diabetes may be linked to early hearing loss. (1) Further confirmation that high homocysteine levels increase the risk for heart attacks in Type 2 diabetics was also recently documented. Investigators report a higher incidence of cognitive decline in diabetics. (2) Researchers studying the relationship between total homocysteine levels and cognitive status in 50 Type 2 diabetics found that elevated homocysteine may be a marker for cognitive decline. (3) Cognitive decline could be more common among elderly female Type-2 diabetics who are not taking diabetic medication. (2) However, investigators surmise that oral hypoglycemic therapy might ameliorate the risk of cognitive decline in diabetics. 

Investigators recently reported that coffee drinkers may be at lower risk for Type 2 diabetes. Also, in a preliminary study of 32 men, Samman and others reported that supplementation with Juice Plus (a dehydrated juice concentrate from mixed fruit and vegetables) is inversely associated with the risk of heart disease. (4) In the preliminary study, Juice Plus increased plasma ß-carotene, retinol, tocopherol, ascorbic acid, and folic acid concentrations. 

A recent article published by the American Medical Association discussed physician communication with diabetic patients who have low health literacy (Arch Intern Med 2003;163:83-90). Investigators reported that patients recall or comprehend as little as half of what physicians tell them. And researchers from the National Institute of Diabetes and Digestive and Kidney Diseases recently reported that most diabetics do not meet treatment goals. 

Readers can review “Cardiovascular Disease in Type 2 Diabetes Mellitus Current Management Guidelines”. Two diabetes resource collections have also been updated: BMJ and MEDLINEplus. Further leads to information on diabetes are in the weekly update Archives

References
1. Hopkin M. Studies Point To Danger Of Deafness And Mental Decline In Old Age. 27 February 2004.
2. Logroscino G, Kang JH, Grodstein F. Prospective Study Of Type 2 Diabetes And Cognitive Decline In Women Aged 70-81 Years. BMJ (published 23 February 2004). 
3. de Luis DA, Fernandez N, Arranz M, et al. Total Homocysteine And Cognitive Deterioration In People With Type 2 Diabetes. Diabetes Res Clin Pract 2002;55(3): 185-90.
4. Samman S, Sivarajah G, Man JC, et al. A Mixed Fruit and Vegetable Concentrate Increases Plasma Antioxidant Vitamins and Folate and Lowers Plasma Homocysteine in Men. J Nutr 2003;133:2188-2193.

Conference Updates

* amfAR's 16th National HIV/AIDS Update Conference was held on March 27-30, 2004 at the Hyatt Regency in Miami, FL. Visit the web site

* HIV and Woman’s Health was held on April 2-3, 2004 in Los Angeles, CA. The program will focus on proper and comprehensive care of HIV-positive women, children and couples. Further information

* The International Society of Sports Nutrition (ISSN) had their First Annual Conference from June 18-19, 2004 in Las Vegas. Conference sessions focused on the importance of understanding the interaction between food, supplements, exercise and performance. 

* The Third National Clinical Conference on Cannabis Therapeutics was held on May 20-22, 2004 in Charlottesville, VA. The conference was designed to resurrect the knowledge base of therapeutic cannabis in public, accredited venues that are directed to health care clinicians. The program faculty included experts from the U.S., Canada, Israel, The Netherlands and the United Kingdom. The conference brought replicated, science based research to clinicians, patients, legislators, the press and the public upon which individuals could make informed decisions about therapeutic cannabis use. The conference was jointly sponsored by Patients Out of Time and the University of
Virginia School of Medicine. 
 

HIV ReSources Web Site Update - March 5, 2004

Updated Pages: 
* HIV ReSources Index Page

* Nutrition & HIV Discussion Area Archive 1

* Nutrition & HIV Discussion Area Archive 2

* HIV ReSources Product Order Form

New Links: 
* Diabetes

* Books On Complementary Treatments

* Food Safety Resources

ANSA adds new staff

The Association of Nutrition Services Agencies (ANSA) hired an additional staff person.  This new job has many facets to it including: working on the Positive Helpings and Community Coalitions grant initiatives; assisting with various aspects of the annual conference; recruiting new members; developing more group purchasing opportunities for the membership; and other diverse and interesting responsibilities. View Membership information
 

HIV/AIDS Nutrition Discussion Electronic Lists 

* Discussion Group on Nutritional Care and Support for People Living with HIV/AIDS 
ProNut-HIV aims to share up-to-date information, knowledge and experience on nutrition and HIV/AIDS. The discussion promotes constructive dialogue between HIV-positive people, front line workers, researchers, HIV/AIDS specialists and policy makers. The forum intends to focus primarily on the nutrition care and support f mothers and children. Send a message to ProNut-HIV     To subscribe or unsubscribe: in the body of the message type: subscribe pronut-hiv. Contact a person Information and archives

* HIV Nutrition Discussion List 
The HIV Nutrition Discussion List is dedicated to issues surrounding nutrition and HIV and is sponsored by A1WebServer and HIV ReSources, Inc. It is open to anyone who chooses to subscribe. Only subscribers can post messages but messages can be freely shared with non-subscribers and are archived. To learn more or subscribe to the list visit the archived messages web site. 
 

Clinical Trial Update

Bionexus is currently conducting a clinical trial entitled, “A Double-Blinded, Placebo-Controlled Study of the Dietary Supplement BION493 in HIV patients exhibiting ART/HAART -associated lipodystrophy.”  Patients with morphological changes such as fat redistribution, including buffalo hump, central and visceral fat accumulation, facial and limb fat atrophy and lipomatosis and those with either high cholesterol, high triglycerides or insulin resistance may qualify for study inclusion. 

The Bionexus clinical trial objective is to provide a preliminary assessment of the tolerability, safety and efficacy of a dietary supplement designed for the management of antiretroviral therapy (ART)-associated lipodystrophy, hyperlipidemia and hyperglycemia in HIV-positive men. Over a 12-week or 15- week period, subjects will be randomly assigned to the test dietary supplement BION493 or an isocaloric placebo.  The test material provides 6 grams CLA, N-acetylcysteine, and a patented organic form of chromium. 

Subjects completing the study will receive monetary compensation. 

Food Recall

On February 24, 2004, USDA's Food Safety and Inspection Service (FSIS) announced a Class I ground beef product recall due to possible E. coli O157:H7 contamination. E. coli O157:H7 is a potentially deadly bacteria that can cause bloody diarrhea and dehydration. The very young, seniors, and persons with compromised immune systems are the most susceptible to foodborne illness. 

Richwood Meat Co., Inc. in Merced, California is voluntarily recalling approximately 90,000 pounds of frozen ground beef and beef patties that may be contaminated with E. coli O157:H7. The products were produced on August 11, 2003 and distributed to U.S. military installations in the Far East and to retail stores and institutions in California, Washington, Oregon and Idaho. 

The products subject to recall include: 
* CALIFORNIA PACIFIC ASSOCIATES "PURE BEEF PATTIES and BEEF/SIRLOIN & BEEF PATTIES shipped to military installations. 
* GROUND BEEF PATTIES and GROUND BEEF BULK packed for sent to institutional establishments. 
* GROUND BEEF, BEEF PATTIES, BEEF SIRLION AND BEEF PATTIES and GROUND BEEF PATTIES shipped to institutional and retail establishments. 
* GROUND BEEF and GROUND BEEF CHUCK sent to institutional establishments. 
* BEEF PATTIES sent to institutional establishments. 
* PURE BEEF PATTIES sent to institutional establishments. 
* GROUND BEEF CHUCK sent to institutional establishments. 
* GROUND BEEF sent to institutional establishments. 

For information on preparing ground beef for safe consumption, contact the USDA Meat and Poultry Hotline at 888/ MPHOTLINE or visit the web site. For a listing of other recalls and market withdrawals visit this web site. 
 

HAART Potpourri

Results from a recent study to examine the use of highly active antiretroviral therapy (HAART) among young HIV-positive people revealed that many patients discontinue the therapy due to side effects while nonusers cite fear of adverse HAART side effects. (1) We now know about the link between HAART and heart attack. (2) HAART can increase both LDL (low-density lipoprotein) cholesterol and triglycerides. The risk of heart attack increases 26% each year for people taking HAART. (2) HIV infection is also associated with heart disease independent of the metabolic effects of antiretroviral therapy. (3) 

Diabetes and other glucose abnormalities are also associated with an increased incidence of heart disease. As smoking is associated with a significant increase in heart disease risk, smokers with insulin resistance might further enhance their risk of heart disease. (4) Data (body mass index, percentage of body fat, waist- to-hip ratio and laboratory results) from a retrospective study of non-diabetic outpatients were compared between smokers (n = 883) and non-smokers (n = 2921). Investigators associated smoking with a metabolic profile indicating a higher degree of insulin resistance in men with and without heart disease. In men with heart disease however, the adverse metabolic profile of smokers was more evident. 

As noted in HIV ReSource Review Issue 22 and Issue 23, lipodystrophy management includes a diet low in saturated fat and high in fiber. Omega-3 fatty acid supplements are more effective for reducing fatal heart attack, sudden death and overall mortality than a control diet or placebo. (5) Along with the information in HIV ReSource Review Issues 22 and 23, additional tips on the dietary management of lipodystrophy are in the weekly HIV Nutrition News Update archives. 

References
1. Comulada WS, Swendeman DT, et al. Use of HAART Among Young People Living with HIV. Am J Health Behavior 2003;27(4):389-400. 
2. Friis-Moller N, Sabin CA, et al. Combination Antiretroviral Therapy And The Risk Of Myocardial Infarction. N Engl J Med 2003;349(21):1993-2003. 
3. Matetzky S, Domingo M, et al. Acute Myocardial Infarction in Human Immunodeficiency Virus- Infected Patients. Arch Intern Med 2003;163(4):457-60. 
4. Dzien A, Dzien-Bischinger C, et al. The Metabolic Syndrome As A Link Between Smoking And Cardiovascular Disease. Diabetes Obes Metab 2004;6(2):127-32.
5. Bucher HC, Hengstler P, et al. N-3 Polyunsaturated Fatty Acids In Coronary Heart Disease: A Meta-Analysis Of Randomized Controlled Trials. Am J Med 2002;112(4): 298-304. 

Conference Updates

* The HIV/AIDS Dietetics Practice Group (DPG) of the American Dietetic Association (ADA) held the “3rd Annual NIAC & HIV/AIDS DPG Conference: Comprehensive Management of Metabolic Complication in HIV”. The conference was on March 13th, 2004 at Cabrini Medical Center in New York City, NY. 

* The Association of Nutrition Services Agencies (ANSA) held the “11th Annual ANSA Conference” in New York City, NY on August 12th-15th 2004. ANSA offered two Pre-Conference Institutes:
i- The Future of AIDS Services: Mergers, Acquisitions and Expanded Missions
ii- Pre-Conference Nutrition Institute. Visit their web site for further information. 
 

Food for Thought

We now know that nutritional therapy is integral to the care of HIV-positive people, particularly those on medications, which can affect nutritional status (HIV Nutrition Update Issue 38 and Issue 39). Several studies have demonstrated that nutrition therapy for people with HIV infection is effective. (1) Nutrition assessments using HIV/AIDS medical nutrition therapy protocols by a registered dietitian with experience in HIV nutrition is more effective than that given by a registered dietitian without such experience. Nerad and others define levels of nutritional care and discuss patient referrals in the April 2003 CID supplement. 

Aside from overt vitamin or mineral deficiencies, Nerad and others point out that documentation of positive clinical outcomes due to dietary supplementation beyond standard recommendations is limited. As noted in the current HIV Nutrition Update feature article, however dietary supplement use for general immune functions, HIV/AIDS wasting syndrome, oxidative stress and mitochondrial toxicity may be useful. Nutritional therapy for dyslipidemia in individuals infected with HIV should first include diet, exercise, weight reduction for obesity, and management of other hygienic risk factors for cardiovascular disease. (2) Unhealthy lifestyles without exercise and with unhealthy behaviors such as smoking may predispose HIV-positive patients to the development of fat deposition. Information from the Nutrition for Healthy Living cohort indicates that a high-quality diet, rich in fiber and adequate in energy and protein, may be beneficial in preventing fat deposition. (3) 

Recent reports note immunity in hyperlipidemic individuals may be enhanced with the consumption of low-fat, low-calorie meals. According to preliminary studies, a low-fat, low-calorie regimen may boost immune system health. (4) Low-fat diets containing 15% of total calories can result in weight loss and may enhance cell-mediated immunity of middle-aged and elderly hyperlipidemic subjects. Skin patch tests and blood tests were used to assess immune response in 10 adult volunteers and cholesterol levels were significantly reduced after all of the fat-restricted phases of the study. ARS-funded scientists at the Jean Meyer USDA Human Nutrition Research Center on Aging at Tufts University reported these findings. 

Studies with larger groups of volunteers will help to determine more about the effects of low-calorie regimens on cholesterol levels and the immune system. For additional information, contact Simin N. Meydani at 617/556-3129 or visit the ARS Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. 

ReSource Review Issue 22 and Issue 23 highlight “Food Choices in the Era of HAART” for HIV-positive people. The National Heart, Lung, and Blood Institute and the American Heart Association offer "Heart-Smart Substitutions" to help the general public change their unhealthy eating habits. Instead of whole milk or cream use 1 percent or 2 percent milk or skim milk. Fried foods can be replaced with baked, steamed, boiled, broiled, or microwaved foods and lard, butter, palm and coconut oils can be replaced with unsaturated vegetable oils such as olive, canola, safflower, sesame, soybean, sunflower, or peanut oil. For more general information on heart healthy food substitutions visit the National Heart, Lung, and Blood Institute web site or the American Heart Association  web site. 

References
1. Nerad J, Romeyn M, Silverman E, et al. General Nutrition Management In Patients Infected With Human Immunodeficiency Virus. Clin Infect Dis 2003;36(suppl 2): S52-S62. 
2. Dube M, Fenton M. Lipid abnormalities. Clin Infect Dis 2003;36(Suppl 2):S79-83.
3. High-fiber diet in HIV-positive men is associated with lower risk of developing fat deposition. Am J Clin Nutr 2003;78(4):790-795. 
4. Santos MS, Lichtenstein AH, Leka LS, et al. Immunological Effects of Low-Fat Diets with and without Weight Loss. J Am Coll Nutr 2003;22;174-182.
 

HIV ReSources Web Site Update - 2/1/04

The HIV ReSources Web Site is updated.
New pages are at:
Issue 46 HIV Nutrition Update

Electronic Newsletter Archive 2003- Issue Three, No. 1

New links are at:
Freebies, Movies & Game Links

HIV Nutrition Update Preview Links

Meeting Announcements

HIV and Nutrition was held on the evening of Wednesday, February 11, 2004 at the AIDS Service Center in Pasadena, CA. 

A public meeting to address the Codex Committee On Food Additives was held from 1-4 p.m., Monday, February 15, in the auditorium of the Harvey W. Wiley Federal Building in College Park, MD. The meeting provided information and received comments on agenda items in anticipation of the 36th Session of the Codex Alimentarius Commission's Committee on Food Additives and Contaminants (CCFAC). Codex develops food standards, guidelines and codes of practice in order to protect the health of consumers, ensure fair trade practices in the food trade and promote coordination of food standards work
undertaken by international governmental and non-governmental organizations. 

HIV Nutrition Update - Newszine Issue 45

The Jan/Feb 2004 HIV Nutrition Update Newszine issue is now available. The feature article in this issue is authored by Glenn Preston, MS, RD, LD, of Kansas City, Missouri. He has worked with HIV positive people since 1992 and is the CEO, Head Trainer and Dietitian for Real World Fitness, Inc. Glenn has worked in a variety of settings in the fitness/recreation industry for over 20 years and is the author of articles published in Body Positive and on TheBody.com web site. His interest in dietary supplements offers some insight into why so many clinicians now choose to suggest vitamins, minerals and other dietary supplements for their patients with HIV infection. 

These columns are also in Issue 46:

* Program Spotlight - Heartland CARES, Inc. in Paducah, KY;
* Conference News - "Eat Up Seminars: Medical Nutrition Therapy in HIV Care", "APLA Nutrition in HIV Care Education and Training", "Comprehensive Management of Metabolic Complication in HIV", "13th International Symposium on HIV and  Emerging Infectious Diseases", "Food as Medicine", and "2nd Annual Symposium: Drug-Induced Hepatotoxicity Signal Detection: Practical Implications for Risk Management";
* Update Central - Metabolic Syndrome News;
* Med Watch - REYATAZ (atazanavir sulfate). 
 

Resources on HIV/AIDS and Nutrition

* CDC Daily Summary
* Food & Nutrition Information Center, AIDS/HIV nutrition
* American Journal of Public Health
* Articles on HIV/AIDS
* MEDLINEplus AIDS topic page

National Food Safety Educator's Network News

Considering the current food security threats discussed in our last update, and the increased susceptibility of HIV-positive people to foodborne illness, it's prudent to stay up-to-date on food safety issues. 

EdNet is a reliable electronic newsletter from the Food and Drug Administration (FDA), Food Safety and Inspection Service (FSIS), and the Centers for Disease Control and Prevention (CDC). The newsletter provides updates on food safety activities to educators and others concerned about food safety. To subscribe send an email. In your message, write SUBSCRIBE EDNET-L YOUR NAME" placing your name in the message instead of the words YOUR NAME. Excerpts from the most recent newsletter are noted below:

* On December 23, 2003, Agriculture Secretary Ann M. Veneman announced that the U.S. Department of Agriculture diagnosed a presumptive positive case of bovine spongiform encephalopathy (BSE, known as mad cow disease) in an adult Holstein cow in the State of Washington. A CDC report summarizes the findings of the initial investigation of this case in the "Morbidity and Mortality Weekly Report" of January 9, 2004.

FDA investigators and inspectors from the states of Washington and Oregon have located all of the potentially-infectious product rendered from the one cow that tested positive for BSE in Washington State. None of the potentially-infectious product left the control of the companies or entered commercial distribution.

Additional resources on BSE from USDA, and FDA are at:
>USDA's BSE Web Page
>FDA's BSE Web Page

* The FDA is advising consumers to stop using ephedra- containing dietary supplements and plans to prohibit the sale of these products. Questions and answers about FDA's actions on ephedra dietary supplements are at their web site.

* The Partnership for Food Safety Education is dedicated to preventing foodborne illness by educating Americans at home and at work about safe food handling and by building awareness of food security. Visit the Fight BAC!(R) Web site for further information.

* USDA's Food Safety Mobile is working its way up the East Coast through July, then heading back toward the Midwest and Southwest for the Fall. Updates to the schedule. 

* The January-February 2004 issue of the "FDA Consumer" Magazine is now available online. It contains articles about fighting terrorism and preventing "Listeria" contamination in foods.

* Proposed Conference on Food Safety for Those Most At-Risk
The USDA's Food Safety and Inspection Service, along with other government agencies, are considering sponsoring a national conference in September 2004 focusing on the public health implications of foodborne illness for at-risk audiences and effective education programs. They need your help to find out about research and programs underway concerning at-risk audiences, such as HIV-positive people, and foodborne illness. If you are working in this field, please send a descriptive paragraph about your research by Monday, February 2, via e-mail to:  Susan Conley, Director, Food Safety Education, Food Safety and Inspection Service. 

Archived EDNET newsletters since October 1997.
 

This update is being delivered one-day early due to the Omnibus Appropriations Bill vote, which will take place at noon today. If you have access to C-SPAN 2 you can watch the voting process.

Nutrition And Food Safety

The Food and Drug Administration's (FDA) Center for Food Safety and Applied Nutrition/Office of Nutritional Products, Labeling, and Dietary Supplements announces claims that can be used on food and dietary supplement labels. As noted in HIV ReSource Review Issue 21, these claims fall into three categories: health claims, nutrient content claims, and structure/ function claims. The responsibility for ensuring the validity of these claims rests with the manufacturer, FDA, or the Federal Trade Commission. In the future we may need to consider much more than these claims if the Omnibus Appropriations Bill passes.

Although, "Assuring the safety of our food supply is a priority for the Bush Administration", a pending policy undermines the U.S. Department of Agriculture (USDA) and will make it difficult if not impossible to enhance food safety and improve food inspection systems.

In the wake of the 'mad cow' scare we are now faced with the possibility of consuming food from other countries due to lax rules on food labeling noted in the new Omnibus Appropriations Bill. This fact underscores the need for everyone, particularly food distribution agencies to make it their business to learn where their food comes from. 

Country of Origin Labeling was adopted by Congress and requires labeling of all fruits, vegetables and meats with their country of origin. It is scheduled to go into effect in September 2004. To ask your United States Senator to send the Omnibus Appropriations Bill back to conference to remove the provision delaying Country of Origin Labeling telephone the Congressional Switchboard at 202/224-3121.
 

HIV ReSources Web Site Update - 1/16/04

The HIV ReSources Web Site is updated.
New pages are at:
Electronic Newsletter Archive 2002 - Iss. 2, No. 3

New links are at:
Electronic Newsletter Main Menu

Women and HIV/AIDS Information

HIV/AIDS Transmission

Heart Health

Concentrating on heart health may be prudent as some of us attempt to shed extra weight gained over the holiday season. A recent article in the November- December 2003 Issue of FDA Consumer magazine builds upon information published in HIV ReSource Review Issue 22 and Issue 23. 

Heart disease is the leading cause of death for American men and women. Although there are uncontrollable risk factors for heart disease such as age, gender, and family history, other risk factors can be controlled. Increasing physical activity and losing excess weight are steps that can help to limit the risk of heart disease. It's advisable to get at least 30 minutes of moderate physical activity every day, which can more easily be accomplished, by three 10-minute intervals throughout your day.

Living a healthier life by changing dietary habits to lower high blood pressure, high blood cholesterol, and glucose abnormalities can also help to delay heart disease or minimize its damage. As noted in Issue 23 of the HIV ReSource Review, margarine-like spreads such as Benecol and Take Control are considered functional foods effective in lowering both total and LDL cholesterol levels. Readers of the HIV ReSource Review can refer to the above mentioned issues on how to make other heart healthy food choices in the era of HAART. Smoking is also a major influence on the development and severity of heart disease.

For help in changing poor eating habits consult with a nutrition professional such as a Registered Dietitian or Dietetic Technician, Registered. Visit the Association of Nutrition Services Agencies web site for information on nutritional services available for HIV-positive people. Also, check the links listed at our Electronic Newsletter Main Menu for more information on heart health.
 

Fall/Winter 2003 NUMEDX

The current issue of HIV NUMEDX is now available. This issue includes a copy of "Boosting Protease Inhibitors Advancing Therapies" and a pull-out "Daily Dosing of Antiretroviral Agents." 

Along with articles and resources on HIV, medicine, and complementary treatments, the Fall/Winter NUMEDX issue features a number of articles related to HIV/AIDS, exercise and nutrition. They are:

* Energy Needs for HIV-Positive Individuals by Sharon Ann Meyer, AS, AA, DTR
* A Matter of Heart: Exercise Improves Cardiovascular Health by Stacey Jackson, BS and Mary Jane Detroyer, MS, RD, CDN
* Nutrition for the Child with HIV/AIDS by Katherine Dennison, RD, LD 
* Weight Loss and Wasting in the HAART Era by Cade Fields-Gardner, MS, RD, LD, CD
* Oral Cancer: Signs, Symptoms and Recognition by Louis G. Depaola, DDS, MS and 
* Pain Management in the Era of HAART by Richard S. Ferri, PhD, ANP, ACRN, FAAN.

Food Safety News

* Green Onion Consumer Advisory
The Food and Drug Administration (FDA) recently advised the public that several hepatitis A outbreaks were associated with eating raw or undercooked green onions (scallions).

* Food Tampering: An Extra Ounce of Caution
Although deliberate tampering of food to cause major disease outbreaks is rare, particularly in the United States, recent news events have focused attention on the increasing possibility of such tampering. The FDA is enhancing its surveillance of foodborne disease and increasing the inspection of domestic and foreign food-processing plants. The food industry is also stepping up safety measures to ensure that its products are produced as safely as possible. Reviewing safety measures to decrease the possibility of distributing food that is tainted is now an even greater priority for food banks and other free food distribution points. Consumers also play a role in preventing illness due to food tampering as well.

* USDA Announces New Food Safety and Security Guidelines for Consumers The United States Department of Agriculture's (USDA) new publication, "Food Safety and Food Security: What Consumers Need to Know" is available on the Internet.

* USDA Issues New Regulations To Address BSE
The USDA's Food Safety and Inspection Service (FSIS) has issued four new rules to implement announcements made last week by Agriculture Secretary Ann M. Veneman to further enhance safeguards against Bovine Spongiform Encephalopathy (BSE).

Rules released today include-
Product Holding: USDA is publishing a notice announcing that FSIS inspectors are no longer marking cattle tested for BSE as "inspected and passed" until confirmation is received that the cattle have, in fact, tested negative for BSE. FSIS will be issuing a directive to inspection program personnel outlining this policy.

Specified Risk Material: FSIS is declaring that skull, brain, trigeminal ganglia, eyes, vertebral column, spinal cord and dorsal root ganglia of cattle 30 months of age or older and the small intestine of all cattle are specified risk materials, thus prohibiting their use in the human food supply. Tonsils from all cattle are already considered inedible and therefore do not enter the food supply. These enhancements are consistent with the actions taken by Canada after the discovery of BSE there in May. These prohibitions are effective immediately upon publication in the Federal Register.

Advanced Meat Recovery: AMR is a technology that removes muscle tissue from the bone of beef carcasses under high pressure without incorporating bone material. AMR product can be labeled as "meat." FSIS has previously established and enforced regulations that prohibit spinal cord from being included in products labeled as "meat." 

This interim final rule expands that prohibition to include dorsal root ganglia, clusters of nerve cells connected to the spinal cord along the vertebral column, in addition to spinal cord tissue. In addition, because the vertebral column and skull in cattle 30 months and older will be considered inedible, they cannot be used for AMR. 

Air-Injection Stunning: To ensure that portions of the brain are not dislocated into the tissues of the carcass as a consequence of humanely stunning cattle during the slaughter process, FSIS is issuing an interim final rule to ban the practice of air-injection stunning.

NOTE: Access news releases and other information at the FSIS web site.

Mercury Warning Revisited

Information in the July/Aug 1998 HIV ReSource Review (Issue 13) noted, "When suggesting increased consumption of fish it's important to know that tuna or swordfish more than once a week may be harmful in some regions of the U.S. because of increased mercury content." It's important to note tuna steaks and canned albacore tuna generally contain higher levels of mercury than canned light tuna. In a subsequent HIV ReSource Review issue (Issue 16), we reported that, "...more than once a week consumption of certain fish found in the Everglades may also contain increased amounts of mercury." Consumers can check with their state or local health department to see if there are special advisories on fish caught locally. Visit the EPA's web site for Federal, State, and Tribal Contacts for fish advisories. 

The Food and Drug Administration's (FDA) advisory on methylmercury in fish was released in March of 2001. FDA received a number of recommendations from its Food Advisory Committee on how to improve the advisory  now under revision. The current revised advisory contains information concerning consumption of all fish, including both commercial and locally caught fish. Pregnant women and women of childbearing age who may become pregnant should not eat shark, swordfish, king mackerel or tilefish. The nervous system
of the developing fetus and of young children is most at risk from high methylmercury levels in fish. Other individuals including those living with HIV/AIDS may wish to limit their intake of these specific fish species as well. Guallar and others have suggested that the mercury content of fish may counteract the beneficial effects of its omega-3 fatty acids.

An overview of the Draft FDA/Environment Protection Agency (EPA) Methylmercury (MeHg) Consumer Advisory is on the Internet. FDA continues to seek recommendations or concurrence from the committee before finalizing a joint FDA and EPA revised advisory concerning fish and shellfish consumption. A final version of the new consumer advisory should be published in early 2004. Following the Committee’s concurrence, FDA will initiate an outreach and educational program early in 2004 for at-risk populations. FDA recommends that consumers eat a balanced diet, choosing a variety of foods that are low in trans fat and saturated fat and rich in high fiber grains, fruits and vegetables. Fish and shellfish can be an important part of a balanced diet and people can safely eat about 12 ounces per week of cooked fish species not listed on the FDA advisory. A list of methylmercury levels in commercial seafood is on the Internet. 

For more information about the risks of mercury in fish and shellfish call the FDA’s Food Information Hotline toll-free at 1/888/SAFEFOOD or visit FDA’s Food Safety web site. Additional recent sources of information on mercury are in "Perspective: Mercury and Health" by P.M. Bolger and B.A. Schwetz.