MEDICAL NUTRITION
QUIZ 1: NUTRITIONAL THERAPY OF HIV/AIDS
20 OCTOBER 2021
QUESTION
1. Which of the following is a physical factor that
should be considered during nutritional assessment of
patients with HIV/AIDS?
A. Presence of comorbidities
B. Functional status
C. Food allergies and intolerances
D. Metabolic complications
2. Which of the following HIV/AIDS-related condition is
correctly paired with its nutritional implication?
A. PCP: watery diarrhea and abdominal
cramping
B. Oral candidiasis: inability to prepare food and
coordinate movement
C. AIDS dementia: prolonged fatigue and
anorexia
D. HIV-induced enteropathy malabsorption and
weight loss
ANSWER RATIONALE
B Table 2. Factors to consider in nutrition assessment
Medical • Stage of HIV disease
• Comorbids (i.e. HTN, DM, dyslipidemia)
• Opportunistic infections
• Biochemical measurement to support ongoing
metabolic problems
Physical • Observed body shape changes (significant
weight loss or gain)
• Present weight or growth concerns
• Oral or gastrointestinal symptoms
• Functional status (i.e. cognition and mobility)
• Anthropometrics
Social • Living setup
• Unusual eating behaviors
• Mental health (i.e. depression)
Economic • Barriers to nutrition (i.e. access to food,
resources)
Nutritional • Typical intake
• Food shopping and preparation
• Food allergies and intolerances
• Vitamin, mineral, and other supplements
• Alcohol and drug use
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D • HIV-induced enteropathy: idiopathic, direct or indirect effect of HIV
on enteric mucosa
® Chronic diarrhea, weight loss, malabsorption, changes in
cognition and behavior
• PCP: difficulty chewing and swallowing caused by shortness of
breath
• Oral candidiasis (oral thrush): affects the patient’s capacity to
swallow food
→ Oral sores, dysphagia, hypo or dysgeusia, odynophagia = affect
appetite
• AIDS dementia (HIV encephalopathy): Consider other forms of
feeding (tube feeding, enteral, parenteral) to make up for patient’s
loss of coordination and cognitive functions, and inability to prepare
food
• Cryptosporidioisis: watery diarrhea, abdominal cramping,
malnutrition and weight loss, electrolyte imbalance
• Brain involvement: inability to prepare food and coordinate
movement
• TB: causes prolonged fatigue, anorexia, nutrient malabsorption,
altered metabolism, and weight loss
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3. The increased activation of this metabolic pathway C • The answer was mentioned by Doc. Vheejay in passing.
in patients with HIV/AIDS necessitates a fat • According to Sekhar, et al. (2002), there is a defect in the regulation
recommendation that ranges between 25%-35% of the of intra-adipocyte lipolysis in the HLS subjects that could lead to both
TER? the characteristic dyslipidemia and lipoatrophy. The rates of both
A. Ketogenesis total and net lipolysis were elevated in the HIV lipodystrophy
B. Both lipolysis and ketogenesis syndrome (HLS) patients in the fasted state despite their reduced
C. Lipolysis total fat mass. This could be due to either increased tissue-specific
D. Gluconeogenesis lipolysis via hormone-sensitive lipase or increased lipoprotein lipase
or hepatic lipase activity against TG-rich lipoproteins.
Table 3. Basic nutrient composition of the TLC Diet
Nutrient Recommended Intake
Saturated fat <7% of the total calories
Polyunsaturated fat Up to 10%
Monounsaturated fat Up to 20%
Total fat 25-35%
Carbohydrates 50-60%
Fiber 20-30 g/day
Protein Approximately Approximately 15%
Cholesterol < 200 mg/day
Total Calories (energy) Balance energy intake and expenditure
to maintain the desirable body weight
(DBW) or prevent weight gain
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Sekhar, R. V., Jahoor, F., White, A. C., Pownall, H. J., Visnegarwala, F., Rodriguez-
Barradas, M. C. Balasubramanyam, A. (2002). Metabolic basis of hiv-lipodystrophy
syndrome. American Journal of Physiology-Endocrinology and Metabolism, 283(2).
doi:10.1152/ajpendo.00058.2002
4. An HIV patient with inadequate intake of Vitamin A D • Low levels of Vit. A, B12, and Zinc are identified to be low in
will? advanced stages of the disease.
A. Have diminished information processing and ® If not addressed à faster disease progression!
problem-solving skills
B. Suffer from myelopathy and increased
oxidative stress Batch 2022 Trans on HIV AIDS MNT p.4
C. Develop dementia and peripheral neuropathy
D. Have an increased risk of progression to
AIDS
5. This is a common nutritional diagnosis in patients A Common Nutritional Diagnoses
with HIV/AIDS? • Inadequate oral food or beverage intake: anorexia, oral ulcers,
A. Dysphagia dysphagia
B. Volunatry weight loss • Increased nutrient needs: catabolic state
C. Decreased nutrient needs • Swallowing difficulty: dysphagia, odynophagia
D. Undersupplementation of nutrients • Altered gut function: alternating diarrhea and constipation
• Food-medication interactions
• Involuntary weight loss
• Overwight and obesity: HIV-associated lipodystrophy
• Food and nutrient-related knowledge deficit: lack of knowledge
affects adherence to mx
• Oversupplementation of nutrients
• Impaired ability to prepare foods or meals independently
• Inadequate access to food: socioeconomical implication of HIV
• Intake of unsafe or undercooked foods: infections
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6. An increased CD4 count is associated with higher A • Higher intakes of Vitamins B and C (ascorbic acid) are associated
dietary intake of? with CD4 counts and slower disease progression to AIDS.
A. Ascorbic acid ® Vit C: antioxidant that restores the antioxidant activity of vit. A
B. Alpha-tocopherol (sacrifices itself to ensure an effective oxidation process)
C. Beta-carotene ® Energy-releasing B vitamins (B1, B2, B3, B5, and B6) are
D. Selenium important especially when you have started increasing the energy
requirements.
n Increased the energy requirement = increased demand for the
coenzyme
n form of these B vitamins
n Will participate in the energy-generating reactions in glycolysis
or Krebs cycle.
• Beta-carotene: 30 mg/d provides immunomodulating effects; 80
mg/d can prevent diarrhea and weight loss
• Selenium: anti-oxidant; enchances of both cell-mediated and
humoral immune responses
• Alpha-tocopherol (vit. E): also an antioxidant; avoid megadosing!
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7. Excessive fish oil supplementation may? C Omega-3 FA supplements

A. Decrease the HDL-cholesterol level • Decreases serum TAGs (4g fish oil supplements per day)
B. Decrease both HDL- and LDL-cholesterol • May reduce inflammation and improve depression
levels • Optimal effects are seen with highly concentrated marine (ie., deep
C. Increase LDL-cholesterol level sea fishes) omega-3 FA with high EPA and DHA levels
D. Increase both LDL-cholesterol and TAG • Side effects:
levels ® GIT distress: N/V; inability to tolerate greasiness and fishy odor
® Hyperglycemia: excess intake of >4g/d; glyceral backbone will be
utilized in glycolysis
® Increases LDL-C levels: primary transporter of essential FA
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8. The recommended intake of polyunsaturated fat D Table 3. Basic nutrient composition of the TLC Diet
based on the TLC diet is? Nutrient Recommended Intake
A. Less than 7% of TER Saturated fat <7% of the total calories
B. 25-35% of TER Polyunsaturated fat Up to 10%
C. Up to 20% of TER Monounsaturated fat Up to 20%
D. Up to 10% of TER Total fat 25-35%
Carbohydrates 50-60%
Fiber 20-30 g/day
Protein Approximately Approximately 15%
Cholesterol < 200 mg/day
Total Calories (energy) Balance energy intake and expenditure to
maintain the desirable body weight (DBW)
or prevent weight gain
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9. Which of the following recommendations is most C • Oatmeal and rice are recommended while citrusy foods should be
suitable in an AIDS patient complaining of sore throat? avoided.
A. Limiting the intake of oatmeals or rice • Drink liquids with meals to soften and smoothen the transition of the
B. Increasing the consumption of citrusy fruits food bolus from the oral cavity à esophagus à stomach
C. Drinking beverages at room temperature • Eat food and beverages that are at room temperature
D. Drinking liquids before or after meals
Recommended Foods Foods to Avoid
• Soft foods • Acidic foods
→ Oatmeal → Citrus
→ Rice → Vinegar
→ Applesauce → Spicy
→ Scrambled eggs → Salty
→ Milkshakes → Hot
→ Yogurt • Acidic beverages
• Very hot or very cold
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10. Faster progression of HIV to AIDS is associated C • Low levels of Vit. A, B12, and Zinc are identified to be low in
with low serum level of? advanced stages of the disease.
A. Selenium ® If not addressed à faster disease progression!
B. Ascorbic acid
B12 = Cyanocobalamin
C. Cyanocobalamin
D. Folic acid
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