Hispanic Nutrition Protocols

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Nutrition Education and Counseling for Hispanics
Living With HIV/AIDS

• By
• Karla Torres
• Nutritionist
• San Ysidro Health Center

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Guidelines for Implementing HIV/AIDS Medical
Nutrition Therapy Protocols

• In the United States, all HIV-infected
  individuals have the right to early and ongoing
  medical nutrition therapy, that is, accurate
  nutrition assessment, education and intervention
  by the most qualified medical professionals in
  linguistically and culturally non judgmental
  manner.

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Hispanics

• Spanish speaking individuals
• Implies heritage restricted to Spain
• Official name used by the federal government.
• Refers to Puerto Ricans, Cuban Americans, Mexican
  Americans and persons from other countries, in
  Central and South America.
• Although Hispanics immigrated from a variety of
  countries, they share a common language and
  cultural heritage.
• Feeding the Hispanic hospital patient Cultural
  considerations Samolsky et al. J of the American
  Dietetic Association Deec. 1990

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Nutrition and HIV/AIDS

• Wasting Syndrome, a major contributor to
  morbidity and mortality, is not an inevitable.
• All stages of HIV disease are at risk for
  nutritional deficiency.
• All HIV-infected persons should be considered at
  risk for malnutrition.
• Chlebowski and colleagues suggested that
  nutritional status may be a major determinant of
  survival in aptient with HIV
• Nutritional Assessment and Management HIV Disease
  Patients Laura Mcnally AIDS read,
• 8(3) 121 130 1998

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Eating Well Can

• Prevent or delay loss of muscles
• tissue or wasting
• Strengthen the immune system
• Reduce viral mutations
• Decrease the incidence and severity of
  opportunistic infections and hospitalizations.
• Lessen debilitating symptoms of HIV/AIDS.
• Why Nutrition Matters. Monumental AIDS Project
  Organizational Web site. http//www.momentumaidspr
  oject.org/nutrition/numatter.htm

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Where to start?

• 1. Target Population
• 2. What was already out there?
• 3. Research
• 4. Protocols
• 5. Materials
• 6. Implementation

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HIV/AIDS Among Hispanics

• Hispanics represented 13 of the US population
  but accounted for 19 of the total number of new
  U.S. AIDS cases.
• The AIDS incidence rate among Hispanics was
  22.5.
• Females represent 19 of the cumulative AIDS
  cases among Hispanics, but account for 23 of
  cases reported in 2000 alone.
• 114,019 Hispanic men have been reported with AIDS
  in the United States.
• CDC HIV/AIDS Among Hispanics in the United Sates,
  March 11, 2002

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San Diego CountyAnnual Report

• 119,900 AIDS cases reported in California
• A total of 10,636 of those cases were reported
  among S.D.C. residents
• S.D.C. is the 3rd largest contributor of AIDS
• cases in California.
• The County of San Diego Health and Human Services
  Agency Community Epidemiology annual report
  states that as of December 31, 2000

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San Diego County AIDS Among Hispanics

• Hispanics account for 20 of all S.D County AIDS
  cases.
• A total of 2242 cases of AIDS reported in 2001.
• Mexicans 81.5
• Hispanics non specific 8.0
• Puerto Rican 4.1
• The proportion of cases newly reported among
  Hispanics has increased and is approximately 19.
• HIV/AIDS Epidemiology Report, January 2001Vol. V,
  No 1 County of San Diego Health and Human
  Services Agency Community Epidemiology

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San Ysidro Health CenterGrouped by Sex

• Female 25 15.5
• Male 134 83.2
• TrnSex 1 0.6
• Lab Tracker Query Report 1/3/03

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San Ysidro Health CenterRace by

• Asian/Pac Islander 1.0 0.6
• Black (Not Hispanic) 1.0 0.6
• Hispanic 145 90.1
• White (Not Hispanic) 14.0 8.7
• Lab Tracker Query Report 1/3/03

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San Ysidro Health CenterRisk Factor Report

• Gay/Bisexual 7 4.3
• Heterosexual 56 34.8
• Heterosexual IDU 2 1.2
• IDU 1 0.6
• MSM 81 50.3
• MSM IDU 2 1.2
• Other Risks/NR 2 1.2
• Blood Transfusions 3 1.9

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What is already out there?

• Guidelines for Implementing HIV/AIDS Medical
  Nutrition Therapy Protocols by Los Angeles County
  Commission on HIV Health Services.
• Nutrition Intervention in the Care of Persons
  with Human Immunodeficiency Virus Infection
  Position of the American Dietetic Association and
  Dieticians of Canada.
• AIDS Project Los Angeles
• Gods Love We Deliver

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Research

• HIV/AIDS and Nutrition
• Culture and Food Choices
• Culture and Body Image Perception
• Acculturation
• Food and Water Safety
• Anthropometrics
• Food and Drug Interactions

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Acculturation

• Process of adopting certain traits, attitudes
  and behaviors of a dominant culture.
• Research indicates that level of acculturation
  of Hispanics adults influences dietary choices
  such as fiber and high energy food consumption
  and sat. fat/cholesterol avoidance.
• Food intake is influenced by acculturation
  levels.
• Evans et al. Journal of the American Dietetic
  Association November 2000 Vol. 100 No. 11

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Fruit and Vegetable Consumption among Mexican-
American college students

• Self reported mean intake was 2.2 servings of
  fruits, juice and vegetables per day.
• 59 consumed 2.5 or fewer daily servings.
• 7.4 consumed 5 or more servings per day.
• Vegetables were consumed less often than fruits.
• Juices were the most common fruit consumed.
• Journal of the American Dietetic Association
  November 200 vol. 100 Number 11

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The influence of Gender and Socioeconomic Factors
on Hispanics/White Differences in B. M. I.

• 688 pairs of Hispanics and Whites.
• Ages 25 74 drawn form 5 population based surveys
  from 1979 to 1990 in 4 northern CA. cities.
• Hispanic women and men both have significant
  higher BMI levels than whites.
• Hispanics reported higher desired body weight
  than whites.
• The least educated Hispanic women also had the
  highest prevalence of severe overweight.
• Winkleby, Gardner and Taylor, Preventive
  Medicine 25, 203 211 1996 Art. No. 0047

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Nutrition Protocols

• Nutrition Referral Form
• Nutrition Assessment Tools
• Basic Sessions
• I. Nutrition Basics
• II. Food Labels
• III. Food and Water Safety
• IV. Anthropometric Parameters

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Nutrition Referral

• Services Available for all PLWA
• Referral Forms
• Criteria for Referrals
• Levels of Care
• Asymptomatic HIV infection at least 1-2 times
  per year.
• HIV/AIDS Symptomatic but Stable at least 2- 6
  times per year
• HIV/AIDS Acute at least 2-6 times per year
• Palliative at least 2-6 times per year
• Guidelines for Implementing HIV/AIDS Medical
  Nutrition Therapy Protocols by the
• Los Angeles County Commission on HIV Health
  Services

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Criteria for Nutrition Referral

• Unintentional Weight Loss from U.B.W. in the last
  6 months or since last visit.
• Visible Wasting
• Poor Oral Intake of Food or Fluids.
• Persistent Diarrhea, Constipation, or Changes in
  Stools.
• Persistent Nausea or Vomiting.
• Persistent Gas, Bloating, Heartburn.

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Cont. Nutrition Referral

• Difficulty Chewing or Swallowing.
• Changes in perception of Taste or Smell. Food
  Allergies/Intolerance
• Financially Unable to Meet Caloric or Nutrient
  Needs.
• Concomitant, Hypo- or Hyperglycemia, Insulin
  Resistance, Hyperlipidemias, HTN, Anemia or other
  Nutrition Related Conditions.

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Cont. Nutrition Referral

• Abnormal Blood Lipids
• Medication Involving Food or Meal Modifications
• Weight Management
• Medication Involving Food or Meal Modifications
• Weight Management
• Client Requested

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Nutrition Assessment

• Age, Gender, Height, Weight, UBW, BMI, and
  Referral.
• HIV/AIDS Diagnosis
• Dietary History
• Barriers, Culture and Lifestyle
• Cardiovascular Risks
• Symptoms
• Labs
• Anthropometrical Parameters
• 1 Guidelines for Implementing HIV/AIDS Medical
  Nutrition Therapy Protocols created by the Los
  Angeles County Commission on HIV Health Services
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• 1 Nutrition Intervention in the Care of Persons
  with Human Immunodeficiency Virus infection
  Position of the American Dietetic Association and
  the Dieticians of Canada Journal of the American
  Association 2000 100708 -717

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Recognize any of these?

• Aguas Frescas
• Tacos
• Ceviche
• Pico de Gallo
• Champurrado
• Tamales
• Carnitas

• Sopes
• Albondigas
• Quesadillas
• Atole
• Calientitos
• Capirotada
• Flautas

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Yes, eating a healthy diet can include
tortillas, beans and some meat but learning
about other varieties of food is imperative.