Association of diet and physical activity with overweight and obesity in people living with HIV: a cross-sectional study in Brescia, Italy

: The increasing prevalence of overweight/obesity (OO) among people living with HIV (PLWH) is rising concerns. However, limited data are available on the role of modifiable lifestyle factors, particularly adherence to the Mediterranean diet, among PLWH on long-term stable ART. The aim of this study was to investigate the association between modifiable lifestyle factors, particularly dietary habits, adherence to the Mediterranean diet and physical activity, and overweight/obesity among virologically suppressed PLWH on long-term stable ART. PLWH on stable ART and with HIV-RNA suppression, followed at a tertiary care center in Northern Italy were enrolled. Data about diet (dietary recall and MediLite, a validated tool to assess adherence to the Mediterranean diet) and physical activity level (PAL) were collected. Out of 385 eligible subjects, 176 agreed to participate in the study (median age and HIV infection duration, 51 and 17 years, respectively) and categorized according to Body Mass Index (BMI) in normal weight (NW, BMI < 25 kg/m2) and OO (BMI ≥ 25 kg/m2, n = 93, 52.8%). OO vs. NW participants had lower Mediterranean diet adherence scores (MediLite 10 vs. 11; p = 0.009). Beer and aperitif consumption were more frequent among OO participants (p = 0.022; p = 0.002), while PAL was comparable between groups. At multivariable analysis, BMI ≥ 25 kg/m2 at the time of ART initiation was positively associated (OR = 7.61, 95% CI 3.27-19.6; p < 0.01), and each 1-point increase in the MediLite was negatively associated (OR = 0.80, 95% IC 0.67-0.94 < 0.01) with OO. In PLWH on long-term stable ART, OO is associated with modifiable diet factors, particularly adherence to the Mediterranean diet, and with past BMI.