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Caffeine Intake and Its Association with Disease Progression, Sleep Florida International University FIU Digital Commons FIU Electronic Theses and Dissertations University Graduate School 10-30-2015 Caffeine nI take and its Association with Disease Progression, Sleep Quality and Anxiety Symptoms and Nutritional Alterations in People Living with HIV in the Miami Adult Studies on HIV Cohort Venkataraghavan Ramamoorthy Florida International University, [email protected] DOI: 10.25148/etd.FIDC000147 Follow this and additional works at: https://digitalcommons.fiu.edu/etd Part of the Human and Clinical Nutrition Commons Recommended Citation Ramamoorthy, Venkataraghavan, "Caffeine nI take and its Association with Disease Progression, Sleep Quality and Anxiety Symptoms and Nutritional Alterations in People Living with HIV in the Miami Adult Studies on HIV Cohort" (2015). FIU Electronic Theses and Dissertations. 2255. https://digitalcommons.fiu.edu/etd/2255 This work is brought to you for free and open access by the University Graduate School at FIU Digital Commons. It has been accepted for inclusion in FIU Electronic Theses and Dissertations by an authorized administrator of FIU Digital Commons. For more information, please contact [email protected]. FLORIDA INTERNATIONAL UNIVERSITY Miami, Florida CAFFEINE INTAKE AND ITS ASSOCIATION WITH DISEASE PROGRESSION, SLEEP QUALITY AND ANXIETY SYMPTOMS AND NUTRITIONAL ALTERATIONS IN PEOPLE LIVING WITH HIV IN THE MIAMI ADULT STUDIES ON HIV COHORT A dissertation submitted in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY in DIETETICS AND NUTRITION by Venkataraghavan Ramamoorthy To: Interim Dean Mark Williams Robert Stempel College of Public Health & Social Work This dissertation, written by Venkataraghavan Ramamoorthy, and entitled Caffeine Intake and its Association with Disease Progression, Sleep Quality and Anxiety Symptoms and Nutritional Alterations in People Living With HIV in the Miami Adult Studies On HIV Cohort, having been approved in respect to style and intellectual content, is referred to you for judgment. We have read this dissertation and recommend that it be approved. _______________________________________ Marianna Baum _______________________________________ Juan Liuzzi _______________________________________ Florence George _______________________________________ Adriana Campa, Major Professor Date of Defense: October 30, 2015 The dissertation of Venkataraghavan Ramamoorthy is approved. _______________________________________ Interim Dean Mark Williams Robert Stempel College of Public Health & Social Work _______________________________________ Dean Lakshmi N. Reddi University Graduate School Florida International University, 2015 ii © Copyright 2015 by Venkataraghavan Ramamoorthy All rights reserved. iii DEDICATION I dedicate this dissertation to my parents Meenakshy R and Ramamoorthy K V, and Lord Guruvayoorappan. Without their help, timely grace, support, and unconditional love, the completion of this work would not have been possible. iv ACKNOWLEDGMENTS I wish to extend my sincere gratitude to all people who made this dissertation possible, especially my committee members who helped me all these years. Dr. Marianna Baum, the PI of the twin studies, a special appreciation for her excellent guidance and her course Research Concept Development. Dr. Juan Liuzzi, all my admiration for his understanding and unrelenting encouragement. Dr. Florence George, my respects for her willingness to help and provide hours of unconditional support. Dr. Adriana Campa, my Major Professor, my sincere gratitude for her constructive opinions and limitless flow of ideas. Dr. Fatma G Huffman, The Chair, her support has been the beacon of hope during troubled times. I would like to thank all my fellow Ph.D. students, especially Muni Rubens and Christina Fleetwood for their immense support in the entire process of this dissertation. Finally, I would also like to acknowledge the University Graduate School for Data and Evidence Acquisition Fellowship and Dissertation Year Fellowship. v ABSTRACT OF THE DISSERTATION CAFFEINE INTAKE AND ITS ASSOCIATION WITH DISEASE PROGRESSION, SLEEP QUALITY AND ANXIETY SYMPTOMS AND NUTRITIONAL ALTERATIONS IN PEOPLE LIVING WITH HIV IN THE MIAMI ADULT STUDIES ON HIV COHORT by Venkataraghavan Ramamoorthy Florida International University, 2015 Miami, Florida Professor Adriana Campa, Major Professor Miami-Dade County has approximately 27,000 people living with HIV (PLWH), and the highest HIV incidence in the nation. PLWH have reported several types of sleep disturbances. Caffeine is an anorexic and lipolytic stimulant that may adversely affect sleep patterns, dietary intakes and body composition. High caffeine consumption (>250 mg. per day or the equivalent of >4 cups of brewed coffee) may also affect general functionality, adherence to antiretroviral treatment (ART) and HIV care. This study assess the relationship of high caffeine intake with markers of disease progression, sleep quality, insomnia, anxiety, nutritional intakes and body composition. A convenience sample of 130 PLWH on stable ART were recruited from the Miami Adult Studies on HIV (MASH) cohort, and followed for three months. After consenting, questionnaires on Modified Caffeine Consumption (MCCQ), Pittsburg Insomnia Rating Scale (PIRS), Pittsburg Sleep Quality Index (PSQI), Generalized Anxiety Disorder-7 (GAD-7), socio-demographics, drug and medication use were vi completed. CD4 count, HIV viral load, anthropometries, and body composition measures were obtained. Mean age was 47.89±6.37 years, 60.8% were male and 75.4% were African- Americans. Mean caffeine intake at baseline was 337.63 ± 304.97 mg/day (Range: 0- 1498 mg/day) and did not change significantly at 3 months. In linear regression, high caffeine consumption was associated with higher CD4 cell count (β=1.532, P=0.049), lower HIV viral load (β=-1.067, P=0.048), higher global PIRS (β=1.776, P=0.046), global PSQI (β=2.587, P=0.038), and GAD-7 scores (β=1.674, P=0.027), and with lower fat mass (β=-0.994, P=0.042), energy intakes (β=-1.643, P=0.042) and fat consumption (β=-1.902, P=0.044), adjusting for relevant socioeconomic and disease progression variables. Over three months, these associations remained significant. The association of high caffeine with lower BMI weakened when excluding users of other anorexic and stimulant drugs such as cocaine and methamphetamine, suggesting that caffeine in combination, but not alone, may worsen their action. In summary, high caffeine consumption was associated with better measures of disease progression; but was also detrimental on sleep quality, nutritional intakes, BMI and body composition and associated with insomnia and anxiety. Large scale studies for longer time are needed to elucidate the contribution of caffeine to the well-being of PLWH. vii TABLE OF CONTENTS CHAPTER PAGE CHAPTER I: INTRODUCTION AND SPECIFIC AIMS ..................................................1 General Introduction ............................................................................................................1 Justification for the Study ....................................................................................................4 Significance of the Study .....................................................................................................6 Specific Aims and Hypotheses ............................................................................................7 CHAPTER II: LITERATURE REVIEW ..........................................................................23 Daily Reported Caffeine use in United States ...................................................................24 Safe Levels of Caffeine Consumption ...............................................................................24 Caffeine-Biological Actions-Adenosine Receptors (A1, A2a, A2b and A3) ....................26 Caffeine and A1 Adenosine Receptors in the Central Nervous System (CNS) ................28 Caffeine Effects on A2a and A2b Adenosine Receptors ..................................................30 Biphasic Effects of Caffeine .............................................................................................31 Caffeine-Adverse Effects Outweigh Apparent Beneficial Effects ...................................33 Adverse Effects of Caffeine Withdrawal ..........................................................................35 Caffeine is Associated with Changes in CD4 levels as well as Plasma Viral Loads ........38 Caffeine Adversely Affects Sleep Quality and Precipitates Anxiety Disorders ...............40 Caffeine Intake is Associated with Significant Nutritional Alterations .............................47 Caffeine Intake and its Effects on Fluid-Electrolyte Balance and Blood Pressure ...........51 Caffeine is Associated with Smoking, Alcohol Consumption and Drug Abuse ..............53 Caffeine and its Metabolites and Their Collective Role in Metabolic Alterations ...........56 Inference ...........................................................................................................................58 CHAPTER III: METHODOLOGY ...................................................................................70 CHAPTER IV: CAFFEINE INTAKE AND ITS ASSOCIATION WITH DISEASE PROGRESSION IN MIAMI ADULT STUDIES ON HIV (MASH) COHORT—AN OBSERVATIONAL STUDY ................................................96 CHAPTER V: CAFFEINE INTAKE AND ASSOCIATIONS WITH SLEEP QUALITY AND GENERALIZED ANXIETY SCORES IN MIAMI ADULT STUDIES ON HIV (MASH) COHORT—AN
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