**13. Diet and lifestyle**

Changes in diet and lifestyle, and the adequacy of a hypocaloric diet are recommendations that seek to reduce the concentrations of TC and its fractions, especially LDL [282-284]. These changes bring benefits over short periods of time and reduce the risk for cardiovascular and atherosclerotic diseases. The dietary recommendations are addressed to the entire population and specifically to HIV-1 patients which also indicates measures that should be applied to delay the need for lipid-lowering drugs, even before the treatment of dyslipidemia [282-285]. Changes in diet can directly alter the levels of circulating LDL including saturated fats, cholesterol, and trans-unsaturated fats. The highest impact comes from saturated fats, which are in a solid state at room temperature or under refrigeration. The major sources of saturated fats are meat and meat products (poultry, pork, beef, lard, and sausages), dairy (milk and cheeses), and vegetable oils (derived from palm or coconut). For an adequate daily diet, the recommended consumption is equal or <7% of saturated fats, for the total daily caloric intake. Dietary cholesterol is exclusively found in animal products such as meats (particularly organ meats and tissues such as brain, kidney, and liver), egg yolks, and dairy products. It is recommended to keep dietary cholesterol consumption to <200 mg/day. Trans fats and unsaturated fats are found in breads and cookies, doughnuts, stick margarine, and fried foods [286, 287]. The consumption of unsaturated fats preferred sources include fish such as salmon, mackerel, tuna, and vegetables such as avocado, olives and olive oil and vegetable oils [289]. Other foods that are considered for the maintenance and/or lipid-lowering effects are the omega-3 fats, which are polyunsaturated fats that can lower TG levels. Omega-3 fats are considered as fish oils, they are present in fish such as salmon, tuna and mackerel, but these are also found in krill and flax seed oil. Currently, a diet with 25-35% of daily calories derived from fat sources is recommended, including saturated fats, which must be <7% [289]. In addition, physical activity improves cardiorespiratory function, promotes the reduction of LDL and TG, and decreases insulin resistance (in both uninfected and HIV-1 patients) [290, 291]. Physical exercise has shown reduction effects in TC and TG, also reduced total fat mass, and increased muscle mass in HIV-1 patients with hypertriglyceridemia [291-293]. Addition‐ ally, physical exercise is associated with greater cardiovascular fitness, improved muscle strength and endurance, and the reduction of depression and anxiety. In addition, it helps with problems resulting from lipodystrophy (dyslipidemia, insulin resistance, and osteoporosis) and cardiovascular disease [291-293]. However, there are several factors that can directly influence the reduction of metabolic disorders observed in seropositive patients. The common observation of gastrointestinal diseases in patients in advanced stages of infection may reduce the positive effects of a balanced dietary regimen [292, 293].
