Proper nutrition plays an important role in overall health care. For the HIV-infected woman, adequate nutrition is critical, and efforts must be made to optimize nutritional status. Since women in today's society are pulled in so many different directions by taking on many roles, playing homemaker, mother, caregiver, wife, and career women all in the same day, often we neglect ourselves. Part of that neglect may be in our diet habits. Reasons such as too busy, too tired, and forgetting to eat are some of the more common phrases used to explain why proper diet is often lost during the day.

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Eventually something serious occurs, most obviously presented by unexplained weight loss. This is a visible indication of what has already been a progression of body changes from HIV disease itself.

HIV-infected women are all at risk for poor nutrition status. Women who play "superwoman" and do not take care of their health may be at increased risk for compromised nutritional status. Unfortunately, unless there has been some significant weight loss, we may not know what's going on inside the body. It is not until this time that a woman thinks about her diet and food intake.

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Unintentional weight loss is called wasting. In the context of HIV disease, it can be considered AIDS-related wasting. The cause of wasting can be complex and varied. Researchers believe that aside from the changes in food intake, absorption, and metabolism all playing a role in wasting, hormonal changes may also contribute to the difference in body wasting in women. Wasting in a woman appears different than in a man. Women tend to lose fat tissue, whereas men appear to lose lean tissue quicker. It is important not only to monitor weight and to measure what the body is made of, or your body composition (body fat, body cell mass), but we must preserve body cell mass, and preserve a certain amount of fat to live and function. Be sure to ask your registered dietitian to test and monitor your body composition. Although some women initially may be somewhat excited about some weight loss, it is not something to be taken lightly. Weight loss may indicate an infection or other problem, and can become life threatening.

What can we do to help prevent wasting? Aside from visiting your doctor regularly, nutritionally you can do a number of things. First, you can eat a variety of foods. Use the food guide pyramid to make sure you are getting enough vitamins and minerals, calories, and protein daily, which recommends the following:

• Breads and cereal group: 6 to 11 servings

• Meat, poultry, fish, egg, or alternative: 2 to 3 servings

• Fruits and vegetables: 3 to 5 servings each

• Milk/Dairy: 2 to 4 servings

• Fats, sweets, and oils: sparingly

If you need to gain weight, or to keep from losing weight, eat the higher number of servings for extra calories.

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Because women are more susceptible to osteoporosis, it is essential we get enough calcium. Calcium is a mineral responsible for bone health. Lack of adequate calcium can lead to loss of bone mass and tissue. Calcium is found in dairy foods, and can also be found in calcium-enriched juices and cereals, sardine (with bones), salmon (with bones), collard greens, broccoli, and turnip greens. Women need 1000 mg daily of calcium, 1200 mg for pregnant women and the elderly (51+years). This is equal to 3 cups of milk or calcium-fortified orange juice.

When cooking, preparing, and/or handling foods, your primary goal should be to avoid food infection. It is critical that hands are washed with hot soapy water before and after handling any type of food, whether you are cooking or eating. Keep foods at a safe temperature -- cold foods should be cold, and hot foods hot. Food left at a temperature between 40-140 degrees F are in the "danger zone," where bacteria may grow. Heat leftovers to at least 140 degrees F. Check food labels -- do not use packaged food past the recommended date on the label. Finally, avoid eating raw foods, including eggs, fish, and meats. Check to be sure milk products and juices are pasteurized because not all milk and juice is. If the item has not gone through the pasteurization process it may contain harmful bacteria. Food safety is especially important in the immune compromised patient, as it can be hard to fight infection. Symptoms of food borne illness can include nausea, vomiting, fever, diarrhea and dehydration, and can lead to hospitalization.

Women must learn to make their own mental and physical health a priority. Without good health, we are putting family, job/financial security, and ourselves on the line. Kids want and need healthy moms, and co-workers need healthy colleagues. Proper nutrition is one way to help obtain and keep good health. It is a crucial part of the overall healthcare of the HIV-infected person, and should be taken seriously.

Tami Jones Mackle, RD is a Registered Dietitian, and works in the Infectious Disease Clinic at the University of Medicine and Dentistry in Newark, NJ.