1
|
Nguyen HS, Van Tran K, Chen SY, Tam KW. A Systematic Review and Meta-Analysis of Randomized Controlled Trials of the Effects of Vitamin D Supplementation on Children and Young Adults with HIV Infection. J Nutr 2023; 153:138-147. [PMID: 36913447 DOI: 10.1016/j.tjnut.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/15/2022] [Accepted: 10/31/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Children and young adults with HIV infection may exhibit vitamin D deficiency, which is harmful to bone health as well as the endocrine and immune systems. OBJECTIVES This study sought to investigate the effect of vitamin D supplementation on children and young adults with HIV infection. METHODS The PubMed, Embase, and Cochrane databases were searched. Randomized controlled trials that have evaluated the effects of vitamin D supplementation (ergocalciferol or cholecalciferol) at any dose or for any duration in children and young adults with HIV infection, aged 0-25 y, were included. A random-effects model was used, and the standardized mean difference (SMD) and 95% CI were calculated. RESULTS Ten trials, with 21 publications and 966 participants (mean age: 17.9 y), were included in the meta-analysis. The supplementation dose and the duration of the studies included ranged from 400 to 7000 IU/d and from 6 to 24 mo, respectively. Vitamin D supplementation was associated with a significantly higher serum 25(OH)D concentration at 12 mo (SMD: 1.14; 95% CI: 0.64, 1.65; P < 0.00001) compared with a placebo. No significant difference was observed in spine BMD (SMD: -0.09; 95% CI: -0.47, 0.3; P = 0.65) at 12 mo between these 2 groups. However, participants who received higher doses (1600-4000 IU/d) had significantly higher total BMD (SMD: 0.23; 95% CI: 0.02, 0.44; P = 0.03) and nonsignificantly higher spine BMD (SMD: 0.3; 95% CI: -0.02, 0.61; P = 0.07) at 12 mo compared with those who received standard doses (400-800 IU/d). CONCLUSIONS Vitamin D supplementation in children and young adults with HIV infection increases the serum 25(OH)D concentration. A relatively high daily dose of vitamin D (1600-4000 IU) improves total BMD at 12 mo and results in sufficient 25(OH)D concentrations.
Collapse
Affiliation(s)
- Hung Song Nguyen
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan; Division of Infectious Disease, Department of Pediatrics, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Infectious Disease Department, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Khoi Van Tran
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Shih-Yen Chen
- Division of Allergy, Asthma, and Immunology, Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Ka-Wai Tam
- Center for Evidence-based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei City, Taiwan; Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.
| |
Collapse
|
2
|
Effects on body composition and handgrip strength of a nutritional intervention for malnourished HIV-infected adults referred for antiretroviral therapy: a randomised controlled trial. J Nutr Sci 2019; 8:e19. [PMID: 31143445 PMCID: PMC6522867 DOI: 10.1017/jns.2019.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 01/12/2023] Open
Abstract
Lipid-based nutrient supplements (LNS) may be beneficial for malnourished HIV-infected patients starting antiretroviral therapy (ART). We assessed the effect of adding vitamins and minerals to LNS on body composition and handgrip strength during ART initiation. ART-eligible HIV-infected patients with BMI <18·5 kg/m2 were randomised to LNS or LNS with added high-dose vitamins and minerals (LNS-VM) from referral for ART to 6 weeks post-ART and followed up until 12 weeks. Body composition by bioelectrical impedance analysis (BIA), deuterium (2H) diluted water (D2O) and air displacement plethysmography (ADP), and handgrip strength were determined at baseline and at 6 and 12 weeks post-ART, and effects of LNS-VM v. LNS at 6 and 12 weeks investigated. BIA data were available for 1461, D2O data for 479, ADP data for 498 and handgrip strength data for 1752 patients. Fat mass tended to be lower, and fat-free mass correspondingly higher, by BIA than by ADP or D2O. At 6 weeks post-ART, LNS-VM led to a higher regain of BIA-assessed fat mass (0·4 (95 % CI 0·05, 0·8) kg), but not fat-free mass, and a borderline significant increase in handgrip strength (0·72 (95 % CI −0·03, 1·5) kg). These effects were not sustained at 12 weeks. Similar effects as for BIA were seen using ADP or D2O but no differences reached statistical significance. In conclusion, LNS-VM led to a higher regain of fat mass at 6 weeks and to a borderline significant beneficial effect on handgrip strength. Further research is needed to determine appropriate timing and supplement composition to optimise nutritional interventions in malnourished HIV patients.
Collapse
Key Words
- ADP, air displacement plethysmography
- ART, antiretroviral therapy
- Antiretroviral therapy
- BIA, bioelectrical impedance analysis
- Body composition
- CD4, cluster of differentiation 4
- D2O, deuterium (2H) diluted water
- FFMI, fat-free mass index
- FMI, fat mass index
- Handgrip strength
- LNS, lipid-based nutrient supplement
- LNS-VM, lipid-based nutrient supplement with added vitamins and minerals
- Malnutrition
- Minerals
- NUSTART, Nutritional Support for African Adults Starting Antiretroviral Therapy
- Vitamins
Collapse
|
3
|
The effect of iron replacement therapy on appetite in children with iron deficiency anemia. JOURNAL OF CONTEMPORARY MEDICINE 2019. [DOI: 10.16899/jcm.559567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
4
|
Penner J, Ferrand RA, Richards C, Ward KA, Burns JE, Gregson CL. The impact of vitamin D supplementation on musculoskeletal health outcomes in children, adolescents, and young adults living with HIV: A systematic review. PLoS One 2018; 13:e0207022. [PMID: 30439968 PMCID: PMC6237309 DOI: 10.1371/journal.pone.0207022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 10/22/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE HIV-positive children, adolescents, and young adults are at increased risk poor musculoskeletal outcomes. Increased incidence of vitamin D deficiency in youth living with HIV may further adversely affect musculoskeletal health. We investigated the impact of vitamin D supplementation on a range of musculoskeletal outcomes among individuals aged 0-25 years living with HIV. METHODS A systematic review was conducted using databases: PubMed/Medline, CINAHL, Web of Knowledge, and EMBASE. Interventional randomised control trials, quasi-experimental trials, and previous systematic reviews/meta-analyses were included. Outcomes included: BMD, BMC, fracture incidence, muscle strength, linear growth (height-for-age Z-score [HAZ]), and biochemical/endocrine biomarkers including bone turnover markers. RESULTS Of 497 records, 20 studies met inclusion criteria. Thirteen studies were conducted in North America, one in Asia, two in Europe, and four in Sub-Saharan Africa. High-dose vitamin D supplementation regimens (1,000-7,000 IU/day) were successful in achieving serum 25-hydroxyvitamin-D (25OHD) concentrations above study-defined thresholds. No improvements were observed in BMD, BMC, or in muscle power, force and strength; however, improvements in neuromuscular motor skills were demonstrated. HAZ was unaffected by low-dose (200-400 IU/day) supplementation. A single study found positive effects on HAZ with high-dose supplementation (7,000 vs 4,000IU/day). CONCLUSIONS Measured bone outcomes were unaffected by high-dose vitamin D supplementation, even when target 25OHD measurements were achieved. This may be due to: insufficient sample size, follow-up, intermittent dosing, non-standardised definitions of vitamin D deficiency, or heterogeneity of enrolment criteria pertaining to baseline vitamin D concentration. High-dose vitamin D may improve HAZ and neuromuscular motor skills. Adequately powered trials are needed in settings where HIV burden is greatest. PROSPERO Number: CRD42016042938.
Collapse
Affiliation(s)
- Justin Penner
- University of Manitoba, Winnipeg, Canada
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Paediatrics, University of British Columbia, Vancouver, Canada
| | - Rashida A. Ferrand
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Kate A. Ward
- MRC Lifecourse Epidemiology, University of Southampton, Southampton, United Kingdom
| | - James E. Burns
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Queen Elizabeth University Hospital, Greater Glasgow & Clyde NHS Trust, Glasgow, United Kingdom
| | - Celia L. Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
5
|
Ickes SB, Hossain M, Ritter G, Lazarus M, Reynolds K, Nahar B, Ahmed T, Walson J, Denno DM. Systematic Review of Tools and Methods to Measure Appetite in Undernourished Children in the Context of Low- and Middle-Income Countries. Adv Nutr 2018; 9:789-812. [PMID: 30462177 PMCID: PMC6247147 DOI: 10.1093/advances/nmy042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Child undernutrition has multifactorial causes, ranging from food insecurity to etiologies refractory to conventional nutritional approaches, such as infections, environmental enteric dysfunction, and other conditions that lead to systemic inflammation. Poor appetite may be an important symptom of these causes and may be a useful marker of an undernourished child's ability to recover. We conducted a systematic review to characterize the methods and tools to measure appetite among children <5 y old in low- and middle-income countries. A systematic search of 8 databases identified 23 eligible studies published since 1995. Thirteen described methods based on direct feeding observation or quantification of nutrient intake from caregiver report, 16 described tools that assessed caregiver perceptions of appetite, and 6 reported assessments in both categories. Four studies that gauged caregiver perceptions assessed multiple appetite domains, whereas 12 assessed 1 domain-often with a single question. Only 6 studies reported validation processes, the most common of which compared an observed test meal with daily energy intake. No studies reported the use of a method or tool that was validated in multiple cultural or linguistic contexts. Although dietary intake measures and observed feeding tests have shown validity in some contexts, they are resource intensive. Subjective caregiver questionnaires may offer a more efficient appetite evaluation method, but they have been evaluated less consistently. A rigorously developed and validated tool to rapidly assess child appetite is needed and could be best addressed by a questionnaire that leverages the multiple domains of appetite. The application of interventions that target causes of undernutrition that are not amenable to food-based interventions in clinical or research contexts could be facilitated by an efficient appetite screening tool to identify appetite-related causes of undernutrition and to monitor children's response to such interventions.
Collapse
Affiliation(s)
- Scott B Ickes
- Departments of Health Services,Global Health,Program in Nutritional Sciences, University of Washington, Seattle, WA,Wheaton College Department of Applied Health Sciences, Wheaton, IL
| | - Muttaquina Hossain
- Nutrition and Clinical Services Division, International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b)
| | - Gaelen Ritter
- Program in Nutritional Sciences, University of Washington, Seattle, WA
| | - Monica Lazarus
- Program in Nutritional Sciences, University of Washington, Seattle, WA
| | | | - Baitun Nahar
- Nutrition and Clinical Services Division, International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b)
| | - Tahmeed Ahmed
- Global Health,Nutrition and Clinical Services Division, International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b)
| | - Judd Walson
- Pediatrics,Global Health,Medicine,Epidemiology,Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
| | - Donna M Denno
- Departments of Health Services,Pediatrics,Global Health,Childhood Acute Illness and Nutrition Network, Nairobi, Kenya,Address correspondence to DMD (e-mail: )
| |
Collapse
|
6
|
Effects on anthropometry and appetite of vitamins and minerals given in lipid nutritional supplements for malnourished HIV-infected adults referred for antiretroviral therapy: results from the NUSTART randomized controlled trial. J Acquir Immune Defic Syndr 2015; 68:405-12. [PMID: 25501607 PMCID: PMC4337586 DOI: 10.1097/qai.0000000000000483] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is Available in the Text. Background: The evidence base for effects of nutritional interventions for malnourished HIV-infected patients starting antiretroviral therapy (ART) is limited and inconclusive. Objective: We hypothesized that both vitamin and mineral deficiencies and poor appetite limit weight gain in malnourished patients starting ART and that vitamin and mineral supplementation would improve appetite and permit nutritional recovery. Design: The randomized controlled Nutritional Support for Africans Starting Antiretroviral Therapy trial was conducted in Mwanza, Tanzania, and Lusaka, Zambia. ART-naive adults referred for ART and with body mass index <18.5 kg/m2 received lipid-based nutritional supplements either without (LNS) or with added vitamins and minerals (LNS-VM), beginning before ART initiation. Participants were given 30 g/d LNS from recruitment until 2 weeks after starting ART and 250 g/d from weeks 2 to 6 of ART. Results: Of 1815 patients recruited, 365 (20%) died during the study and 813 (45%) provided data at 12 weeks. Controlling for baseline values, anthropometric measures were consistently higher at 12-week ART in the LNS-VM than in the LNS group but statistically significant only for calf and mid-upper arm circumferences and triceps skinfold. Appetite did not differ between groups. Using piecewise mixed-effects quadratic models including all patients and time points, the main effects of LNS-VM were seen after starting ART and were significant for weight, body mass index, and mid-upper arm circumference. Conclusions: Provision of high levels of vitamins and minerals to patients referred for ART, delivered with substantial macronutrients, increased nutritional recovery but did not seem to act through treatment group differences in appetite.
Collapse
|
7
|
Serum Micronutrient Status of Haart-Naïve, HIV Infected Children in South Western Nigeria: A Case Controlled Study. AIDS Res Treat 2014; 2014:351043. [PMID: 25180086 PMCID: PMC4144154 DOI: 10.1155/2014/351043] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 06/22/2014] [Accepted: 07/22/2014] [Indexed: 12/23/2022] Open
Abstract
Background. Though micronutrients are vital in the pathogenesis of human immunodeficiency virus infection, most studies have been conducted in adults. Knowledge of the status of key micronutrients in HIV infected African children will indicate if supplementation may be beneficial to these children living in this resource-poor region. Objectives. We sought to determine the micronutrient status and associated factors of HAART-naïve HIV infected children and compare them with those of the HIV negative controls. Methods. We enrolled 70 apparently stable HAART naïve HIV infected children. Seventy age and sex matched HIV negative children were equally enrolled as the controls. Their social class, anthropometry, clinical stage, CD4 counts, serum zinc, selenium, and vitamin C were determined. Results. The prevalence of zinc, selenium, and vitamin C deficiency in HIV infected subjects was 77.1%, 71.4%, and 70.0%, respectively, as compared to 44.3%, 18.6%, and 15.7% in HIV negative controls. Among the HIV infected subjects, 58.6% were deficient in the three micronutrients. Micronutrient status was related to the weight, clinical, and immunological stages but not BMI or social class. Conclusion. Deficiency of these key micronutrients is widely prevalent in HAART naïve HIV infected children irrespective of social class. This suggests that supplementation trial studies may be indicated in this population.
Collapse
|
8
|
Appetite testing in HIV-infected African adults recovering from malnutrition and given antiretroviral therapy. Public Health Nutr 2014; 18:742-51. [PMID: 24785906 DOI: 10.1017/s1368980014000718] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Nutritional Support for Africans Starting Antiretroviral Therapy (NUSTART) trial was designed to determine whether nutritional support for malnourished HIV-infected adults starting antiretroviral therapy (ART) can improve early survival. Appetite is related to health outcomes in this population, but the optimal appetite metric for field use is uncertain. We evaluated two measures of appetite with the goal of improving understanding and treatment of malnutrition in HIV-infected adults. DESIGN Longitudinal cohort study embedded in a clinical trial of vitamin and mineral-fortified, v. unfortified, lipid-based nutritional supplements. SETTING HIV clinics in Mwanza, Tanzania and Lusaka, Zambia. SUBJECTS Malnourished (BMI<18.5 kg/m2) HIV-infected adults starting ART. RESULTS Appetite measurements, by short questionnaire and by weight of maize porridge consumed in a standardized test, were compared across time and correlated with changes in weight. Appetite questionnaire scores, from polychoric correlation, and porridge test results were normally distributed for Tanzanians (n 187) but clustered and unreliable for Zambians (n 297). Among Tanzanian patients, the appetite score increased rapidly from referral for ART, plateaued at the start of ART and then increased slowly during the 12-week follow-up. Change in appetite questionnaire score, but not porridge test, correlated with weight change in the corresponding two-week intervals (P=0.002) or over the whole study (P=0.05) but a point estimate of hunger did not predict weight change (P=0.4). CONCLUSIONS In Tanzania change in appetite score correlated with weight change, but single point measurements did not. Appetite increases several weeks after the start of ART, which may be an appropriate time for nutritional interventions for malnourished HIV-infected adults.
Collapse
|
9
|
Effect of folic acid on appetite in children: Ordinal logistic and fuzzy logistic regressions. Nutrition 2014; 30:274-8. [DOI: 10.1016/j.nut.2013.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 08/01/2013] [Accepted: 08/12/2013] [Indexed: 11/24/2022]
|
10
|
Irlam JH, Siegfried N, Visser ME, Rollins NC. Micronutrient supplementation for children with HIV infection. Cochrane Database Syst Rev 2013:CD010666. [PMID: 24114375 DOI: 10.1002/14651858.cd010666] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Micronutrient deficiencies are widespread and compound the effects of HIV disease in children, especially in poor communities. Micronutrient supplements may be effective and safe in reducing the burden of HIV disease. This review is an update of an earlier Cochrane review of micronutrient supplementation in children and adults which found that vitamin A and zinc are beneficial and safe in children exposed to HIV and living with HIV infection (Irlam 2010). OBJECTIVES To assess whether micronutrient supplements are effective and safe in reducing mortality and morbidity in children with HIV infection. SEARCH METHODS The CENTRAL, EMBASE, and PubMed databases were searched for randomised controlled trials of micronutrient supplements (vitamins, trace elements, and combinations of these) using the search methods of the Cochrane HIV/AIDS Group. SELECTION CRITERIA Randomised controlled trials were selected that compared the effects of micronutrient supplements with other supplements, or placebo or no treatment on the primary outcomes of mortality, morbidity, and HIV-related hospitalisations. Indicators of HIV disease progession, anthropometric measures, and any adverse effects of supplementation were secondary outcomes. DATA COLLECTION AND ANALYSIS Two reviewers independently screened and selected trials for inclusion, assessed the risk of bias using standardised criteria, and extracted data. Review Manager 5.1 was used to calculate the risk ratio (RR) for dichotomous data and the weighted mean difference (WMD) for continuous data, and to perform random effects meta-analysis where appropriate. MAIN RESULTS We included three new studies in addition to the eight studies in the earlier version of the review (Irlam 2010). Eleven studies with a total of 2412 participants were therefore included: five trials of vitamin A, one trial of vitamin D, two trials of zinc, and three trials of multiple micronutrient supplements. All except one trial were conducted in African children.Vitamin A halved all-cause mortality in a meta-analysis of three trials in African children, had inconsistent impacts on diarrhoeal and respiratory morbidity, and improved short-term growth in a Tanzanian trial. No significant adverse effects were reported.A single small trial of vitamin D in North American adolescents and children demonstrated safety but no clinical benefits. Zinc supplements reduced diarrhoeal morbidity and had no adverse effects on disease progression in one small South African trial. Another trial in South African children with and without HIV infection did not show benefit from the the prophylactic use of zinc or multiple supplements versus vitamin A in the small subgroup of children with HIV infection.Multiple micronutrient supplements at twice the RDA did not alter mortality, growth, or CD4 counts at 12 months in Ugandan children aged one to five years. Short-term supplementation until hospital discharge significantly reduced the duration of all hospital admissions in poorly nourished South African children, and supplementation for six months after discharge improved appetite and nutritional indicators. AUTHORS' CONCLUSIONS Vitamin A supplementation is beneficial and safe in children with HIV infection. Zinc is safe and appears to have similar benefits on diarrhoeal morbidity in children with HIV as in children without HIV infection. Multiple micronutrient supplements have some clinical benefit in poorly nourished children with HIV infection.Further trials of single supplements (vitamin D, zinc, and selenium) are required to build the evidence base. The long-term effects and optimal composition and dosing of multiple micronutrient supplements require further investigation in children with diverse HIV disease status.
Collapse
Affiliation(s)
- James H Irlam
- Primary Health Care Directorate, University of Cape Town, E47 OMB, Groote Schuur Hospital, Cape Town, Western Cape, South Africa, 7925
| | | | | | | |
Collapse
|
11
|
de Pee S, Semba RD. Role of Nutrition in HIV Infection: Review of Evidence for more Effective Programming in Resource-Limited Settings. Food Nutr Bull 2010. [DOI: 10.1177/15648265100314s403] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background HIV infection and malnutrition negatively reinforce each other. Objective For program guidance, to review evidence on the relationship of HIV infection and malnutrition in adults in resource-limited settings. Results and conclusions Adequate nutritional status supports immunity and physical performance. Weight loss, caused by low dietary intake (loss of appetite, mouth ulcers, food insecurity), malabsorption, and altered metabolism, is common in HIV infection. Regaining weight, particularly muscle mass, requires antiretroviral therapy (ART), treatment of opportunistic infections, consumption of a balanced diet, physical activity, mitigation of side effects, and perhaps appetite stimulants and growth hormone. Correcting nutritional status becomes more difficult as infection progresses. Studies document widespread micronutrient deficiencies among HIV-infected people. However, supplement composition, patient characteristics, and treatments vary widely across intervention studies. Therefore, the World Health Organization (WHO) recommends ensuring intake of 1 Recommended Nutrient Intake (RNI) of each required micronutrient, which may require taking micronutrient supplements. Few studies have assessed the impact of food supplements. Because the mortality risk in patients receiving ART increases with lower body mass index (BMI), improving the BMI seems important. Whether this requires provision of food supplements depends on the patient's diet and food security. It appears that starting ART improves BMI and that ready-to-use fortified spreads and fortified-blended foods further increase BMI (the effect is somewhat less with fortified-blended foods). The studies are too small to assess effects on mortality. Once ART has been established and malnutrition treated, the nutritional quality of the diet remains important, also because of ART's long-term metabolic effects (dyslipidemia, insulin resistance, obesity). Food insecurity should also be addressed if it prevents adequate energy intake and reduces treatment initiation and adherence (due to the opportunity costs of obtaining treatment and mitigating side effects).
Collapse
|