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Gastrointestinal symptoms in HIV-positive kidney transplant candidates and recipients from an HIV-positive donor. Sci Rep 2021; 11:12592. [PMID: 34131245 PMCID: PMC8206362 DOI: 10.1038/s41598-021-92016-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 06/02/2021] [Indexed: 11/26/2022] Open
Abstract
Gastrointestinal symptoms (GIS) are common in kidney transplant candidates and recipients and may be worsened by HIV. Objective: To determine the frequency and severity of GIS in HIV-positive kidney transplant recipients from HIV-positive donors, and those waiting to receive one. A GIS rating scale (GSRS) was completed by 76 participants at baseline and at 6 months. GIS frequency was defined as having at least one symptom (GSRS > 1). Severity was indicated by the GSRS score. Transplant candidates: GIS frequency was 88.9% and 86.3% at baseline and 6 months respectively. Indigestion was the most frequent (79.6% and 66.7% at baseline and 6 months), and severe GIS (GSRS 2.3). Women reported global mean (p = 0.030) severity significantly more than men. Transplant recipients: GIS frequency was 95.2% and 76.2% at baseline and 6 months respectively. At both assessment points, indigestion occurred most frequently (85.7% and 61.9% respectively). Highest GSRS was reported for indigestion at baseline (2.33) and at 6 months (1.33). Waist circumference (WC) was positively associated with the severity of constipation GSRS. GIS are common in both groups, especially indigestions. WC in transplant recipients should be monitored.
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Man SLC, Chau WW, Chung KY, Ho KKW. Hypoalbuminemia and obesity class II are reliable predictors of peri-prosthetic joint infection in patient undergoing elective total knee arthroplasty. Knee Surg Relat Res 2020; 32:21. [PMID: 32660593 PMCID: PMC7219214 DOI: 10.1186/s43019-020-00040-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/14/2020] [Indexed: 11/30/2022] Open
Abstract
Background Malnutrition is a common and modifiable risk factor for postoperative complications and adverse outcomes in orthopedics. The purpose of this study was to identify biomarkers of malnutrition in patients undergoing elective total knee arthroplasty (TKA) that are predictive of adverse in-hospital postoperative complications, to facilitate the identification of at-risk patients for nutritional optimization before surgery. Methods A total of 624 patients who underwent elective TKA between 2013 and 2017 were evaluated; potential biomarkers of preoperative malnutrition, including hypoalbuminemia (serum albumin < 3.5 g/dL), total lymphocyte count (TLC < 1500 cells/mm3), and body mass index (BMI), were assessed for any association with in-hospital postoperative complications. Results The prevalence of hypoalbuminemia, low TLC, overweight, obesity class I, and obesity class II were, respectively 2.72%, 33.4%, 14.8%, 44.5%, and 26.9%. There was a significant association between hypoalbuminemia and obesity class II (BMI ≥ 30.0 kg/m2) with rates of peri-prosthetic joint infection, and no significant association between such complications and low TLC, overweight, or obesity class I. Logistic regression analysis showed that patients with hypoalbuminemia or being in obesity class II with gouty arthritis were more likely to suffer from peri-prosthetic joint infection. Conclusions Hypoalbuminemia and obesity class II together is a reliable biomarker of preoperative malnutrition for predicting peri-prosthetic joint infection after elective TKA, whereas low TLC, overweight, and obesity class I were not significantly associated with an increased risk of such complications.
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Affiliation(s)
- Sheryl Lok-Chi Man
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - Wai-Wang Chau
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - Kwong-Yin Chung
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - Kevin Ki Wai Ho
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR.
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Martin CJ, Muller E, Labadarios D, Veldman FJ, Kassier SM. Body composition of HIV-positive candidates for and recipients of a kidney transplant: comparative analysis between DEXA and anthropometric indices. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2020. [DOI: 10.1080/16070658.2020.1741902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- CJ Martin
- Dietetics and Human Nutrition, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - E Muller
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - D Labadarios
- Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - FJ Veldman
- Department of Human Nutrition and Dietetics, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - SM Kassier
- Dietetics and Human Nutrition, University of KwaZulu-Natal, Pietermaritzburg, South Africa
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Nutritional assessment of Oraons of West Bengal: a comparison between biochemical and anthropometric methods. ANTHROPOLOGICAL REVIEW 2019. [DOI: 10.2478/anre-2019-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Comprehensive nutritional assessment is the basis of nutritional diagnosis and necessary to identify the individual or the population at a risk of dietary deficiencies. However, there is no specific and confirmatory method to measure nutritional status. Present study tried to find out the efficacy of two nutritional assessment method (1) biochemical test like Total serum protein (TSP) and (2) anthropological measurements like body mass index (BMI) and mid-upper-arm-circumference (MUAC). Later, three methods were tested and compared for the strength of assessing the nutritional status. Study was conducted among 198 adult Oraon, 84 male, 114 female individuals of Madarihat and Falakata police station area, Alipurduar district, West Bengal. Selected blood parameters such as total serum protein (TSP), serum albumin and haemoglobin and anthropometric measurements (height, weight, mid-upper arm circumference, waist circumference, hip circumference, calf circumference, biceps skinfold, triceps skinfold, and calf skinfold) were obtained following standard instruments and protocols. Nutritional status of all individuals was assessed by TSP, BMI and MUAC classification methods. Comparison between/among three classification methods (TSP, BMI and MUAC) was done and discriminant function analysis was adopted to find out the percentage of correct classification by each methods. It was found that prevalence of undernutrition using TSP classification was 38.1% male and 43.0% female; using BMI was 34.5% male and 53.5% female; using MUAC was 45.2% male and 64.9% female. Discriminant function analysis showed that BMI (97.0%) had the highest capability of correct classification followed by MUAC (84.80%) and TSP (63.60%). Results indicate that however, TSP is an objective way of nutritional assessment, but BMI had the highest capability of correct classification of nutritional status. It may be pointed out that the evaluation with TSP was expensive and invasive whereas BMI is non-expensive and completely a non-invasive way of evaluation. Therefore, BMI may widely be used for nutritional assessment.
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Affuso O, Pradhan L, Zhang C, Gao S, Wiener HW, Gower B, Heymsfield SB, Allison DB. A method for measuring human body composition using digital images. PLoS One 2018; 13:e0206430. [PMID: 30395607 PMCID: PMC6218036 DOI: 10.1371/journal.pone.0206430] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 10/12/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND/OBJECTIVES Body mass index (BMI) is a proxy for obesity that is commonly used in spite of its limitation in estimating body fatness. Trained observers with repeated exposure to different body types can estimate body fat (BF) of individuals compared to criterion methods with reasonable accuracy. The purpose of this study was to develop and validate a computer algorithm to provide a valid estimate %BF using digital photographs. SUBJECTS/METHODS Our sample included 97 children and 226 adults (age in years: 11.3±3.3; 38.1±11.6, respectively). Measured height and weight were used (BMI in kg/m2: 20.4±4.4; 28.7±6.6 for children and adults, respectively). Dual x-ray absorptiometry (DXA) was the criterion method. Body volume (BVPHOTO) and body shape (BSPHOTO) were derived from two digital images. Final support vector regression (SVR) models were trained using age, sex, race, BMI for % BFNOPHOTO, plus BVPHOTO and BSPHOTO for %BFPHOTO. Separate validation models were used to evaluate the learning algorithm in children and adults. The differences in correlations between %BFDXA, %BFNOPHOTO and %BFPHOTO were tested using the Fisher's Z-score transformation. RESULTS Mean BFDXA and BFPHOTO were 27.0%±9.2 vs. 26.7%± 7.4 in children and 32.9± 10.4% vs. 32.8%±9.3 in adults. SVR models produced %BFPHOTO values strongly correlated with %BFDXA. Our final model produced correlations of rDP = 0.80 and rDP = 0.87 in children and adults, respectively for %BFPHOTO vs. %BFDXA. The correlation between %BFNOPHOTO and %BFDXA was moderate, yet statistically significant in both children rDB = 0.70; p <0.0001 and adults rDB = 0.86; p<0.0001. However, the correlations for rDP were statistically higher than rDB (%BFDXA vs. %BFNOPHOTO) in both children and adults (children: Z = 5.95, p<0.001; adults: Z = 3.27, p<0.0001). CONCLUSIONS Our photographic method produced valid estimates of BF in both children and adults. Further research is needed to create norms for subgroups by sex, race/ethnicity, and mobility status.
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Affiliation(s)
- Olivia Affuso
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ligaj Pradhan
- Department of Computer and Information Sciences, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Chengcui Zhang
- Department of Computer and Information Sciences, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Song Gao
- Department of Computer and Information Sciences, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Howard W. Wiener
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Barbara Gower
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Nutrition Science, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Steven B. Heymsfield
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, United States
| | - David B. Allison
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University-Bloomington, Bloomington, IN, United States
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Bassichetto KC, Bergamaschi DP, Garcia VRS, Veras MADSM. Factors associated with undernourishment among people 20 years old or over with HIV/AIDS, attending public health services in the São Paulo municipality, Brazil. CAD SAUDE PUBLICA 2016; 30:2578-86. [PMID: 26247987 DOI: 10.1590/0102-311x00174513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 07/16/2014] [Indexed: 11/22/2022] Open
Abstract
The study evaluated the nutritional status of 629 people living with HIV/AIDS attended at 12 specialized services of São Paulo's Municipal Health Department, Brazil. Data were obtained from medical records and through interviews during nutritional consultation. We used the classification criteria established by World Health Organization to assess malnourished individuals, a BMI < 18.5kg/m2. The prevalence of malnutrition in people with AIDS is 3.12 times that observed among people with HIV, and among people with co-infection it is 3.41 times that obtained among people without co-infection. This indicates how these conditions can harm the maintenance of the nutritional status, and shows that they demand a comprehensive understanding of the mechanisms involved in this phenomenon, as well as the development of strategies to improve the health care of individuals at nutritional risk.
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Mulol H, Coutsoudis A. Breastmilk Output in a Disadvantaged Community with High HIV Prevalence as Determined by the Deuterium Oxide Dose-to-Mother Technique. Breastfeed Med 2016; 11:64-9. [PMID: 26862660 DOI: 10.1089/bfm.2015.0139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION World Health Organization breastfeeding guidelines for HIV-infected mothers are exclusive breastfeeding for 6 months and then continued breastfeeding for 12 months, provided the mother is receiving antiretroviral prophylaxis. Many African women perceive that breastmilk alone is not sufficient for their infant's nutritional requirements for the first 6 months of life, and mixed feeding is a common practice. METHODOLOGY A stable isotope technique was used to determine breastmilk output volumes and maternal body composition objectively at five different time points in the first year of the infant's life. RESULTS Breastmilk output volumes were high for HIV-infected mothers: 831 ± 185 g/day at 6 weeks; 899 ± 188 g/day at 3 months; 871 ± 293 g/day at 6 months; 679 ± 281 g/day at 9 months; and 755 ± 287 g/day at 12 months. These high output volumes had no negative impact on the mother's fat-free mass. The breastmilk output volumes for HIV-uninfected mothers were not significantly different to the outputs for HIV-infected mothers at any of the time points (p > 0.05): 948 ± 223 g/day at 6 weeks; 925 ± 227 g/day at 3 months; 902 ± 286 g/day at 6 months; 746 ± 263 g/day at 9 months; and 713 ± 264 g/day at 12 months. CONCLUSION This study using objective methodology shows that breastmilk outputs of HIV-infected mothers were relatively high (and within published reference ranges), and mothers are able to provide sufficient breastmilk for their infants without compromising their own fat-free mass.
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Affiliation(s)
- Helen Mulol
- Department of Pediatrics and Child Health, University of KwaZulu-Natal , Durban, South Africa
| | - Anna Coutsoudis
- Department of Pediatrics and Child Health, University of KwaZulu-Natal , Durban, South Africa
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Bassichetto KC, Bergamaschi DP, Frainer DES, Garcia VRS, Trovões EAT. Weight and height of people living with HIV/AIDS attended by the Brazilian National Health System. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2013; 16:622-32. [DOI: 10.1590/s1415-790x2013000300007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 08/14/2013] [Indexed: 11/22/2022] Open
Abstract
The nutritional status of people living with HIV/AIDS (PLWHA) is related to morbidity and mortality and its monitoring is important in the maintenance of the health status. This is a cross-sectional study carried out in Brazilian National Health System in the Municipality of São Paulo. It describes anthropometrical characteristics: weight and height; indices of weight for height (W/H), height for age (H/A), body mass index for age (BMI/A) and Z score for height and weight. The study includes 772 participants from all ages: children, adolescents, adults and elderly. The graphical analysis shows that in under-5s and in the 5 to 19 years old group, the W/H, the H/A and the BMI/A curves are similar to the reference population with an exception in the H/A for 5 to 19 years old group which is left-shifted (mean Z = -0.66). In the case of adults, graphics for the study population show median weight apparently lower than in the reference population for most age groups in the case of men, and when age is greater in women. The proportion of people over 20 years old with AIDS on anti-retroviral therapy is lower when coinfection is present (p < 0.001). The findings of the study showed that, for children and adolescents with HIV/AIDS, the average weight and height are lower than the values for non infected population. For adults and elderly, the weight average is lower than the reference population with a worsening among coinfected patients. This underscores the need to direct more effort in nutritional actions thus helping enhance the health status of this group.
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Palchetti CZ, Patin RV, Machado DM, Szejnfeld VL, Succi RCDM, Oliveira FLC. Body composition in prepubertal, HIV-infected children: a comparison of bioelectrical impedance analysis and dual-energy X-ray absorptiometry. Nutr Clin Pract 2013; 28:247-52. [PMID: 23447408 DOI: 10.1177/0884533612471401] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The aim of this study was to compare bioelectrical impedance analysis (BIA) equations developed for healthy pediatric populations and for HIV-infected children using dual-energy X-ray absorptiometry (DXA) as the gold standard. MATERIALS AND METHODS A cross-sectional study was carried out with 40 prepubertal, HIV-infected children who regularly attended the Pediatric Infectious Disease Clinic at the Universidade Federal de São Paulo, São Paulo, Brazil. The study was conducted from August to November 2008. Demographic data, clinical parameters, immunological status, and use of antiretroviral therapy were obtained from the patients' medical records. We performed anthropometric parameters and body composition analyses, analyzed body composition by BIA and DXA, and compared the results obtained from BIA through using equations for both healthy and HIV-infected populations. RESULTS The mean ± SD age of the study population was 9.8 ± 1.2 years. Half of the population were females, and 82.5% of the children were clinically classified as B and C. Total body fat, by both absolute mass and by percentage, exhibited high homogeneity between the results obtained from BIA and DXA. However, there was no concordance in fat-free mass. The equation for healthy children showed good sensitivity and specificity when comparing the percentage of total body fat measured by DXA. CONCLUSION BIA provides reliable data on total body fat but not fat-free mass when compared with DXA. The BIA equation developed for healthy pediatric populations can be used to determine total body fat in HIV-infected children.
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Affiliation(s)
- Cecília Zanin Palchetti
- Division of Nutrology, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil
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Andrade CS, Jesus RP, Andrade TB, Oliveira NS, Nabity SA, Ribeiro GS. Prevalence and characteristics associated with malnutrition at hospitalization among patients with acquired immunodeficiency syndrome in Brazil. PLoS One 2012; 7:e48717. [PMID: 23144941 PMCID: PMC3492415 DOI: 10.1371/journal.pone.0048717] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 09/27/2012] [Indexed: 12/02/2022] Open
Abstract
Background Brazil’s National STD/AIDS Program is considered a model of success worldwide. However, AIDS-associated malnutrition continues in subgroups of Brazilian patients despite access to free highly active antiretroviral therapy (HAART). We aimed to identify the prevalence of malnutrition and associated factors among patients hospitalized with AIDS. Methods We conducted a cross-sectional nutritional assessment among 127 adults hospitalized with AIDS in Brazil’s third largest city. Using anthropometric measurements, we determined the prevalence of malnutrition (body mass index <18.5 kg/m2) at hospitalization. Prevalence ratios of malnutrition by demographic, socioeconomic, and clinical conditions were estimated using log-binomial regression. Results One-third of participants were first informed of their HIV disease during the current hospitalization and recent treatment interruption was common (71%) among those on HAART. Forty-three percent were malnourished and 35% had severe weight loss at admission. Patient characteristics independently associated with malnutrition were older age (2% increased prevalence for each year; 95% confidence interval [CI] 0–4%) and very low daily per capita household income. Living on <USD 2.00, USD 2.00–4.99 or USD 5.00–9.99 increased the prevalence of malnutrition by 2.01 (95% CI 1.06–3.81), 1.75 (95% CI 0.92–3.35) and 1.42 (95% CI 0.76–2.65) times, respectively, compared to ≥USD 10.00 per day. Chronic diarrhea was marginally associated with malnutrition (RR 1.42; 95% CI 0.99–2.04). Overall, 16% of the patients died during hospitalization. We observed a trend toward higher in-hospital case fatality among malnourished patients (22% vs. 12% for patients with and without malnutrition, respectively; chi square P = 0.14). Conclusions Unacceptably high rates of malnutrition persist in Brazilians hospitalized with AIDS and our results reinforce the importance of nutritional evaluations in these patients. Improved early testing and treatment adherence strategies may continue to help reduce AIDS-related morbidity and mortality in Brazil, yet novel interventions to disrupt the cycle of poverty, HIV, and malnutrition are also urgently needed.
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Affiliation(s)
- Carine S. Andrade
- School of Nutrition, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Rosângela P. Jesus
- School of Nutrition, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Taciana B. Andrade
- School of Nutrition, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Neyara S. Oliveira
- School of Nutrition, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Scott A. Nabity
- School of Medicine, Duke University, Durham, North Carolina, United States of America
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Bahia, Brazil
| | - Guilherme S. Ribeiro
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
- * E-mail:
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Tremeschin MH, Sartorelli DS, Cervi MC, Negrini BVDM, Salomão RG, Monteiro JP. Nutritional assessment and lipid profile in HIV-infected children and adolescents treated with highly active antiretroviral therapy. Rev Soc Bras Med Trop 2011; 44:274-81. [PMID: 21739071 DOI: 10.1590/s0037-86822011005000039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Accepted: 02/17/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION HIV-infected children and adolescents treated with highly active antiretroviral therapy (HAART) regimens that include a protease inhibitor (PI) can show significant improvements in clinical outcomes, nutritional status and quality of life. The study aimed to report nutritional and metabolic alterations for pediatric patients continuously exposed to HAART and for healthy controls for up to 1 year. METHODS Clinical, anthropometric, lipid profile and food intake data were collected prospectively over approximately 12-months for each patient. RESULTS Fifty-one individuals were studied, of these, 16 were healthy. After 12 months follow-up, HIV-positive individuals remained below the healthy control group parameters. No change was observed concerning food intake. Triglyceride serum levels were higher in patients using protease inhibitor at the onset of the study [PI groups: 114 (43 - 336), and 136 (63 - 271) versus control group: 54.5 (20 - 162); p = 0.003], but after twelve months follow-up, only the group using protease inhibitor for up to two months presented higher values [140 (73 - 273) versus 67.5 (33 - 117); p = 0.004]. HDL-cholesterol was lower in HIV-positive individuals [HIV-positive groups: 36 (27 - 58) and 36 (23 - 43); control 49.5 (34 - 69); p = 0.004]. CONCLUSIONS HIV-infected children and adolescents treated with highly active antiretroviral therapy showed compromised nutritional parameters compared to a paired healthy control group. Individuals using protease inhibitor presented worse triglyceride serum levels compared to their healthy counterparts.
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Affiliation(s)
- Marina Hjertquist Tremeschin
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP
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Somarriba G, Neri D, Schaefer N, Miller TL. The effect of aging, nutrition, and exercise during HIV infection. HIV AIDS (Auckl) 2010; 2:191-201. [PMID: 22096398 PMCID: PMC3218696 DOI: 10.2147/hiv.s9069] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Medical advances continue to change the face of human immunodeficiency virus- acquired immunodeficiency syndrome (HIV/AIDS). As life expectancy increases, the number of people living with HIV rises, presenting new challenges for the management of a chronic condition. Aging, nutrition, and physical activity can influence outcomes in other chronic conditions, and emerging data show that each of these factors can impact viral replication and the immune system in HIV. HIV infection results in a decline of the immune system through the depletion of CD4+ T cells. From initial infection, viral replication is a continuous phenomenon. Immunosenescence, a hallmark of aging, results in an increased susceptibility to infections secondary to a delayed immune response, and this phenomenon may be increased in HIV-infected patients. Optimal nutrition is an important adjunct in the clinical care of patients with HIV. Nutritional interventions may improve the quality and span of life and symptom management, support the effectiveness of medications, and improve the patient's resistance to infections and other disease complications by altering immunity. Moderate physical activity can improve many immune parameters, reduce the risk of acute infection, and combat metabolic abnormalities. As people with HIV age, alternative therapies such as nutrition and physical activity may complement medical management.
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Affiliation(s)
- Gabriel Somarriba
- Division of Pediatric Clinical Research, Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Daniela Neri
- Division of Pediatric Clinical Research, Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Natasha Schaefer
- Division of Pediatric Clinical Research, Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Tracie L Miller
- Division of Pediatric Clinical Research, Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida, USA
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Position of the American Dietetic Association: Nutrition Intervention and Human Immunodeficiency Virus Infection. ACTA ACUST UNITED AC 2010; 110:1105-19. [PMID: 20645459 DOI: 10.1016/j.jada.2010.05.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
It is the position of the American Dietetic Association that efforts to optimize nutritional status through individualized medical nutrition therapy, assurance of food and nutrition security, and nutrition education are essential to the total system of health care available to people with human immunodeficiency virus (HIV) infection throughout the continuum of care. Broad-based efforts to improve health care access and treatment have stabilized HIV prevalence levels in many parts of the world and led to longer survival for people living with HIV infection. Confounding clinical and social issues, such as medication interactions, comorbidities, wasting, lipodystrophy, food insecurity, aging, and other related conditions further complicate disease management. With greater understanding of the mechanisms of HIV disease and its impact on body function, development of new treatments, and wider ranges of populations affected, the management of chronic HIV infection continues to become more complex and demanding. Achievement of food and nutrition security and management of nutrition-related complications of HIV infection remain significant challenges for clients with HIV infection and health care professionals. Registered dietitians and dietetic technicians, registered, should integrate their efforts into the overall health care strategies to optimize their clinical and social influence for people living with HIV infection.
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Curti MLR, Almeida LB, Jaime PC. Evolução de parâmetros antropométricos em portadores do vírus da Imunodeficiência Humana ou com Síndrome da Imunodeficiência Adquirida: um estudo prospectivo. REV NUTR 2010. [DOI: 10.1590/s1415-52732010000100007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Avaliar o estado nutricional e a evolução de parâmetros antropométricos para alterações morfológicas em pacientes vivendo com o vírus da Imunodeficiência Humana ou com Síndrome da Imunodeficiência Adquirida em uso de terapia antirretroviral de alta atividade. MÉTODOS: Trata-se de estudo de coorte prospectiva com duração de 12 meses, envolvendo indivíduos adultos, de ambos os sexos, em terapia antirretroviral recém introduzida. Os indicadores antropométricos estudados foram índice de massa corporal, circunferência de cintura, dobras cutâneas subescapular, biciptal e triciptal, avaliados com intervalos de três meses, totalizando 4 medidas do tempo. Variáveis foram descritas segundo mediana e percentis 25 e 75 e analisadas por ANOVA para medidas repetidas. RESULTADOS: A população estudada foi composta por 53 indivíduos, a maioria do sexo masculino (81%), entre 30 e 39 anos. Apenas a dobra cutânea subescapular apresentou significante variação no tempo (T1=13,7 vs T4=16,0; p<0,001), apontando para lipo-hipertrofia dorso-cervical. CONCLUSÃO: Os achados deste estudo, embora limitados, direcionam para a necessidade de vigilância de parâmetros antropométricos associados a alterações morfológicas, em especial, aqueles usados no diagnóstico de acúmulo de gordura abdominal e dorso-cervical.
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The effect of individual antiretroviral drugs on body composition in HIV-infected persons initiating highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2009; 51:298-304. [PMID: 19412117 DOI: 10.1097/qai.0b013e3181aa1308] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To examine the long-term effects of individual antiretroviral drugs on body composition among 416 persons initiating antiretroviral therapy (ART). METHODS In a substudy of a clinical trial of persons initiating ART, changes in body composition attributable to individual ART were examined. ARTs assessed were as follows: indinavir, ritonavir, nelfinavir, efavirenz, nevirapine, stavudine (d4T), zidovudine (ZDV), lamivudine (3TC), didanosine, and abacavir. Skinfolds and circumferences were measured at baseline and every 4 months. Mid arm, mid thigh, and waist subcutaneous tissue areas and nonsubcutaneous tissue areas were calculated. Rates of change per year of exposure to each individual ART drug were determined using multivariate longitudinal regression. RESULTS d4T and ZDV use was associated with losses in subcutaneous tissue area and skinfold thickness. 3TC use was associated with gains in all subcutaneous tissue areas and skinfold thickness, whereas abacavir use was associated with an increase in waist subcutaneous tissue area. Indinavir was associated with gains in waist subcutaneous tissue area, whereas indinavir, efavirenz, and nevirapine were associated with increases in upper back skinfolds. d4T use was also associated with increases in all nonsubcutaneous tissue areas; 3TC use was associated with the greatest increase in waist nonsubcutaneous tissue area. CONCLUSION In this prospective nonrandomized evaluation, the nucleoside reverse transcriptase inhibitors d4T and ZDV were associated with decreases in subcutaneous tissue areas, whereas 3TC use was associated with increased subcutaneous tissue areas and waist nonsubcutaneous tissue area.
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Khalili H, Soudbakhsh A, Hajiabdolbaghi M, Dashti-Khavidaki S, Poorzare A, Saeedi AA, Sharififar R. Nutritional status and serum zinc and selenium levels in Iranian HIV infected individuals. BMC Infect Dis 2008; 8:165. [PMID: 19068104 PMCID: PMC2613901 DOI: 10.1186/1471-2334-8-165] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Accepted: 12/09/2008] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus infected individuals are prone to malnutrition due to increased energy requirements, enteropathy and increased catabolism. Trace elements such as zinc and selenium have major role in maintaining a healthy immune system. This study was designed to evaluate the nutritional status of Iranian subjects who were newly diagnosed with human immunodeficiency virus infection and to compare serum level of zinc and selenium in these patients with those of the sex and aged match healthy subjects. METHODS After an interview and physical examination, nutritional assessment was done based on clinical and anthropometric parameters. Body mass index (normal range 18.5-27 kg/m2 based on age) of less than 16, 16-16.9 and 17-18.4 kg/m2 were considered as severe, moderate and mild malnutrition respectively. Serum level of zinc and selenium were measured by graphite furnace atomic absorption. RESULTS Severe, moderate and mild malnutrition were detected in 15%, 38% and 24% of human immunodeficiency virus infected individuals respectively. Compared with the healthy control group, serum level of zinc and selenium in the human immunodeficiency virus infected subjects were significantly lower (P = 0.01 and P = 0.02 respectively). CONCLUSION Malnutrition found to be prevalent in Iranian human immunodeficiency virus infected individuals and low serum zinc and selenium levels are common in this population.
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Affiliation(s)
- H Khalili
- Department of Pharmacotherapy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - A Soudbakhsh
- Department of Infectious Disease, School of Medicine, Iranian Research Center for HIV/AIDS (IRCHA), Tehran University of Medical Sciences, Tehran, Iran
| | - M Hajiabdolbaghi
- Department of Infectious Disease, School of Medicine, Iranian Research Center for HIV/AIDS (IRCHA), Tehran University of Medical Sciences, Tehran, Iran
| | - S Dashti-Khavidaki
- Department of Pharmacotherapy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - A Poorzare
- Department of Pharmacotherapy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - AA Saeedi
- Department of Infectious Disease, School of Medicine, Iranian Research Center for HIV/AIDS (IRCHA), Tehran University of Medical Sciences, Tehran, Iran
| | - R Sharififar
- Department of Infectious Disease, School of Medicine, Iranian Research Center for HIV/AIDS (IRCHA), Tehran University of Medical Sciences, Tehran, Iran
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Long-term subcutaneous tissue changes among antiretroviral-naive persons initiating stavudine, zidovudine, or abacavir with lamivudine. J Acquir Immune Defic Syndr 2008; 48:53-62. [PMID: 18491421 DOI: 10.1097/qai.0b013e31816856ed] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To assess long-term changes in subcutaneous tissue among antiretroviral-naive persons initiating 1 of 3 nucleoside reverse transcriptase inhibitor (NRTI)-containing regimens. METHODS We compared changes in 308 participants initiating stavudine plus lamivudine (d4T+3TC; N = 63), zidovudine plus lamivudine (ZDV+3TC; N = 192), and abacavir plus lamivudine (ABC+3TC; N = 53), along with protease inhibitors and/or non-NRTIs. Anthropometric measurements (skinfolds) were performed at baseline and 4-month intervals. Rates of change (mm/y) over 36 months, for the early period (months 4 through 12) and late period (months 16 through 36), were calculated. RESULTS The rates were negative (tissue loss) for the abdomen and thigh (d4T+3TC, ZDV+3TC) and triceps (ZDV+3TC) skinfolds. For ABC+3TC, most rates were positive (tissue gain). No differences among regimens were seen for the rates of change in the subscapular or suprascapular skinfolds. Rates in the early period were generally positive. The late period rates were negative for d4T+3TC and ZDV+3TC and significantly different from 0 for the abdomen and thigh (d4T+3TC, ZDV+3TC) and triceps (ZDV+3TC) skinfolds, whereas ABC+3TC had less loss in the late period. Most early versus late differences were significant for d4T+3TC and ZDV+3TC; only the triceps skinfold was significant for ABC+3TC. CONCLUSIONS In this prospective nonrandomized evaluation, subcutaneous tissue changes varied by regimen. Similar losses were demonstrated for d4T+3TC and ZDV+3TC, whereas ABC+3TC had gains. Temporal differences in rates for d4T+3TC and ZDV+3TC suggest initial recovery followed by long-term treatment effect.
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Shlay JC, Bartsch G, Peng G, Wang J, Grunfeld C, Gibert CL, Visnegarwala F, Raghavan SS, Xiang Y, Farrough M, Perry HE, Kotler D, El-Sadr WM. Long-Term Body Composition and Metabolic Changes in Antiretroviral Naive Persons Randomized to Protease Inhibitor-, Nonnucleoside Reverse Transcriptase Inhibitor-, or Protease Inhibitor Plus Nonnucleoside Reverse Transcriptase Inhibitor-Based Strategy. J Acquir Immune Defic Syndr 2007; 44:506-17. [PMID: 17325603 DOI: 10.1097/qai.0b013e31804216cf] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess changes in metabolic parameters and body composition among 422 antiretroviral-naive patients randomized to 3 antiretroviral therapy (ART) strategies: protease inhibitor (PI; n = 141)-, nonnucleoside reverse transcriptase inhibitor (NNRTI; n = 141)-, or PI + NNRTI (n = 140)-based strategies with a median follow-up of 5 years. METHODS At baseline and 1-month (metabolic parameters only) and 4-month follow-up intervals, fat-free mass (FFM) and total body fat were calculated, anthropometric measurements were performed, and fasting metabolic parameters were obtained. Rates of change and mean change were compared. RESULTS The PI + NNRTI strategy resulted in greater increases in triglycerides and low-density lipoprotein cholesterol compared with the PI and the NNRTI strategies (P < 0.005), with no differences between the PI and NNRTI strategies. High-density lipoprotein cholesterol increased significantly more in the NNRTI strategy than in the PI strategy (P < 0.005). Insulin and insulin resistance increased similarly with all 3 strategies. Changes in total and regional body composition (loss of subcutaneous tissue area and gains in FFM, nonsubcutaneous tissue area, and visceral tissue area) were observed but did not differ by strategy. CONCLUSIONS Long-term follow-up of participants initiating 3 ART strategies demonstrated similar changes in total and regional fat, with no differences by ART strategy. The differential effects on lipid metabolism by strategy and the overall increases in insulin and insulin resistance with all 3 strategies necessitate close monitoring of patients on ART.
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Affiliation(s)
- Judith C Shlay
- Denver Community Programs for Clinical Research on AIDS, Department of Family Medicine, University of Colorado Health Sciences Center, and Denver Public Health, 605 Bannock Street, Denver, CO 80204, USA.
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Asensi V, Martín-Roces E, Collazos J, Cartón JA, Maradona JA, Alonso A, Medina M, Aburto JM, Fernández C, Martínez E. Association between physical and echographic fat thickness assessments and a lipodystrophy grading scale in lipodystrophic HIV patients: practical implications. AIDS Res Hum Retroviruses 2006; 22:830-6. [PMID: 16989606 DOI: 10.1089/aid.2006.22.830] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A simple diagnostic method for detecting in clinical routine HAART-associated lipodystrophy in HIV-infected patients is lacking. We studied the relationships between the scores obtained with a subjective lipodystrophy severity grading scale (LSGS) and standard anthropometric and echographic measurements of the subcutaneous and visceral fat thickness of 74 HIV-infected patients. Patients were divided into four groups according to their LSGS score (0, 1-7, 8-14, 15-21). Significant correlations between the LSGS and the anthropometric and echographic measurements of fat thickness, mainly the limb circumferences (brachial: r= -0.43, p < 0.001; thigh: r= -0.41, p < 0.001), and, especially, the echographically assessed perirenal fat diameters either adjusted (r= 0.46, p < 0.001) or nonadjusted to the body mass index (r= 0.35, p < 0.001) were observed. Significant differences in most of these anthropometric parameters between either the lowest (score 0) and the highest (score 15-21) score groups and the remaining groups were found, but not between the two intermediate groups (scores 1-7 vs. 8-14). This suggests that lipodystrophy should be clinically categorized as absent, mild, or marked, and that even minor changes in physical aspect should be considered as indicative of this disorder. The combination of these subjective and objective parameters could be helpful in the early detection of lipodystrophy in clinical practice.
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Affiliation(s)
- Victor Asensi
- Infectious Diseases Unit, Hospital Central de Asturias, Oviedo University School of Medicine, Barcelona, Spain.
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Shlay JC, Visnegarwala F, Bartsch G, Wang J, Peng G, El-Sadr WM, Gibert C, Kotler D, Grunfeld C, Raghavan S. Body Composition and Metabolic Changes in Antiretroviral-Naive Patients Randomized to Didanosine and Stavudine vs. Abacavir and Lamivudine. J Acquir Immune Defic Syndr 2005; 38:147-55. [PMID: 15671799 DOI: 10.1097/01.qai.0000143599.64234.15] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Comparisons of body composition and metabolic changes among antiretroviral-naive patients randomly assigned to didanosine and stavudine- (ddI+d4T) vs. abacavir and lamivudine- (ABC+3TC) containing regimens were assessed in a nested substudy of an ongoing multicenter randomized trial. At baseline and every 4 months, body cell mass and total body fat were calculated, anthropometric measurements were performed, and fasting metabolic parameters were obtained. The rates of change (unit/mo) estimated using the slopes of regression lines and overall mean changes from baseline were compared by study assignment. Among 96 patients enrolled, 46 received ddI+d4T- and 50 received ABC+3TC-containing regimens with a median follow-up of 32.4 months. For both study arms, an overall increase in the rates of change was seen for body cell mass. For ddI+d4T, after an initial increase, the rates of change declined for regional fat and total body fat compared with an increase for ABC+3TC, with the 2 arms being significantly different (P<0.05). For high-density lipoprotein cholesterol rates of change, ddI+d4T decreased, while ABC+3TC increased. For both arms, low-density lipoprotein cholesterol decreased, while triglycerides increased. Early and sustained increases in insulin and insulin resistance were seen only for ddI+d4T. In this prospective study, metabolic and body composition changes varied according to whether subjects received ddI+d4T or ABC+3TC.
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Affiliation(s)
- Judith C Shlay
- Denver Community Programs for Clinical Research on AIDS, Denver Public Health, University of Colorado Health Sciences Center, Denver, CO, USA
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Fields-Gardner C, Fergusson P. Position of the American Dietetic Association and Dietitians of Canada: nutrition intervention in the care of persons with human immunodeficiency virus infection. ACTA ACUST UNITED AC 2004; 104:1425-41. [PMID: 15354161 DOI: 10.1016/j.jada.2004.07.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Infection with the human immunodeficiency virus (HIV) and the development of acquired immunodeficiency syndrome (AIDS) have had a significant impact on domestic and global health, social, political, and economic outcomes. Prevention and treatment efforts to control HIV infection are more demanding than in previous decades. Achieving food and nutrition security, and managing nutrition-related complications of HIV infection and the multiple aspects of disease initiated by or surrounding HIV infection, referred to as HIV disease, remain challenges for patients and for those involved with HIV/AIDS prevention, care, and treatment efforts. Confounding clinical issues include medication interactions, coinfection with other infections and diseases, wasting, lipodystrophy, and others. Dietetics professionals, other health care professionals, and people infected with HIV will need to understand and address multiple complex aspects of HIV infection and treatment to improve survival, body functions, and overall quality of life. Individualized nutrition care plans will be an essential feature of the medical management of persons with HIV infection and AIDS.
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