Assessing Nutrient Intake and Nutrient Status of HIV Seropositive Patients Attending Clinic at Chulaimbo Sub-District Hospital, Kenya

Associated factors of diet quality among people living with HIV/AIDS in Ghana

INTRODUCTION

Nutrition is a very important element of a comprehensive care for people living with HIV/AIDS (PLHIV), especially in resource-constrained settings where malnutrition and food insecurity are common. Dietary diversity is a useful indication of nutritional adequacy (diet quality) in people of all ages. An optimally diverse diet strengthens the body's immune system.

OBJECTIVE

This study aimed to assess diet quality and its associated factors among PLHIV.

METHODS

A facility-based cross-sectional study design was employed to select 440 PLHIV from two hospitals in the Eastern Region of Ghana. Dietary intakes were determined using 24-hour recall. A stadiometer and bioimpedance analysis machine were used to obtain anthropometric and body composition data. Diet quality was assessed using FAO's individual dietary diversity score (IDDS) as a proxy. SPSS version 20 was used for analysis. Odds ratios and ordinal logistic regression were used to identify factors associated with diet quality among the PLHIV. P-value was set at 0.05.

RESULTS

Most of the PLHIV (73%) consumed from 'Starchy staple" food group. Less than 20% of the study sample consumed 'Fruits' and 'Vegetables' (17% and 14% respectively) a day before the survey. The mean IDDS was 4.11 (SD = 1.29). Overall, most of the PLHIV (56%) had medium IDDS which is equivalent to "diet needing improvement', 14% had higher IDDS (good diet), whiles about 31% of the participants actually had poor diet (lower IDDS). Associated factors of diet quality were age (AOR = 0.966: 95%CI: 0.936-0.997: p = 0.031), married (AOR = 4.634: 95%CI: 1.329-16.157: p = 0.0016), separated (AOR = 0.0203: 95%CI: .036-0.994: p = 0.049), and daily meal frequency (AOR = 0.441: 95%CI: .478-1.948: p = 0.020). Overall, the model accounts for about 20% of the variation in diet quality of the participants (pseudo-R square = 0.196).

CONCLUSION

This study demonstrates that most of the PLHIV did not consume good diet which may have an implication on their immune system, which is already under attack by HIV, and probably emerging infections. Age, marital status, and meal frequency were the variables that predicted diet quality among the study participants.

Influence of HIV/AIDS Infection on Immunological and Nutritional Status in Adults and Older Adults: A Cross-Sectional Study in Kingdom of Bahrain

Background and Objectives: HIV infection is a global public health problem that can lead to the progression of AIDS. Nutritional status and biochemical markers can significantly contribute to the progression of AIDS in HIV/AIDS patients. The main objective of this study is to examine the association between nutritional and biochemical markers as well as BMI in HIV/AIDS patients in the kingdom of Bahrain. Methods: A retrospective cohort study, including 300 patients (248 males and 52 females) with HIV/AIDS in Bahrain, was carried out. Various biochemical markers were collected from patients' medical records, including CD4+ T cell count, albumin, Hb, HCT, MCV, WBCs, and creatinine. A semi-structured questionnaire using a standardized food frequency questionnaire (FFQ) was used, from which total energy and total macronutrients were calculated. Results: The mean BMI of the participants was 27.20 kg/m2, and none of the participants had a BMI lower than 18.5 kg/m2 (underweight). The majority of patients' dietary intake of macronutrients and total calorie intake were either within or above the recommended RDA levels. The results also showed that all of the mean values of the nutritional and biochemical markers (CD4+ T cell count, albumin, Hb, HCT, MCV, WBCs, and creatinine) were within the normal reference ranges. A significant positive correlation between CD4+ T cell count, Hb, HCT, and albumin at the <0.05 level was found. There was no significant correlation between CD4+ T cell count and MCV, WBCs, and creatinine. A positive significant correlation was found between BMI, CD4+ T cell count, and WBCs at the <0.01 level. Conclusion: The BMI values were significantly correlated with the biochemical markers of AIDS progression. The dietary patterns of the participants were undiversified, with a high prevalence of obesity and overweight. Malnutrition among this study population was not present.

A qualitative study exploring perceptions of people living with HIV using antiretroviral therapy on self-management of healthy nutrition and the related healthcare service in Ethiopia

In Ethiopia, undernutrition is a quite common health problem among people living with HIV. Unlike in developed countries, nutritional counseling for people living with HIV has not received much attention. This study aimed to explore the perception of people living with HIV on their dietary practice and the existing health care service in Ethiopia. A phenomenological qualitative study was conducted in two hospitals in southern Ethiopia from March to June 2018. A pre-tested interview guide was prepared in English and translated into the Amharic language. The data were collected using key informant interviews, focus group discussions and observations in the ART clinics by six trained nurses. The data were analyzed thematically. Almost all focus group discussion participants mentioned that a healthy diet for ART patients is very important. The majority of the participants mentioned that they were not satisfied with the counseling service given at the ART clinics. Lack of training for health care professionals on nutritional counseling was also reported as a challenge by the nurses themselves. Nutritional counseling given by health care professionals at the ART clinic was poor. Emphasis should be given to the training of healthcare professionals working in ART clinics on nutritional counseling.

The cardiometabolic profile and related dietary intake of Ugandans living with HIV and AIDS

Introduction

Suboptimal diet and physical inactivity downgrade the putative benefits of Antiretroviral Therapy (ART) among People Living with HIV (PLWH). However, there is paucity of literature on dietary intake and cardiometabolic profiles of PLWH in Uganda.

Methods

A cross-sectional study among PLWH in Uganda was conducted. Dietary intake was assessed using a 24h recall method of 2 non-consecutive days. The short International Physical Activity Questionnaire assessed participants' physical activity. Fasted blood samples were analyzed for Fasting Blood Glucose (FBG), total cholesterol, LDL-c, HDL-c and triglycerides. Blood pressure and anthropometric measurements were performed following step 2 of the WHO STEPS.

Results

253 patients completed in this study. A high prevalence of low HDL-c (31.9%), abdominal obesity (44.5%), high BMI (51.6%), raised FBG (45.3%), high SBP (31.5%), elevated triglycerides (26.4%) and metabolic syndrome (28%) was found. More women were identified with metabolic syndrome (31.5%) than men (19.2%). Low prevalence of high LDL-c (4.7%) and total cholesterol (9.8%) was found. Diets had a high carbohydrate (65.8 ± 10.4) E% and fiber intake (30.1 ± 12.7) g with minimal PUFA (6.1 ± 2.3) E%, fruits and vegetables (1.4 servings). High proportions were found of unmet intake for vitamin A (38.2%), B1(48.8%), B2 (29.6%), B12 (29%), folate (61.4%), Ca (76%), Zn (53.1%) and Mg (41.7%). Mean MET min was 6,700 ± 5,509 and over 68% of the participants had >3,000 MET min.

Conclusion

Our findings reveal a high prevalence of metabolic disturbances among PLWH in Uganda and further highlight that their diets are suboptimal with low fruits and vegetable intake.

Dietary Micronutrients and Gender, Body Mass Index and Viral Suppression Among HIV-Infected Patients in Kampala, Uganda

BACKGROUND

HIV/AIDS is a hallmark of immune suppression. Micronutrient deficiencies in diet and recurrent opportunistic infections play major roles in the lives of people living with HIV. Although benefits of providing adequate diet to HIV positive persons are well documented, the demand for key elements still remain unclear in particular settings, especially in low and middle-income countries.

METHODS

This was a cross sectional analysis of baseline data collected from HIV-infected adults initiating antiretroviral therapy, and who were enrolled in a multivitamin supplementation trial. A food frequency questionnaire was used and intake were obtained as a product of quantities consumed. Adequacy was calculated as the proportion of Recommended Dietary Allowances (RDA). A chi square test and logistic regression analysis were used at p-value 0.05 to show significant associations.

RESULTS

Mean intakes were above minimum requirements for analyzed micronutrients with the exception of Calcium and Iron. Participants who met RDA intakes were as follows: highest (≥ 80%) for Magnesium, Selenium, Zinc and Vitamins B2, B6, B9, C and E; moderate (50% to <80%) for Vitamins B3, and A; and lowest (≤50%) for Iron (30%), Calcium (14.9%), Vitamins B12 and B1. Gender differences in met RDA were observed for Iron, Selenium, Zinc, Vitamins A, B1, B3 and E. In multivariable analyses, nutritional status and CD4 count had no influence on meeting RDA for majority of micronutrients such as magnesium, Selenium, B class vitamins (B1, B2, B3, B6, B9, B12), vitamin (A, C, and E), Zinc and Calcium, but not including iron.

CONCLUSION AND GLOBAL HEALTH IMPLICATIONS

Diets consumed by the study participants were low in most protective nutrients (Iron, Calcium, Zinc, Vitamin A, B1, B3, and B12). This deficiency was more common among females than males, and irrespective of BMI or CD 4 count. Findings warrant further investigation on the impact and cost implications for suplementation interventions that target the elements lacking in the diets of people living with HIV in similar low-resourced settings.

Dietary Diversity and Associated Factors among HIV Positive Adult Patients Attending Public Health Facilities in Motta Town, East Gojjam Zone, Northwest Ethiopia, 2017

Introduction. Dietary diversity is defined as the amount of different food groups or foods that are consumed over a specific reference time. The human immune deficiency virus problem remains one of the main public health challenges, especially in low and middle income countries. Nutrition has been linked to both the transmission of human immune deficiency virus and poor outcomes related to human immune deficiency virus. Objective. To assess dietary diversity and associated factors among human immune deficiency virus positive adult patients in Motta administrative town, Northwest Ethiopia, 2017. Methods. A facility based cross-sectional study design was conducted on 410 study participants selected using a stratified sampling technique with proportional allocation. The data were collected using semi-structured and pretested questionnaire. Data were entered into Epi-Data version 3.1 and analysis was performed using SPSS version 20. Descriptive statistics were used to describe the number and percentage of the study variables. The bivariate and multivariable logistic regression analyses were done to identify the independent factors associated with dietary diversity among adult human immune virus (HIV) positive patients. Result. A total of 410 study participants were included in the analysis. Of the total, 121 (29.5%) of adult HIV positive respondents consumed diversified diet with the mean dietary diversity score of 3.2 (SD±1.88). The predominant food item consumed during the study periods was starchy staples (96.1%) and legumes (81.7%). Having means of communication cell phone (mobile phone) [(AOR= 2.13 (1.16, 3.60)], media exposure status in the household [(AOR =1.95 (1.22, 3.11)] and nutrition counselling [(AOR =2.17 (1.09, 4.67)] were significant factors associated with dietary diversified feeding at 95% CI. Conclusion. The study revealed that low dietary diversity score was significant nutritional problem among HIV positive adults in Motta town health facilities. Having mobile cell phone, media exposure status and nutritional counseling were significantly associated with dietary diversity score. Therefore efforts should be strengthened to improve the counseling service at each health institution and encourage the patients to use media for the source of information.

Food elimination, food substitution, and nutrient supplementation among ARV-exposed HIV-positive persons in southern Ghana

BACKGROUND

Optimal nutrition is a determinant of health in all persons. In persons living with HIV (PLHIV), nutrition is particularly important. Various factors, including dietary practices, play a role in guaranteeing nutritional health.

OBJECTIVES

We investigated multiple non-prescription drugs use among HIV-positive persons receiving antiretroviral therapy (ART) from four treatment centers in southern Ghana. This paper, however, focuses on nutrient supplement use, food elimination, and food substitution practices by the PLHIV.

METHODS

Using quantitative and qualitative methods, we collected data from 540 HIV-positive persons at the health facility level. This paper focuses on only the quantitative data. Individual study participants were selected using a systematic random sampling procedure. Participants were interviewed after informed consent. We used univariate analysis to generate descriptive tabulations for key variables. Multivariable logistic regression modeling identified predictors of three practices (nutrient supplementation, food elimination, and food substitution). P value less than 0.05 or 95% confidence intervals facilitated determination of statistical significance. All analyses were performed using IBM SPSS Statistics for Windows, version 20.0.

RESULTS

The use of nutrient supplements was a popular practice; 72% of the PLHIV used various kinds. The primary motive for the practice was to boost appetite and to gain weight. A little over 20% of the participants reportedly eliminated certain foods and beverages, while 17% introduced new foods since their initial HIV diagnosis. All the three practices were largely driven by the quest for improved health status. We determined predictors of nutrient supplementation to be ART clinic location and having an ART adherence monitor. Having an ART adherence monitor was significantly associated with reduced odds of nutrient supplementation (AOR = 0.34; 95% CI 0.12-0.95). The only predictor for food elimination was education level (AOR = 0.29; 95% CI 0.30-0.92); predictors of food substitution were ART clinic location (AOR = 0.11; 95% CI 0.02-0.69) and anemia (defined as hemoglobin concentration less than 11.0 g/dl) (AOR = 0.21; 95% CI 0.12-0.85).

CONCLUSIONS

The practice of supplementation is popular among this group of PLHIV. Food elimination and substitution are practiced, albeit in moderation. The predictors identified may prove helpful in provider-client encounters as well as local HIV programming.

Comparison of sarcopenic status between elderly leprosy survivors and general population

Because of chronicity and poor environments, elderly leprosy survivors might be at greater risk of developing obesity and sarcopenia than healthy individuals. This study aimed to investigate whether body composition and the prevalence of obesity and sarcopenia among elderly leprosy survivors with no or mild physical impairment differ from those of the general population. A total of 36 leprosy survivors aged 65-90 years with no or mild physical impairment were recruited. Individuals matched for sex, age, and height were selected as a control group from the Fourth Korea National Health and Nutrition Examination Survey. Anthropometric characteristics, body composition, appendicular skeletal muscle mass (ASM), modified skeletal muscle mass index (SMI), and the prevalence of obesity and sarcopenia were compared between the leprosy survivors and the control group. Compared to the control group, the leprosy survivors had higher body weight, BMI, total fat mass, and total fat percentage. The leprosy survivor group also had lower ASM (P=0.035) and SMI (P<0.001) values. Comparison of the composition of regional body parts showed that the lean body mass of the legs was lower in the leprosy survivor group even though this group had higher body weight. The leprosy survivor group also had a significantly higher prevalence of sarcopenia than the control group (38.7% vs. 5.6%; P=0.002). These findings suggest that leprosy survivors are at greater risk of developing obesity and sarcopenia than healthy individuals. Further researches are required to investigate causes and mechanisms of sarcopenia in leprosy survivors.