Nutrition and HIV/AIDS: The Efficacy of Food Based Interventions Evaluated by Stable Isotope Techniques

Closed for proposals

Project Type

Coordinated Research Project

Project Code

E43020

CRP

1315

Approved Date

2 September 2005

Status

Closed

Start Date

15 December 2005

Expected End Date

14 December 2011

Completed Date

6 February 2012

Description

Out of the more than 40 million people living with HIV/AIDS worldwide, nearly 30 million individuals are living in sub-Saharan Africa. The extremely high prevalence of RN/AIDS combined with food shortages and high prevalence of under-nutrition highlight the current crisis in sub-Saharan Africa. The importance of access to an adequate diet and to integrate nutrition into a comprehensive response to HIV/AIDS was recently highlighted by the WHO. In particular, as
antiretroviral (ARV) treatment becomes readily avai1able in resource poor areas, the associations between nutrition - HIV I AIDS – ARB treatment need special attention. To achieve the full benefits of ARV treatment, adequate dietary intake is essential. Very limited information is available on the interactions between ARV treatment and nutrition, in particular chronically under nourished populations. There is thus an urgent need to evaluate locally appropriate, sustainable
food based strategies on nutritional status and the potential impact of nutritional supplementation on delaying the initiation of ARV treatment and/or on the response to ARV treatment.
The overall aim of the proposed CRP is to evaluate the efficacy of nutrition interventions in people living with HIV I AIDS based on changes in body composition (muscle mass), measured by stable isotope technique. In particular the associations between nutrition -HIV/AIDS - AARV treatment will be given special emphasis

Objectives

To contribute to a better understanding of the importance of adequate nutrition for people living with HIV/AIDS.

Specific objectives

To evaluate associations between nutrition - HIV infection - ARV treatment whenever appropriate

To evaluate the efficacy of food based nutrition interventions in people living with HIV/AIDS based on changes in body composition (muscle mass), measured by stable isotope technique

Impact

The results of the CRP have improved the understanding of the importance of nutrition in the management of HIV/AIDS. The findings will inform nutritionists and clinicians on the relative value of various measurements in assessing nutritional status and body composition of HIV-infected persons and consequently assist in the provision of improved care. Bioimpedance equations currently used for deriving total body water and fat-free mass in Nigerian and HIV-infected American children are not precise to be applied to HIV-infected children in other African countries, such as South Africa. Findings also contribute to an increase in knowledge of the relationship between HIV medication status and the problems of lipodystrophy and the metabolic syndrome in female adults. In addition, the CRP results contribute to a better understanding of the effect of ART and nutritional support on malnourished children with comorbidities in lower middle income countries and will inform the design of nutrition interventions.
The CRP also provided training to young scientists (2 PhD and two MD student projects).

Relevance

The outputs of this CRP are highly relevant to the Agency and will inform on-going and future TC projects in this area. The use of the reference method for assessment of body composition, the deuterium dilution technique, helped to understand changes in fat and fat-free mass deposition in individuals on ARV treatment and actual nutritional requirements of patients. The results of this CRP complement the efforts of the TC programme with the RAF7/006, which main outcome was its contribution to the improvement in services delivery in the priority areas of social development of national nutrition intervention campaigns related to people living with HIV/AIDS. In addition, the research results of the CRP on nutritional interventions targeted at people living with HIV/AIDS complement IAEA's efforts on nutrition and HIV/AIDS and the integration of nutrition into HIV programmes provided in regional workshops with WHO (2007 and 2008).

CRP Publications

Type

Book chapter

Year

2010

Publication URL

http://www.africanpalliativecare.org/images/stories/pdf/APCA_Standards.pdf

Description

NAMUSOKE, H. Complementary therapies in palliative care. In: Standards for providing palliative care across Africa. Africa Palliative Care Association. University Medical Center (2010) pp. 56-58.

Country/Organization

Uganda

Type

Peer reviewed journal article

Year

2013

Publication URL

http://www.ncbi.nlm.nih.gov/pubmed/23514764

Description

PRAYGOD, G. et al., Sex, Smoking, and Socioeconomic Status Are Associated with Body Composition among Tuberculosis Patients in a Deuterium Dilution Cross-Sectional Study in Mwanza, Tanzania. J Nutrition 143 (5) (2013) 735-741. Underweight is common among tuberculosis (TB) patients. However, there is little information on determinants of body composition at TB treatment initiation in high-TB-burdened countries. This study aimed to determine factors associated with body composition at commencement of TB treatment in Mwanza, Tanzania. Across-sectional study was conducted from 2007 to 2008 among newly diagnosed TB patients. Fat and fat-free mass were determined using a deuterium dilution technique and fat and fat-free mass indices were computed. Correlates were assessed using multiple regression analysis. A total of 201 pulmonary TB patients were recruited; of these, 37.8% (76) were female, 51.7% (104) were HIV infected, 65.3% (126) had sputum-positive TB, and 24.4% (49) were current smokers. In multiple regressions analysis, males had a 2.2-kg/m(2) [(95% CI = 1.6, 2.9); P < 0.0001] lower fat mass index but 1.5 kg/m(2) [(95% CI = 0.9, 2.0); P < 0.0001]higher fat-free mass index compared with females. Sputum-positive TB was associated with a lower fat mass index among HIV-uninfected patients [-1.4 kg(95% CI = -2.5, -0.4); P = 0.006] but not among HIV-infected patients(P-interaction = 0.09). Current smokers had a 0.7-kg/m(2) [(95% CI = 0.02, 1.5); P = 0.045] lower fat mass index, but smoking did not affect fat-free mass. High socioeconomic status (SES) was associated with higher fat as well as fat-free mass. HIV infection, cluster of differentiation 4 count, and antiretroviral therapy were not correlates. Sex, smoking, and SES were associated with body composition of TB patients at treatment commencement. Prospective studies are needed to determine the role of these factors on weight gain, functional recovery, and survival during and after treatment.

Country/Organization

Tanzania

Type

Peer reviewed journal article

Year

2010

Publication URL

http://www.ncbi.nlm.nih.gov/pubmed/20149295

Description

RANGE, N.S. et al. Body composition of HIV-positive patients with pulmonary tuberculosis: a cross-sectional study in Mwanza, Tanzania. Annals of Tropical Medicine & Parasitology 104 (1) (2010) 81-90. To estimate the weight deficit and body composition of cases of pulmonary TB(PTB), and assess the roles of HIV and the acute-phase response, across-sectional study was carried out in Tanzania. Weight, body mass index (BMI),arm muscle area (AMA), arm fat area (AFA) and the serum concentration of the acute-phase protein alpha(1)-antichymotrypsin (serum ACT) were evaluated for each of 532 cases of PTB and 150 'non-TB' controls. On average, the female cases of PTB not only weighed 7.8 kg less but also had BMI that were 3.1-kg/m(2) lower, AMA that were 14.8-cm(2) lower, and AFA that were 7.6-cm(2) lower than those seen in the female subjects without TB. Similarly, on average, the male cases of PTB weighed 7.1 kg less and had BMI that were 2.5-kg/m(2) lower, AMA that were18.8-cm(2) lower and AFA that were 1.6-cm(2) lower than those seen in the male subjects without TB. Although HIV infection was associated with a 1.7-kg lower weight and a 0.6-kg/m(2) lower BMI (with deficits in both AMA and AFA) among males, it was not associated with any such deficits among the female subjects. Elevated serum ACT was found to be a negative predictor of BMI, AMA and AFA, partially explaining the effects of the PTB but not those of the HIV. There is need for a better understanding of the determinants and effects of loss of fat and lean body mass in HIV-positive tuberculosis.

Country/Organization

Tanzania

Type

Peer reviewed journal article

Year

2012

Publication URL

http://www.ncbi.nlm.nih.gov/pubmed/21729372

Description

PRAYGOD, G. et al. The effect of energy–protein supplementation on weight, body composition and handgrip strength among pulmonary tuberculosis HIV-co-infected patients: randomised controlled trial in Mwanza, Tanzania. Br J Nutr 107 (2) (2012) 263-271. Undernutrition is common among smear-positive pulmonary tuberculosis (PTB+) patients. Micronutrient supplementation may improve treatment outcomes, but it is unclear whether additional energy–protein would be beneficial. The present study aimed to assess the effect of energy–protein supplementation on weight, body composition and handgrip strength against a background of high micronutrient intake during tuberculosis (TB) treatment. A total of 377 PTB+ patients co-infected with HIV were randomly allocated one or six biscuits daily for 60 d during TB treatment. Weight, arm fat area, arm muscle area and handgrip strength were assessed at baseline and 2 and 5 months. There were no effects on any outcome at 2 months, but energy–protein supplementation was associated with a 1·3 (95 % CI - 0·1, 2·8) kg marginally significant gain in handgrip strength at 5 months. However, after 2 months, energy–protein supplementation led to a weight gain of 1·9 (95 % CI 0·1, 3·7) kg among patients with cluster of differentiation 4 (CD4) counts = 350 cells/µl, but not among patients with low CD4 counts ( - 0·2 kg; 95 % CI - 1·3, 0·8, Pinteraction = 0·03). Similarly, at 5 months, energy–protein supplementation led to a 2·3 (95 % CI 0·6, 4·1) kg higher handgrip strength gain among patients with CD4 counts < 350 cells/µl, but not in those with high CD4 counts (Pinteraction = 0·04). In conclusion, energy–protein supplementation to PTB+ HIV-co-infected patients had no overall effects on weight and body composition, but was associated with marginally significant gain in handgrip strength. More research is needed to develop an effective supplement, before it is recommended to TB programmes.

Country/Organization

Tanzania

Type

Peer reviewed journal article

Year

2011

Publication URL

http://www.ncbi.nlm.nih.gov/pubmed/21239027

Description

PRAYGOD, G. et al. Weight, body composition and handgrip strength among pulmonary tuberculosis patients: a matched cross-sectional study in Mwanza, Tanzania. Trans R Soc Trop Med Hyg 105 (3) (2011) 140-147. This study aimed to estimate deficits in weight, arm fat area (AFA), arm muscle area (AMA) and handgrip strength among smear-positive pulmonary TB (PTB+)patients starting treatment. We conducted a cross-sectional study among PTB+patients and age- and sex-matched neighborhood controls. HIV status, anthropometric measurements and handgrip strength were determined. Deficits in weight, AFA, AMA and handgrip strength associated with PTB+ and HIV were estimated using multiple regression analysis. We recruited 355 pairs of PTB+patients and controls. PTB+ was associated with deficits of 10.0kg (95% CI 7.3;12.7) in weight and 6.8kg (95% CI 5.2; 8.3) in handgrip strength among females and 9.1kg (95% CI 7.3; 10.9) in weight and 6.8kg (95% CI 5.2; 8.4) in handgrip strength among males. In both sexes, PTB+ was associated with deficits in AFA and AMA. Among females, HIV was associated with deficits in AMA and handgrip strength, but the deficit in handgrip strength was larger among PTB+ patients(3.2kg 95% CI 1.3; 5.2) than controls (-1.6kg 95% CI -4.8; 1.5) (interaction, P=0.009). These findings suggest that deficits in weight and handgrip strength among patients starting TB treatment are severe. Thus, nutritional support may be necessary to ensure reversal of the deficits, and may improve treatment outcomes.

Country/Organization

Tanzania

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