gdevi001 wrote:is anyone doing research on HIV/AIDS infected persons especially in the area of supplementation of nutrients?
Here are a few articles for you. If you'd like, I can send you a few of interest through MNR.
Effect of a dietary intervention and n-3 fatty acid supplementation on measures of serum lipid and insulin sensitivity in persons with HIV
Margo N Woods, Christine A Wanke, Pei-Ra Ling, Kristy M Hendricks, Alice M Tang, Tamsin A Knox, Charlotte E Andersson, Kimberly R Dong, Sally C Skinner, Bruce R Bistrian. The American Journal of Clinical Nutrition. Bethesda:Dec 1, 2009. Vol. 90, Iss. 6, p. 1566
Elevated serum triglyceride and low HDL-cholesterol concentrations have been reported in persons with HIV. The effect of a dietary intervention plus n-3 (...-3) fatty acid supplementation on serum triglycerides and markers of insulin sensitivity was investigated. Fifty-four persons with HIV and elevated serum triglycerides (>150 mg/dL) and/or abnormal Quantitative Insulin Sensitivity Check Index values (<0.35 but >0.30) were recruited for a dietary intervention in which total fat, type of fat, fiber, and glycemic load were controlled along with supplementation with n-3 fatty acids to achieve an intake of 6 g/d. The subjects were randomly assigned to an intervention or control group, and serum lipids, markers of insulin sensitivity, and serum phospholipid fatty acids were measured in both groups at baseline, 3 wk, and 13 wk. Triglycerides in the intervention group decreased from a median of 180 mg/dL (interquartile range: 141, 396) to 114 mg/dL (interquartile range: 84, 169) from baseline to 3 wk, whereas they remained stable in the control group (P = 0.003). Serum phospholipid fatty acids indicated a decrease in de novo lipogenesis and a decrease in arachidonic acid (% nmol; P ≤ 0.001) in the intervention group. At 3 wk, the insulin area under the curve decreased but not significantly. Diet and n-3 fatty acid supplementation dramatically reduced serum triglycerides, decreased arachidonic acid in the phospholipids fraction, and appeared to decrease the de novo lipogenesis associated with the metabolic syndrome in the intervention group. (ProQuest: ... denotes formulae/symbols omitted.)
Addressing severe acute malnutrition where it matters
Zulfiqar A Bhutta. The Lancet. London:Jul 11-Jul 17, 2009. Vol. 374, Iss. 9684, p. 94-6 (3 pp.)
[...] the need for horizontal integration of programmes for community management of acute malnutrition with existing health-system interventions, so that moderately and severely malnourished children are promptly recognised and triaged for care and receive essential lifesaving interventions in addition to food. [...] in HIV-endemic populations, rapid and continued access to antiretrovirals and ancillary support strategies for children with severe acute malnutrition11 is key to ensuring that children survive and benefit from nutrition interventions.
Mortality in HIV infection is independently predicted by host iron status and SLC11A1 and HP genotypes, with new evidence of a gene-nutrient interaction
Joann M McDermid, Maarten F Schim van der Loeff, Assan Jaye, Branwen J Hennig, Chris Bates, Jim Todd, Giorgio Sirugo, Adrian V Hill, Hilton C Whittle, Andrew M Prentice. The American Journal of Clinical Nutrition. Bethesda:Jul 1, 2009. Vol. 90, Iss. 1, p. 225
Iron-related genes and iron status may independently contribute to variable HIV outcomes. The nature of the biologically plausible gene-nutrient interaction remains unknown. The objectives were to investigate whether iron-related genotypes and clinically abnormal iron status independently predict mortality in HIV and whether a gene-nutrient interaction exists. Baseline plasma, DNA, and clinical data were obtained from 1362 HIV-seropositive Gambian adults followed for 11.5 y to ascertain all-cause mortality. Iron status was estimated on the basis of plasma iron, soluble transferrin receptor (sTfR), ferritin, transferrin, transferrin index, and log(sTfR/ferritin). One haptoglobin (HP) and 5 SLC11A1 (NRAMP1) polymorphisms were genotyped. SLC11A1-SLC3 and CAAA polymorphisms were the best independent genetic predictors of mortality [adjusted mortality rate ratio (95% CI)]: SLC3:G/C = 0.59 (95% CI: 0.45, 0.85), CAAA:del/ins = 1.51 (95% CI: 1.10, 2.07). In an adjusted model that included all polymorphisms, SLC1:199/199, SLC1:other/other, SLC6a:A/A, and CAAA:del/ins were associated with significantly greater mortality, whereas Hp 2-1 and SLC3:G/C were protective. In unadjusted analyses, all biomarker concentrations were significantly associated with mortality. In an extension of previous findings, both low and elevated iron states were associated with mortality, but the nature of the risk was variable, with linear, inversely linear, and U-shaped associations depending on the biomarker. Mortality was significantly lower in HIV-2 than in HIV-1 infection in the presence of abnormal (low or elevated) iron status. A gene-iron interaction was detected (likelihood-ratio test P = 0.018); however, subject numbers restricted category-specific interpretation. Iron-related genes, iron status, and their interaction predict mortality in HIV. These findings illustrate the complexity and uncertainty surrounding best practice for managing abnormal iron status and anemia during HIV infection and in regions with a high risk of infection.
Food supplements and HIVNigel Rollins. British Medical Journal. (International Edition ). London:May 30, 2009. Vol. 338, Iss. 7706, p. 1282
Rollins talks about the confusing relationship between food supplements and HIV. Here, he highlights a randomized controlled trial by Ndekha and colleagues, which compares the effect of two nutritional interventions on clinical outcomes, including weight gain and lean body mass, in adults with HIV who are receiving antiretroviral therapy. Results of the study show that people with HIV have greater nutritional needs than those without.
Adherence to the Mediterranean diet is associated with a lower risk of body-shape changes in Croatian patients treated with combination antiretroviral therapy
Drago Turcinov, Christine Stanley, George W Rutherford, Thomas E Novotny, Josip Begovac. European Journal of Epidemiology. Dordrecht:May 2009. Vol. 24, Iss. 5, p. 267-74 (8 pp.)
Lipoatrophy and lipohypertrophy have been observed during long-term combination antiretroviral therapy (CART). We investigated whether consumption of a Mediterranean diet is associated with lower risk of body-shape changes in Croatian patients treated with CART. Between May 2004 and June 2005, we conducted a cross-sectional study of 136 adults with HIV-1 infection who were treated with CART for at least 1 year. Lipoatrophy and lipohypertrophy were assessed by self-report and physical examination. Adherence to a Mediterranean diet was determined by a 150-item questionnaire; a 0-9 point diet scale was created that stratified respondents as having low adherence (<4 points) and moderate to high adherence (≥4 points). Lipoatrophy was present in 41% and lipohypertrophy in 32% of participants. Non-smokers with a dietary score ≥4 had the lowest risk for lipoatrophy. Stavudine use, female gender, and duration of CART were also independently associated with a higher risk of lipoatrophy. A dietary score of ≥4 was associated with lower risk of lipohypertrophy (adjusted OR 0.3, 95% CI 0.1-0.7; P = 0.012). Female gender, longer duration of CART, and longer known duration of HIV infection prior to CART were also independently associated with higher risk of lipohypertrophy. In conclusion, Croatians who did not smoke and moderately or highly adhered to the Mediterranean diet were least likely to have the clinical syndrome of lipoatrophy. Moderate to high adherence to a Mediterranean diet was associated with a lower risk of lipohypertrophy. [PUBLICATION ABSTRACT]
Effect of early exclusive breastfeeding on morbidity among infants born to HIV-negative mothers in Zimbabwe
Ai Koyanagi, Jean H Humphrey, Lawrence H Moulton, Robert Ntozini, Kuda Mutasa, Peter Iliff, Robert E Black. The American Journal of Clinical Nutrition. Bethesda:May 1, 2009. Vol. 89, Iss. 5, p. 1375
Early exclusive breastfeeding (EBF) is recommended by the World Health Organization, but EBF rates remain low throughout the world. For infants born to breastfeeding HIV-positive mothers, early EBF is associated with a lower risk of postnatal transmission than is feeding breast milk together with other liquids or foods. No studies conducted in Africa have reported any benefits of EBF for infants born to HIV-negative women. The objective was to compare the rate of sick clinic visits by infants aged 43-182 d according to breastfeeding exclusivity [EBF, predominant breastfeeding (PBF), and mixed breastfeeding (MBF)]. We compared rates of all-cause clinic visits and clinic visits related to diarrhea and lower respiratory tract infection (LRTI) among a cohort of 9207 infants of HIV-negative mothers during 2 age intervals: 43-91 and 92-182 d according to exclusivity of breastfeeding. Breastfeeding exclusivity was defined in 2 ways ("ever since birth" and "previous 7 d") and was assessed at 43 and 91 d. EBF between birth and 3 mo was significantly protective against diarrhea between 3 and 6 mo of age with the "ever since birth" definition [incidence rate ratios (IRRs) of 8.83 (95% CI: 1.07, 65.53) and 8.76 (95% CI: 1.13, 68.09) for PBF and MBF, respectively] and with the "previous 7 d" definition [2.04 (95% CI: 1.11, 3.77) and 2.05 (95% CI: 1.13, 3.72) for PBF and MBF, respectively]. The adverse effect of MBF on LRTI visits was weaker, reaching borderline significance only by the "ever since birth" definition during the 43-91-d interval (IRR: 1.91; 95% CI: 0.99, 3.67). Early EBF is associated with a significant reduction in sick clinic visits, especially those due to diarrhea.
Provision of Multiple Rather Than Two or Fewer Micronutrients More Effectively Improves Growth and Other Outcomes in Micronutrient-Deficient Children and Adults1-3Lindsay H Allen, Janet M Peerson, Deanna K Olney. The Journal of Nutrition. Bethesda:May 2009. Vol. 139, Iss. 5, p. 1022-1030 (9 pp.)
Deficiencies of multiple micronutrients (MMN) usually coexist in developing countries, but supplements have usually provided only 1 or 2 micronutrients (MN). To inform policy, in this article we compared the relative benefits of supplying MMN vs. a placebo or 1 or 2 MN on the following: children's growth, health, and development; pregnancy outcome; nutritional status; and HIV/AIDS mortality and morbidity in adults. Sufficient data were available to perform random-effects meta-analyses of randomized controlled trials (RCT) for the effects of MMN on child growth and nutritional status. Results for other outcomes are presented as effect sizes (ES) when available. In children, MMN interventions resulted in small but significantly greater improvements in length or height (ES = 0.13; 95% CI: 0.055, 0.21) and weight (ES = 0.14; 95% CI: 0.029, 0.25), hemoglobin (ES = 0.39; 95% CI: 0.25, 0.53), serum zinc (ES = 0.23; 95% CI: 0.18, 0.43), serum retinol (ES = 0.33; 95% CI: 0.050, 0.61), and motor development. A Cochrane review reported that compared with no supplementation or a placebo, MMN supplementation during pregnancy reduced the relative risk of low birth weight (0.83), small-for-gestational age (0.92), and anemia (0.61); however, MMN were not more effective than iron + folic acid alone. There is some evidence that MMN supplementation improves CD4 counts and HIV-related morbidity and mortality in adults. The efficacy of MMN varies across trials, but overall there is evidence that outcomes are better than when providing ≤2 MN. The policy implications of these studies are discussed. [PUBLICATION ABSTRACT]
Metabolic syndrome and serum fatty acid patterns in serum phospholipids in hypertriglyceridemic persons with human immunodeficiency virus
Margo N Woods, Christine A Wanke, Pei-Ra Ling, Kristy M Hendricks, Alice M Tang, Charlotte E Andersson, Kimberly R Dong, Heidi MB Sheehan, Bruce R Bistrian. The American Journal of Clinical Nutrition. Bethesda:Apr 1, 2009. Vol. 89, Iss. 4, p. 1180
HIV infection and its treatment are associated with abnormal lipid profiles. High triglyceride concentrations and low HDL-cholesterol concentrations are the most common health abnormalities and raise concerns about an increased risk of cardiovascular disease. We compared the fatty acid patterns of serum phospholipids between persons with HIV and non-HIV controls to determine whether there are differences that explain the elevated triglyceride concentrations, insulin resistance, and inflammation that are part of the metabolic syndrome in patients with HIV. Thirty-nine persons with HIV and elevated serum triglycerides (>150 mg/dL) and/or indicators of insulin resistance were recruited to examine fatty acid profiles in serum phospholipid fractions relative to those of 2 control groups without HIV (n = 31). Higher concentrations of 16:1 and 18:0 fatty acids in the phospholipid fraction indicated increased lipogenesis in the HIV patients and in the non-HIV controls at risk of the metabolic syndrome. However, the subjects with HIV had higher concentrations of both n-6 (omega-6) and n-3 fatty acids of higher elongation and desaturation levels, which indicated a greater promotion of these pathways in this population. The nanomolar percentage (%nmol) arachidonic acid was the same in all 3 groups. Persons with and without HIV, at risk of the metabolic syndrome, show indications of increased lipogenesis, more so in subjects with HIV taking medication. Higher proportions of distal elongation and desaturation fatty acid products were seen only in the phospholipids fatty acid fraction of the subjects with HIV.
Effect of vitamin supplementation on breast milk concentrations of retinol, carotenoids and tocopherols in HIV-infected Tanzanian women
A L Webb, S Aboud, J Furtado, C Murrin, H Campos, W W Fawzi, E Villamor. European Journal of Clinical Nutrition. London:Mar 2009. Vol. 63, Iss. 3, p. 332-9 (8 pp.)
BACKGROUND/OBJECTIVE: The effect of daily prenatal and postnatal vitamin supplementation on concentrations of breast milk nutrients is not well characterized in HIV-infected women. We examined the impact of vitamin supplementation during pregnancy and lactation on breast milk concentrations of retinol, carotenoids and tocopherols during the first year postpartum among 626 HIV-infected Tanzanian women. SUBJECTS/METHODS: We conducted a randomized, double-blind, placebo-controlled trial. Women were assigned to one of four daily oral supplements: vitamin A+beta-carotene (VA+BC); multivitamins (MV; B, C and E); MV+VA+BC or placebo. Concentrations of breast milk nutrients were determined by high-performance liquid chromatography at birth and every 3 months thereafter. RESULTS: Supplementation with VA+BC increased concentrations of retinol, beta-carotene and alpha-carotene at delivery by 4799, 1791 and 84 nmol l(-1), respectively, compared to no VA+BC (all P<0.0001). MV supplementation did not increase concentrations of alpha-tocopherol or delta-tocopherol at delivery but significantly decreased concentrations of breast milk gamma-tocopherol and retinol. Although concentrations of all nutrients decreased significantly by 3 months postpartum, retinol, alpha-carotene and beta-carotene concentrations were significantly higher among those receiving VA+BC at 3, 6 and 12 months compared to no VA+BC. alpha-Tocopherol was significantly higher, while gamma-tocopherol concentrations were significantly lower, among women receiving MV compared to no MV at 3, 6 and 12 months postpartum. CONCLUSIONS: Sustained supplementation of HIV-infected breastfeeding mothers with MV could be a safe and effective intervention to improve vitamin E concentrations in breast milk. VA+BC supplementation increases concentrations of breast milk retinol but it is not recommended in HIV-infected mothers due to the elevated risk of vertical transmission. [PUBLICATION ABSTRACT]
Integrating Nutrition Support for Food-Insecure Patients and Their Dependents Into an HIV Care and Treatment Program in Western Kenya
Joseph Mamlin, Sylvester Kimaiyo, Stephen Lewis, Hannah Tadayo, Fanice Komen Jerop, Catherine Gichunge, Tomeka Petersen, Yuehwern Yih, Paula Braitstein, Robert Einterz. American Journal of Public Health. Washington:Feb 2009. Vol. 99, Iss. 2, p. 215-21 (7 pp.)
The Academic Model Providing Access to Healthcare (AMPATH) is a partnership between Moi Teaching and Referral Hospital, Moi University School of Medicine, and a consortium of universities led by Indiana University. AMPATH has over 50000 patients in active care in 17 main clinics around western Kenya. Despite antiretroviral therapy, many patients were not recovering their health because of food insecurity. AMPATH therefore established partnerships with the World Food Program and United States Agency for International Development and began high-production farms to complement food support. Today, nutritionists assess all AMPATH patients and dependents for food security and refer those in need to the food program. We describe the implementation, challenges, and successes of this program. [PUBLICATION ABSTRACT]
CD4 Counts Decline Despite Nutritional Recovery in HIV-lnfected Zambian Children With Severe Malnutrition
Stephen Miles Hughes, Beatrice Amadi, Mwiya Mwiya, Hope Nkamba, Georgina Mulundu, Andrew Tomkins, David Goldblatt. Pediatrics. Evanston:Feb 2009. Vol. 123, Iss. 2, p. E347
The objective of this study was to establish the contribution that severe malnutrition makes to CD4 lymphopenia in HIV-infected and uninfected children and to determine the changes in CD4 count during nutritional rehabilitation. Fifty-six children with severe malnutrition and with and without HIV infection were recruited from a pediatric ward in Lusaka for measurement of CD4 counts on admission, on discharge, and at final nutritional recovery. HIV-uninfected children with severe malnutrition had normal CD4 counts. In contrast, CD4 counts in HIV-infected children with severe malnutrition were reduced, more so in those without edema compared with those with edema. Mean CD4 count of HIV-infected SM children fell despite nutritional recovery so that at the time of full nutritional recovery, >85% of HIV-infected children required antiretroviral therapy. Severe malnutrition did not reduce the CD4 counts of children without HIV. HIV-infected children with severe malnutrition may respond well to nutritional rehabilitation, despite low CD4 counts, but nearly all require early antiretroviral therapy to prevent disease progression.
