Masters Degrees (Nutrition and Dietetics)

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Browsing Masters Degrees (Nutrition and Dietetics) by Subject "AIDS (Disease) -- Nutritional aspects"

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    The impact of a high protein food supplement on the nutritional status of HIV infected patients on ARV treatment and their families
    (University of the Free State, 2013-01) Coetzee, Jolanda (Yssel); Walsh, C. M.
    The advantages of anti-retroviral (ARV) treatment in human immunodeficiency virus (HIV) infected patients are well documented. Although it has been noted that food security impacts on treatment success and quality of life, very few studies have investigated the impact of food supplementation in HIV-infected patients. This study determined the impact of a nutrition intervention (meatballs and spaghetti in tomato sauce) on parameters of nutritional status (including foods bought or consumed, food security and anthropometry) in HIV-infected participants on ARV therapy. The study formed part of a larger study titled: “Improving the effectiveness of AIDS treatment while strengthening prevention in the Free State Province, South Africa (FEATS)”. The FEATS study had three objectives that included: to develop a view of treatment success, develop a more complete model of the determinants of treatment success and understand the nature of links between treatment and prevention. The study took place in 12 of the 16 phase I ARV therapy assessment sites (primary health care facilities) in the Free State province. This sub-study described sociodemographic status, household information, symptoms experienced as a result of taking HAART and food supplements received from the government in a control (no nutrition intervention) and experimental (nutrition intervention) group. The impact of the intervention on foods bought or consumed by the household, food security and anthropometry were determined in both groups after the intervention in the experimental group. Socio-demographic and household information, symptoms experienced as a result of taking ART, food supplements received from the government, food bought or consumed by the household and household food security were assessed using questionnaires completed in personal interviews with participants. Anthropometric status was assessed by trained fieldworkers (adherence supporters) using recognised techniques and included height, weight, and waist circumference. Participants in the experimental group received two tins (410 g tins) of meatballs and spaghetti in tomato sauce per week for a median period of 15 months. These were delivered by the adherence supporters during routine visits to the households of participants. A total of 260 participants were included in the study (135 in the control group and 125 in the experimental group). The mean age of both the groups (control and experimental) was similar at 38 years for the control and 37.3 years for the experimental group with a standard deviation of [-1.8;2.9]. The majority of participants were of African race (99.3% in the control and 97.6% in the experimental group) and female (80% in the control and 81.6% in the experimental group). A large percentage had never been married (43% in the control and 45.5% in the experimental group). Most had a low level of formal education. About 65% had access to a flush toilet and more than 80% had electricity. About one in three participants reported experiencing side effects as a result of ARV therapy. These included tiredness (8.1% in the control and 10.4% in the experimental group), dizziness (8.1% in the control and 7.2% in the experimental group), skin rash (5.9% in the control and 10.4% in the experimental group) and nausea (6.7% in the control and 4% in the experimental group). Less than 80% of participants in the current study had received food supplementation from the government Nutrition Supplementation Programme in the past. Although food and nutrient intake cannot be estimated very accurately from information related to foods bought or consumed, they do give an idea of what foods are available in the household. From this list it was concluded that a large percentage of households frequently bought and consumed starchy staple foods (mealie meal, rice, bread and potatoes), vegetable oil and sugar. As far as foods containing protein are concerned, a large percentage of households did purchase and consume dairy products (milk, sour milk or yoghurt), chicken and eggs. In both the control and experimental groups the percentage of households that bought or consumed breakfast cereals, legumes (dried peas, lentils and beans), and fruits and vegetables were relatively low. In addition, more costly protein sources such as red meat, fish and cheese were not bought or consumed by a large percentage of participants. Only a few changes in the foods bought or consumed occurred after intervention, and these were unlikely to be related to the nutrition intervention. In both groups, participants reported that they often do not have enough to eat (31.1% in the control and 30.4% of the experimental group), the food that they buy does not last (40.6% in the control and 48.4% in the experimental group) and they worry whether they will run out of food. Households that had children, also struggled to feed them a balanced meal (53.8% of the control and 46.0% of the experimental group), and reported that the children in the household were not eating enough (46.2% in the control and 41.9% in the experimental group). After intervention participants in the experimental group worried less about running out of food (50.4 % before intervention and 37.2% after intervention, [-25.5;0.9]), and fewer reported that they could not afford a balanced meal (50.8% before intervention and 39.2% after intervention,[-23.0;-0.4]). Fewer respondents that had received the food supplement felt that the food that they eat just did not last (49.2% before intervention and 35.0% after intervention,-26.0;-2.4]). This statistically significant change in the experimental group could possibly be ascribed to the food supplements that were provided as part of the intervention. For all anthropometric parameters the control and experimental groups were very similar at baseline. Mean body mass index (BMI) of participants was 24.7kg/m2 in both groups. About one in every 10 participants was underweight according to their BMI and 50% of all participants had a normal weight. A relatively large percentage of respondents in both groups were either overweight (26.4% in the control and 21.7% in the experimental group) or obese (14.7% in the control and 18.8% in the experimental group), putting them at risk for chronic non-communicable diseases. More than half of respondents also had a waist circumference in the high risk category. Mean waist circumference in the control group was 85.7cm and 83.7cm in the experimental group. After intervention, no significant changes in anthropometric variables were observed in the experimental group. Other than a small improvement in some measures of food security, the nutrition intervention that was implemented in this study did not have a significant impact on foods bought or consumed, or anthropometric variables of HIV-infected participants on ARV therapy. Possible reasons for this lack of improvement in these parameters could be that the amount of food supplement provided was not enough to make a significant contribution to food intake, especially if it was shared with family members. The food supplement could also have replaced other foods instead of supplementing the usual diet. Other forms of supplementation, such as ready-to-use therapeutic foods, may be of more benefit to food insecure HIV-infected patients.
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    Nutritional status of HIV/AIDS infected adults on HAART
    (University of the Free State, 2009-05) Julsing, Claire Eanette
    English: The aim of this study was to describe the nutritional status of HIV/AIDS infected patients on two HAART regimens. A convenience sample of 111 HIV infected patients on HAART from the Helen Joseph CCMT site in Johannesburg were included (55% on regimen 1 and 45% on regimen 2). HAART regimens differed, with regimen 2 including protease inhibitor (PI) based therapy and regimen 1 a non-PI based therapy. Dietary intake, biochemical markers, lifestyle and anthropometric variables, as well as associations between the above were determined. Dietary intake was determined by means of a 24-hour recall of usual intake and a short food frequency questionnaire. Weight, height, body composition (using bioelectrical impedance), waist and hip circumference measurements were obtained to calculate body mass index (BMI) and fat distribution. Lifestyle factors included smoking habits, alcohol consumption and physical activity levels. These variables were determined by means of a questionnaire completed by the researcher in a structured interview with each participant. Adequacy of diet was evaluated by comparing each patient's dietary intake to the recommended servings of the Food Guide Pyramid. Approximately 70% of patients on HAART consumed less than the required amount of fruit servings per day. Low vegetable consumption was reported, and 98% (regimen 1) and 94% (regimen 2) of patients did not consume the recommended number of servings of vegetables per day. Refined carbohydrates were consumed by 96% of patients on regimen 1 and 84% of patients on regimen 2. Salt intake in this population group was high, with 93.44% of patients on regimen 1 and 94% of patients on regimen 2 consuming added salt every day. Polyunsaturated fats like sunflower oils and margarines were used daily by 92% of patients on regimen 1 and 80% of patients on regimen 2. Full cream dairy products were used more frequently than low fat dairy products, due to the cheaper price. Peanut butter, a monounsaturated fat, was consumed relatively frequently (66% on regimen 1 and 62% on regimen 2). Medians for carbohydrates, proteins, fat and total energy intake were 310g, 77g, 54g and 7968kJ per day for the 1st line regimen group. In the 2nd line regimen group the medians were as follows: carbohydrates 220.5g, protein 68g, fat 45g and total energy 9233kJ per day. Total energy intake and carbohydrate intake as a percentage of total energy were significantly higher in patients on regimen 1. Dietary intakes of participant in this study showed that the quality of the diet was poor and not conducive to optimal nutritional status. Anthropometric information included BMI, body composition analysis, waist circumference and waist hip ratio. Median BMI of patients in the 1nd regimen (25.34kg/m2) group were significantly higher that that of patients in the 1st regimen group (22.80kg/m2) when comparing medians for BMI. BMI was above 25kg/m2 in 32.79% and 56% of patients on regimen 1 and 2 respectively. Approximately half of all patients in this study had waist circumference measurements above the recommended 80cm for females and 94cm for males. Undesirable waist to hip ratio measurements (for females >0.8 and for males >0.9) occurred in 95% of patients on regimen 1 and 66% of patients on regimen 2. Central obesity, increased BMI and high risk waist circumference and waist to hip ratios were evident in the majority of patients. High body fat percentages (more than 25%) were present in more than half of all the patients in this study. No significant differences were apparent when comparing anthropometric medians between the two groups. A large percentage of patients in this study were at risk of developing chronic diseases according to the results of the anthropometric assessments. The incidence of dyslipidemia in this population was high, with almost half of patients (47.92%) on regimen 2 and 34.43% of patients on regimen 1 having elevated tryglyceride levels. HDL levels were low in 43.75% of patients on regimen 1 and 22.95% of patients on regimen 2. High cholesterol levels were prevalent in 39% of patients on regimen 1 and 27.66% of patients on regimen 2. Patients on regimen 1 had significantly higher median cholesterol levels than patients on regimen 2. LDL cholesterol levels were elevated in a 60.66% of patients on regimen 1 and 52.08% on regimen 2. Despite all patients being on HAART, low CD4 counts (<500) and high viral loads (≤25) were prevalent in the majority of participants. In regimen 1, 80.8% of patients had a CD4 count below 500 and viral load above 25, while patients on regimen 2, 78.0% showed similar results. The majority of patients reported never smoking, with only 18.03% of participants on regimen 1 and 14.00% on regimen 2 reporting current smoking. Reported alcohol consumption was relatively low with 21.31% of patients on regimen 1 and 24.00% of regimen 2 currently using alcohol. Eighty two percent of patients on regimen 1 and 93.88% of patients on regimen 2 were sedentary. The nutritional status of the HIV infected patients on HAART in this study was found to be poor. Anthropometric measurements, lifestyle factors and biochemical markers indicated that these patients had an increased risk for developing chronic disease. HIV/AIDS and HAART are linked with metabolic abnormalities and associated chronic diseases. Poor nutrition exacerbates the risk and urgent interventions are required in this population.
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    Supplement consumption and energy intake of HIV+ children receiving an enzyme-modified, enriched maize supplement
    (University of the Free State, 2005-05) Cox, Cindy Deborah; Dannhauser, A.
    English: Protein-energy malnutrition (PEM) is an important clinical manifestation of human immunodeficiency virus (HIV) infection in children and have immunosuppressive effects. Reduced energy and oral intake are the most prominent contributing factors leading to malnutrition. Several studies have proven that addition of amylase to bulky cereals decreases the viscosity of cereals and increases children’s dietary intake. However, the impact of amylase modified supplements (AMS) on actual AMS consumption and energy intake from AMS by HIV-infected children is unknown. The main objective of this study was to determine the actual supplement consumption and energy intake from a supplement by HIV-infected children. The study design was a double-blinded, randomized, clinical controlled prospective trial, and included 16 HIV-infected children resident in Lebone House. Children were stratified according to baseline age, CD4+ counts and weight-for-age, and randomly placed into an experimental (E-) group and a control (C-) group. The E-group received an enzyme-modified, enriched maize supplement (E-supplement) and the C-group received an enriched maize supplement (C-supplement). The supplements were served as a breakfast replacement on 4 days per week, for a total period of 16 weeks. The actual supplement consumption was determined by subtracting the amount of leftover supplement from the amount of supplement served. The energy intake from the supplements was calculated by the Department of Biostatistics, University of Free State. The actual supplement consumption was expressed as the mean amount of supplement consumed, the mean percentage of the served supplement consumed, and the percentage of days the participants consumed the entire supplement. The data on the actual supplement consumption demonstrated that the participants consumed large amounts (E-group 489g; C-group 490g) of supplements, which accounted to 98.1 percent and 98.6 percent of the E- and C-supplements served. The median of the percentage of times the E-group consumed the entire served supplement was 94.4 percent and 92.9 percent for the C-group. No statistical significant difference was established between mean amount of supplement consumed (p=0.83), mean percentage of supplement consumed (p=0.67) and the percentage of times the entire served supplement was consumed (p=0.83). The actual supplement consumption was influenced by the viscosities of the supplements and cultural acceptability. The mean energy intake from the supplement for both groups were high (E-group 2540.4 kJ; C-group 2553.2 kJ). The mean percentage of energy consumed from the supplement served was identical to the percentage of the served supplement consumed. No significant difference was observed for the energy intake between the two groups in terms of mean energy intake (p=0.67) and the mean percentage of energy consumed from the portion served (p=0.67). The energy intake of these HIV-infected children was increased with approximately 2000 kJ per day with the addition of a single portion of either supplement, even when the supplements were served as a replacement for their usual breakfast. In conclusion, this study demonstrated that reducing the viscosity of the experimental supplement with amylase did not significantly increase the consumption or the energy intake. Both supplements were palatable and acceptable for these HIV-infected children and also increased the total daily energy intake of the children. Both supplements can therefore be used in the rehabilitation of HIV-infected children in South Africa. Future research should evaluate whether the addition of amylase to an enriched soy-maize supplement would have a positive effect on the weight, immune status and health status of HIV-infected children in comparison to the control supplement without the added amylase. Future research should address the limitations mentioned in this study. Future application of the research if proven to have a significant benefit may include the use of the supplement as part of existing or new feeding schemes to improve the nutritional status of HIV-infected children.