Impact of an enzyme-modified enriched maize supplement on the growth, immune and health status of HIV+ children

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Date
2007-05
Authors
Steenkamp, Juliana
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Publisher
University of the Free State
Abstract
English: The aim of the study was to describe changes in growth, immune status, micronutrients linked to immune status and health status in food secure HIV-infected children, after nutrition intervention with an enzyme modified maize supplement. Sub-objectives included the determination of baseline data with regard to growth, immune and health status and to determine correlations between these indicators. One hundred and fifty five food-secure HIV-affected children in care centres in Mangaung were screened to determine HIV status. A randomised, double blind, clinically controlled, prospective trial was subsequently undertaken on 37 clinically stable, antiretroviral naïve, HIV-infected children. All the children received co-trimoxazole prophylaxis and were dewormed prior to the intervention. Baseline data showed a median age of 5.35 years within the group. Fifteen children (46%) were underweight, 30 children (77%) were stunted and one child was wasted. The median viral load of the group was 117 000 copies/ml, with the median CD4+ cell count and percentage, 477 cells/mm3 and 22.5% respectively. Multiple micronutrient deficiencies were found amongst the children in relation to glutathione in 91%, albumin in 78%, vitamin A in 63%, vitamin D in 44%, zinc in 38% and vitamin E in 13%. Sixty percent of the children were anaemic and 30% were iron deficient. The most commonly occurring clinical features were lymphadenopathy in 84%, skin rashes in 51% and hepatomegaly in 32%. Nutrition related disorders presented in less than 20% of the sample. Significant but weak positive correlations were demonstrated between the height-for-age z-score (HAZ) and the CD4%, serum cholesterol and -albumin. Apart from a significant but weak positive correlation between the weight-for-height z-score (WHZ) and glutathione, no other correlations could be demonstrated between micronutrient levels and growth. Viral load was significantly but weakly to moderately negatively correlated with the CD4:CD8, CD4%, CD4+ cell count, haemoglobin, serum albumin, -cholesterol, -vitamin A, -vitamin D and -zinc. Significantly weak to moderate positive correlations were reported between CD4 concentrations and serum albumin, -hemoglobin, -cholesterol, -vitamin A, -vitamin D, -zinc and -glutathione. High viral loads and decreased CD4 concentrations in food secure children in care centres are linked to decreased serum levels of micronutrients, albumin and haemoglobin. Nutrition supplementation with two maize soy blends (experimental and placebo) with exactly the same content, apart from the enzyme mixture in the experimental product, resulted in the following: Non-significant decreases in median viral loads of 30 145 copies/ml for the experimental group (E) and 350 copies/ml for the placebo group (P). The median (quartiles) CD4+ cell count increases were 38.5 (-17; 180) cells/mm3 for E (p=0.07) and 167 (-160; 575) cells/mm3 for P (p=0.76). No significant differences relating to growth and changes in micronutrient levels could be demonstrated between the two groups. Children in P experienced a significant (p=0.003) decrease in serum albumin levels, while the E group maintained their levels, resulting in a significant difference. Nutrition supplementation in both groups led to non-significant improvements in median viral loads and CD4+ cell counts. Improvements could, however, not reproduce decreases in viral loads expected from children on ARVs. There was a significant difference between the two groups in relation to changes in serum albumin levels. As serum albumin levels are linked to higher CD4+ cell counts in most studies, this outcome need to be further investigated. None of the groups benefited in terms of growth, health status or micronutrient status, despite micronutrient intakes in excess of 100% RDA. The high prevalence of underweight and stunting found at baseline indicate that inclusion of HIV-infected AIDS orphans in care centres, do not necessarily protect them from becoming malnourished. Known HIV-infected children in care centers should receive optimal care by including ARVs and more aggressive nutrition support into treatment regimens.
Afrikaans: Die doel van die studie was om veranderinge in groei, immuunstatus, mikronutriënte wat met immuunstatus verband hou en gesondheidstatus in MIV+ kinders te bepaal, na supplementasie met ‘n ensiemgemodifiseerde mieliepapsupplement. Die sub-doelwittte was om basislyndata rakende groei, immuun- en gesondheidstatus in hierdie HIV+ kinders, wat in sentrums versorg word te bepaal, asook om korrelasies tussen die onderskeie indikatore vas te stel. Honderd-vyf-en-vyftig kinders deur MIV geaffekteer, in sentrums in Mangaung, is getoets om MIV-status te bepaal. Die 37 MIV+ kinders (nog nooit aan antiretrovirale middels blootgestel nie), is vervolgens ingesluit in ‘n gerandomiseerde, dubbelblinde, klinies gekontroleerde, prospektiewe proef oor ‘n periode van 120 dae. Die hele groep het co-trimoxazole profilakse ontvang en is voor die intervensie ontwurm. Basislyndata het getoon dat die mediaan ouderdom van die kinders 5.35 jaar was. Vyftien kinders (46%) was ondermassa vir ouderdom, 30 (77%) se lengtegroei was ingekort en een kind was wangevoed. Die mediaan virale telling was 117 000 kopieë/ml, met die mediaan CD4+-seltelling en persentasie 477 selle/mm3 en 22.5% onderskeidelik. Veelvuldige mikronutriënttekorte was in die meeste kinders teenwoordig en wel m.b.t. glutatioon (91%), albumien (78%), vitamien A (63%), vitamien D (44%), sink (38%) en vitamien E (13%). Sestig persent van die kinders was anemies en 30% het met ‘n ystertekort presenteer. Die mees algemene kliniese tekens was limfadenopatie in 84%, veluitslag in 51% en hepatomegalie in 32% van die kinders. Voedingverwante simptome was in minder as 20% van die kinders aanwesig. Betekenisvolle, dog swak positiewe korrelasies is tussen lengte-vir-ouderdom en die CD4%, serumcholesterol en –albumien aangetoon. Behalwe vir ‘n betekenisvol swak positiewe korrelasie tussen massa-vir-lengte en glutatioonvlakke, kon geen ander korrelasies tussen groei en mikronutriënte gevind word nie. Die virale tellings het betekenisvolle, maar swak tot matige negatiewe korrelasies met die CD4:CD8, CD4%, CD4+ seltelling, hemoglobien, serumalbumien, -cholesterol, -vitamien A, -vitamien D en -sink getoon. Betekenisvolle swak to matige positiewe korrelasies is gerapporteer tussen CD4 konsentrasies en serumalbumien, -hemoglobien, -cholesterol, -vitamien A, -vitamien D, -sink en -glutatioon. Hoë virale tellings en verlaagde CD4 konsentrasies in kinders in versorgingsentrums kan verbind word aan verlaagde mikronutriëntvlakke, asook verlaagde albumien en hemoglobien. Voedingsupplementasie met twee mielie/soja mengsels (eksperimentele (E) en plasebo (P) produk) met identies dieselfde inhoud, behalwe vir die ensiemmengsel in die eksperimentele produk, het die volgende resultate tot gevolg gehad: Nie-betekenisvolle afnames in die mediaan virale tellings van 30 145 kopieë/ml vir die groep op E en 350 kopieë/ml vir die groep op P is gedemonstreer. Die mediaan (kwartiele) CD4+-seltellings het met 38.5 (-17; 180) selle/mm3 vir die groep op E (p=0.07) en 167 (-160; 575) selle/mm3 vir die groep op P (p=0.76) toegeneem. Geen betekenisvolle verskille kon aangetoon word rakende groei en mikronutrientindikatore tussen basislyn en eindwaardes nie. Kinders op die plaseboproduk het ‘n betekenisvolle (p=0.003) verlaging in serumalbumienvlakke ondervind, terwyl kinders op die eksperimentele produk hul albumienvlakke in stand gehou het. Voedingsupplementasie in beide groepe het tot nie-betekenisvolle verbeterings in virale tellings en CD4-konsentrasies aanleiding gegee. Dié verbeterings was egter heelwat swakker as die resultate wat verwag word wanneer kinders op antiretrovirale middels geplaas word. ‘n Betekenisvolle verskil tussen uitkomste rondom serumalbumienvlakke is tussen die twee groepe aangetoon. Aangesien serumalbumien met immuunstatus verbind word, behoort hierdie resultate verder ondersoek te word. Geeneen van die groepe het voordeel getrek in terme van groei, verbetering van mikronutriëntstatus of gesondheidstatus nie, ten spyte van ‘n mikronutriëntinname wat 100% van die Aanbevole Daaglikse Toelating oorskry het. Die hoë persentasie kinders met ondervoeding dui daarop dat insluiting van VIGS-wesies in versorgingsentrums nie noodwendig kinders teen die ontwikkeling van wanvoeding beskerm nie. Bekende MIV+ kinders in versorgingsentrums behoort optimale behandeling te ontvang deur die beskikbaarstelling van antiretrovirale middels asook aggressiewe voedingondersteuning.
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Keywords
HIV, Nutrition intervention, Micronutrients, Immune, Viral load, Maize/soy blends, Supplementation, HIV infections -- Nutritional aspects, HIV infections -- Diet therapy, AIDS (Disease) -- Nutritional aspects, AIDS (Disease) -- Diet therapy, Thesis (Ph.D. (Nutrition and Dietetics))--University of the Free State, 2007
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