The impact of an enzyme-modified enriched maize-based supplement on the anthropometric nutritional status of institutionalised HIV⁺ children

English: HIV/AIDS negatively influences the health, quality of life and nutritional status of infected individuals. The negative influence on nutritional status is even worse in children than in adults, due to children's additional needs for growth. The aim of this study was to determine the impact of an enzyme-modified, enriched maizebased supplement on the anthropometric nutritional status of children infected with HIV, and residing in or attending day care at institutions for HIV-infected and affected children in Mangaung. A total of 155 food secure HIV-infected children aged 1 - 10 years were screened to determine HIV status. HIV-infection was confirmed in 37 clinically stable, antiretroviral naïve children, who were included in the study sample. The study was a randomised, double blind, clinically controlled, prospective trial. Intervention over a period of 16 weeks consisted of an experimental and control supplement given to the children in the experimental- (E) and control (C) groups respectively. Both products were enriched maize/soy blends of exactly the same nutritional value, except that α-amylase was added to the E-product. The addition of a-amylase to starchy foods decreases the viscosity of the mixed product, enabling the individual to consume larger quantities for more energy and nutritional benefit, especially in the case of young children with high nutritional needs but lack of capacity to consume large enough quantities to provide in these needs. Twenty-nine children completed the intervention. The mean age of the 29 (E=14; C=15) at baseline was 64.1 months (SD 23.6 months). Baseline nutritional status of the children was poor. Underweight for age was identified in 42.9% of both the E- and C-groups. The median Z-score for WAZ was -1.9 for both the E- and the C-group. These findings support findings of other researchers that growth in HIV-infected children is significantly slower than in non-infected children. A high percentage of stunting was found in both groups: 57.1% in the E-group and 80% in the C-group were stunted. The median Z-scores for HAZ were -2.3 for the E- and -2.9 for the C-group. This was in accordance with findings of other researchers who reported that HIV-infected children are more often stunted than non-infected children. The prevalence of stunting in this study is high in comparison to existing national data for children of unknown HIV status. The poor anthropometric nutritional status in children in care centres emphasises the detrimental effect of HIV-infection on the nutritional status and growth in young children, as well as the importance of extending community based nutrition intervention initiatives to care centres and other facilities taking care of HIV-infected and HIV-affected children. Although the data of the intervention phase of this study did not show significant improvement in the anthropometrical nutritional status, other studies using a product with added α-amylase did show improvement in anthropometrical nutritional status. The practical problems experienced in the present study may have had a negative effect on the outcome of the study. In conclusion, the high prevalence of malnutrition found at baseline, indicate that children infected with or affected by HIV are vulnerable and that being a resident or being registered at a care centre does not necessarily protect them from malnutrition. It is important that children in these facilities are included in routine health and nutritional assessments and that the centres are included in initiatives that target malnutrition. HIV-infected children in care centres should receive more aggressive nutrition support to make provision for their increased requirements and also to protect them from malnutrition and early disease progression. The inclusion of additional sources of energy dense supplements such as RUTF to current supplementation regimens for malnourished children may be needed to achieve catch-up growth in malnourished children.