The impact of a high protein food supplement on the nutritional status of HIV infected patients on ARV treatment and their families
Coetzee, Jolanda (Yssel)
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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.