Fwd: Fw: [pronut-hiv] What amount of food for 12-15% protein? (3)

[Samson Desie]

---------- Forwarded message ----------
From: samson desie <samson...@yahoo.com>
Date: Oct 17, 2006 3:31 PM
Subject: Fw: [pronut-hiv] What amount of food for 12-15% protein? (3)
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Samson Desie
Tel: 251 911 79 81 90

----- Forwarded Message ----
From: Tony Castleman < tcas...@smtp.aed.org>
To: Nutrition and HIV/AIDS <pronu...@healthnet.org>; smund...@yahoo.com
Sent: Monday, October 16, 2006 11:02:57 PM
Subject: Re: [pronut-hiv] What amount of food for 12-15% protein? (3)

As Stacia and George both pointed out, the amount of food needed for
12-15% of energy to come from protein depends on the amount of energy an
individual requires and the types of foods s/he consumes.

The amount of energy an individual requires depends on his/her age,
sex, weight, level of physical activity, reproductive status (whether
pregnant or lactating), and, if HIV+, the stage of disease.  There are a
number of sources for energy requirement figures.  A recent source is
the 2004 FAO publication, "Human energy requirements
Report of a Joint FAO/WHO/UNU Expert Consultation" is available at
http://www.fao.org/docrep/007/y5686e/y5686e00.htm.  These figures do
not account for HIV, so 10% needs to be added for asymptomatic
individuals, 20-30% for symptomatic adults and symptomatic children
without weight loss, and 50-100% for symptomatic children experiencing
weight loss.

An individual's protein requirement can be calculated based on the
total energy requirement, using the fact that protein has 4 kcal per
gram.  For example, a moderately active, 35-year-old woman who weighs 50
kg. and is neither pregnant nor lactating requires 2,200 kcal/day (using
a physical activity level of 1.75 as per the FAO doc).  If she is HIV+
and asymptomatic, energy requirements increase by 10% to 2,420 kcal.
For 12-15% of this to come from protein means 290-363 kcal from protein,
which translates into 72.5-91 g/day.  As Stacia pointed out, this is an
increase of about 6.5-8.5 g/day (if the woman was already consuming
2,200 kcal and getting 12-15% of this from protein before increasing her
energy intake due to HIV).  

The quantity of food corresponding to this level of protein depends on
the protein density of the foods in one's diet.  It is recommended that
the increased energy be obtained through a diverse diet, i.e. increasing
frequency and/or portions of a balanced diet.  If (a big if) one is
already getting 12-15% of energy from protein, then increasing
quantities of the existing diet will ensure that the 12-15% requirement
continues to be met.  If one is not already getting 12-15% of energy
from protein, then as Tim mentioned, the objective should be to get to
that level, while also increasing energy to required levels.  Some
countries have recommendations for balanced diets using food groups,
pyramids, etc. to support dietary diversification.

Hope this is helpful.

-Tony



Tony Castleman
Food and Nutrition Senior Program Officer
FANTA (Food and Nutrition Technical Assistance) Project
Academy for Educational Development
1825 Connecticut Ave., NW
Washington DC 20009-5721
Tel: 202-884-8893
Fax: 202-884-8432
E-mail: tcas...@aed.org
www.fantaproject.org

--- Stella Mundi wrote:
Tim,

["Quick, Timothy C wrote :
...Second, the WHO Technical Advisory Group for HIV/AIDS & Nutrition
reviewed the evidence in 2005 and concluded that the data did not
warrant an increase in protein level above this 12-15% level]

What amount of food does 12 - 15% protein translate into?
  
  Thanks
  
  Stella

--- "Quick, Timothy C (GH/OHA/TLR) wrote:
  
Two things: I'm sure you're aware that a 12-15% protein level is
actually considerably higher (frequently ~2X) than what is typical in
cereal- or tuber-based diets among relatively food insecure
populations
affected by HIV/AIDS in Africa. So, if we just pushed the level to
12-15%, we would have made a substantial difference. Second, the WHO
Technical Advisory Group for HIV/AIDS & Nutrition reviewed the
evidence
in 2005 and concluded that the data did not warrant an increase in
protein level above this 12-15% level
( http://www.who.int/nutrition/topics/consultation_nutrition_and_hivaids/
en/).
Yes, there is a need to research
this further, but I think we have to recognize the cost/price
implications of further elevating protein levels in diets for PLWHA.
Let's focus first on assuring all PLWHA have access to these minimal
requirements for macro and micronutrients.

Tim Quick, PhD, MS
Senior Technical Advisor for HIV/AIDS & Nutrition
Co-Chair, PEPFAR Food & Nutrition Technical Working Group
USAID Office of HIV/AIDS, 5.10.20
1300 Pennsylvania Avenue NW
Washington, DC 20523
1-202-712-0974 (office)
1-301-275-6652 (cell)
1-202-216-3015 (fax)
tqu...@usaid.gov



----- Stacia Nordin wrote:



True Tim, but in application this is not an overall significant rise
in
protein intake and can hardly be translated as a recommendation of
increasing
protein in the diet.

The WHO recommendations of 12-15% of calories from protein
translate to approximately:

* 2,000 calorie diet, 60-75 gm protein

With the addition of 10 percent energy:
* 2,200 calorie diet, 66-82.5 gm protein
(This 6-7.5 gm increase in protein is roughly equal to the amount
found
in 1
medium egg)

With the addition of 20 percent energy:
* 2,400 calorie diet, 72-90 gm protein
(This 12-15 gm increase in protein is roughly equal to the amount
found
in 2
medium eggs)

With the addition of 30 percent energy:
* 2,600 calorie diet, 78-97.5 gm protein
(This 18-22.5 gm increase in protein is roughly equal to the amount
found in
3 medium eggs)

None of these constitute a level of high protein intake. Dietitans
generally prescribe high protein diets in the level of 2.0-3.0 g per
kg,
depending on the medical condition and research to back this. This
translates into 120 gm-180 gm of protein per day for a 60 kg person.

I completely agree with what Linda from Namibia added to the
discussion
related to protein being burned as energy if it is not needed for
'building'
purposes. There can also be other organs that are stressed by high
protein
diets, so this is not something to take on without the proper research
and
medical support.

My original comment was only that the study was interesting and might
call
for additional research on protein intake with HIV in the African
context.

Stacia

-----"Quick, Timothy C wrote:
>
> Actually, the recommendations are (for adults), 10% increased energy
> intake for asymptomatic PLWHA and 20-30% increased energy intake for
> symptomatic PLWHA, while maintaining protein levels at 12-15% of
total
> energy. So, the protein level is maintained, but there is a net
intake
> of protein associated with the 10-30% increase in total energy
intake,
> 12-15% of which is protein.
>
> Tim Quick, PhD, MS
> Senior Technical Advisor for Nutrition
> USAID Office of HIV/AIDS, 5.10.20
> 1300 Pennsylvania Avenue NW
> Washington, DC 20523
> 202-712-0974
> 202-216-3015 (fax)
> 301-275-6652 (cell)
>
>
>
>
> -----Stacia Nordin wrote:
>
> That's true at the moment in the current WHO guidelines, they merely
> recommend an increase in calories, not specifying whether those
calories
> be
> protein, carbohydrate or fat. But, with more research coming out in
the
>
> future, maybe this recommendation will change.
>
> Stacia
>
> ----- "Mundi Stella" wrote:
>
>
> Stacia,
> WHO does not recommend any increase in protein intake
> for PLWHA.
>
> Stella
>
> --- "Stacia Nordin wrote:
>
>>
>> Seems like all the more reason to improve the
>> protein levels in the diet -
>> although this cannot be extrapolated directly from
>> the study, it would be
>> worth studying in the African context.
>>
>> Stacia
>>
>> ----- "ProNut-HIV" wrote:
>>
>> > Aidsmap
>> >
>> > Albumin levels can predict HIV disease severity
>> and indicate success of
>> > antiretroviral therapy
>> > Michael Carter, Monday, September 18, 2006
>> >
>> > Serum albumin levels are a good predictor of the
>> severity of HIV
>> > disease in individuals who are not taking
>> antiretroviral therapy and can
>> > also indicate the extent of a patient's response
>> to HIV treatment,
>> > according to a study conducted in Nigeria and
>> published in the September
>> > edition of HIV Medicine. The investigators believe
>> testing serum albumin
>> > could be a particularly useful means of monitoring
>> HIV disease
>> > progression, and the success of antiretroviral
>> therapy, in poorer
>> > countries where many patients with access to HIV
>> drugs cannot afford CD4
>> > cell counts or viral load tests.
>> >
>> > Although albumin levels are not a marker of HIV
>> infection status, they
>> > have been found to be a strong predictor of
>> mortality in HIV-positive
>> > adults and children. Tests to monitor serum
>> albumin are cheap, and could
>> > therefore be a useful investigative tool in
>> resource limited settings.
>> > Investigators from the university of Ilorin in
>> Nigeria looked at the
>> > ability of serum albumin levels to predict the
>> severity of HIV disease
>> > in 185 antiretroviral naive patients and their
>> subsequent response to
>> > HIV therapy. CD4 cell count, and body weight were
>> also measured in these
>> > patients to see how using serum albumin compared
>> to the use of
>> > traditional measures of HIV disease progression
>> and response to HIV
>> > therapy.
>> >
>> > All the patients received an antiretroviral
>> regimen consisting of
>> > lamivudine, stavudine and nevirapine and had a
>> mean age of 37 years,
>> > with equal numbers being men and women. The
>> patients had tests at
>> > baseline and then after three months of anti-HIV
>> therapy.
>> >
>> > Mean serum albumin level prior to the initiation
>> of HIV therapy was
>> > 32mg/l, a level associated with an increased risk
>> of mortality in
>> > earlier studies, but increased significantly to
>> 37.7mg/l (p = 0.004).
>> >
>> > Body weight was only a mean of 51kg prior to HIV
>> treatment being
>> > provided, but it increased by a significant amount
>> to a mean of 59kg
>> > after the initiation of HIV therapy (p < 0.001).
>> >
>> > CD4 cell count before antiretroviral therapy was
>> 215 cells/mm3,
>> > indicating that the patients had a very real risk
>> of developing
>> > AIDS-defining illness. As would be expected, the
>> provision of potent HIV
>> > therapy lead to a significant increase in CD4 cell
>> count, to a mean of
>> > 372 cells/mm3, high enough to protect patients
>> from life-threatening
>> > infections.
>> >
>> > A significant correlation was found by the
>> investigators between
>> > pre-treatment serum albumin levels and
>> pre-treatment CD4 cell count (r =
>> > 0.231; p = 0.006) and pre-treatment serum albumin
>> levels and
>> > pre-treatment weight (r = 0.354; p < 0.001).
>> >
>> > What's more, there was also a significant positive
>> correlation
>> > between post-treatment serum albumin and CD4 cell
>> count up to 700
>> > cells/mm3 (r = 0.07; no p value provided), and
>> between post-therapy
>> > serum albumin levels and weight (r = 0.278; p =
>> 0.006).
>> >
>> > Attention was then turned by the investigators to
>> the relationship
>> > between increases in serum albumin levels and
>> increases in weight and
>> > CD4 cell count. A significant positive correlation
>> was found between
>> > increases in serum albumin and increases in weight
>> (r = 0.505; p =
>> > 0.001), but the relationship between increases in
>> albumin and
>> > post-treatment gains in CD4 cell count were just
>> below the threshold for
>> > statistical significance (r = 0.20; p = 0.057).
>> >
>> > "With a sensitivity of 91.5% and a positive
>> predictive value of
>> > 96.15%, it is valid to use serum albumin in place
>> of CD4 cell counts",
>> > write the investigators.
>> >
>> > They conclude, "in developing countries where many
>> people are living
>> > below the poverty line, serum albumin would be a
>> very useful surrogate
>> > test for predicting the severity of HIV infection
>> and also for the
>> > clinical monitoring of response to antiretroviral
>> therapy."
>> >
>> > Reference
>> >
>> > Olawuni HO et al. The value of serum albumin in
>> pretreatment assessment
>> > and monitoring of therapy in HIV/AIDS patients.
>> HIV Med 7: 351 - 355,
>> > 2006.
>
>
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--
Samson Desie
Emergency Nutritionist
UNICEF
Tel: 251 9 15 743797
      251 9  11 798190
email : sde...@unicef.org