Fwd: Fw: [pronut-hiv] Nutritional assistance in regards to infant feeding (3)
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Samson Desie
Oct 17, 2006, 9:08:16 AM10/17/06
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From: samson desie <samson...@yahoo.com>
Date: Oct 17, 2006 3:47 PM
Subject: Fw: [pronut-hiv] Nutritional assistance in regards to infant feeding (3)
To: samson...@gmail.com
Tel: 251 911 79 81 90
----- Forwarded Message ----
From: Nynke Nutma < hiv...@aahmw.org>
To: Nutrition and HIV/AIDS <pronu...@healthnet.org>
Sent: Monday, October 16, 2006 11:15:18 AM
Subject: RE: [pronut-hiv] Nutritional assistance in regards to infant feeding (3)
From: Nynke Nutma < hiv...@aahmw.org>
To: Nutrition and HIV/AIDS <pronu...@healthnet.org>
Sent: Monday, October 16, 2006 11:15:18 AM
Subject: RE: [pronut-hiv] Nutritional assistance in regards to infant feeding (3)
Hi Jill,
In the case of Malawi, infant formula poses some big challenges. Lack of
access to clean water, poor sanitation and a high burden of infectious
diseases make formula feeding not feasible and safe for the majority of
Malawian children.
In Malawi, the MoH has started to make nutrition care an integrated part of
HIV care. Some centers are giving support to PMTCT mothers and their babies,
but this is still relatively underdeveloped unfortunately. Which clinic in
Lilongwe are you supporting?
Nynke Nutma
HIV/nutrition adviser
Action Against Hunger Malawi
hiv...@aahmw.org
09 960 499/ 01 758 992
-----Jill Strejc wrote:
George,
I agree whole-heartedly with everything you've said! I also wonder about
nutritional assistance, particularly in regard to infant feeding. I asked a
friend, who works for a large nutritionals company, why formula was so hard
to come by in Africa. From what I understand, this company has offered
assistance and was told "no thank you" by the international organizations.
I surmise that response has a lot to do with the events that occurred during
the 1970's. I am involved in assisting a clinic in Lilongwe, Malawi and a
nutrition therapy component will be a focus of mine. How can nutrition not
be an integral part of the treatment of HIV/AIDS?
As far as the issue of protein- this is where dietitians have to
individualize, be creative and educate themselves. My area of practice is
renal nutrition and getting many patients to consume enough protein and
calories continues to be a challenge. Whatever works, whether it from food
or supplements or the combination, is the goal- using whatever resources are
available to you and procuring the resources that are not. I agree that
change is possible and identifying and solving the problems at the community
level is a place to start.
Regards,
Jill Strejc,MS,RD,CSR
Adult Renal Dietitian
Department of Nutrition
UCLA Medical Center
310.825.1037
-----George M. Carter wrote:
[At 09:38 AM 10/2/2006, you wrote:
>I have been reading this discussions and it is really interesting.
>As we have all heard, there is no evidence for increased protein need in
>HIV patients.]
This is demonstrably untrue. Especially given wasting in the absence of
ARV. Especially for children. See the citations below.
However, your practical points are well taken--yet, I have never thought it
was a good idea to be too realistic.
How can we advocate for better access to good nutrition? Yes, this is an
age-old problem and yes, billions will die of malnutrition or related
diseases this year.
But in each community, we can identify needs. We can address them. We can
CHANGE this.
Not long ago, it was simply accepted that antiretrovirals could NEVER
arrive in Africa.
Why can't something so much less costly as good nutritional programs (that
look at micronutrients, good fats and carbs and adequate caloric intake)?
For example, whey proteins are an inexpensive, easily digested form of
protein that has shown an impact in children with HIV in reversing failure
to thrive. Can supplements be made available inexpensively? Through a UN or
DFID program?
Accepting the status quo remains unacceptable.
George M. Carter
***
Kessler L, Daley H, Malenga G, Graham S. The impact of the human
immunodeficiency virus type 1 on the management of severe malnutrition in
Malawi. Ann Trop Paediatr. 2000 Mar;20(1):50-6.
Department of Paediatrics, College of Medicine, Blantyre, Malawi.
A study was undertaken in a central nutritional rehabilitation unit in
southern Malawi to assess the impact of HIV infection on clinical
presentation and case fatality rate. HIV seroprevalence in 250 severely
malnourished children over 1 year of age was 34.4% and overall mortality
was 28%. HIV infection was associated significantly more frequently with
marasmus (62.2%) than with kwashiorkor (21.7%) (p < 0.0001). Breastfed
children presenting with severe malnutrition were significantly more likely
to be HIV-seropositive (p < 0.001). Clinical and radiological features were
generally not helpful in distinguishing HIV-seropositive from
HIV-seronegative children. The case fatality rate was significantly higher
for HIV-seropositive children (RR 1.6 [95% CI 1.14-2.24]). The increasing
difficulties of managing the growing impact of HIV infection on severely
malnourished children in Malawi are discussed in the context of reduced
support for nutritional rehabilitation units.
***
Berneis K, Battegay M, Bassetti S, Nuesch R, Leisibach A, Bilz S, Keller
U. Nutritional supplements combined with dietary counselling diminish
whole body protein catabolism in HIV-infected patients. Eur J Clin Invest.
2000 Jan;30(1):87-94.
University Hospital Basel, Switzerland.
BACKGROUND: Weight loss and protein malnutrition are frequent complications
in HIV-infected patients. The effect of an oral nutritional supplement
combined with nutritional counselling on whole body protein metabolism was
assessed. MATERIALS AND METHODS: HIV-infected individuals with a body mass
index < 21 kg m-2 or CD4-T cells < 500 micro L-1 in stable clinical
condition were randomly allocated to [1] receive either oral nutritional
supplements (containing 2510 kJ, complete macro- and micronutrients) and
dietary counselling (n = 8), or [2] identical monitoring but no supplements
or specific nutritional advice (controls, n = 7). Whole body leucine
kinetics and leucine oxidation rate were determined by [1-13C]-leucine
infusions and lean and fat mass were measured before and 12 weeks after
intervention. RESULTS: Leucine oxidation (protein catabolism) decreased in
the group receiving nutritional intervention from 0.33 +/- 0.02 to 0.26 +/-
0.02 micromol kg-1 min-1 after 12 weeks (P < 0.05; P < 0.05 vs. control
group) but remained unchanged in the control group. Whole body leucine flux
showed a tendency to decrease in the intervention group from 1.92 +/- 0.19
to 1.73 +/- 0.14 micromol kg-1 min-1 (P = 0.07) and remained unchanged in
the control group (2.21 +/- 0.16 and 2.27 +/- 0.14 micromol kg-1 min-1,
respectively). Lean body mass determined by bioelectrical impedance
analysis increased in the nutritional intervention group from 84 +/- 2 to
86 +/- 2 per cent (P < 0.05) and fat mass decreased from 17 +/- 2 to 14 +/-
2 per cent (P < 0.05) of total body weight whereas neither mass changed in
the control group. Nutritional intervention had no significant effect on
lymphocyte CD4 counts, on plasma TNFR 55, TNFR 75 and ILR 2 concentrations
and on quality of life. CONCLUSIONS: The data demonstrate an anticatabolic
effect of nutritional supplements combined with dietary counselling in
HIV-infected subjects. They suggest that diminished whole body protein
catabolism resulted in a change of body composition (increased lean mass,
decreased fat mass).
_______________________________________________
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In the case of Malawi, infant formula poses some big challenges. Lack of
access to clean water, poor sanitation and a high burden of infectious
diseases make formula feeding not feasible and safe for the majority of
Malawian children.
In Malawi, the MoH has started to make nutrition care an integrated part of
HIV care. Some centers are giving support to PMTCT mothers and their babies,
but this is still relatively underdeveloped unfortunately. Which clinic in
Lilongwe are you supporting?
Nynke Nutma
HIV/nutrition adviser
Action Against Hunger Malawi
hiv...@aahmw.org
09 960 499/ 01 758 992
-----Jill Strejc wrote:
George,
I agree whole-heartedly with everything you've said! I also wonder about
nutritional assistance, particularly in regard to infant feeding. I asked a
friend, who works for a large nutritionals company, why formula was so hard
to come by in Africa. From what I understand, this company has offered
assistance and was told "no thank you" by the international organizations.
I surmise that response has a lot to do with the events that occurred during
the 1970's. I am involved in assisting a clinic in Lilongwe, Malawi and a
nutrition therapy component will be a focus of mine. How can nutrition not
be an integral part of the treatment of HIV/AIDS?
As far as the issue of protein- this is where dietitians have to
individualize, be creative and educate themselves. My area of practice is
renal nutrition and getting many patients to consume enough protein and
calories continues to be a challenge. Whatever works, whether it from food
or supplements or the combination, is the goal- using whatever resources are
available to you and procuring the resources that are not. I agree that
change is possible and identifying and solving the problems at the community
level is a place to start.
Regards,
Jill Strejc,MS,RD,CSR
Adult Renal Dietitian
Department of Nutrition
UCLA Medical Center
310.825.1037
-----George M. Carter wrote:
[At 09:38 AM 10/2/2006, you wrote:
>I have been reading this discussions and it is really interesting.
>As we have all heard, there is no evidence for increased protein need in
>HIV patients.]
This is demonstrably untrue. Especially given wasting in the absence of
ARV. Especially for children. See the citations below.
However, your practical points are well taken--yet, I have never thought it
was a good idea to be too realistic.
How can we advocate for better access to good nutrition? Yes, this is an
age-old problem and yes, billions will die of malnutrition or related
diseases this year.
But in each community, we can identify needs. We can address them. We can
CHANGE this.
Not long ago, it was simply accepted that antiretrovirals could NEVER
arrive in Africa.
Why can't something so much less costly as good nutritional programs (that
look at micronutrients, good fats and carbs and adequate caloric intake)?
For example, whey proteins are an inexpensive, easily digested form of
protein that has shown an impact in children with HIV in reversing failure
to thrive. Can supplements be made available inexpensively? Through a UN or
DFID program?
Accepting the status quo remains unacceptable.
George M. Carter
***
Kessler L, Daley H, Malenga G, Graham S. The impact of the human
immunodeficiency virus type 1 on the management of severe malnutrition in
Malawi. Ann Trop Paediatr. 2000 Mar;20(1):50-6.
Department of Paediatrics, College of Medicine, Blantyre, Malawi.
A study was undertaken in a central nutritional rehabilitation unit in
southern Malawi to assess the impact of HIV infection on clinical
presentation and case fatality rate. HIV seroprevalence in 250 severely
malnourished children over 1 year of age was 34.4% and overall mortality
was 28%. HIV infection was associated significantly more frequently with
marasmus (62.2%) than with kwashiorkor (21.7%) (p < 0.0001). Breastfed
children presenting with severe malnutrition were significantly more likely
to be HIV-seropositive (p < 0.001). Clinical and radiological features were
generally not helpful in distinguishing HIV-seropositive from
HIV-seronegative children. The case fatality rate was significantly higher
for HIV-seropositive children (RR 1.6 [95% CI 1.14-2.24]). The increasing
difficulties of managing the growing impact of HIV infection on severely
malnourished children in Malawi are discussed in the context of reduced
support for nutritional rehabilitation units.
***
Berneis K, Battegay M, Bassetti S, Nuesch R, Leisibach A, Bilz S, Keller
U. Nutritional supplements combined with dietary counselling diminish
whole body protein catabolism in HIV-infected patients. Eur J Clin Invest.
2000 Jan;30(1):87-94.
University Hospital Basel, Switzerland.
BACKGROUND: Weight loss and protein malnutrition are frequent complications
in HIV-infected patients. The effect of an oral nutritional supplement
combined with nutritional counselling on whole body protein metabolism was
assessed. MATERIALS AND METHODS: HIV-infected individuals with a body mass
index < 21 kg m-2 or CD4-T cells < 500 micro L-1 in stable clinical
condition were randomly allocated to [1] receive either oral nutritional
supplements (containing 2510 kJ, complete macro- and micronutrients) and
dietary counselling (n = 8), or [2] identical monitoring but no supplements
or specific nutritional advice (controls, n = 7). Whole body leucine
kinetics and leucine oxidation rate were determined by [1-13C]-leucine
infusions and lean and fat mass were measured before and 12 weeks after
intervention. RESULTS: Leucine oxidation (protein catabolism) decreased in
the group receiving nutritional intervention from 0.33 +/- 0.02 to 0.26 +/-
0.02 micromol kg-1 min-1 after 12 weeks (P < 0.05; P < 0.05 vs. control
group) but remained unchanged in the control group. Whole body leucine flux
showed a tendency to decrease in the intervention group from 1.92 +/- 0.19
to 1.73 +/- 0.14 micromol kg-1 min-1 (P = 0.07) and remained unchanged in
the control group (2.21 +/- 0.16 and 2.27 +/- 0.14 micromol kg-1 min-1,
respectively). Lean body mass determined by bioelectrical impedance
analysis increased in the nutritional intervention group from 84 +/- 2 to
86 +/- 2 per cent (P < 0.05) and fat mass decreased from 17 +/- 2 to 14 +/-
2 per cent (P < 0.05) of total body weight whereas neither mass changed in
the control group. Nutritional intervention had no significant effect on
lymphocyte CD4 counts, on plasma TNFR 55, TNFR 75 and ILR 2 concentrations
and on quality of life. CONCLUSIONS: The data demonstrate an anticatabolic
effect of nutritional supplements combined with dietary counselling in
HIV-infected subjects. They suggest that diminished whole body protein
catabolism resulted in a change of body composition (increased lean mass,
decreased fat mass).
_______________________________________________
Post message: pronu...@healthnet.org
Subscribe: pronut-...@healthnet.org
Unsubscribe: pronut-h...@healthnet.org
Help: pronut-h...@healthnet.org
Info & archives: http://list.healthnet.org/mailman/listinfo/pronut-hiv
--
Samson Desie
Emergency Nutritionist
UNICEF
Tel: 251 9 15 743797
251 9 11 798190
email : sde...@unicef.org
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