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

[摘要] English: HIV/AIDS negatively influences the health, quality of life and nutritional status of infectedindividuals. The negative influence on nutritional status is even worse in children than inadults, due to children's additional needs for growth.The aim of this study was to determine the impact of an enzyme‐modified, enriched maizebasedsupplement 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 inMangaung.A total of 155 food secure HIV‐infected children aged 1 �?10 years were screened todetermine HIV status. HIV‐infection was confirmed in 37 clinically stable, antiretroviral naïvechildren, 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 controlsupplement given to the children in the experimental�?(E) and control (C) groupsrespectively. Both products were enriched maize/soy blends of exactly the same nutritionalvalue, except that α‐amylase was added to the E‐product. The addition of α‐amylase tostarchy foods decreases the viscosity of the mixed product, enabling the individual toconsume larger quantities for more energy and nutritional benefit, especially in the case ofyoung children with high nutritional needs but lack of capacity to consume large enoughquantities to provide in these needs.Twenty‐nine children completed the intervention. The mean age of the 29 (E=14; C=15) atbaseline was 64.1 months (SD 23.6 months). Baseline nutritional status of the children waspoor. Underweight for age was identified in 42.9% of both the E�?and C‐groups. The medianZ‐score for WAZ was �?.9 for both the E�?and the C‐group. These findings support findings ofother researchers that growth in HIV‐infected children is significantly slower than in noninfectedchildren. A high percentage of stunting was found in both groups: 57.1% in the E‐group and 80% inthe C‐group were stunted. The median Z‐scores for HAZ were �?.3 for the E�?and �?.9 for theC‐group. This was in accordance with findings of other researchers who reported that HIVinfectedchildren are more often stunted than non‐infected children. The prevalence ofstunting in this study is high in comparison to existing national data for children of unknownHIV status.The poor anthropometric nutritional status in children in care centres emphasises thedetrimental effect of HIV‐infection on the nutritional status and growth in young children, aswell as the importance of extending community based nutrition intervention initiatives tocare 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 significantimprovement in the anthropometrical nutritional status, other studies using a product withadded α‐amylase did show improvement in anthropometrical nutritional status. Thepractical problems experienced in the present study may have had a negative effect on theoutcome of the study.In conclusion, the high prevalence of malnutrition found at baseline, indicate that childreninfected with or affected by HIV are vulnerable and that being a resident or being registeredat a care centre does not necessarily protect them from malnutrition. It is important thatchildren in these facilities are included in routine health and nutritional assessments andthat the centres are included in initiatives that target malnutrition. HIV‐infected children incare centres should receive more aggressive nutrition support to make provision for theirincreased requirements and also to protect them from malnutrition and early diseaseprogression. The inclusion of additional sources of energy dense supplements such as RUTFto current supplementation regimens for malnourished children may be needed to achievecatch‐up growth in malnourished children.

[发布机构] University of the Free State