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.
Afrikaans: HIV/VIGS het 'n negatiewe invloed op die gesondheid, lewenskwaliteit en voedingstatus van geïnfekteerde individue. Die negatiewe invloed op voedingstatus is in kinders selfs erger as in volwassenes, as gevolg van kinders se addisionele behoeftes vir groei. Die doel van hierdie studie was om die impak van supplementasie met 'n ensiemgemodifiseerde mieliepapsuppiement op die antropometriese voedingstatus van MIV- geïnfekteerde kinders in versorgingsentrums vir MIV-geïnfekteerde en MIV-geaffekteerde kinders in Mangaung te bepaal. Honderd-vyf-en-vyftig kinders tussen 1 en 10 jaar oud, is getoets om HIV-status te bepaal. HIV-infeksie is bevestig in 37 kinders wat nog nooit aan anti-retrovirale middels blootgestel is nie, en die 37 kinders is ingesluit in die studie. Die studie was 'n gerandomiseerde, dubbelblinde, klinies gekontroleerde, prospektiewe intervensie. 'n Eksperimentele produk is aan kinders in die eksperimentele groep (E) en 'n kontroleproduk aan kinders in die kontrolegroep (K) gegee, oor 'n tydperk van 16 weke. Beide produkte was verrykte mielie/soja produkte wat identies was in voedingswaarde, maar die eksperimentele produk het bygevoegde a-amilase bevat. Die byvoeging van α-amilase by styselprodukte verlaag die viskositeit van die produk, wat die individu in staat stelom groter hoeveelhede te eet en gevolglik meer energie- en voedingswaarde-voordeel te put, veral in die geval van jong kinders met hoë voedingsbehoeftes maar onvermoë om groot genoeg hoeveelhede te eet om in die voedingsbehoeftes te voorsien. Nege-en-twintig kinders het die projek voltooi. Die gemiddelde ouderdom van die 29 kinders (E=14; K=15) met aanvang van die studie was 64.1 maande (SD 23.6 maande). Die kinders se basislyn voedingstatus was swak. Ondergewig is gediagnoseer in 42.9% van beide die E- en K-groepe. Die mediaan gewig-vir-ouderdom was -1.9SD in albei groepe. Hierdie basislyn bevindings het die bevindings van ander navorsers ondersteun, nl. dat groei in HIVgeïnfekteerde kinders aansienlik stadiger is as in nie-geïnfekteerde kinders. 'n Groot persentasie lengtegroei-inkorting is in albei groepe gevind - 57.1% van die kinders in die E-groep en 80% van die kinders in die K-groep se lengtegroei was ingekort. Die mediaan lengte-vir-ouderdom was -2.3SD vir die E- en -2.9SD vir die K-groep. Hierdie bevindings het die bevindings van ander navorsers ondersteun dat lengtegroei-inkorting meer dikwels in HIV-geïnfekteerde kinders voorkom as in nie-geïnfekteerde kinders. Die voorkoms van lengtegroei-inkorting in hierdie groep was hoog in vergelyking met bestaande nasionale data vir kinders van onbekende HIV-status. Die swak antropometriese voedingstatus van kinders in versorgingsentrums beklemtoon die nadelige effek van HIV-infeksie op die voedingstatus en groei van jong kinders, asook die belangrikheid om gemeenskapgebaseerde voedingingtervensie-inisiatiewe na sentrums vir HIV-geïnfekteerde en -geaffekteerde kinders uit te brei. Hoewel die data verkry uit die intervensie-fase van hierdie studie nie 'n beduidende verbetering in die antropometriese voedingstatus in enige van die E- of die K-groep kon aandui nie, het die gebruik van bygevoegde a-amilase in ander studies verbetering in antropometriese voedingstatus ondervind. Die praktiese probleme wat in hierdie studie ondervind is, kon die uitkoms van hierdie studie negatief beïnvloed. Samevattend, die hoë voorkoms van wanvoeding in hierdie studiegroep dui daarop dat MIVgeïnfekteerde en MIV-geaffekteerde kinders kwesbaar is en dat inwoning in 'n versorgingsentrum of bywoning van 'n dagsentrum hulle nie, soos algemeen aanvaar, vrywaar van wanvoeding nie. Dit is belangrik dat kinders in versorgingsentrums ingesluit sal word in roetine gesondheid- en voedingassesserings en dat versorgingsentrums ingesluit word in inisiatiewe vir die voorkoming en behandeling van wanvoeding. MIV- geïnfekteerde kinders in versorgingsentrums behoort meer aggressiewe voedingondersteuning te kry om voorsiening te maak vir hul verhoogde behoeftes en om hulle teen wanvoeding en vervroegde HIV/VIGS simptome te beskerm. Die insluiting van addisionele energiedigte supplemente soos RUTF tot bestaande supplementasie-regimes vir wangevoede kinders mag nodig wees om agterstallige groei in te haal.