Effects of a micronutrient, glutamine, pre- and probiotic enriched liquid supplement on nutritional status and immunity of adults with HIV/AIDS : a pilot study

Kennedy, Roy Donovan (2003)

Thesis (Mnutr)--Stellenbosch University, 2003.

Thesis

ENGLISH ABSTRACT: INTRODUCTION: The objective of this pilot study was to evaluate the effects of a new micronutrient, glutamine, pre- and probiotic enriched liquid nutritional supplement on the nutritional status and immunity of adults living with HIV/AIDS. The study was designed as a prospective randomised double-blind placebo-controlled trial. Subjects were HIV-infected male and female adult volunteers (n = 47) from a community-based hospice centre in a peri-urban area in a resource-poor setting and were included irrespective of duration or clinical stage of HIV/AIDS. None of the subjects received antiretroviral therapy. METHOD: The intervention involved the daily ingestion of 40g (200 ml reconstituted) of either the enriched test product or an lsocalorie carbohydrate placebo for a period of 12 weeks. Anthropometric assessment (weight, height and triceps skinfold thickness; mid-upper arm, waist and hip circumferences) was performed at baseline and thereafter every 4 weeks (4 times). Biochemical (serum total protein, serum albumin and C-reactive protein) and haematological (full blood count and immunophenotyping) assessment was performed at baseline and again after week 12. RESULTS: Statistical analysis of baseline values was performed with Wilcoxon two-sample tests for comparison between the supplemented and placebo groups. Outcomes were evaluated using analysis of variance with Shapiro-Wilk tests and thereafter either pair-wise t-tests or sign tests (for nonparametric data) were used. Thirty-two subjects completed the trial, 14 in the supplemented group and 18 in the placebo group. Weight increased significantly in the supplemented group (2.73 ± 3.53 kg, P = 0.013). Triceps skinfold thickness increased significantly in both the supplemented (p = 0.047) and placebo group (p = 0.001). No other significant anthropometric change was observed. Serum albumin increased significantly in the supplemented group (p = 0.003) and was associated with a significant decline in C-reactive protein (p = 0.028). Haemoglobin decreased significantly in both groups. A significant decline in CD4+ count was observed in the placebo group while the decline in the supplemented group did not reach significance. CONCLUSION: Oral nutritional supplementation in limited quantities was well tolerated for a period of 3 months. This study demonstrated that an enriched nutritional supplement was able to promote weight gain and ameliorate hypoalbuminaemia and possibly inflammation in adults living with HIV/AIDS in the short to medium term. The enriched nutritional supplement does not appear to have an effect on the immunity of people with HIV/AIDS. The small sample is a limitation of the study and the conclusions pertain to the test product as a whole and not to any of its respective ingredients. Although further studies are required to evaluate long-term feasibility, these findings suggest that the use of an enriched nutritional supplement has a role in the management of weight loss in persons with HIV/AIDS.

AFRIKAANSE OPSOMMING: INLEIDING: Die doel van hierdie loodsstudie was om die uitwerking van 'n nuwe mikronutriënt, glutamien, pre- en probiotika verrykte voedingsaanvulling in vloeistof vorm te ondersoek. Die studie is ontwerp as 'n prospektiewe ewekansige dubbelblinde plasebogekontroleerde toets. Proefpersone was MIV-geïnfekteerde manlike and vroulike vrywilligers (n = 47) van 'n gemeenskapsgebaseerde hospitium in a semi-stedelike gebied in 'n hulpbron-arme omgewing. Proefpersone is ingesluit ongeag die duur of kliniese graad van MIVNIGS. Geen proefpersoon het antiretrovirale behandeling ontvang nie. METODE: Die intervensie het die daaglikse inname van 40g (200 ml gerekonstitueer) van óf die toetsproduk óf 'n isokaloriese koolhidraatplasebo gedurende 'n 12 week periode behels. Antropometriese evaluering (gewig, lengte en trisepsvelvoudikte; midbo-arm-, middel- en heupomtrekke) is uitgevoer met aanvang en daarna weer elke 4 weke (4 keer). Biochemiese (serum totale protein, serumalbumien en C-reaktiewe protein) en hematologiese (volbloedtelling en immunofenotipering) evaluering is uitgevoer met aanvang en weer na 12 weke. RESULTATE: Statistiese verwerking van basislyndata is gedoen deur middel van Wilcoxon twee-steekproef toetse waarmee vergelyking tussen die aangevulde en plasebogroep uitgevoer is. Studiegevolge is geëvalueer deur verspeidingsanalise met behulp van Shapiro-Wilk toetse waarna óf paargewyse t-toetse óf tekentoetse (vir nie-parametriese data) gebruik is. Twee-en-dertig proefpersone het die studietydperk voltooi, 14 in die aangevulde groep en 18 in die plasebogroep. Gewig het betekenisvol toegeneem in die aangevulde groep (2.73 ± 3.53 kg, p = 0.013). Triseps velvoudikte het betekenisvol toegeneem in beide die aangevulde (p = 0.047) en die plasebogroep (p = 0.001). Geen ander betekenisvolle antropometriese veranderinge is waargeneem nie. Serumalbumien het betekenisvol gestyg in die aangevulde groep (p = 0.003) en het gepaard gegaan met 'n betekenisvolle daling in C-reaktiewe protein (p = 0.028). Hemoglobienwaardes het in beide groepe betekenisvol gedaal. 'n Betekenisvolle daling in CD4+ telling is waargeneem in die plasebogroep terwyl die daling in die aangevulde groep nie betekenisvol was nie. GEVOLGTREKKING: Mondelingse voedingsaanvulling van 'n beperkte hoeveelheid was goed aanvaar en verdra oor 'n 3-maande tydperk. Hierdie studie toon dat 'n verrykte voedingsaanvulling in staat is om gewigstoename te bevorder en om hipoalbumienemie en moontlik ook inflammasie te verlig in volwassenes met MIVNIGS oor 'n kort tot medium tydperk. Die verrykte voedingsaanvulling blyk nie 'n effek op die immuniteit van mense met MIVNIGS te hê nie. Die klein steekproef is 'n beperking van die studie en die gevolgtrekkinge is slegs van toepassing op die toetsproduk as 'n geheel en nie op enige van die onderskeie bestanddele daarvan nie. Hoewel verdere studies nodig geag word om langtermyn uitvoerbaarheid te ondersoek, dui hierdie bevindinge daarop dat die gebruik van 'n verrykte voedingsaanvulling 'n rol speel in die beheer van gewigverlies in persone met MIVNIGS.

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