Browsing by Author "Van Niekerk, Margaret-Antoinette"
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- ItemThe effect of an enriched nutritional supplement on growth and inflammatory markers in underweight HIV-positive children aged 24-72 months(Stellenbosch : Stellenbosch University, 2016-03) Van Niekerk, Margaret-Antoinette; Labadarios, Demetre; Du Plessis, Lisanne; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.ENGLISH SUMMARY : BACKGROUND: Infection with the human immuno-deficiency virus (HIV) causes immune impairment which leads to malnutrition. Malnutrition worsens the effects of HIV, resulting in faster progression to acquired immune-deficiency syndrome (AIDS). The combination of malnutrition and HIV in children negatively impacts their growth and immune status. Addressing malnutrition in HIV-positive individuals can potentially result in a strengthened immune system which is better able to cope with opportunistic infections. This thesis explored whether a cohort of HIV-positive children in a child outpatient healthcare setting and receiving nutritional supplementation showed associated changes in defined anthropometric indices (height, weight), and in defined immune and inflammatory markers. DESIGN: The thesis describes a sub-study within a successfully completed large randomized controlled clinical trial. The latter compared catch-up weight in HIV positive children receiving a complete nutritional supplement and were randomized to two groups. One group consumed supplement A (complete supplement) and the other consumed supplement B (complete supplement with added functional nutrients). The sub-study analysed data on the whole cohort and also conducted a sub-group analysis to determine bio-equivalence of the two supplements. METHODOLOGY: Study participants were recruited if they were HIV-positive, between the ages of 24-72 months and met the trial’s pre-determined inclusion criteria. Participants were recruited from Anti-retroviral treatment (ART) clinics within the Cape Town Metropole area. Anthropometric data (weight; height) was collected at baseline and at each of the six follow-up visits. Venous blood was drawn to analyse biomedical parameters [C-reactive protein (CRP); calprotectin; Immunoglobulin A (IgA)]. Anthropometric data was analysed using the World Health Organisation (WHO) Anthro Plus program and SAS General linear models (GLM Procedure) was used to calculate change overtime. Biomedical raw data was exported to STATA and statistical significance was calculated using the Related-Samples Wilcoxon Signed Rank test. RESULTS: The total number of children included in the study was 138 (64 boys; 74 girls). The cohort comprised of 69 (50%) children aged 2-3 years and 69 (50%) aged 4-6 years. The addition of the complete nutritional supplement, in its two variants, in the cohort increased mean energy intake by 1000kJ for both age-categories. For the 2, 4 and 5 year old children, weight and height gain from baseline to visit 6 was significant (p<0.000; p<0.001; p<0.000; p<0.000; p<0.004; p<0.000). Weight-for-age z-scores (WAZ) improved significantly for the 2-year old children (p<0.0082) only. CRP and calprotectin levels of the cohort showed a significant reduction to within normal ranges (p<0.002; p<0.005). Immunoglobulin A (IgA) was substantially reduced (p<0.003) close to the normal range. Children receiving supplement B had a significant improvement in the <-3SD height-for-age z-scores (HAZ) in comparison to group A (p<0.038). Children <5th percentile for weight-for-age (WFA) and height-for-age (HFA) showed a significant improvement in IgA levels compared to group A (p<0.018). Children receiving supplement A, who were >5th percentile for WFA, showed a significant improvement in CRP levels compared to children receiving supplement B. CONCLUSION: The findings of this study showed a positive effect on energy intake by consuming a balanced nutritional supplement, irrespective of composition, and on the growth and immune markers of HIV-positive, underweight children within in an outpatient setting. The addition of specific functional nutrients was found to be safe but efficacy needs to be further investigated.