SUNScholar will be down for routine maintenance from 2018-12-11 10:00 SAST.

The effect of an enriched nutritional supplement on growth and inflammatory markers in underweight HIV-positive children aged 24-72 months

Van Niekerk, Margaret-Antoinette (2016-03)

Thesis (MNutr)--Stellenbosch University, 2016.

Thesis

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.

AFRIKAANSE OPSOMMING : AGTERGROND: Infeksie met die menslike immuniteitsgebreksvirus (MIV) veroorsaak immuun-inkorting wat lei tot wanvoeding. Wanvoeding vererger die effek van MIV wat lei tot vinniger vordering na vervorwe immuniteitsgebrek-sindroom (VIGS). Die kombinasie van wanvoeding en MIV het 'n negatiewe impak op die groei- en immuun-status van kinders. Die aanspreek van wanvoeding in HIV-positiewe individue kan moontlik lei tot 'n versterking van die immuunstelsel wat opportunistiese infeksies beter kan hanteer. Hierdie tesis het ten doel gehad om te ondersoek of 'n groep MIV-positiewe kinders, in 'n kinder-buitepasiënt gesondheidsorg-instelling, wat voedingsaanvullings ontvang het, ooreenstemmende veranderinge in die voorkoms van gedefinieerde antropometriese indekse (lengte, gewig) en in gedefinieerde immuun- en inflammasie merkers getoon het. ONTWERP: Die tesis beskryf 'n sub-studie binne 'n suksesvol voltooide groot ewekansige beheerde kliniese proefneming. Laasgenoemde het die inhaal-gewig in MIV-positiewe kinders wat 'n volledige voedingaanvulling ontvang het vergelyk en was lukraak toegewys in twee groepe. Een groep het aanvulling A (volledige aanvulling) ingeneem en die ander aanvulling B (volledige aanvulling met meer funksionele voedingstowwe). Die sub-studie het data ontleed van die hele kohort en het ook 'n sub-groep analise ingesluit om bio-ekwivalensie van die twee aanvullings te bepaal. METODE: Deelnemers was ingesluit indien hul MIV-positief was, tussen die ouderdomme van 24-72 maande en voldoen het aan voorafbepaalde kriteria vir insluiting in die studie. Deelnemers was gewerf uit anti-retrovirale terapie (ART) klinieke binne die Kaapse Metropool area. Antropometriese data (gewig; lengte) is tydens die basislyn versamel asook tydens elk van die ses opvolgbesoeke. Veneuse bloed was getrek om biomediese parameters te ontleed (C-reaktiewe proteïen [CRP]; calprotectin; Immunoglobulien A [IgA]). Antropometriese data was ontleed met behulp van die WGO Anthro Plus program en SAS algemene lineêre modelle (GLM Prosedure) is gebruik om verandering met verloop van tyd te bereken. Biomediese rou data is uitgevoer na STATA en statistiese betekenisvolheid was bereken deur die Verwante-Monsters Wilcoxon rangordetoets. RESULTATE: Die totale aantal kinders, ingesluit in die studie, was 138 (64 seuns, 74 dogters). Die groep het bestaan uit 69 (50%) kinders van 2-3 jaar en 69 (50%) van 4-6 jaar oud. Die byvoeging van die voedingaanvulling in die groep het die gemiddelde energie-inname met 1000kJ verhoog vir beide ouderdomskategorieë. Die gewig en lengte toename vir die 2, 4 en 5 jaar oue kinders vanaf die basislyn tot die 6de besoek was betekenisvol (p <0,000; p <0,001; p <0,000; p <0,000; p <0,004; p <0,000). Gewig vir ouderdom z-tellings het aansienlik verbeter slegs vir die 2-jarige kinders (p <0,0082). CRP en calprotectin het beduidend verlaag tot binne normale waardes (p <0,002; p <0,005). Immunoglobulien A het beduidend verlaag (p <0,003) tot naby aan normale reikwydtes. Kinders wat supplement B ontvang het, het 'n beduidende verbetering in die <-3SD HAZ groep in vergelyking met 'n groep A getoon (p <0,038). Kinders <5de persentiel vir gewig-vir-ouderdom (GVO) en lengte-vir-ouderdom (LVO) het 'n beduidende verbetering in IgA vlakke in vergeleke met groep A (p <0,018) getoon. Kinders wat supplement A ontvang het en >5de persentiel vir GVO was, het 'n beduidende verbetering in CRP vlakke getoon in vergelyking met kinders wat supplement B ontvang het. GEVOLGTREKKING: Die bevindinge van hierdie studie dui die positiewe gevolge van gebalanseerde voedingsaanvullings, ongeag die samestelling daarvan, op die groei - en immuun-merkers van MIV-positiewe, ondergewig kinders in 'n buitepasiënt omgewing aan. Die byvoeging van 'n spesifieke funksionele voedingstowwe was veilig bevind, maar doeltreffendheid moet verder ondersoek word.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/98320
This item appears in the following collections: