Thesis (Mnutr)--Stellenbosch University, 2003. / 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.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/53403 |
| Date | January 2003 |
| Creators | Kennedy, Roy Donovan |
| Contributors | Labadarios, D., Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | Unknown |
| Type | Thesis |
| Format | 81 p. : ill. |
| Rights | Stellenbosch University |
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