A lipid-based nutrient supplement mitigates weight loss among HIV-infected women in a factorial randomized trial to prevent mother-to-child transmission during exclusive breastfeeding

Kayira, Dumbani; Bentley, Margaret E.; Wiener, Jeffrey; Mkhomawanthu, Chimwemwe; King, Caroline C.; Chitsulo, Phindile; Chigwenembe, Maggie; Ellington, Sascha; Hosseinipour, Mina C.; Kourtis, Athena P.; Chasela, Charles; Tembo, Martin; Tohill, Beth Carlton; Piwoz, Ellen; Jamieson, Denise J.; Charles, Der Van Horst,; Adair, Linda S.

doi:10.3945/ajcn.111.018812

Cited by 32 publications

(45 citation statements)

References 20 publications

(24 reference statements)

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“…3 Mean 6 SD (all such values). 4 Derived from a principal components analysis of the possession of 20 different household assets, whereby households with higher values represented greater household wealth relative to that of others in the sample (Supplemental Figure 1). 5 Includes formal, self, informal, and other self-reported employment.…”

Section: Resultsmentioning

confidence: 99%

“…In general, lactating women experienced mild and gradual weight loss, but there is substantial heterogeneity (17,33). Weight loss, weight maintenance, and even moderate weight gains have been reported in HIV+ (4,5,11,15) and HIV2 (17,34,35) postpartum populations. For example, in HIV+ women in the Kesho Bora Study, weight changes from 2 to 6 mo were generally stable, ranging from +1.5 to 20.9 kg (11).…”

Section: Discussionmentioning

confidence: 99%

“…In terms of ARV exposure and weight change, 2 studies have described weight changes in women who initiated ART prenatally (12,13), and weight changes in women who initiated ART in the postpartum period have been reported in 1 cohort (4,5). However, these studies have not examined body composition (4,5,(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

“…It is also recommended that antiretroviral therapy (ART) 11 should be initiated for anyone who is living with HIV and should be continued for life (3). However, some ART regimens may propagate weight loss and concomitant shifts in body composition (4,5) and adversely affect micronutrient status (6)(7)(8). These deficits can be exacerbated during periods of higher nutritional needs such as lactation.…”

Section: Introductionmentioning

confidence: 99%

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Food insecurity, but not HIV-infection status, is associated with adverse changes in body composition during lactation in Ugandan women of mixed HIV status

Widen

Collins

Khan

et al. 2017

The American Journal of Clinical Nutrition

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Background: Body composition is an important indicator of nutritional status and health. How body composition changes during 12 mo of breastfeeding in HIV-infected women receiving antiretroviral therapy (ART) is unknown. Objective: We assessed whether HIV or food insecurity was associated with adverse postpartum body-composition changes in Ugandan women. Design: A cohort of 246 women [36.5% of whom were HIV positive (HIV+) and were receiving ART] were followed to 12 mo postpartum. Repeated measures included weight, fat mass, fat-free mass, midupper arm circumference, triceps skinfold thickness [which allowed for the derivation of arm muscle area (AMA) and arm fat area (AFA)], breastfeeding, and individual food insecurity. Longitudinal regression models were constructed to assess associations between HIV and food insecurity and changes in body composition over time. Results: At baseline, HIV+ women compared with HIV-negative women had a higher mean 6 SD food-insecurity score (11.3 6 5.5 compared with 8.6 6 5.5, respectively; P , 0.001) and lower AMA (40.6 6 5.7 compared with 42.9 6 6.9 cm 3 , respectively; P = 0.03). Participants were thin at 1 wk postpartum [body mass index (BMI; in kg/m 2 ): 22.9 6 2.9]. From 1 wk to 12 mo, the weight change was 21.4 6 4.4 kg. In longitudinal models of body-composition outcomes, HIV was not associated with body composition (all P . 0.05), whereas food insecurity was inversely associated with body weight and BMI at 6, 9, and 12 mo and with AFA at 6 and 12 mo (all P , 0.05). At 6 mo, every 1-unit increase in the food-insecurity score was associated with a 0.13-kg lower body weight (P , 0.001) and a 0.26-cm 3 lower AFA (P , 0.01).Conclusions: Body-composition changes are minimal during lactation. HIV is not associated with body composition; however, food insecurity is associated with changes in body composition during lactation. This trial was registered at clinicaltrials. gov as NCT02922829 and NCT02925429. Am J Clin Nutr 2017;105:361-8.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Food insecurity, but not HIV-infection status, is associated with adverse changes in body composition during lactation in Ugandan women of mixed HIV status

Widen

Collins

Khan

et al. 2017

The American Journal of Clinical Nutrition

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“…The BAN (Breastfeeding, Antiretrovirals, and Nutrition) Study in Malawi recently published the results of a randomized 2 9 5 factorial design trial of lipid-based nutrient supplements and ART prophylaxis to HIV-infected mothers and their infants. The authors report that lipid-based nutrient supplements reduced weight loss among HIV-infected, breastfeeding women, both for those taking maternal antiretroviral prophylaxis to prevent postnatal HIV transmission and in those not receiving antiretroviral prophylaxis [39].…”

Section: Nutrition Supplementation Interventions Targeted To Plhivmentioning

confidence: 99%

Food Security and Nutrition Interventions in Response to the Aids Epidemic: Assessing Global Action and Evidence

et al. 2014

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The number of people receiving antiretroviral therapy in developing countries has increased dramatically. The last decade has brought an increased understanding of the interconnectedness between HIV/AIDS, food insecurity, and undernutrition and a surge of evidence on how to address the food security and nutrition dimensions of the epidemic. We review this evidence as well as the corresponding evolution of policy support for incorporating food security and nutrition concerns into HIV programming. The available evidence, although varied in scope and methodologies, shows that nutrition supplementation and safety nets in the form of food assistance and livelihood interventions have potential in certain contexts to improve food security and nutrition outcomes in an HIV/AIDS context. In the face of funding uncertainties and competing priorities, we must maintain momentum towards effective and sustainable solutions to the epidemic through continued systematic research to inform policy and through the strengthening of monitoring systems to dynamically inform intervention development.

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Lipid-based nutrient supplements for maternal, birth, and infant developmental outcomes

Das

Hoodbhoy

Salam

et al. 2018

Cochrane Database of Systematic Reviews

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Findings from this review suggest that LNS supplementation has a slight, positive effect on weight at birth, length at birth, SGA and newborn stunting compared to IFA. LNS and MMN were comparable for all maternal, birth and infant outcomes. Both IFA and MMN were better at reducing maternal anaemia when compared to LNS. We did not find any trials for LNS given to pregnant women in emergency settings.Readers should interpret the beneficial findings of the review with caution since the evidence comes from a small number of trials, with one-large scale study (conducted in community settings in Bangladesh) driving most of the impact. In addition, effect sizes are too small to propose any concrete recommendation for practice.

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A lipid-based nutrient supplement mitigates weight loss among HIV-infected women in a factorial randomized trial to prevent mother-to-child transmission during exclusive breastfeeding

Cited by 32 publications

References 20 publications

Food insecurity, but not HIV-infection status, is associated with adverse changes in body composition during lactation in Ugandan women of mixed HIV status

Food insecurity, but not HIV-infection status, is associated with adverse changes in body composition during lactation in Ugandan women of mixed HIV status

Food Security and Nutrition Interventions in Response to the Aids Epidemic: Assessing Global Action and Evidence

Lipid-based nutrient supplements for maternal, birth, and infant developmental outcomes

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