Nutrition supplementation in patients with HIV infection

OBJECTIVE: To evaluate the use of high-energy, high protein, oral, liquid, nutrition supplementation and nutrition counselling on the weight status of patients infected with the human immuno-deficiency virus (HIV) with and without secondary infections. DESIGN: prospective, descriptive, intervention trial. Follow-up clinic visits were scheduled every 1 to 3 weeks for at least 6 weeks to monitor weight, gastrointestinal symptoms, number of supplements consumed, and incidence of secondary infections. SUBJECTS/SETTING: community-based, HIV-infected patients, with and without acquired immunodeficiency syndrome (AIDS) defining illness, who were receiving outpatient medical care at Deaconess Hospital, 17 patients were evaluated. INTERVENTION: dietary counselling consisted of recommendations to consume a high protein diet (1.5 g/kg ideal body weight); select foods that minimize gastrointestinal complications; and at least one high-energy, high-protein, oral, liquid, nutrition supplement daily. MAIN OUTCOME MEASURES: Energy intake from the supplements and weight change over time in relation to whether a secondary infection occurred. STATISTICAL ANALYSIS: Means, standard deviations, and frequency. RESULTS: At the time of entry to the study, the patients with pre-existing weight loss (16 of 17) were 14 ñ 8 percent below their usual body weight. On average, patients consumed 11 ñ 4 supplements per week for 6 ñ 3 weeks. The majority (12 out of 17) were able to gain or maintain weight. Overall weight gain was 1.1 ñ 2.2 kg. Only 5 of 17 patients lost weight, 4 of whom developed a secondary infection during the study (i.e, after enrollment in the study). All of those who developed a secondary infection were classified as having AIDS and had lower mean CD4 counts at baseline than those who did not develop a secondary infection. Although those who developed a secondary infection had a higher incidence of weight loss, their consumption of oral supplements per week was greater than that of those without a secondary infection. APPLICATIONS/CONCLUSIONS: In patients with HIV infection and in the early stages of AIDS without a secondary infection, weight gain and/or maintenance was achieved with a high-energy, high-protein, oral, liquid, nutrition supplement in conjunction with nutrition counselling. The majority of patients who developed a secondary infection, however, lost weight despite the use of supplements and counselling (AU)

The controversy of thin and thick porridges: does viscosity influence intake? - abstract

There is controversy concerning the best weaning foods for infants in developing countries with some promoting thick porridges while others claim viscosity reduction of thick porridges is necessary. We assessed the effects of viscosity and energy density on energy intake in fifteen children aged 7-15 months recovered from malnutrition. Three porridges were developed: thin-low energy (51 kcal/100gm viscosity 280-480 cP): thick-high energy (kcal/100gm viscosity 3000-4000 cP); and amylase-treated - high energy (97 kcal/100 gm viscosity 280-480 cP). Using a cross-over design, each porridge was fed ad lib four times daily for four days by specially trained feeders. The mean daily intake in grams of the thin porridge was significantly higher than that of the amylase-treated or thick porridges. However, the mean energy intake of the thin porridge was significantly lower than that of the amylase-treated or thick porridges. The mean daily energy intakes of the amylase-treated and thick porridges were similar and matched WHO/FAO recommended requirements. Meal duration was significantly longer for the thick porridge, which was fed by cup and spoon, than for the amylase-treated or the thin porridges. Feeding a thick porridge with an energy density of 100 kcal/100 gm four times daily therefore satisfied the recommended daily energy requirements for infants and young children. The only adventure of reducing the viscosity of the thick porridge was the shorter time spent feeding (AU)

Very low calorie diets and pre-fasting prolonged QT interval: a hidden potential danger

The asssociation of torsade de pointes and a prolonged electrocardiographic QT interval is well described. A prolonged QT interval may be congenital or acquired in several ways - by the use of anti-arrhythmic agents exemplified, by the presence of hypocalcaemia or hypokaemia, by the use of psychotropic drugs, and by the presence of intrinsic cardiac disease or bradycardias. Possible less well appreciated is the potiental for drastic weight loss to prolong the QT interval, as the present case report illustrates. A young woman weighing 244 pounds lost 24 pounds in two weeks with a consequent prolongation of QTc interval from pre-diet value of 0.57 seconds to 0.72 seconds at administration, when severly symptomatic paroxysms of torsade de pointes were recorded. Successful therapy with lignocaine and prompt re-feeding supressed the arrhythmia and, three days later, the QTc was reduced to almost its pre-diet state. A (UK) DHSS report offers guidelines in the use of very low caloric diets. This case suggests that a pre-diet electrocardiogram should be carefully assessed for QT prolongation before initiation of dieting to achieve serious weight loss (AU)

Breast-feeding practices in Trinidad

A study of breast-feeding practices in Trinidad indicates that despite the evident advantages of breast-feeding, early abandonment of the practice is widespread. Within some four months of delivery nearly half of the infants in the study group had been completely weaned from the breast. A significant association was found between early bottle-feeding (before the first breast-feeding session) and early termination of breast feeding (AU)