The efficacy of micronutrient-fortified sorghum meal in improving the immune status of HIV-positive adults.

BACKGROUND: Micronutrient deficiencies are common and compound the effects of human immunodeficiency virus (HIV) infection in Africa. Nutritional interventions, particularly vitamin A supplementation, may improve immune functioning and delay disease progression. AIM: To investigate the effect of fortified sorghum meal provided for 12 months on the immune status of adults with HIV. METHODS: HIV-infected men and women were enrolled in a double-blind randomized placebo-controlled trial in Kanye, Botswana, to receive either sorghum meal fortified with micronutrients including vitamin A (n = 67) or control (n = 65). Serum retinol, iron, zinc, albumin, CD4 cell count and HIV viral load were assessed at baseline and every 3 months. RESULTS: Baseline serum retinol levels were 1.6 µmol/l in both groups and no significant difference was observed at the end of the intervention (control group: 1.5 µmol/l; experimental group: 1.6 µmol/l). In addition, there was no significant difference in the mean (Q1, Q3) CD4 cell count; 348 (220, 456) cells/mm(3) for the control group versus 338 (228, 426) cells/mm(3) in the experimental group after intervention. CONCLUSION: In this study, fortified sorghum meal did not influence serum retinol, CD4 cell count and HIV viral load. Future intervention studies should carefully consider the composition and dosing of food supplements needed to improve immune status and delay disease progression.

Validation and reproducibility of an FFQ for use among adults in Botswana.

OBJECTIVE: To evaluate the validity and reproducibility of a 122-item interviewer administered quantitative FFQ developed to determine food and nutrient intakes of adults in Botswana. DESIGN: Relative validity of the FFQ was evaluated by comparing nutrient and food group intakes against four non-consecutive 24 h recalls administered over 12 months. The FFQ was repeated after 1 year to assess reproducibility. SETTING: Kanye, Botswana. SUBJECTS: Seventy-nine adults aged 18­75 years. RESULTS: Spearman correlation coefficients for the validity of energy-adjusted nutrients ranged from 0.42 (carbohydrate) to 0.49 (protein) for macronutrients and from 0.23 (Fe) to 0.44 (PUFA) for micronutrients. Exact agreement of quartile distribution for nutrients between the FFQ and recalls ranged from 27% to 72%. Weighted kappa values were lowest for retinol (0.13), Fe (0.22) and b-carotene (0.25) and ranged from 0.33 (SFA) to 0.59 (folate) for other nutrients (energy, carbohydrate, protein, fat, Ca and vitamin E). Spearman correlation coefficients between the recalls and FFQ for food groups ranged from 0.18 (dark green leafy and yellow vegetables) to 0.58 (poultry). Reproducibility correlation coefficients (energy-adjusted) varied between 0.39 for retinol and 0.66 for vitamin E, with most values falling between 0.50 and 0.60. CONCLUSIONS: The FFQ had good relative validity for estimating habitual food group and nutrient intakes, but was poor for some micronutrients (Fe, retinol and b-carotene) and foods (fruits and dark green leafy vegetables).