Antiretroviral Treatment Is Associated With Iron Deficiency in HIV-Infected Malawian Women That Is Mitigated With Supplementation, but Is Not Associated With Infant Iron Deficiency During 24 Weeks of Exclusive Breastfeeding.

OBJECTIVE: In resource-limited settings without safe alternatives to breastfeeding, the WHO recommends exclusive breastfeeding and antiretroviral (ARV) prophylaxis. Given the high prevalence of anemia among HIV-infected women, mothers and their infants (through fetal iron accretion) may be at risk of iron deficiency. We assessed the effects of maternal micronutrient-fortified lipid-based nutrient supplements (LNS) and maternal ARV treatment or infant ARV prophylaxis on maternal and infant iron status during exclusive breastfeeding from birth to 24 weeks. METHODS: The Breastfeeding, Antiretrovirals, and Nutrition study was a randomized controlled trial conducted in Lilongwe, Malawi, from 2004 to 2010. HIV-infected mothers (CD4 >200 cells/µL) and their infants were randomly assigned to 28-week interventions: maternal LNS/maternal ARV (n = 424), maternal LNS/infant ARV (n = 426), maternal LNS (n = 334), maternal ARV (n = 425), infant ARV (n = 426), or control (n = 334). Longitudinal models tested intervention effects on hemoglobin (Hb). In a subsample (n = 537) with multiple iron indicators, intervention effects on Hb, transferrin receptors (TfR), and ferritin were tested with linear and Poisson regression. RESULTS: In longitudinal models, LNS effects on maternal and infant Hb were minimal. In subsample mothers, maternal ARVs were associated with tissue iron depletion (TfR >8.3 mg/L) (risk ratio: 3.1, P < 0.01), but not in ARV-treated mothers receiving LNS (P = 0.17). LNS without ARVs was not associated with iron deficiency or anemia (P > 0.1). In subsample infants, interventions were not associated with impaired iron status (all P > 0.1). CONCLUSIONS: Maternal ARV treatment with protease inhibitors is associated with maternal tissue iron depletion; but LNS mitigates adverse effects. ARVs do not seem to influence infant iron status; however, extended use needs to be evaluated.

Validity of bioelectrical impedance analysis for measuring changes in body water and percent fat after bariatric surgery.

BACKGROUND: Few studies have validated bioelectrical impedance analysis (BIA) following bariatric surgery. METHODS: We examined agreement of BIA (Tanita 310) measures of total body water (TBW) and percent body fat (%fat) before (T0) and 12 months (T12) after bariatric surgery, and change between T0 and T12 with reference measures: deuterium oxide dilution for TBW and three-compartment model (3C) for %fat in a subset of participants (n = 50) of the Longitudinal Assessment of Bariatric Surgery-2. RESULTS: T0 to T12 median (IQR) change in deuterium TBW and 3C %fat was -6.4 L (6.4 L) and -14.8% (13.4%), respectively. There were no statistically significant differences between deuterium and BIA determined TBW [median (IQR) difference: T0 -0.1 L (7.1 L), p = 0.75; T12 0.2 L (5.7 L), p = 0.35; Δ 0.35 L(6.3 L), p = 1.0]. Compared with 3C, BIA underestimated %fat at T0 and T12 [T0 -3.3 (5.6), p < 0.001; T12 -1.7 (5.2), p = 0.04] but not change [0.7 (8.2), p = 0.38]. Except for %fat change, Bland-Altman plots indicated no proportional bias. However, 95% limits of agreement were wide (TBW 15-22 L, %fat 19-20%). CONCLUSIONS: BIA may be appropriate for evaluating group level response among severely obese adults. However, clinically meaningful differences in the accuracy of BIA between individuals exist.