Gastrointestinal symptoms in HIV-positive kidney transplant candidates and recipients from an HIV-positive donor.

Gastrointestinal symptoms (GIS) are common in kidney transplant candidates and recipients and may be worsened by HIV. Objective: To determine the frequency and severity of GIS in HIV-positive kidney transplant recipients from HIV-positive donors, and those waiting to receive one. A GIS rating scale (GSRS) was completed by 76 participants at baseline and at 6 months. GIS frequency was defined as having at least one symptom (GSRS > 1). Severity was indicated by the GSRS score. Transplant candidates: GIS frequency was 88.9% and 86.3% at baseline and 6 months respectively. Indigestion was the most frequent (79.6% and 66.7% at baseline and 6 months), and severe GIS (GSRS 2.3). Women reported global mean (p = 0.030) severity significantly more than men. Transplant recipients: GIS frequency was 95.2% and 76.2% at baseline and 6 months respectively. At both assessment points, indigestion occurred most frequently (85.7% and 61.9% respectively). Highest GSRS was reported for indigestion at baseline (2.33) and at 6 months (1.33). Waist circumference (WC) was positively associated with the severity of constipation GSRS. GIS are common in both groups, especially indigestions. WC in transplant recipients should be monitored.

Maternal socio-demographic characteristics and associated complementary feeding practices of children aged 6-18 months with moderate acute malnutrition in Arua, Uganda.

BACKGROUND: There is a paucity of published data regarding maternal socio-demographic characteristics and associated complementary feeding practices of moderately malnourished infants and young children (IYC) in sub-Saharan Africa. In the present study, this association was investigated in Arua, Uganda. METHODS: A cross-sectional baseline survey was conducted among 204 conveniently sampled mothers of IYC aged 6-18 months with moderate acute malnutrition earmarked for dietary supplementation in four randomly selected sub-counties to determine their socio-demographic characteristics using a validated questionnaire. A 24-h recall was used to evaluate complementary feeding practices in terms of minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD). Associations were determined using multivariate logistic regression analysis. RESULTS: The majority (70.1%) of mothers had a primary school education, with 15% having no formal education. Foods especially purchased or prepared for IYC were provided by 42.6% of the mothers. The MDD and MMF of IYC were 13.2% and 41.2%, respectively. MMF and MDD for MAD were met by 6.9% of IYC. Maternal level of education and MMF was significantly associated (P = 0.003), whereas the provision of foods especially purchased or prepared for IYC was significantly associated with MMF (P = 0.003). Maternal care was significantly associated with MAD (P = 0.004). CONCLUSIONS: Optimal complementary feeding practices were not met by the majority of mothers. Maternal level of education and care of IYC were strong predictors of MMF. Nutrition education and care should be promoted among mothers of IYC with moderate acute malnutrition to improve MDD, MMF and MAD.

Effect of a novel supplementary porridge on the nutritional status of infants and young children diagnosed with moderate acute malnutrition in Uganda: a cluster randomised control trial.

BACKGROUND: Moderate acute malnutrition (MAM) and anaemia are prevalent among infants and young children (IYC) in Uganda. A lack of consensus regarding the most effective strategy for managing MAM among IYC resulted in the present study comparing the effect of malted sorghum-based porridge (MSBP) (an active malt, extruded maize and soy sorghum supplementary porridge developed for the purpose of the present study) as an intervention versus an extruded maize and soy micronutrient fortified blend (CSB+) as a control and current standard care. Outcome measures were anthropometric status and haemoglobin levels. METHODS: The study comprised a double-blind cluster randomised control trial with eight to 10 conveniently sampled consenting mother-IYC pairs per cluster who were randomly assigned to the intervention (n = 110) or control (n = 110) for 3 months. Weekly anthropometric measurements were taken. Haemoglobin levels were measured at baseline and end line. Mean length-for-age, weight-for-age, length-for-weight and mean haemoglobin levels of the treatment and control groups were compared using an independent t-test. The Z-test was used to compare proportions of the outcome indicators between the treatment and control groups. RESULTS: Difference in mean weight-for-age Z-scores in the treatment group improved compared to control (P = 0.010). The change in mean haemoglobin levels was lower in the treatment versus the control group (P = 0.010). The proportion of IYC recovering from MAM between treatment and control did not differ significantly (P = 0.055). CONCLUSIONS: Recovery rates after supplementation with MSBP versus CSB+ resulted in similar weight-for-length and haemoglobin levels. Therefore, MSBP has the potential for being scaled up in the management of IYC with MAM in Uganda.

Metabolic Profile of HIV-Infected Women in Mangaung; Free State

Objective: To determine the biochemical nutritional status of HIV-infected women in Mangaung. Design: Cross-sectional. Setting: The community of Mangaung; Free State; South Africa. Subjects: A representative group of 500 black women (25-44 years) was selected randomly to participate. Outcome measures: Biochemical analyses were performed for total lymphocytes; serum protein; serum albumin; plasma fibrinogen; serum insulin; serum glucose; serum triglycerides and serum cholesterol using standard methodology. Values were compared to standard references; and between HIV-infected and HIV-uninfected women. Results: After screening for eligibility; 488 women qualified. Sixty-one per cent of the younger women (25-34 years) and 38of the older women (35-44 years) were HIV-infected. HIV-infected women had significantly lower median blood values for total lymphocytes (p = 0.0001 and p = 0.02 for younger and older group respectively) and serum albumin (p = 0.0001 for both age groups); but significantly higher median concentrations of serum protein (p = 0.0001 for both age groups) than uninfected women. Plasma fibrinogen and serum insulin concentrations were significantly lower in HIV-infected younger women than in their uninfected counterparts (p = 0.002 for both parameters). Older HIV-infected women had significantly lower total serum cholesterol values (p = 0.01) than older HIV-uninfected women. Serum glucose and serum triglycerides did not differ significantly between HIV-infected and HIV-uninfected women. Conclusions: The results indicate a possible impact of HIV infection on serum protein and serum albumin; which may adversely affect biochemical nutritional status and the course of HIV progression. Future research into the causes and possible treatment of metabolic changes in women in this community should be prioritised

Micronutrient Intake of HIV-Infected Women in Mangaung; Free State

Background. Poor nutritional status in HIV/AIDS patients can affect immune function profoundly; leading to faster disease progression and earlier death.Objective. To determine the micronutrient intake of HIV-infected women in Mangaung.Design and setting. A cross-sectional study was undertaken in Mangaung; Bloemfontein; Free State.Subjects and methods. A representative group of 500 pre-menopausal women (25 - 44 years) was randomlyselected to participate in the study. Micronutrient intake was determined using a Quantitative Food FrequencyQuestionnaire (QFFQ). Median micronutrient intakes were compared with the Recommended Dietary Allowance(RDA) or Adequate Intake (AI) values. The prevalence of women with intakes 67of the RDA or AI was calculated. Median micronutrient intakes were compared between HIV-infected and uninfected women using non-parametric 95confidence intervals (CIs) and the Mann-Whitney test.Results. Sixty-one per cent of women in the younger age group (25 - 34 years) and 38of older women (35 - 44 years) were HIV-infected. Between 46.6and 70.7of all women consumed 67of the RDA or AI for calcium;total iron; selenium; folate and vitamin C. At least 25of HIV-infected women did not meet either the RDA or the AI for vitamins A; D and E. Younger HIV-infected women had significantly higher intakes of calcium (p = 0.046);phosphorus (p = 0.04); potassium (p = 0.04); vitamin B12 (p = 0.01); vitamin D (p = 0.03) and vitamin E (p = 0.04)than their HIV-uninfected counterparts. Older HIV-infected women had significantly lower intakes of haem iron (p = 0.03); non-haem iron (p = 0.04) and selenium (p = 0.04) than their HIV-uninfected counterparts.Conclusions. Insufficient micronutrient intakes are common in both HIV-infected and uninfected women. A well-balanced diet and micronutrient supplementation seem warranted to ensure optimal health and survival; particularly in HIV-infected women

Nutritional status influences plasma fibrinogen concentration: evidence from the THUSA survey.

Nutritional status and risk factors for chronic diseases, including plasma fibrinogen and its determinants, of Africans in the Northwest Province of South Africa, have been studied in a cross-sectional survey. A representative sample of 1854 "apparently healthy" African men and women volunteers aged 15 years and older was recruited from 37 randomly selected sites throughout the Province and stratified for level of urbanisation. Information was collected using validated and culture-sensitive questionnaires. Fasting blood samples were drawn, and all measurements were done with standardised methodology using appropriate equipment, procedures, and controls. Fibrinogen concentration was measured in citrated plasma with the method of Clauss, using the ACL200 automated system and the international fibrinogen standard. The results revealed a population with a high mean plasma fibrinogen (3.17+/-1.10 g/L for HIV-negative men and 3. 64+/-1.12 g/L for HIV-negative women). Factors known to influence plasma fibrinogen, such as age, gender, smoking habit, and physical activity, were also observed in this population. Young rural men and women had the lowest fibrinogen level. Nasal snuff taking and HIV infection did not influence fibrinogen concentration. Multivariate analyses revealed that lower plasma fibrinogen was associated with low to normal body mass index in women, and with dietary intakes compatible with prudent dietary guidelines in men and women (low intakes of animal protein; trans fatty acids and higher intakes of plant protein; dietary fibre, vitamin E, and iron, and a high dietary P/S ratio). Subjects in the higher quartiles of plasma fibrinogen had significantly lower iron, vitamin E, and vitamin B6 (women) status. Increases in fibrinogen were associated with significant increases in serum lipids. Both under- and overnutrition seem to be associated with high plasma fibrinogen. It is concluded that overall nutritional status, possibly in addition to specific nutrients (and foods), influences plasma fibrinogen.

Possible mechanisms through which dietary pectin influences fibrin network architecture in hypercholesterolaemic subjects.

It is suspected that not only fibrinogen concentration but also the quality of fibrin networks may contribute to cardiovascular risk. Evidence is accumulating that a "prudent" diet may protect against diseases associated with raised clotting factors. The effect of diet on fibrinogen is, however, still controversial. In a previous study performed in our laboratory, it was shown that dietary pectin influences fibrin network architecture in hypercholesterolaemic men without causing any changes in fibrinogen concentration. To elucidate the possible mechanisms, it was necessary to study the possibility that pectin may itself have indirect effects on fibrin network architecture. Pectin is fermented in the gastrointestinal tract to acetate, propionate, and butyrate. In humans, only acetate reaches the circulation beyond the liver. This investigation primarily examined the possibility that pectin may, through acetate, influence fibrin network architecture in vivo. The effects of pectin and acetate supplementation in hypercholesterolaemic subjects were compared. Furthermore, this study also aimed at describing the possible in vitro effects of acetate on fibrin network architecture. Two groups of 10 male hyperlipidaemic volunteers each received a pectin (15 g/day) or acetate (6.8 g/day) supplement for 4 weeks. Acetate supplementation did not cause a significant change in plasma fibrinogen levels. As in the pectin group, significant differences were found in the characteristics of fibrin networks developed in plasma after 4 weeks of acetate supplementation. Fibrin networks were more permeable (from 213+/-76 to 307+/-81 x 10(11) cm2), had lower tensile strength (from 23+/-3 to 32+/-9% compaction), and were more lyseable (from 252+/-11 to 130+/-15 minutes). These results strongly suggest that the effect of pectin on network architecture could partially be mediated by acetate. Progressive amounts of acetate were used in vitro to investigate the possibility that acetate may be directly responsible for changes that occurred in fibrin network architecture in the plasma medium. Results indicated that acetate influenced fibrin network architecture directly. From the results, it seems highly possible that acetate may be responsible in part for the beneficial effects of pectin supplementation in vivo. It is evident that pectin or acetate supplementation can be useful during the treatment or prevention of some clinical manifestations, especially those associated with raised total cholesterol and possibly also plasma fibrinogen.

Lecithin has no effect on serum lipoprotein, plasma fibrinogen and macro molecular protein complex levels in hyperlipidaemic men in a double-blind controlled study.

OBJECTIVE: To examine the effects of lecithin on serum lipoprotein, plasma fibrinogen and macro molecular protein complex (MPC) levels. SUBJECTS AND STUDY DESIGN: Twenty free living hyperlipidaemic men participated in this double-blind study which controlled for possible indirect effects. The subjects were randomly assigned to one of three treatments: frozen yoghurt or frozen yoghurt with 20 g soya bean lecithin or frozen yoghurt with 17 g sunflower oil. Sunflower oil was used to control for the increased energy and linoleic acid intake from lecithin. Yoghurt served as the 'vehicle' for the lecithin and sunflower oil and yoghurt alone was given to one group to control for possible effects due to the yoghurt 'vehicle', as well as other environmental influences. Variables were measured with standard methods twice at baseline and after 2 and 4 weeks of treatment. RESULTS: Plasma linoleic acid levels increased significantly with lecithin and sunflower oil treatments indicating that compliance to the treatments were obtained. Lecithin treatment did not have significant effects on serum total cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, apolipoprotein A, apolipoprotein B or lipoprotein (a) levels. Plasma fibrinogen and MPC levels were also not affected by lecithin therapy. Sunflower oil treatment resulted in significant increased body weight, serum TC and decreased MPC levels. CONCLUSION: Lecithin treatment had no independent effects on serum lipoprotein, plasma fibrinogen or MPC levels in hyperlipidaemic men.

Soluble-fibre concentrate lowers plasminogen activator inhibitor-1 in baboons (Papio ursinus).

The effects of a soluble NSP (fibre) concentrate (SFC) on plasma fibrinogen and plasminogen activator inhibitor-1 (PAI-1), serum and liver lipids and lipoproteins and glucose tolerance were compared with those of bezafibrate (BF), a lipid-lowering drug, in obese baboons (Papio ursinus). The basal diet was a high-fat (37% of total energy), low-NSP (12.4 g/d) Westernized diet, supplemented for 8 weeks with either 20 SFCg/baboon per d or 6.7 mg BF/kg body weight per baboon per d. SFC supplementation significantly lowered PAI-1, total serum cholesterol, HDL-cholesterol and circulating free fatty acid levels. BF significantly lowered total serum cholesterol, but unexpectedly raised serum triacylglycerol levels. Although not statistically significant, the mean liver triacylglycerol concentration of baboons fed on BP was lower than that of baboons fed on SFC supplements. These results suggest that: (1) the mechanism of action of the two cholesterol-lowering treatments differ, with BF having a liver triacylglycerol-lowering effect and (2) the SFC ahd additional beneficial effect on fibrinolysis by lowering PAI-1 levels.

Venom of a six-eyed crab spider, Sicarius testaceus (Purcell, 1908), causes necrotic and haemorrhagic lesions in the rabbit.

By employing haematological, histological and isotope studies on rabbit, it was shown that envenomation by the South African crab spider, Sicarius testaceus, results in tissue necrosis and a marked increase in the permeability of the blood vessels in the vicinity of envenomation. The venom also acts systemically, which results in petechial bleeding of some viscera, thrombocytopaenia and elevated fibrinogen levels. Rabbit envenomation by this species results in a dramatic drop of the platelet count, without haemolytic anaemia. Should these parameters be the same in humans, they may serve as a yardstick to distinguish presumptive S. testaceus envenomation from that of Loxosceles.

Dietary pectin influences fibrin network structure in hypercholesterolaemic subjects.

Fibrinogen is an important risk factor for atherosclerosis, stroke and cardiovascular heart disease (CHD). This risk is increased when associated with a high serum cholesterol. Furthermore, it is also believed that not only fibrinogen concentration, but also the quality of fibrin networks may be an important risk factor for the development of CHD. CHD and stroke as a result of atherosclerosis, plus the related problems of hyperinsulinaemia, hyperlipidaemia and hypertension are strongly related to diet. The "western" diet, defined by low fibre and high fat, sucrose and animal protein intakes, appears to be a major factor leading to death. It has been established that the water-soluble dietary fibre, pectin, significantly decrease the concentration of serum cholesterol levels. Evidence is also accumulating that a diet rich in fibre may protect against diseases associated with raised clotting factors. This investigation studied the possible effects of pectin on fibrinogen levels and fibrin network architecture. Two groups of 10 male hyperlipidaemic volunteers each, received a pectin supplement (15 g/day) or placebo (15 g/day) for 4 weeks. Lipid and fibrin network structure variables were measured at baseline and the end of supplementation. Pectin supplementation caused significant decreases in total cholesterol, low-density lipoprotein cholesterol, apolipoprotein A & B and lipoprotein (a). Significant changes in the characteristics of fibrin networks developed in the plasma of the pectin supplemented group indicated that networks were more permeable and had lower tensile strength. These network structures are believed to be less atherogenic. It is suspected that pectin modified network characteristics by a combination of its effects on metabolism and altered fibrin conversion. This confirms the therapeutic possibilities of dietary intervention. Furthermore, this study also showed that changes in plasma fibrinogen need not be present to induce alterations in fibrin network architecture.

Diet and haemostasis: time for nutrition science to get more involved.

Abnormal haemostasis, and specifically a pre-thrombotic state characterized by hypercoagulability, increased platelet aggregation and impaired fibrinolysis, is associated with increased atheroma and thrombosis. The recent literature clearly indicates that diet may prevent or be used to treat some abnormal haemostatic states. There are reports on effects of energy intake and expenditure, alcohol consumption, intakes of total fat, different fatty acids, fish oil, NSP and vitamins on markers of coagulation, platelet function and fibrinolysis. Some of the confusion and controversy in this field has arisen because the wrong markers of haemostasis have been measured in dietary trials. Moreover, many of the studies have lacked good dietary control. It is suggested that more sensitive, functional markers of the balance between the different facets of the haemostatic system should be measured. It is also important to test hypotheses developed from known observations and to propose mechanisms of action of the various dietary factors, based on our improved understanding of the haemostatic system.