Vitamin D status, nutrition and growth in HIV-infected mothers and HIV-exposed infants and children in Botswana.

BACKGROUND: Poor vitamin D status is a global health problem and common in patients with human immunodeficiency virus (HIV) in high-income countries. There is less evidence on prevalence of vitamin D deficiency and nutrition and growth in HIV-infected and -exposed children in low- and middle-income countries. OBJECTIVES: To determine the vitamin D status in Batswana HIV-infected mothers and their children, differences among HIV-infected mothers and between HIV-exposed and -infected infants and children, and associations between vitamin D and disease-related outcomes, nutrition, and growth. METHODS: This was a cross-sectional study of HIV+ mothers and HIV-exposed infants and unrelated children (1-7.9 years). Serum 25-hydroxyvitamin D (25(OH)D) was measured, among other nutritional indicators, for mothers, infants and children. Vitamin D status for HIV-infected mothers and children, and an immune panel was assessed. History of HIV anti-retroviral medications and breastfeeding were obtained. Data were collected prior to universal combination antiretroviral therapy in pregnancy. RESULTS: Mothers (n = 36) had a mean serum 25(OH)D of 37.2±12.4ng/mL; 11% had insufficient (<20ng/mL), 17% moderately low (20.0-29.9ng/mL) and 72% sufficient (≥30ng/mL) concentrations. No infants (n = 36) or children (n = 48) were vitamin D insufficient; 22% of HIV- and no HIV+ infants had moderately low concentrations and 78% of HIV- and 100% of HIV+ infants had sufficient status, 8% of HIV- and no HIV+ children had moderately low concentrations and 92% of HIV- and 100% HIV+ children had sufficient concentrations. HIV+ children had significantly lower length/height Z scores compared to HIV- children. Length/height Z score was positively correlated with serum 25(OH)D in all children (r = 0.33, p = 0.023), with a stronger correlation in the HIV+ children (r = 0.47 p = 0.021). In mothers, serum 25(OH)D was positively associated with CD4% (r = 0.40, p = 0.016). CONCLUSIONS: Results showed a low prevalence of vitamin D insufficiency in Botswana. Growth was positively correlated with vitamin D status in HIV-exposed children, and HIV+ children had poorer linear growth than HIV- children.

Vitamin D3supplementation in Batswana children and adults with HIV: a pilot double blind randomized controlled trial.

OBJECTIVES: Since vitamin D insufficiency is common worldwide in people with HIV, we explored safety and efficacy of high dose cholecalciferol (D3) in Botswana, and evaluated potential modifiers of serum 25 hydroxy vitamin D change (Δ25D). DESIGN: Prospective randomized double-blind 12-week pilot trial of subjects ages 5.0-50.9 years. METHODS: Sixty subjects randomized within five age groups to either 4000 or 7000 IU per day of D3 and evaluated for vitamin D, parathyroid hormone, HIV, safety and growth status. Efficacy was defined as serum 25 hydroxy vitamin D (25D) ≥32 ng/mL, and safety as no simultaneous elevation of serum calcium and 25D. Also assessed were HIV plasma viral RNA viral load (VL), CD4%, anti-retroviral therapy (ART) regime, and height-adjusted (HAZ), weight-adjusted (WAZ) and Body Mass Index (BMIZ) Z scores. RESULTS: Subjects were 50% male, age (mean±SD) 19.5±11.8 years, CD4% 31.8±10.4, with baseline VL log10 range of <1.4 to 3.8 and VL detectable (>1.4) in 22%. From baseline to 12 weeks, 25D increased from 36±9 ng/ml to 56±18 ng/ml (p<0.0001) and 68% and 90% had 25D ≥32 ng/ml, respectively (p = 0.02). Δ25D was similar by dose. No subjects had simultaneously increased serum calcium and 25D. WAZ and BMIZ improved by 12 weeks (p<0.04). HAZ and CD4% increased and VL decreased in the 7000 IU/d group (p<0.04). Younger (5-13y) and older (30-50y) subjects had greater Δ25D than those 14-29y (26±17 and 28±12 vs. 11±11 ng/ml, respectively, p≤0.001). Δ25D was higher with efavirenz or nevirapine compared to protease inhibitor based treatment (22±12, 27±17, vs. 13±10, respectively, p≤0.03). CONCLUSIONS: In a pilot study in Botswana, 12-week high dose D3 supplementation was safe and improved vitamin D, growth and HIV status; age and ART regimen were significant effect modifiers. TRIAL REGISTRATION: ClinicalTrials.gov NCT02189902.

Evidence of nutrition transition in Southern Africa.

Nutrition transition is characterised by shift to highly refined diets high in fat, salt and caloric sweeteners and low in fibre in rapidly growing economies. Dietary shifts occur almost concurrently with demographic and epidemiologic shifts, urbanisation and industrialisation and together contribute to increased prevalence of nutrition related (NR)-non-communicable disease (NCR). The emergence of nutrition transition in Southern Africa countries (SAC) was examined using anthropometric, NCD prevalence, and food consumption data. The findings reveal growing prevalence of overweight and obesity (OWOB) across SAC, with national prevalence estimated between 30 and 60 % in all but two SAC. Overweight prevalence in excess of 60 % has been reported in some sub-population groups. Hypertension prevalence of at least 30 % has also been reported. Further, the prevalence of OWOB and hypertension in many SAC exceeds that of HIV and is often at par with stunting in children. NCD are equally serious public health problems as stunting and HIV. Collectively, NR-NCD explain 20-31 % of mortality for Botswana, South Africa, Swaziland, Mozambique and Zambia. At least 72 % of adults in SAC have fewer servings of fruit and vegetable servings daily than recommended. Additionally, adults in SAC do poorly in physical activity; 31-75 % do not exercise regularly. Not surprisingly, 15-40 % of adults in SAC have at least three risk factors of CVD. SAC are grappling with NR-NCD which threaten to surpass infectious diseases burden. SAC are at various levels in interventions for moving their populations to stage 5, but there is room for much improvement.

Impact of individual, household and community characteristics on children's nutritional indicators.

This study analyzed WHO-standardized nutritional indicators of children from selected households within communities that were sampled from all districts of Botswana. Data from the 2007 Botswana Family Health Survey were fitted into multilevel models that seek to account for variability due to the macro- and micro-units that have been hierarchically selected. This allowed for estimation of different levels of intraclass correlations while simultaneously assessing the model-fit by accounting for the influence on the nutritional indicators due to the fixed variables attributable to these macro- and micro-units. The results show that variation in nutritional status of under-five children in Botswana is a function of characteristics of the households and communities within which they live. As much as 17% of variation is due to differences in the communities and households. Economic status of households holds an important key in predicting the nutritional status of children.