Abstract
The South African population faces many of the global concerns relating to micronutrient deficiency and the impact this has on health and well-being. Moreover, there is a high prevalence of HIV infection, compounded by a high level of co-infection with TB.This pilot study evaluates the impact of a fortified supplementary food on the health and well-being of a cohort of crèche children, aged 3 to 6, and adult TB patients drawn from the Presidential Node of Alexandra, Johannesburg, South Africa. A further aim of this study was to evaluate the sensitivity and validity of non-invasive indicators of nutritional status in a field-based population sample.The investigational product, e’Pap, is supported by extensive anecdotal evidence that whole grain cereals with food-style nutrients constitute an effective supplementary food for those suffering from the effects of food insecurity, poor health and well-being, and coping with TB and HIV infection.The results indicate a beneficial effect of e’Pap for both study populations, and particularly for adult TB patients, whose baseline data reflected severe food insecurity and malnutrition in the majority of cases. There is evidence to suggest statistically significant improvements in key micronutrient levels, well-being and energy, hand-grip strength, the Bioelectrical Impedance Analysis (BIA) Illness Marker, and certain clinical indicators. Although Body Mass Index (BMI) and Mid Upper Arm Circumference (MUAC) are frequently used as standard measures to evaluate the efficacy of nutritional interventions, these indicators were not sufficiently sensitive in this study. Nor does weight gain necessarily indicate improved nutritional status. Hand-grip strength, lean body mass, and the BIA Illness Marker seem to be more useful indicators of change in nutritional status.
Highlights
Undernutrition is a serious but least addressed global health problem [1]
Nutritional deficiencies of vitamin B12, zinc and selenium in malnourished people living with HIV/AIDS are associated with decreased immunity and a higher risk of disease progression [8,9]
It should be noted that this population’s subsistence diet consists primarily of foods which are fortified according to government guidelines [29]; yet very low micronutrient levels were found at baseline
Summary
Undernutrition is a serious but least addressed global health problem [1]. Undernutrition interacts with repeated bouts of infectious disease, causing an estimated 3.5 million preventable maternal and child deaths annually [2]. Consequent negative outcomes include lower energy levels, lower educational attainment, impaired immunity and higher rates of disability and illness [6]. Those at highest risk are children, pregnant and breastfeeding mothers and immune compromised people, such as those living with HIV/AIDS and/or TB [7]. Nutritional deficiencies of vitamin B12, zinc and selenium in malnourished people living with HIV/AIDS are associated with decreased immunity and a higher risk of disease progression [8,9]. Problems related to childhood malnutrition and micronutrient deficiency include stunting of growth, low body weight, decreased physical activity and reduced resistance to disease [10]
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