Abstract
Loss of lean muscle mass impairs immunity and increases mortality risk among individuals with HIV/AIDS. We evaluated the relative contributions of protein supplementation and nutrition education on body composition among 600 women living with HIV/AIDS in rural Andhra Pradesh, India. We conducted a cluster randomized controlled 2 × 2 factorial trial lasting six months with follow up at twelve and eighteen months. Interventions occurred in the Nellore and Prakasam regions of Andhra Pradesh by trained village women, ASHA (Accredited Social Health Activists), and included: (1) the usual supportive care from ASHA (UC); (2) UC plus nutrition education (NE); (3) UC plus nutritional protein supplementation (NS); (4) combined UC plus NE plus NS. A Bioimpedance Analyzer Model 310e measured body composition. SAS 9.4 analyzed all data. Mixed models using repeated measures evaluated lean mass change from baseline as primary and fat weight and total weight as secondary outcomes. Lean mass change was significantly associated with NS (p = 0.0001), NE (p = 0.0001), and combined NS plus NE (p = 0.0001), with similar associations for secondary outcomes. Stronger associations for total weight were observed with greater ART adherence. Nutritional interventions may improve physiologic response to HIV. Significant increases in lean mass resulted from independent and combined protein supplementation and nutrition education.
Highlights
A healthy immune response to infectious disease is dependent upon adequate nutrition
We assessed the relative contributions of nutritional protein supplementation and nutrition education on body composition outcomes by conducting a cluster-randomized 2 × 2 factorial trial among 600 women living with HIV/AIDS in the rural region of Andhra Pradesh, India
Study results point to important influences of nutrition both in terms of supplementation as well as education, and when provided in conjunction with an AIDS self-management intervention inclusive of Asha support result in improved lean mass as well as body weight and fat mass among women living with HIV/AIDS in rural South India
Summary
A healthy immune response to infectious disease is dependent upon adequate nutrition. Lack of nutrients, and diminished absorption can lead to immune deficiency; thereby increasing susceptibility to infectious diseases, worsening prognosis, and increasing risk of mortality [1]. Stimulation of the immune response increases demand for critical nutrients associated with enzymatic reactions and substrates, and this excess strain on the immune system can lead to nutritional deficiency [3]. If these deficiencies occur at the start of anti-retroviral therapy (ART), the risk of mortality is increased independent of immune status [5,6,7]. Nutrient deficiencies can, through weakening of the immune response, increase susceptibility to infection from opportunistic diseases [2]
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