A Randomized Controlled Trial Evaluating Nutrition Counseling with or without Oral Supplementation in Malnourished HIV-Infected Patients

Rabeneck, Linda; Palmer, Ann; Knowles, Jarol B.; Seidehamel, R. J.; Harris, Cheryl L.; Merkel, Kimberly L.; Risser, Jan M. H.; Akrabawi, S. S.

doi:10.1016/s0002-8223(98)00099-6

Cited by 62 publications

(28 citation statements)

References 12 publications

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“…A similar phenomenon of increased REE has been observed in other chronic diseases, such as end-stage renal disease [7], rheumatoid arthritis [8], cancer [9], and chronic obstructive pulmonary disease [10]. Interventions, such as diet counseling [11,12], nutritional supplementation [13][14][15], exercise [16,17], and pharmacologic therapies (with megestrol acetate [18], dronabinol [19], thalidomide [20,21], growth hormone [22][23][24], and testosterone [25,26]) may prevent loss of lean body mass in HIV-infected patients. However, no intervention has proven to be effective for normalizing REE.…”

supporting

confidence: 54%

“…A similar phenomenon of increased REE has been observed in other chronic diseases, such as end-stage renal disease [7], rheumatoid arthritis [8], cancer [9], and chronic obstructive pulmonary disease [10]. Interventions, such as diet counseling [11,12], nutritional supplementation expenditure in other patient populations. Finally, 97 sources were selected, including 10 randomized, controlled trials; 18 cohort studies; 40 cross-sectional studies; 8 review articles; 2 letters; 2 meta-analyses; 12 laboratory reports; 1 textbook; 2 case-control studies; 1 case series; and 1 case report.…”

supporting

confidence: 52%

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Dysregulated Energy Expenditure in HIV-Infected Patients: A Mechanistic Review

Chang¹,

Sekhar²,

Patel³

et al. 2007

Clinical Infectious Diseases

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Metabolic abnormalities are common in patients with human immunodeficiency virus (HIV) infection and range from protein catabolism to lipodystrophy and dyslipidemia associated with the use of highly active antiretroviral therapy. One abnormality is increased resting energy expenditure, which even occurs in clinically stable HIV-infected patients. Increased resting energy expenditure may aggravate the tendency towards weight loss and wasting, which are independent predictors of mortality. Despite much investigation, the factors associated with altered resting energy expenditure remain unclear; viral load, CD4 cell count, use of antiretroviral drugs, body composition, hormones, and proinflammatory cytokines have been imputed. Mechanisms that could explain increased resting energy expenditure include the HIV accessory protein viral protein R, antiretroviral drugs that affect mitochondrial function, and futile cycling within adipocytes. Other components of energy expenditure are also important to overall energy balance and may also be affected. Identifying unifying mechanisms will be an important step to finding effective treatments for HIV-related alterations in energy expenditure and to reversing metabolic risks in patients with HIV infection.

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supporting

confidence: 54%

“…A similar phenomenon of increased REE has been observed in other chronic diseases, such as end-stage renal disease [7], rheumatoid arthritis [8], cancer [9], and chronic obstructive pulmonary disease [10]. Interventions, such as diet counseling [11,12], nutritional supplementation expenditure in other patient populations. Finally, 97 sources were selected, including 10 randomized, controlled trials; 18 cohort studies; 40 cross-sectional studies; 8 review articles; 2 letters; 2 meta-analyses; 12 laboratory reports; 1 textbook; 2 case-control studies; 1 case series; and 1 case report.…”

supporting

confidence: 52%

Dysregulated Energy Expenditure in HIV-Infected Patients: A Mechanistic Review

Chang¹,

Sekhar²,

Patel³

et al. 2007

Clinical Infectious Diseases

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“…48 In the early stages of HIV infection, counseling should emphasize in- creasing protein and energy intake (eg, by mixing oil, eggs or milk powder through the meal). In case the caregiver lacks the physical strength or means to prepare calorie-dense meals, nutritional supplements could be helpful.…”

Section: Micronutrient Supplementation and Nutrition Counselingmentioning

confidence: 99%

“…In case the caregiver lacks the physical strength or means to prepare calorie-dense meals, nutritional supplements could be helpful. [47][48][49] Once HIV infection is more advanced, malabsorption becomes the determining factor and counseling should aim to enhance digestion and absorption. 47,50 Loss of developmental feeding skills, interference with effects of intercurrent illnesses, medication and psychosocial problems should be assessed routinely.…”

Section: Micronutrient Supplementation and Nutrition Counselingmentioning

confidence: 99%

Care and Treatment of HIV-Infected Children in Africa

Baets

Bulterys²,

Abrams³

et al. 2007

The Pediatric Infectious Disease Journal

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More than 90% of pediatric HIV infection occurs in sub-Saharan Africa and 75% of these children currently die before their fifth birthday. Most HIV-infected children in Africa rely on district hospitals for HIV treatment, but insufficient attention has been paid to improving HIV/AIDS care at this level. Considerable confusion exists about optimal use of combination antiretroviral treatment, prophylaxis for opportunistic infections and other rational healthcare interventions that can greatly improve the quality of life for these children. A simple and inexpensive infant HIV diagnostic assay and alternative laboratory markers of pediatric HIV disease progression would be highly beneficial. Routine anthropometric and neurodevelopmental assessments could help guide initiation and monitoring of antiretroviral therapy. Even in the absence of antiretroviral therapy, interventions such as immunizations, provision of micronutrients and nutrition counseling, prevention and treatment of opportunistic as well as endemic infections (such as helminths and malaria) can substantially reduce pediatric HIV-related morbidity and mortality. The need for pain relief, palliative care, counseling and emotional support is often underestimated. Surmounting the sense of hopelessness by providing district healthcare workers with training in basic pediatric HIV/AIDS care is an urgent priority.

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“…Following ONS, weight gain varied considerably and depended on the duration and amount of supplementation, and the disease status of patients. Mean percentage weight change in supplemented patients compared with unsupplemented control patients could be calculated in twenty-two randomized controlled studies of adults (duration of ONS 10 d-1 year, n 900 patients; Douglass et al 1978;Foster et al 1980;Elkort et al 1981;Simko, 1983;Lewis et al 1987;Norregaard et al 1987;Efthimiou et al 1988;Knowles et al 1988;Arnold & Richter, 1989;Donahoe et al 1989;Otte et al 1989;Fuenzalida et al 1990;Nayel et al 1992;Rogers et al 1992;Hirsch et al 1993;Fiatarone et al 1994;Woo et al 1994;Gray-Donald et al 1995;Volkert et al 1996;Jensen & Hessov, 1997;Keele et al 1997;Rabeneck et al 1998). The mean percentage weight change of patients receiving ONS (2·93 %) was greater than that of the unsupplemented control patients (1·15 %, mean difference 1·77, range −2·69 to 9·2 %; weighted for the number of subjects in each category).…”

Section: Outcome Measuresmentioning

confidence: 99%

Summary of a systematic review on oral nutritional supplement use in the community

Stratton

2000

Proc. Nutr. Soc.

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Despite a marked increase in the prescription of oral nutritional supplements (ONS) in the community (Department of Health, 1991–7), there is still uncertainty about the value of their use in patients with different diseases. To answer questions about the effects on ONS on body weight and structure, spontaneous food intake and body function, a critical systematic review was undertaken (Stratton & Elia, 1999a). Eighty-four trials were reviewed (forty-five randomized, thirty-nine non-randomized; 2570 patients; diagnoses including chronic obstructive pulmonary disease, Crohn’s disease, cystic fibrosis, human immunodeficiency virus and acquired immune deficiency syndrome and cancer). Most studies (83 %) were conducted in patients living at home. The supplements were typically mixed macronutrients in liquid form, providing < 0.42–10.5 MJ/d for 1 week–2 years. The studies reviewed in patients with predominantly chronic conditions living in the community suggested that: (1) ONS produce demonstrable clinical (including functional) benefits, but the nature and extent of these benefits varies with the underlying chronic condition; (2) ONS increase total energy intake with > 50 % of the energy from ONS typically additional to that from habitual food intake; (3) improvements in body weight, total energy intake and body function following ONS appear to occur more frequently in individuals with a BMI < 20 kg/m2 than in those with a BMI > 20 kg/m2.

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A Randomized Controlled Trial Evaluating Nutrition Counseling with or without Oral Supplementation in Malnourished HIV-Infected Patients

Cited by 62 publications

References 12 publications

Dysregulated Energy Expenditure in HIV-Infected Patients: A Mechanistic Review

Dysregulated Energy Expenditure in HIV-Infected Patients: A Mechanistic Review

Care and Treatment of HIV-Infected Children in Africa

Summary of a systematic review on oral nutritional supplement use in the community

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