Effect of nutritional supplementation of breastfeeding HIV positive mothers on maternal and child health: findings from a randomized controlled clinical trial

Abstract

BackgroundIt has been well established that breastfeeding is beneficial for child health, however there has been debate regarding the effect of lactation on maternal health in the presence of HIV infection and the need for nutritional supplementation in HIV positive lactating mothers.AimsTo assess the effect of nutritional supplementation to HIV infected lactating mothers on nutritional and health status of mothers and their infants.MethodsA randomized controlled clinical trial to study the impact of nutritional supplementation on breastfeeding mothers. Measurements included anthropometry; body composition indicators; CD4 count, haemoglobin and albumin; as well as incidence rates of opportunistic infections; depression and quality of life scores. Infant measurements included anthropometry, development and rates of infections.ResultsThe supplement made no significant impact on any maternal or infant outcomes. However in the small group of mothers with low BMI, the intake of supplement was significantly associated with preventing loss of lean body mass (1.32 kg vs. 3.17 kg; p = 0.026). There was no significant impact of supplementation on the infants.ConclusionsA 50 g daily nutritional supplement to breastfeeding mothers had no or limited effect on mother and child health outcomes.Clinical trial registrationISRCTN68128332 (http://www.controlled-trials.com/ISRCTN68128332)

Use of Lipid-Based Nutrient Supplements by HIV-Infected Malawian Women during Lactation Has No Effect on Infant Growth from 0 to 24 Weeks

“…The Guatemala study showed that thinner, supplemented mothers had higher breast milk energy content and output, indicating one of the biological mechanisms through which maternal supplementation could improve infant growth (23). The South African study is most comparable to the one presented here, because the supplement and study population were similar and high mean maternal BMI likely limited the effect of maternal supplementation in both cases (29). Taken together, these results suggest that maternal supplementation should be targeted at women with poor nutritional status, even in HIV-infected populations.…”

“…The energy and micronutrient content of breast milk is dependent on maternal dietary intake and stores, and some nutrients in breast milk can be increased with supplementation (22,23). The effects of maternal supplementation during pregnancy and lactation on infant growth are mixed (23)(24)(25)(26)(27)(28)(29), but it appears that improvements in maternal weight status and infant growth are more likely to occur in thinner mothers (23,24). We expected to find that HIVinfected mothers in a country with regular food insecurity would fall into this category.…”

Interventions to Address Chronic Disease and HIV: Strategies to Promote Exercise and Nutrition Among HIV-Infected Individuals

“…In contrast, Kindra found that a daily serving of a nutritional supplement that provided 280 kilocalories of energy and 8 grams of protein in a randomized controlled clinical trial had no significant impact on maternal or infant outcomes. The latter study may not have provided sufficient calories to support the additional energy needs of pregnant HIV-infected women [21]. In a small group of mothers with low BMI at baseline in the aforementioned study, the supplement was associated with preservation of lean body mass.…”

Breastmilk Output in a Disadvantaged Community with High HIV Prevalence as Determined by the Deuterium Oxide Dose-to-Mother Technique

“…22 The deuterium dilution method can also be used to determine maternal body composition in terms of whole-body fat and fat-free mass and was used in a study looking at whether nutritional supplementation would alter fat-free body mass in lactating mothers, which is of particular importance for HIV-infected mothers. 23 To the authors' knowledge, there are few studies that have measured postdelivery maternal fat-free mass changes in conjunction with determination of the breastmilk output volumes, using the deuterium dilution technique for both measurements. Two studies of lactating mothers were carried out in different communities in Kenya, but both studies had limited sample sizes of only 10 mothers.…”