Lean Mass Improvement from Nutrition Education and Protein Supplementation among Rural Indian Women Living with HIV/AIDS: Results from Cluster Randomized Factorial Trial at 18-Month Follow-Up

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.

Nutrition counselling and clinical outcomes in HIV: A systematic review and meta‐analysis

“…In terms of morbidity, we observed that, of the four studies that examined the effect of nutrition counselling on CD4 count, nutrition counselling led to significant improvements in CD4 count in two of the studies. The results of our meta-analysis also showed that nutrition counselling improved CD4 count by 55 cells/μL after 6 months, similar to reports from other studies [37]. A change in CD4 count of $55 cells/μL is less likely to alter treatment plans and is within the limits of error of many CD4 instrument evaluations [39].…”

“…Two studies examined other anthropometric measures (Table 4). The first was the 2 Â 2 factorial design cluster RCT conducted in Andhra Pradesh, India, with a follow-up until 18 months [7,37]. Nutrition counselling significantly increased lean mass by 6 months among those who also received supplementation by 2.4 kg (95% CI: 1.3-3.5), but not among those who did not also receive supplementation (MD: 0.5, 95% CI: À0.5-1.5).…”