Department of Nutrition and Dietetics

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The effects of increased energy and protein intakes and highly active antiretroviral therapy on growth and body composition of HIV+ Romanian children.
(Monduzzi Editore, 2000) Ernst, Judith A.; Heiser, C; Fineberg, N; Cuff, P; Dinu, M; Chintea, O; Vasile, R; Mullinax, M; Matusa, R
Diet quality, growth and body composition were assessed over one year in 15 HIV+, prepubescent Romanian children. Those with highly active antiretroviral therapy (+HAART; n=5) vs medication naïve (-HAART; n=10) at Time 0 revealed a greater energy (E) intake in +HAART (p=0.01); both groups exceeded FAO recommended intakes for E and protein (PRO). No difference in age-adjusted weight (WT), height (HT), body mass index (BMI), arm fat (MAFA) or arm muscle was evident at baseline. Changes in z-scores of anthropometrics from 0 to 6 months, were greater in +HAART for WT (p=0.02), HT(p= 0.03), BMI (p=0.06), and MAFA (p <0.001); changes were not different from 6 to 12 months. We conclude that intakes exceeding recommendations for E and PRO are adequate to maintain growth in HIV-infected Romanian children; and HAART is associated with a greater caloric intake although this difference is not maintained over time.
HIV Infection and Nutrition Status: The Importance of Food in Disease Management
(Global Livestock CRSP, UC Davis, 2008-11) Ernst, Judith A.; Ettyang, Grace; Neumann, Charlotte; Nyandiko, Winstone; Siika, Abraham
Preliminary evidence suggests that improved nutrition early in human immunodeficiency virus (HIV) infection may delay progression to acquired immunodeficiency syndrome (AIDS) and delay the initiation or improve the effectiveness of antiretroviral drug therapy (ART). The scientific community has evolved in its appreciation of the value of food as an integral component of comprehensive care for individuals with HIV infection and AIDS. It is now well recognized that those who are food insecure and malnourished are more likely to fail drug treatment regimens. Body mass index (BMI) < 18 at the initiation of ART is strongly predictive of death. In addition, weight loss during the first four weeks of ART is also associated with death. A higher BMI is protective and is associated with better responses with ART. Patient response to nutrition intervention, however, may be confounded by the stage of HIV progression and other infections. That is, those who are in the earlier stages of the disease may respond better to aggressive nutrition intervention. The HIV Nutrition Project (HNP), "Increasing Animal Source Foods in Diets of HIV-infected Kenyan Women and Their Children," will evaluate the effect of protein quality and micronutrients found in meat on the health and nutritional well-being of women living with HIV in rural Kenya and the health and development of their children. By means of a randomized nutrition feeding intervention, researchers will study if the inclusion of meat added as an ingredient to a biscuit, when compared to soy or wheat, will best protect the immune system and prevent severe infection, prevent the loss of body mass and enhance the quality of life. These women are not yet receiving antiretroviral drugs and therefore not yet experiencing metabolic inefficiencies associated with AIDS.
The Academic Model Providing Access To Healthcare (AMPATH) in Kenya
(Global Livestock CRSP, UC Davis, 2008-11) Nyandiko, Winstone; Siika, Abraham; Ernst, Judith A.; Ettyang, Grace; Neumann, Charlotte; Yiannoutsos, Constantin
In sub-Saharan Africa, an estimated 28 million people are living with the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). In 2001, Moi University in Eldoret, Kenya joined with Kenya’s second national referral hospital, Moi Teaching and Referral Hospital (MTRH) and Indiana University (IU) to establish the Academic Model Providing Access To Healthcare (AMPATH). AMPATH’s missions were to (1) provide high-quality patient care; (2) educate patients and health care providers; and (3) establish a laboratory for clinical research in HIV/AIDS (http://medicine.iupui.edu/kenya/hiv.aids.html). Leveraging the power of an academic medical partnership, AMPATH has quickly become one of the largest and most comprehensive HIV/AIDS control systems in sub-Saharan Africa, providing a comprehensive system of care that has been described as a model of sustainable development (Tobias, 2006). Delivery of services occurs in the public sector through hospitals and health centers run by Kenya’s Ministry of Health. AMPATH currently implements prevention activities that touch the lives of millions of persons in a wide geographic area. The research arm of AMPATH, created to facilitate and manage the international research agenda being generated by Kenyan and US faculty, includes the Global Livestock CRSP’s HIV Nutrition Project (HNP), “Increasing Animal Source Foods in Diets of HIV-infected Kenyan Women and Their Children,” which is a collaborative initiative between AMPATH and faculty from Moi University, Indiana University and the University of California, Los Angeles.
Introduction to the HIV Nutrition Project (HNP): Increasing Animal Source Foods (ASF) in Diets of HIV-infected Kenyan Women and Their Children
(Global Livestock CRSP, UC Davis, 2008-11) Ernst, Judith A.; Ettyang, Grace; Neumann, Charlotte; Nyandiko, Winstone; Siika, Abraham; Yiannoutsos, Constantin
Many of the 28 million people with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) estimated to be living in sub-Saharan Africa also suffer from malnutrition. Reproductive-aged women, their infants and young children are among the most vulnerable to malnutrition and progression of HIV to AIDS. As seen in eastern and southern Africa, mortality is increased in the malnourished. The HIV Nutrition Project (HNP) researchers will be evaluating the effect of protein quality and micronutrients found in meat on the health and nutritional well-being of women living with HIV in rural Kenya and the health and development of their children. By means of a randomized nutrition feeding intervention, the study will determine if meat in the diets of HIV-infected women and their children (1) protects the immune system and prevents severe infection, (2) prevents the loss of lean body mass, enhancing the quality of life among these drug naive women and enabling women to carry out their activities of daily living, and (3) supports the growth and development of their vulnerable children when compared to those given supplements with the same amount of energy, but with either soya or wheat protein. The intervention food with beef protein provides significantly more vitamin B12, lysine and bio-available iron and zinc when compared to the soya and wheat supplements. Deficiencies of these nutrients may hasten HIV disease progression.
Experience and Challenges in the Recruitment and Retention of HIV-infected Rural Kenyan Women and Their Children into a Randomized Nutrition Intervention Study
(Global Livestock CRSP, UC Davis, 2010-01) Verdun, Deidre; Siika, Abraham; Sawe, Caroline; Ernst, Judith A.
Despite the knowledge and information available about HIV, stigma is still present. The affects of stigma are real and tangible. Globally HIV positive people are marginalized and often dread that their HIV status will adversely affect them socially. The belief that HIV-infected people are somehow deviant, or misconceptions about the mode of transmission fuels anxiety, fear, and distrust, which translates into barriers to adequate health care, emotional distress, and actions that can have adverse affects on health outcomes. When working with HIV-infected individuals and those at risk of becoming infected with HIV, the impact of stigma can be crippling to research. Stigma associated with HIV has had a significant role in the ability to recruit and retain eligible study subjects for a nutrition based HIV study, Increasing Animal Source Foods in Diets of HIV-infected Kenyan Women and Their Children (HNP). While this study specifically focused on HIV-infected women living in Kenya, the generalization gathered could be extrapolated to other populations. It is recommended that similar studies conduct focus groups with the study population prior to piloting, to ensure stakeholder input and an understanding of the particular challenges and concerns within a local context. Future studies should also employ individuals known in the community that the population trusts to assist with recruitment. Finally, factors that identify study staff, or associate subjects with the study should be minimal to reduce the risk of disclosing a subject’s HIV status.
Food Security Among HIV-infected Rural Kenyan Women
(Global Livestock CRSP, UC Davis, 2010-01) Keverenge-Ettyang, Grace; Neumann, Charlotte; Ernst, Judith A.
Food insecurity limits capacity to meet the specific nutritional needs of HIV/AIDS affected people. HIV infection itself undermines food security and nutrition by reducing work capacity and productivity and jeopardizing household livelihoods. The HIV Nutrition Project’s (HNP) food intervention study funded by the GL-CRSP through USAID has the improvement of household food security through an increased intake of animal source foods as one of the core objectives. In addition to health and nutritional status assessment, the proxy measures being used by HNP to capture changes in a household’s ability to access food over time include the Household Food Insecurity Access Scale (HFIAS) with a range of 0-27, the Household Dietary Diversity Score (HDDS) with a range of 0-12, and the Months of Adequate Household Food Provisioning (MAHFP) score with a range of 0-12. Of the 104 HIV-infected drug naïve women enrolled in the study thus far, 49% live on less than USD 1.00 per day and spend less than USD 5.00 per year for purchases of medicine. Preliminary findings show that at baseline, their mean (SD) age, CD4 cell count, Hemoglobin (Hb), and Body Mass Index (BMI) were 34.8 (7.0), 502 (212), 12.4 (1.6), and 22.4 (3.7), respectively. The HFIAS score (SD) of 7 (2.4) and a 42.7% prevalence of severe food insecurity reflected household worry due to inadequate food, and the consumption of fewer or small meals. The MAHFP score (SD) was 5.24 (2.7) with majority of the households having limited access to food during the months of July (74%), August (83%), and September (72%). The HDDS (SD) of 6.10 (1.9) suggests a prevalence of low food diversity in diets. With the exception of milk, which is mostly consumed in tea, there was very minimal consumption of animal source foods. The scores for these proxy measures of household food insecurity indicate that though the current CD4 counts and Body Mass Indices (BMI) of the study population are within the normal range, their habitual diets are likely to be poor due to the high prevalence of food insecurity.
Estimates of body composition in drug naive asymptomatic HIV-infected rural Kenyan women
(2010-07-19) Ernst, Judith A.; Ettyang, G; Katschke, A; Lewis, B; Neumann, C
To compare methods that estimate body composition in drug naive asymptomatic HIV-infected rural Kenyan women enrolled in a randomized nutrition intervention field study that will determine if meat added to the diet prevents the loss of lean body mass
Zinc protoporphyrin in HIV+ drug naïve rural Kenyan women
(2010-10-06) Ernst, Judith A.; Ettyang, G; Katschke, A; Neumann, C
To determine if ZPP/H is a good indicator of iron depletion in drug naïve asymptomatic HIV-infected rural Kenyan women who are of reproductive age and enrolled in a randomized nutrition intervention field study that will determine the impact of added meat, soy or wheat protein on iron status.
Hand Grip Strength and Body Composition in HIV-Infected Rural Kenyan Women
(2012-04-23) Ernst, Judith A.; Ettyang, Grace; Johnson, Cynthia; Nyandiko, Winstone; Siika, Abraham; Neumann, Charlotte
To determine if meat in the diets of HIV infected rural Kenyan women prevents the loss of strength and body mass in those not yet ill enough to warrant antiretroviral drugs.
High-nutrition biscuits to increase animal protein in diets of HIV-infected Kenyan women and their children: A study in progress
(Food and Nutrition Bulletin, 2014-12-30) Ernst, Judith A.; Ettyang, Grace; Neumann, Charlotte G.
Background. Preliminary evidence suggests that improved nutrition early in HIV infection may delay progression to AIDS and delay the initiation or improve the effectiveness of antiretroviral drug therapy. There are few studies that evaluate food-based interventions in drug-naïve, HIV-infected women and their children. Meat provides several nutrients identified as important in maintaining immune function and lean body mass. Objective. To design supplemental meat and soybean biscuits for use in a randomized trial examining the effect of meat in the diet of drug-naïve, HIV-infected rural Kenyan women on changes in weight, lean body mass, morbidity, nutritional status, and activities of daily living of the women and growth and development of their children. Methods. We designed three supplemental biscuits: one with added dried beef, another with added soybean flour, and a wheat biscuit to serve as a control biscuit to be used in a randomized feeding intervention in drug-naïve, HIV-infected rural Kenyan women and their children. The nutritional contents of the different types of biscuit were examined and compared. Results. The three biscuits were isocaloric. Meat biscuits provided more lysine, vitamin B12, and bioavailable zinc. Soybean biscuits provided more total and absorbable iron; however, higher fiber and phytate contents may inhibit nutrient absorption. Data analysis for clinical outcomes of the trial is ongoing. Conclusions. The “biscuit model” is useful for nutrition supplementation studies because it can be provided in a blinded and randomized fashion, safely and privately in a home under directly observed consumption by a highly stigmatized population. It is well received by adults and children, and the biscuits can be produced locally with available, simple, affordable technology.

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