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Leaf concentrate compared with skimmed milk as nutritional supplementation for HIV-infected children: a randomized controlled trial in Burundi

  • Simon M Collin (a1), Bernard Leclercq (a2), Novat Twungubumwe (a3), Laurent Andréoletti (a4), François-Christophe Richardier (a2) and Eric Bertin (a5)...
Abstract
Objective

The effectiveness of leaf concentrate powder (LCP) as a nutritional supplement was established in trials conducted among adolescent girls and pregnant women in India. Here we evaluate LCP, compared with skimmed milk powder (SMP), as a supplement for antiretroviral-naïve children living with HIV in a sub-Saharan African country.

Design

Randomized controlled, two-arm, 6-month trial comparing effects of isoproteic (5 g) LCP (10 g daily) and SMP (15 g daily) on HIV-1 viral load, CD4+ cell count/percentage, weight/height-for-age, general blood parameters, diarrhoea, respiratory and HIV-related opportunistic infections.

Setting

Bujumbura and Kirundo, Burundi.

Subjects

Eighty-three HIV-positive, antiretroviral-naïve children aged 5–14 years: median (range) CD4+ count, 716 (361–1690) cells/mm3; log10 HIV-1 viral load, 4·39 (1·79–6·00).

Results

LCP was equivalent to SMP in relation to HIV-specific blood parameters and did not demonstrate superiority over SMP in relation to Hb. Three children in each arm (LCP, 7·1 % (3/42); SMP, 7·3 % (3/41)) proceeded to antiretroviral therapy because their CD4+ counts fell below 350 cells/mm3. Children in the LCP group reported higher levels of appetite and overall health at 6 months. There were no differences in clinical events or any other outcome measures. LCP was less palatable than SMP to the children in this population, but there were few negative perceptions of appearance, texture and taste.

Conclusions

LCP appears to be equivalent to SMP as a nutritional supplement in this population, despite slightly lower palatability. In relation to viral load and CD4+ count, equivalence may indicate no effect in either group. Effectiveness relative to no supplementation remains to be determined.

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Corresponding author
* Corresponding author: Email simon.collin@bristol.ac.uk
References
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1. Rose, AM, Hall, CS & Martinez-Alier, N (2014) Aetiology and management of malnutrition in HIV-positive children. Arch Dis Child 99, 546551.
2. World Health Organization (2009) Guidelines for An Integrated Approach to the Nutritional Care of HIV-Infected Children (6 months–14 years). Geneva: WHO.
3. Anema, A, Zhang, W, Wu, Y et al. (2012) Availability of nutritional support services in HIV care and treatment sites in sub-Saharan African countries. Public Health Nutr 15, 938947.
4. Irlam, JH, Siegfried, N, Visser, ME et al. (2013) Micronutrient supplementation for children with HIV infection. Cochrane Database Syst Rev 10, CD010666.
5. Cobb, G & Bland, RM (2013) Nutritional supplementation: the additional costs of managing children infected with HIV in resource-constrained settings. Trop Med Int Health 18, 4552.
6. Davys, MNG, Richardier, FC, Kennedy, D et al. (2011) Leaf concentrate and other benefits of leaf fractionation. In Combating Micronutrient Deficiencies: Food-based Approaches, pp. 338365 [B Thompson and L Amoroso, editors]. Rome: FAO.
7. Vyas, S, Collin, SM, Bertin, E et al. (2010) Leaf concentrate as an alternative to iron and folic acid supplements for anaemic adolescent girls: a randomised controlled trial in India. Public Health Nutr 13, 418423.
8. Magon, A, Collin, SM, Joshi, P et al. (2014) Leaf concentrate fortification of antenatal protein–calorie snacks improves pregnancy outcomes. J Health Popul Nutr 32, 430440.
9. Esan, MO, Jonker, FA, Hensbroek, MB et al. (2012) Iron deficiency in children with HIV-associated anaemia: a systematic review and meta-analysis. Trans R Soc Trop Med Hyg 106, 579587.
10. Auld, AF, Tuho, MZ, Ekra, KA et al. (2014) Temporal trends in mortality and loss to follow-up among children enrolled in Cote d’Ivoire’s national antiretroviral therapy program. Pediatr Infect Dis J 33, 11341140.
11. Zanoni, BC, Phungula, T, Zanoni, HM et al. (2012) Predictors of poor CD4 and weight recovery in HIV-infected children initiating ART in South Africa. PLoS One 7, e33611.
12. Zanoni, BC, Phungula, T, Zanoni, HM et al. (2011) Risk factors associated with increased mortality among HIV infected children initiating antiretroviral therapy (ART) in South Africa. PLoS One 6, e22706.
13. Pirie, NW (1987) Leaf Protein and Its By-Products in Human and Animal Nutrition, 2nd ed. Cambridge: Cambridge University Press.
14. Kennedy, D (1993) Leaf Concentrate: A Field Guide for Small Scale Programs. Berea, KY: Leaf for Life.
15. Association pour la Promotion des Extraits Foliaires en Nutrition (2008) Homepage. http://www.nutrition-luzerne.org/ (accessed July 2015).
16. Conseil National de la Lutte Contre le VIH/SIDA (2010) Schemas de traitement par les arv au Burundi. Bujumbura, Burundi: Conseil National de la Lutte Contre le VIH/SIDA.
17. Cole, TJ, Freeman, JV & Preece, MA (1998) British 1990 growth reference centiles for weight, height, body mass index and head circumference fitted by maximum penalized likelihood. Stat Med 17, 407429.
18. Cole, TJ, Williams, AF & Wright, CM (2011) Revised birth centiles for weight, length and head circumference in the UK–WHO growth charts. Ann Hum Biol 38, 711.
19. Miller, TL (2000) Nutrition in paediatric human immunodeficiency virus infection. Proc Nutr Soc 59, 155162.
20. Salomon, J, De, TP & Melchior, JC (2002) Nutrition and HIV infection. Br J Nutr 87, Suppl. 1, S111S119.
21. Joint United Nations Programme on HIV/AIDS (2014) The Gap Report. Geneva: UNAIDS.
22. Newell, ML, Borja, MC & Peckham, C (2003) Height, weight, and growth in children born to mothers with HIV-1 infection in Europe. Pediatrics 111, e52e60.
23. Drain, PK, Kupka, R, Mugusi, F et al. (2007) Micronutrients in HIV-positive persons receiving highly active antiretroviral therapy. Am J Clin Nutr 85, 333345.
24. Marrodan Serrano, MD, Romero Collazos, JF, Moreno Romero, S et al. (2009) Handgrip strength in children and teenagers aged from 6 to 18 years: reference values and relationship with size and body composition. An Pediatr (Barc) 70, 340348.
25. Schweizer, R, Martin, DD, Schonau, E et al. (2008) Muscle function improves during growth hormone therapy in short children born small for gestational age: results of a peripheral quantitative computed tomography study on body composition. J Clin Endocrinol Metab 93, 29782983.
26. Kosmiski, L (2011) Energy expenditure in HIV infection. Am J Clin Nutr 94, issue 6, 1677S1682S.
27. World Health Organization (2003) Nutrient Requirements for People Living with HIV/AIDS. Geneva: WHO.
28. Ernst, J, Ettyang, G & Neumann, CG (2014) High-nutrition biscuits to increase animal protein in diets of HIV-infected Kenyan women and their children: a study in progress. Food Nutr Bull 35, 4 Suppl, S198S204.
29. Lima, LR, Silva, RC, Giuliano Ide, C et al. (2013) Bone mass in children and adolescents infected with human immunodeficiency virus. J Pediatr (Rio J) 89, 9199.
30. Hong, SY, Hendricks, KM, Wanke, C et al. (2013) Development of a nutrient-dense food supplement for HIV-infected women in rural Kenya using qualitative and quantitative research methods. Public Health Nutr 16, 721729.
31. Zotor, FB & Amuna, P (2008) The food multimix concept: new innovative approach to meeting nutritional challenges in Sub-Saharan Africa. Proc Nutr Soc 67, 98104.
32. Open Data for Africa (2014) Burundi Income and Daily Diet. http://burundi.opendataforafrica.org/aysvqnc/burundi-income-and-daily-diet (accessed July 2015).
33. Ministère des Finances et de la Planification du Développement Economique (2014) Enquête nationale agricole du Burundi 2012–2013. Bujumbura, Burundi: Ministère des Finances et de la Planification du Développement Economique.
34. Rossi, L, Verna, D & Villeneuve, SL (2008) The humanitarian emergency in Burundi: evaluation of the operational strategy for management of nutritional crisis. Public Health Nutr 11, 699705.
35. Verwimp, P (2012) Undernutrition, subsequent risk of mortality and civil war in Burundi. Econ Hum Biol 10, 221231.
36. European Food Safety Authority, Panel on Dietetic Products, Nutrition and Allergies (2009) Opinion on the safety of ‘Alfalfa protein concentrate’ as food. EFSA J 2009, 997.
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