Studies of vitamins and minerals and HIV transmission and disease progression

HIV-1 infection is having a devastating impact on people in developing countries. Poor nutrition and HIV-related adverse health outcomes contribute to a vicious cycle that may be slowed down by using nutritional interventions, including vitamins and minerals. Among children, periodic supplementation with vitamin A starting at 6 mo of age has been shown to be beneficial in reducing mortality and morbidity among both HIV-infected and uninfected children. Limited data exist on the role of other nutrient supplements among children. Among HIV-infected adults, the safety and the efficacy of vitamin A supplements need further study, although adequate dietary intake of this essential nutrient is recommended. Multivitamin supplements were efficacious in reducing adverse pregnancy outcomes and early childhood infections, and is currently provided to pregnant HIV-infected pregnant women in many programs. The efficacy of such supplements among HIV-negative pregnant women needs further study. Daily multivitamin supplements were found to reduce HIV disease progression among men and women in several observational studies and randomized trials, and to provide an important low-cost intervention that could be provided to adults in early stages of HIV disease to prolong the time before antiretroviral therapy is recommended. Next, research priorities include examining the roles of minerals, including selenium, in HIV infection, as well as determining the safety and the efficacy of micronutrient supplements among individuals who are advanced in their disease and who are receiving antiretroviral therapy.     

Nutritional and metabolic abnormalities in pre-AIDS HIV infection

Since the earliest reports of human immunodeficiency virus (HIV) disease, undernutrition has been associated with HIV infection, typically with the late stages of the disease (namely acquired immunodeficiency syndrome), and may advance to severe wasting and cachexia. Specific micronutrient deficiencies are also recognized to occur with HIV infection, but their actual effect on the clinical course of the disease is hard to assess. The studies reviewed provide more insight into the complex interface between undernutrition and, in some cases, obesity and HIV/acquired immunodeficiency syndrome and highlight the possibility of alleviating or curing undernutrition by means of simple and comparatively inexpensive dietary adjustments.     

未足月胎膜早破期待治疗妊娠结局的多因素分析

目的:探讨未足月胎膜早破(PPROM)期待治疗中母儿不良妊娠结局的独立危险因素。方法:回顾性分析132例PPROM孕妇的临床资料,按照有无孕妇及新生儿严重并发症(包括新生儿死亡)的发生分别分为孕妇不良妊娠结局组与对照组和新生儿不良结局组与对照组,分别比较两组患者的一般临床情况及各项检验指标。采用多因素Logistic回归分析母儿不良妊娠结局的危险因素。结果:132例期待治疗中,34例孕妇出现严重并发症,发生率为25.8%(34/132),无孕产妇死亡。胎死宫内4例,47例新生儿出现明显并发症,其中8例新生儿死亡,围产儿死亡率为5.8%(8/138)。经多因素回归分析,就诊时间(以2h为界)及感染是孕妇严重并发症发生的独立危险因素,分娩孕周、就诊时间及感染是新生儿病率及死亡率的独立危险因素。结论:PPROM期待治疗过程需严密监测及预防感染,孕周小者适当延长孕周;在2h内就诊,预防性使用抗生素及促胎肺成熟,可减少孕产妇感染及围生儿病死率。     

HIV与HBV单独感染及共感染对妊娠结局的影响

HIV和HBV有较高的流行率,威胁人类健康。越来越多的研究发现孕产妇HIV/HBV感染与不良妊娠之间存在联系,而且孕产妇HIV/HBV感染还会增加HIV、HBV母婴传播的风险。但目前有关这两种病毒共感染对不良妊娠结局和母婴传播的影响尚不清楚,有待进一步深入研究,为制定有效的预防措施提供科学依据,促进母婴健康。     

Dietary intake in HIV-positive persons with and without malabsorption.

This review examines the relationship among malabsorption, diarrhea, dietary intake, and body composition in an outpatient cohort of individuals with HIV infection. Twenty-three percent of the participants had malabsorption, which was not associated with the presence of current or chronic diarrhea. In this "outpatient" HIV cohort with a mean body-mass index (BMI) of 25 kg/m2, the presence of malabsorption did not have adverse nutritional outcomes in terms of body weight, lean body mass, hemoglobin, or albumin. The diets of those with or without malabsorption did not meet the goals of the Dietary Guidelines for Americans. Median dietary intake was high in percentage of total fat and saturated fat and low in total fiber intake and some key micronutrients.     

The correlates of dietary intake among HIV-positive adults.

BACKGROUND: Dietary adequacy, as distinct from weight loss, has not been examined thoroughly in a diverse cohort of HIV-infected individuals. OBJECTIVE: An analysis was undertaken to determine the correlates of inadequate dietary intake among HIV-infected adults. DESIGN: In a cross-sectional study of 463 men and 170 women (aged 21-70 y) with HIV infection, dietary adequacy was evaluated by using 3-d diet records. RESULTS: Among nondieting males, whites had higher energy intakes than did nonwhites. Injection drug users consumed less energy than did nonusers. Among nondieting females, only the absence of nausea and vomiting was marginally associated with higher energy intakes. Inadequate energy intake, which occurred in 38% of this population, was independently associated with female sex among nondieters. A significant proportion of the study cohort (52%) was consuming less than the recommended dietary allowance of vitamin A. Inadequate protein intake, found in 11% of the study population, occurred more often in females, those without a caregiving adult in the household, and individuals with reduced appetite. A considerable proportion of the participants (23%) reported that they were dieting to lose weight. CONCLUSIONS: Dietary inadequacy was strongly correlated with being in the sociodemographic groups that are at heightened risk of adverse clinical outcomes. It may be worthwhile to study dietary intake as a potential determinant of the clinical outcomes of HIV infection.     

Micronutrients and the pathogenesis of human immunodeficiency virus infection.

Micronutrient deficiencies may be common during human immunodeficiency virus (HIV) infection. Insufficient dietary intake, malabsorption, diarrhoea, and impaired storage and altered metabolism of micronutrients can contribute to the development of micronutrient deficiencies. Low plasma or serum levels of vitamins A, E, B6, B12 and C, carotenoids, Se, and Zn are common in many HIV-infected populations. Micronutrient deficiencies may contribute to the pathogenesis of HIV infection through increased oxidative stress and compromised immunity. Low levels or intakes of micronutrients such as vitamins A, E, B6 and B12, Zn and Se have been associated with adverse clinical outcomes during HIV infection, and new studies are emerging which suggest that micronutrient supplementation may help reduce morbidity and mortality during HIV infection.     

Maternal prenatal vitamin B12 intake is associated with speech development and mathematical abilities in childhood

Deficiencies of many nutrients in pregnancy have adverse effects on fetal brain development with consequent impaired cognitive function in childhood. However, it is unclear whether deficiencies of vitamin B12 prenatally are harmful to the developing fetus. We therefore used the Avon Longitudinal Study of Parents and Children to test the hypothesis that cognitive outcomes in childhood are reduced if their mothers consumed a diet low in vitamin B12 during pregnancy. A detailed exposome analysis was used to identify 9 factors independently associated with low vitamin B12 intake. These were taken into account in each of 26 outcome analyses. Results showed that the children of women with the lowest 10% intake of B12 were at increased risk of poor vocabulary at 24 months, reduced ability at combining words at 38 months, poor speech intelligibility at 6 years, poor mathematics comprehension at school years 4 and 6 (ages 8-9 and 10-11 years), and poor results on the national mathematics tests (age 13). There were no such significant adjusted associations for reading or spelling abilities, or for verbal or full-scale IQ (Intelligence Quotient) at 8 or at 15. Thus, we have confirmed that there are adverse effects on the child's development if the pregnant woman has a low intake of vitamin B12, and we have shown that these are specific to certain speech and mathematical abilities.     

Micronutrients and Adverse Pregnancy Outcomes in the Context of HIV Infection

HIV infection is a global public health problem, particularly in Africa. Concurrently, micronutrient deficiencies and adverse pregnancy outcomes are prevalent in the same settings. Supplements containing B complex and vitamins C and E were efficacious in reducing adverse pregnancy outcomes, including fetal loss, low birth weight, and prematurity among HIV-infected women; the generalizability of this finding to uninfected women is being examined. There is little encouragement from published studies to provide prenatal vitamin A supplements in HIV infection, particularly in light of significantly higher risk of mother-to-child transmission observed in one trial. The efficacy and safety of prenatal zinc and selenium supplements on these outcomes need to be examined in randomized trials .     

围生期解脲支原体感染与不良孕产结局及新生儿疾病关联

围生期解脲支原体感染与不孕不育、胎膜早破、绒毛膜羊膜炎、流产、早产甚至死胎死产等不良妊娠结局及诸多新生儿期疾病存在关联。本文将重点阐述围生期解脲支原体感染的流行病学特点,围生期解脲支原体暴露与不良孕产结局,新生儿尤其是早产儿相关疾病如脓毒症、支气管肺发育不良、脑室内出血和坏死性小肠结肠炎等的关联,以及解脲支原体诊断和防治措施,为临床防治提供参考。     

Dietary fat intakes for pregnant and lactating women

Dietary fat intake in pregnancy and lactation affects pregnancy outcomes and child growth, development and health. The European Commission charged the research project PERILIP, jointly with the Early Nutrition Programming Project, to develop recommendations on dietary fat intake in pregnancy and lactation. Literature reviews were performed and a consensus conference held with international experts in the field, including representatives of international scientific associations. The adopted conclusions include: dietary fat intake in pregnancy and lactation (energy%) should be as recommended for the general population; pregnant and lactating women should aim to achieve an average dietary intake of at least 200 mg DHA/d; intakes of up to 1 g/d DHA or 2.7 g/d n-3 long-chain PUFA have been used in randomized clinical trials without significant adverse effects; women of childbearing age should aim to consume one to two portions of sea fish per week, including oily fish; intake of the DHA precursor, alpha-linolenic acid, is far less effective with regard to DHA deposition in fetal brain than preformed DHA; intake of fish or other sources of long-chain n-3 fatty acids results in a slightly longer pregnancy duration; dietary inadequacies should be screened for during pregnancy and individual counselling be offered if needed.     

妊娠期高血压疾病的相关因素与妊娠结局

目的：分析妊娠高血压疾病的相关因素及其妊娠结局。方法采用回顾性调查法,通过病例对照分析,调查其相关因素及妊娠结局,最后进行单因素方差分析和Logistics多元回归分析。结果年龄、家庭收入、孕前体重指数、孕期不良环境暴露、孕期不良心理、孕期生活事件、孕期不良生活习惯等方面具有统计学差异（χ^2值分别为6．13、11．20、26．19、12．23、13．16、6．35、8．47,均P＜0．05）,而文化程度、早孕反应、先兆流产、既往不良妊娠史无显著性差异（χ^2值分别为3．06、2．56、0．03、1．13,均P＞0．05）。家庭收入、孕前体重指数、孕期不良心理与妊娠期高血压疾病呈显著正相关（P＜0．05）,研究组中不良妊娠结局发生率显著高于对照组（χ^2＝94．911,P＜0．001）。结论年龄、家庭收入、孕前体重指数、孕期生活事件、孕期不良环境暴露、孕期不良心理、孕期不良生活习惯会增加妊娠期高血压疾病的发生率,而妊娠期高血压疾病会增加不良妊娠结局风险。     

Energy and nutrient intake of elderly hospitalized patients in a steady metabolic status versus catabolic status

Protein undernutrition enhances frailty and aggravates intercurrent diseases generally observed in elderly patients. Undernutrition results from insufficient food intake and catabolic status. Daily nutrient intakes were explored for hospitalized geriatric patients. Nutrient intake (carbohydrates, lipids, proteins, and calcium) was determined in randomly selected geriatric patients (n=49) over five consecutive days by weighting food in the plate before and after meals. For each geriatric patient, catabolic status and risk factors of undernutrition were considered. Results were compared between patients in a steady status or catabolic status. In steady status patients, protein, lipid and carbohydrate intake but not calcium intake, met recommended dietary allowances (total caloric intake:1535 +/- 370 Cal/day ; protein:1+/- 0.4 g/kg/day ; carbohydrates:55 +/- 7.7 % ; lipids: 30 +/- 6.3 % ; calcium:918 +/- 341 mg/day) . Patients in catabolic status (cardiopulmonary deficiency , neurologic disease , inflammatory process) had lower total caloric intake, lower protein intake and dramatically lower calcium intake (total caloric intake : 1375 +/- 500 Cal/day ; protein :0.9 +/- 0.4 g/kg/day ; carbohydrates : 54 +/- 8.3 % ; lipids : 31 +/-6.2 % ; calcium : 866 +/- 379 mg/day). Nutrient intake was lower in elderly patients hospitalized in short stay care units, perhaps due to failure to recognize suitable nutrient requirements. Protein-caloric undernutrition should be diagnosed early during hospitalization in order to allow appropriate dietary supplementation. However the incidence of protein undernutrition among elderly patients as a cause or a consequence of adverse pathophysiological processes remains a cause of debate.     

妊娠期下生殖道感染调查

目的:调查妊娠期妇女下生殖道感染及不良妊娠结局的发生率。方法:对象为在天坛医院进行产前检查并住院分娩的412例孕妇,孕36周时取阴道及宫颈分泌物进行滴虫(T)、外阴阴道假丝酵母菌病(VVC)、细菌性阴道病(BV)、衣原体(CT)、支原体(UU或Mh)及B族-溶血性链球菌(GBS)检测。根据感染情况分为感染组和非感染组,并追踪两组患者不良妊娠结局的发生情况。结果:412例妊娠期妇女下生殖道感染总检出率为27.62%,单一病原菌感染者70例,检出率为16.99%,其中UU最多,检出率6.55%,BV次之,检出率2.91%。多种病原菌同时感染者44例,检出率10.68%,其中以BV合并其他病原菌感染者最多,检出率7.28%。感染组胎膜早破、未足月胎膜早破、早产、产褥感染、绒毛膜羊膜炎发生率均较非感染组高(与非感染组相比,P0.05)。BV合并其它病原菌感染导致不良妊娠结局的总致病率为96.64%,远高于其它单一病原菌感染的致病率。结论:UU或BV合并其它病原微生物感染是妊娠期下生殖道感染中较常见的感染类型,相对于其它单一病原体感染,BV合并其它病原菌感染更易导致不良妊娠结局的发生,有必要对妊娠期妇女进行下生殖道感染的筛查和治疗。     

A systematic review of dietary intake after laparoscopic adjustable gastric banding

Background: Laparoscopic adjustable gastric banding (LAGB) is currently one of the most popular surgical obesity treatments worldwide. Although dietary modification is recognised as a key factor in determining weight loss and health outcomes post surgery, existing evidence regarding changes in dietary intake after LAGB has not been systematically evaluated. This is essential for developing best‐practice dietetic guidelines for the management of LAGB patients. The aim of this systematic review was to evaluate the current evidence base regarding changes in dietary intake after LAGB. Methods: A literature search of Medline, EMBASE, Scopus, Cinahl and the Cochrane Library from 1990 to February 2010 was conducted to identify original studies that assessed dietary intake in adults who have undergone LAGB. Results: Only 11 articles (10 separate studies) met inclusion criteria. Although the strength of the evidence base is limited by the small number of studies, observational study designs and methodological weaknesses, the results indicate that short‐term positive changes occur post surgery, including reduced caloric intake, contributed to by reductions in fat, carbohydrate and protein intake. Issues including optimal macronutrient intake, diet quality and longer‐term sustainability of reduced food intake remain largely unexplored. Because no dietary intervention studies were identified, evidence‐based dietary strategies that may help optimise weight loss outcomes and other health outcomes remain unknown. Conclusions: There is a paucity of high‐quality evidence regarding changes in dietary intake after LAGB. Further well‐designed, dietary‐based intervention research will be beneficial to better establish dietetic management guidelines for optimising outcomes for individuals who have LAGB.     

Prevalence and public-health significance of HIV infection and anaemia among pregnant women attending antenatal clinics in south-eastern Nigeria

HIV infection and anaemia are major public-health problems in Africa and are important factors associated with an increased risk of adverse pregnancy outcomes. The objective of this study was to determine the prevalence of HIV infection and anaemia among pregnant women attending antenatal clinics in southeastern Nigeria. To achieve this, a cross-sectional survey was conducted during July 2005-June 2006 using standard techniques. Of 815 pregnant women studied, 31 (3.8%, 95% confidence interval [CI] 2.5-5.1) were HIV-positive. Maternal age and gestational age were not associated with HIV infection (p > 0.05). The prevalence of anaemia (Hb < 11.0 g/dL) was 76.9%, and 15 (1.8%, 95% CI 0.9-2.7) had severe anaemia (Hb <7.0 g/dL). A significantly higher prevalence of anaemia was observed among individuals in their second pregnancy trimester (p < 0.05) and those infected with HIV (p < 0.05). Since HIV and anaemia are preventable, antenatal care services could serve as a pivotal entry point for simultaneous delivery of interventions for the prevention and control of HIV infection and anaemia in pregnant women.     

HIV Pre-Exposure Prophylaxis (PrEP) in a Brazilian Clinical Setting: Adherence,Adverse Events,Sexual Behavior,and Sexually Transmitted Infections

Tenofovir/emtricitabine (TDF/FTC) has been used as pre-exposure prophylaxis (PrEP) in preventing HIV infection. PrEP is an effective prevention tool as demonstrated in clinical trials and studies in clinical practice and was incorporated into the Brazilian public health system in December 2017. The present study was a prospective cohort that included 219 PrEP users monitored over a 10 month follow-up period in a capital city in Northeastern Brazil. Data were collected from the PrEP users’ electronic medical records platform made available by the Brazilian Health Ministry. During the observation period, there was good user retention to the prevention program (84%) and there was high adherence to medication (90%). Almost half the users (49%) presented an adverse event, although these were mild and transient, 30 days after starting prophylaxis. There was a significant reduction in creatinine clearance (p?<?.001), from 104.9 to 83.5 mL/min; however, there was no need for drug discontinuation. Throughout the cohort, there was no significant change in the number of sexual partners, but the use of condoms during sexual intercourse decreased (p?<?.001). There was a non-significant increase in the incidence of syphilis (p?=?.08), and there was a 50% decrease in reporting signs and symptoms of sexually transmitted infections. No cases of HIV infection were observed. PrEP proved to be an effective tool in HIV prevention, presenting few complications of adverse events.

     

Lipid metabolism during the perinatal phase, and its implications on postnatal development

During pregnancy, lipid metabolism plays a major role to warrant the availability of substrates to the foetus. By using different experimental designs in the rat we have been able to answer several questions that were open about the short- and long-term effects of alterations of lipid metabolism during the perinatal stage. The first one was to demonstrate the importance of maternal body fat depot accumulation during the first half of pregnancy. We found that conditions like undernutrition circumscribed to this specific period when foetal growth is still small, that impede such fat accumulation not only restrain intrauterine development but also have long-term consequences, as shown by an impaired glucose tolerance when adults. Secondly, undernutrition during suckling has major long-term effect decreasing body weight, even though food intake was kept normal from the weaning period. Present findings also show that a diet rich in omega-3 fatty acids during pregnancy and lactation has negative effects on offspring development, but cross fostered experiments showed that the effect was a consequence of the intake of these fatty acids during the lactation period rather than during pregnancy. Pups from dams that were fed a fish oil-rich diet during pregnancy and lactation were found to have altered glucose/insulin relationship at the age of 10 weeks. Since a omega-3 fatty acid-rich diet decreases milk yield during lactation, additional experiments were carried out to determine whether decreased food intake, altered dietary fatty acid composition, or both were responsible for the long-term effects on the glucose/insulin axis. Results show that the decreased food intake caused by a omega-3 fatty acid-rich diet rather than the change in milk composition during suckling was responsible for the reduced pancreatic glucose responsiveness to insulin release at 16 weeks of age. In conclusion, present findings indicate that impaired maternal fat accumulation during early pregnancy and food intake during lactation, rather than a difference in dietary fatty acid composition have a greater influence on postnatal development and affect glucose/insulin relationships in adult rats.     

Energy expenditure in HIV infection

Energy intake recommendations for adults should be based preferably on direct measurements of total daily energy expenditure (TDEE) in corresponding populations who are maintaining healthy body weight and satisfactory physical activity levels. During adolescence, pregnancy, and lactation, energy requirements should be based on TDEE plus the additional energy required to advance these physiologic states. With illness, energy expenditure and energy intake change, but nutritional intervention is not necessarily beneficial. This article reviews data on energy expenditure in HIV infection with a focus on adults, adolescents aged ≥14 y, and pregnant and lactating women. Resting energy expenditure (REE) in adults with untreated asymptomatic HIV is ~ 10% higher than in healthy control subjects. In asymptomatic adults receiving antiretroviral therapy, REE may be similarly increased. HIV wasting and secondary infections are also associated with increased REE. In contrast, TDEE is typically normal in asymptomatic HIV and decreased in HIV wasting and secondary infection. No direct measurements of REE or TDEE are available in adolescents or in pregnant or lactating women with HIV. On the basis of current data, energy intake may need to increase by ~ 10% in adults with asymptomatic HIV to maintain body weight. In adolescents and in pregnant and lactating women with asymptomatic HIV, energy requirements should approximate recommendations for their uninfected counterparts until further data are available. In the resource-rich world, the energy expenditure changes associated with HIV are unlikely to contribute to significant weight loss. More data are needed on energy expenditure in HIV-infected populations from developing nations, where concurrent malnutrition and coinfections are common.     

Maternal Vitamin D and Newborn Telomere Length

Nutrition is important during pregnancy for offspring health. Gestational vitamin D intake may prevent several adverse outcomes and might have an influence on offspring telomere length (TL). In this study, we want to assess the association between maternal vitamin D intake during pregnancy and newborn TL, as reflected by cord blood TL. We studied mother–child pairs enrolled in the Maternal Nutrition and Offspring’s Epigenome (MANOE) cohort, Leuven, Belgium. To calculate the dietary vitamin D intake, 108 women were asked to keep track of their diet using the seven-day estimated diet record (EDR) method. TL was assessed in 108 cord blood using a quantitative real-time PCR method. In each trimester of pregnancy, maternal serum 25-hydroxyvitamin D (25-OHD) concentration was measured. We observed a positive association (β = 0.009, p-value = 0.036) between newborn average relative TL and maternal vitamin D intake (diet + supplement) during the first trimester. In contrast, we found no association between average relative TL of the newborn and mean maternal serum 25-OHD concentrations during pregnancy. To conclude, vitamin D intake (diet + supplements), specifically during the first trimester of pregnancy, is an important factor associated with TL at birth.