title: Supplementary feeding with either ready-to-use fortified spread or corn-soy blend in wasted adults starting antiretroviral therapy in Malawi: randomised, investigator blinded, controlled trial.
abstract: OBJECTIVE
  To investigate the effect of two different food supplements on body mass index (BMI) in wasted Malawian adults with HIV who were starting antiretroviral therapy.
  
  
  METHODS
  Randomised, investigator blinded, controlled trial.
  
  
  METHODS
  Large, public clinic associated with a referral hospital in Blantyre, Malawi.
  
  
  METHODS
  491 adults with BMI <18.5.
  
  
  METHODS
  Ready-to-use fortified spread (n=245) or corn-soy blend (n=246).
  
  
  METHODS
  
  
  
  METHODS
  changes in BMI and fat-free body mass after 3.5 months.
  
  
  RESULTS
  survival, CD4 count, HIV viral load, quality of life, and adherence to antiretroviral therapy.
  
  
  RESULTS
  The mean BMI at enrolment was 16.5. After 14 weeks, patients receiving fortified spread had a greater increase in BMI and fat-free body mass than those receiving corn-soy blend: 2.2 (SD 1.9) v 1.7 (SD 1.6) (difference 0.5, 95% confidence interval 0.2 to 0.8), and 2.9 (SD 3.2) v 2.2 (SD 3.0) kg (difference 0.7 kg, 0.2 to 1.2 kg), respectively. The mortality rate was 27% for those receiving fortified spread and 26% for those receiving corn-soy blend. No significant differences in the CD4 count, HIV viral load, assessment of quality of life, or adherence to antiretroviral therapy were noted between the two groups.
  
  
  CONCLUSIONS
  Supplementary feeding with fortified spread resulted in a greater increase in BMI and lean body mass than feeding with corn-soy blend.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN67515515.
authors.affiliation: Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: MacDonald J
authors.initials: MJ
authors.lastname: Ndekha
authors.forename: Joep J G
authors.initials: JJ
authors.lastname: van Oosterhout
authors.forename: Eduard E
authors.initials: EE
authors.lastname: Zijlstra
authors.forename: Micah
authors.initials: M
authors.lastname: Manary
authors.forename: Haroon
authors.initials: H
authors.lastname: Saloojee
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Manary
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count; D019587:Dietary Supplements; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D019247:HIV Wasting Syndrome / Q000178:diet therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D016037:Single-Blind Method; D045730:Soy Foods; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult; D003313:Zea mays