Use of lipid-based nutrient supplements by HIV-infected Malawian women during lactation has no effect on infant growth from 0 to 24 weeks.
The Breastfeeding, Antiretrovirals, and Nutrition Study evaluated the effect of daily consumption of lipid-based nutrient supplements (LNS) by 2121 lactating, HIV-infected mothers on the growth of their exclusively breast-fed, HIV-uninfected infants from 0 to 24 wk. The study had a 2 × 3 factorial design. Malawian mothers with CD4(+) ≥250 cells/mm(3), hemoglobin ≥70 g/L, and BMI ≥17 kg/m(2) were randomized within 36 h of delivery to receive either no LNS or 140 g/d of LNS to meet lactation energy and protein needs, and mother-infant pairs were assigned to maternal antiretroviral drugs (ARV), infant ARV, or no ARV. Sex-stratified, longitudinal, random effects models were used to estimate the effect of the 6 study arms on infant weight, length, and BMI. Logistic regression models were used to calculate the odds of growth faltering [decline in weight-for-age Z-score (WAZ) or length-for-age Z-score (LAZ) >0.67] using the control arm as the reference. Although some differences between study arms emerged with increasing infant age in boys, there were no consistent effects of the maternal supplement across the 3 growth outcomes in longitudinal models. At the ages where differences were observed, the effects on weight and BMI were quite small (≤200 g and ≤0.4 kg/m(2)) and unlikely to be of clinical importance. Overall, 21 and 34% of infants faltered in WAZ and LAZ, respectively. Maternal supplementation did not reduce the odds of infant weight or length faltering from 0 to 24 wk in any arm. These results indicate that blanket supplementation of HIV-infected lactating women may have little impact on infant growth.
Carolina Population Center, School of Medicine, University of North Carolina, Chapel Hill, NC, USA. flax@unc.edu
Valerie L
VL
Flax
Margaret E
ME
Bentley
Charles S
CS
Chasela
Dumbani
D
Kayira
Michael G
MG
Hudgens
Rodney J
RJ
Knight
Alice
A
Soko
Denise J
DJ
Jamieson
Charles M
CM
van der Horst
Linda S
LS
Adair
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001827:Body Height / Q000187:drug effects; D015992:Body Mass Index; D001835:Body Weight / Q000187:drug effects; D001942:Breast Feeding; D015704:CD4 Antigens; D004032:Diet; D004041:Dietary Fats / Q000494:pharmacology / Q000627:therapeutic use; D019587:Dietary Supplements; D005260:Female; D006128:Growth / Q000187:drug effects*; D006130:Growth Disorders / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D015658:HIV Infections / Q000150:complications*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena / Q000187:drug effects*; D007231:Infant, Newborn; D007774:Lactation; D008055:Lipids / Q000494:pharmacology; D016015:Logistic Models; D008137:Longitudinal Studies; D008295:Malawi / Q000453:epidemiology; D008297:Male; D009751:Nutritional Requirements; D015995:Prevalence; D011502:Protein-Energy Malnutrition / Q000517:prevention & control; D012737:Sex Factors; D055815:Young Adult
D019380:Anti-HIV Agents; D015704:CD4 Antigens; D004041:Dietary Fats; D006454:Hemoglobins; D008055:Lipids