|Year : 2013 | Volume
| Issue : 2 | Page : 99-102
Impact of nutritional counseling on dietary practices and body mass index among people living with HIV/AIDS at a tertiary care teaching hospital in Mumbai
Sushma S Gaikwad1, Purushottam A Giri2, Sudam R Suryawanshi3, Suneela Garg4, MM Singh4, VK Gupta4
1 Department of Medicine, T. N. Medical College and BYL Nair Ch. Hospital, Mumbai, India
2 Department of Community Medicine (PSM), Rural Medical College and Pravara Rural Hospital of Pravara Institute of Medical Sciences (Deemed University), Loni, India
3 Department of Community Medicine (PSM), T. N. Medical College and BYL Nair Ch. Hospital, Mumbai, India
4 Department of Community Medicine (PSM), Maulana Azad Medical College, New Delhi, India
|Date of Web Publication||6-Jul-2013|
Sushma S Gaikwad
Department of Medicine, T. N. Medical College and BYL Nair Ch. Hospital, Mumbai
Source of Support: None, Conflict of Interest: None
Background: In India, human immunodeficiency virus (HIV) epidemic occurs in the population in which malnutrition is already endemic. The relationship between HIV and nutrition is multi-faceted and multi-directional. HIV can cause or worsen malnutrition due to decreased food intake, increased energy requirements, and poor nutrient absorption. Malnutrition in turn further weakens the immune system, increasing susceptibility to infections and worsening the disease impact.
Materials and Methods: This interventional study was carried out in the antiretroviral therapy (ART) Centre of Topiwala National Medical College and BYL Nair Ch. Hospital, Mumbai during the period of July 2011 to February 2012. A total of 123 patients during the study period were included and a pre-designed and pre-tested questionnaire was used to collect data. Data were analyzed using Statistical Package of Social Sciences (SPSS) 16.0.
Results: In the present study, out of 123 study participants taken into consideration, 47.15% were males and 52.85% were females. After nutritional counseling, the percentage of participants practice of using boiled or clean water for drinking purpose increased significantly from 30.90% to 82.12% ( P < 0.0001) and to not eat leftover food increased from 26.83% to 81.30% ( P < 0.0001). The change in mean BMI was observed to be statistically significant from baseline Visit I (20.859) to Visit III (21.916) ( P < 0.0001).
Conclusion: Effects of nutritional counselling in our study groups were favourable. There were improvements in dietary practices about nutrition in people living with HIV/AIDS.
Keywords: Antiretroviral therapy, body mass index, dietary practices, nutritional counseling, people living with human immunodeficiency virus/acquired immune deficiency syndrome
|How to cite this article:|
Gaikwad SS, Giri PA, Suryawanshi SR, Garg S, Singh M M, Gupta V K. Impact of nutritional counseling on dietary practices and body mass index among people living with HIV/AIDS at a tertiary care teaching hospital in Mumbai. J Med Nutr Nutraceut 2013;2:99-102
|How to cite this URL:|
Gaikwad SS, Giri PA, Suryawanshi SR, Garg S, Singh M M, Gupta V K. Impact of nutritional counseling on dietary practices and body mass index among people living with HIV/AIDS at a tertiary care teaching hospital in Mumbai. J Med Nutr Nutraceut [serial online] 2013 [cited 2020 Dec 1];2:99-102. Available from: https://www.jmnn.org/text.asp?2013/2/2/99/114721
| Introduction|| |
An estimated 33 million people are infected with human immunodeficiency virus (HIV) worldwide. India stands at a critical junction of HIV pandemic. If the rate of HIV infection were to rise by just a few percentage points, million more Indians will be affected by the virus.  The relationship between HIV and nutrition is multi-faceted and multi-directional. HIV can cause or worsen malnutrition due to decreased food intake, increased energy requirements, and poor nutrient absorption. Malnutrition in turn further weakens the immune system, increasing susceptibility to infections, and worsening the disease impact.  Nutritional care and support helps to break this vicious cycle by helping individuals improve, maintain, or slow down the decline of nutritional status, manage symptoms, boost immune response, and improve adherence.  Addressing the gaps in nutrition among people living with HIV and acquired immune deficiency syndrome (AIDS) (PLWHA) is essential because nutrition plays a vital role in the care and management of HIV and AIDS as it is intrinsically linked to immune function.  However, consumption of proper nutrients, which can be enhanced by knowledge of importance of good nutrition for the PLWHA and proper dietary practices, can support an already-compromised immune system.  Though there are many Indian studies on HIV prevalence and about their high risk behavior, very little is known about nutritional counseling and dietary practices followed by PLWHA. Therefore, this study was undertaken to assess the impact of nutritional counseling on dietary practices of people living with HIV/AIDS with socio-demographic characteristics at a tertiary care teaching hospital in Mumbai.
| Materials and Methods|| |
This pre- and post-test interventional study was carried out during the period of July 2011 to February 2012 at ART Centre of Topiwala National Medical College and BYL Nair Ch. Hospital, Mumbai. It caters to a population coming from all classes of society but predominantly from the middle and lower classes. Ethical committee of the T. N. Medical College, Mumbai had approved the study. A total of 123 patients who were HIV positive and on first line ART treatment as per National AIDS control organization (NACO) guidelines and age >18 years of either sex as an inclusion criteria during the study period were enrolled for the study. All the patients who fulfilled the inclusion criteria during study period were included and were informed about the purpose of the study. No one refused to participate in the study. Hence, the total sample size came to 123 patients. Informed consent of each participant was taken. These patients were scheduled for nutritional counseling session with care giver which included, pre-designed and semi structured interview. Health counselors from HIV service organizations were the main source of health and nutrition information. The information included general care for the PLWHA, importance of good nutrition for the PLWHA, and proper hygiene practices. Patients were counseled individually for dietary practices and also for symptom-based nutritional counseling. This was carried out by ART team with the help of handouts. A pre-designed and pre-tested questionnaire was used to get information regarding socio-demographic factors and dietary practices of patients. All the questions were asked in the participant's language or else the meaning was properly conveyed. Patient's height, weight, and BMI were recorded by the counseling team at Visit I. All patients were given diet sheet individually after assessing daily nutritional requirements. Patients were assessed for the dietary practices of taking snacks in between meal. They were counseled for the importance of adding snacks in between meals, to increase size of portion during meals, and add feed (oil, sugar, etc.) to increase the energy content of dish. Patients were advised to follow-up at one month interval for Visits II and III. The relevant data including weight and BMI were measured and recorded in patient's case report form. At the end of Visit III, patients were assessed for their dietary practices about nutrition with the help of post-test questionnaire. Socio-economic status was assessed by the modified Prasad's classification.  Data were entered in MS Excel and analyzed using Statistical Package of Social Sciences (SPSS) 16.0. Statistical significance was set at P ≤ 0.05.
| Results|| |
Socio-demographic profile of the study participants is shown in [Table 1]. Out of the total 123 patients, 57 (46.35%) were in the age group of 36-45 years followed by 48 (39.03%) in the age group of 26-35 years. According to modified Prasad's classification, about 90 (73.18%) belonged to lower middle class followed by 20 (16.26%) who belonged to upper lower class. Majority 88 (71.55%) were laborers and 29 (23.58%) were housewives. About 47 (38.22%) had studied upto primary level schooling, 41 (33.33%) upto secondary and 31 (25.20%) were illiterate.
|Table 1: Study population according to socio-demographic characteristics|
Click here to view
As observed from [Table 2] that out of the 123 patients, after counseling 89.43% participants were aware of the importance of taking snacks in between meals in a day (P < 0.0001). The number of people who had the practice of usingboiled or clean water for drinking purpose increased from 30.90% to 82.12% and who did not eat leftover food increased from 26.83% to 81.30% (P < 0.0001).After counseling, the percentage of participants whose dietary practice of not eating raw egg/uncooked food like raw vegetable salads increased from 35.78% to 97.56% (P < 0.0001) and the number of people who had the practice to keep food covered increased from 83.74% to 100%.
|Table 2: Questions on dietary practices about nutrition among the study population (n=123)|
Click here to view
Association of mean weight and body mass index in Visits I and III in the study population is depicted in [Table 3]. The change in mean BMI was observed to be statistically significant from baseline Visit I (20.859) to Visit III (21.916) (P < 0.0001).
|Table 3: Association of weight and BMI in visits I and III in the study population (n=123)|
Click here to view
| Discussion|| |
Nutrition interventions are an integral part of HIV care at any stage of disease and throughout the life cycle.  It is well understood that poor nutritional status has a detrimental effect on immune system development and its functions.  Similarly, declining immune function, as is experienced in HIV infection, has a direct and indirect impact on nutritional status.  In our study, the percentage of participant's practice to use boiled or clean water for drinking purpose increased from 30.90% to 82.12% (P < 0.0001) and practice of not eating raw egg/uncooked food like raw vegetable salads increased significantly from 35.78% to 97.56% (P < 0.0001). The practice of hand washing before and after the meals and cooking also increased from 75.60% to 100%. After counseling 89.43% participants had the awareness of taking snacks in between meals in a day (P < 0.0001). Other studies have shown low socio-economic status, level of education, personal beliefs, availability of food, and low nutrition awareness as contributory factors to poor dietary practices.  The cycle of malnutrition and HIV has been well documented. At an individual level, a broad range of factors may contribute to declining health and nutritional status for people with HIV and people who are the most vulnerable to HIV.
In our study, we found that many patients eat less snacks in between meals and majority were eating leftover and uncooked food. The majority of patients did not have access to clean and boiled water for drinking purpose. Religious and cultural beliefs may prohibit the consumption of certain foods and influence behavior change.  When questions were asked to participants like "Have you taken two or more snacks in between meals in a day?," initially only 34.9% participants knew about the same, but after counseling, 89.4% were aware of it (P < 0.0001). In this study, patients were counseled to increase energy contents of food by informing them to eat more frequently by adding snacks in between meals, increase size of portion during meals, and add feed (oil, sugar etc.) to increase the energy content of dish. Food and nutrition security are fundamentally important for the prevention, care, treatment and mitigation of HIV and AIDS. Gillespie and Kadiyala  showed that a program of care without a nutritional component is likely to crumble and the efficacy of ART may be compromised by malnutrition. Similarly, since access to and availability of food are affected by the impact of HIV, any strategy to improve nutrition of those affected must prioritize enhancing appropriate nutritional knowledge and use of the little available food.  Poor nutritional knowledge and dietary practices therefore play a key role in the rapid progression of HIV.  Nutrition interventions can improve health outcomes and are an integral part of HIV care at any stage of disease and throughout the life cycle.
| Conclusion|| |
The individual nutritional counseling was effective in improving dietary practices in adults living with HIV infection. They were also effective in improving the nutritional status (weight and BMI) in these patients. The interventions geared at improving the nutritional practices are essential and may help in the prevention of rapid progression of HIV. There is need for further study of nutritional counseling with protein and micronutrients supplement and for long duration especially in HIV-tuberculosis (TB) co-infected patients.
| Acknowledgment|| |
We express our deep sense of gratitude to the Dr. D. S. Asgoankar, Professor and Head, Department of Medicine, T. N. Medical College, Mumbai. We also acknowledge the help and support of Chief Dietician Mrs. Salomi Benjamin and her team, all the staff of ART Centre, and Dr. Dyneshwar Gajbhare, Department of PSM, Nair Ch. Hospital, Mumbai.
| References|| |
|1.||HIV sentinels surveillance and HIV estimation in India 2007: A technical brief. Social morbidity of AIDS in high prevalence districts of Andhra Pradesh. New Delhi: Ministry of Health and Family Welfare; 2007. NACO. |
|2.||Castleman T, Megan D, Alison T. A Guide to Monitoring and Evaluation of Nutrition Assessment, Education and Counseling of People Living with HIV. Food and Nutrition Technical Assistance Project, Academy for Educational Development, Washington DC, 2008. p. 5-9. |
|3.||Fields-Gardner C, Fergusson P, American Dietetic Association, Dietitians of Canada. Position of the American Dietetic Association and Dietitians of Canada: Nutrition intervention in the care of persons with human immunodeficiency virus infection. J Am Diet Assoc 2004;104:1425-41. |
|4.||Tang AM. Weight loss, wasting and survival in HIV-positive patients: Current strategies. AIDS 2003;13:23-7. |
|5.||Walsh CM, Dannhauser A, Joubert G. Impact of a nutrition education programme on nutrition knowledge and dietary practices of lower socioeconomic communities in the Free State and Northern Cape. S Afr J Clin Nutr 2003;16:89-95. |
|6.||Rao TB. Sociology in Medicine. 1 st ed. Guntur: Sree Graphics; 2002. p. 76. |
|7.||Amati L, Cirimele D, Pugliese V, Covelli V, Resta F, Jirillo E. Nutrition and immunity: Laboratory and clinical aspects. Curr Pharm Des 2003;9:1924-31. |
|8.||Trujillo EB, Borlase BC, Bell SJ, Guenther KJ, Swails W, Queen PM, et al. Assessment of nutritional status, nutrient intake, and nutrition support in AIDS patients. J Am Diet Assoc 1992;92:477-8. |
|9.||Gillespie S, Kadiyala S. HIV and AIDS and Food and Nutrition Security; From Evidence to Action. Washington, DC: International Food Policy Research Institute, Food Policy Review No. 7.; 2005. p. 81. |
|10.||Blossner M, De Onis M. Malnutrition: Quantifying the health impact at national and local levels. Geneva, World Health Organization. WHO Environmental Burden of Disease Series, No. 12, 2005. p. 41-3. |
|11.||Kim JH, Spiegelman D, Rimm E, Gorbach SL. The correlates of dietary intake among HIV-positive adults. Am J Clin Nutr 2001;74:852-61. |
[Table 1], [Table 2], [Table 3]
|This article has been cited by|
||Reducing Undernutrition through Counseling on Diversified Food Intake among Adult People Living with HIV on HAART, Northern Ethiopia
| ||Weldegebrial Hayelom Tedla,Alemseged Aregay,Kidanu Gebremariam,Mulugeta Woldu Abrha,Haftom Gebrehiwot Weldearegay |
| ||Journal of Nutrition and Metabolism. 2020; 2020: 1 |
|[Pubmed] | [DOI]|
||Impact of counseling in knowledge, attitude and practice and association of nutritional status with CD4 count and opportunistic infections of HIV patients of Udupi, India
| ||Pratik Pokharel,Pallavi G. Shettigar |
| ||Clinical Nutrition ESPEN. 2018; |
|[Pubmed] | [DOI]|
||Nutritional Supplementation Is a Necessary Complement to Dietary Counseling among Tuberculosis and Tuberculosis-HIV Patients
| ||Adriana Costa Bacelo,Andrea Ramalho,Pedro Emmanuel Brasil,ClŠudia dos Santos Cople-Rodrigues,Ingebourg Georg,Eliane Paiva,Sheila Vasques Leandro Argolo,Valeria Cavalcante Rolla,Wenzhe Ho |
| ||PLOS ONE. 2015; 10(8): e0134785 |
|[Pubmed] | [DOI]|