2. Department of Nutrition, University of Applied Sciences, Muenster, Germany.
3. Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
4. Department of Biomedical Sciences, University of Dschang, Dschang, Cameroon.
Background: Effective strategies to improve nutritional status exist, though short-termed and less sustainable for HIV patients in resource limited settings. The aim of this study was to describe the BMI of treatment naïve HIV patients in Yaoundé, Cameroon, and investigate the effects of nutritional education and lifestyle modification on the nutritional status of these patients.
Method: A cluster randomized trial was conducted between 2010 and 2012, and included 5 health facilities, randomized either to the intervention (HIV-Care-Program) or control group (usual care). The HIV-Care-Program consisted of counselling lessons for 6 months on: nutrition, hygiene and coping with stigma and discrimination, complemented by practical activities. Primary outcome variable were change in BMI and serum albumin after 6 months, using analysis of covariance. BMI was calculated from weight (kg) and height (m2) and categorized as: underweight (BMI < 18.5), normal weight (18.5 ≤ BMI ≤ 24.9), overweight (25 ≤ BMI ≤ 29.9) and obese (BMI ≥ 30 kg/m2) and used to estimate the prevalence of underweight, normal weight and overweight/obesity. Serum albumin level was determined by the Bromocresol green method.
Results: Of the 201 participants enrolled, 190 were included in the final analysis. 58% of the study participants in the intervention group were overweight/obese, 40% normal weight and 2% underweight. Whereas the distribution in the control group was: 54.5% overweight/obese, 43.5% normal weight and 2% underweight. The BMI in the intervention group was 26.1 kg/m2 95% CI (24.5, 27.6) and 25.8 kg/m2 95% CI (24.5, 27.1) in the control group. After six months, BMI increased by 1.9% in the intervention group and decreased by 3% in the control group (P= 0.088). Serum albumin level increased from 2.1 g/dl 95% CI (1.8, 2.4) to 4.2 g/dl 95% CI (3.8, 4.5) in the intervention group and decreased from 3.4 g/dl 95% CI (3.2, 3.7) to 3.3 g/dl 95% CI (3.0, 3.6) in the control group (p<0.001).
Conclusion: The HIV-Care-Program provides an effective low-cost alternative improving serum albumin for treatment naïve HIV patients. The high prevalence of overweight and obesity observed, suggests that qualified dieticians should be involved in the care and management of HIV, and thus future nutritional interventions should also focus on optimising weight in treatment naive patients.
Keywords: BMI, HIV, nutritional education, lifestyle, cluster randomization, nutritional status