A Lipid-Based Nutrient Supplement Mitigates Weight Loss among HIV-Infected Women in a Factorial Randomized Trial to Prevent Mother-to-Child Transmission during Exclusive Breastfeeding

Citation

Kayira, Dumbani; Bentley, Margaret E.; Wiener, Jeffrey B.; Mkhomawanthu, Chimwemwe; King, Caroline C.; Chitsulo, Phindile; Chigwenembe, Maggie; Ellington, Sascha R.; Hosseinipour, Mina C.; & Kourtis, Athena P., et al. (2012). A Lipid-Based Nutrient Supplement Mitigates Weight Loss among HIV-Infected Women in a Factorial Randomized Trial to Prevent Mother-to-Child Transmission during Exclusive Breastfeeding. American Journal of Clinical Nutrition, 95(3), 759-765. PMCID: PMC3278250

Abstract

Background: Breastfeeding increases metabolic demands on the mother, and excessive postnatal weight loss increases maternal mortality.Objective: We evaluated the efficacy of a lipid-based nutrient supplement (LNS) for prevention of excess weight loss in breastfeeding, HIV-infected women.
Design: The BAN (Breastfeeding, Antiretrovirals, and Nutrition) Study was a randomized controlled trial in Lilongwe, Malawi. At delivery, HIV-infected mothers and their infants were randomly assigned according to a 2-arm (with and without LNS) by 3-arm (maternal triple-antiretroviral prophylaxis, infant-nevirapine prophylaxis, or neither) factorial design. The 28-wk LNS intervention provided daily energy (700 kcal), protein (20 g), and micronutrients (except for vitamin A) to meet lactation needs. Women were counseled to breastfeed exclusively for 24 wk and to wean by 28 wk. Weight change (0–28 wk) was tested in an intent-to-treat analysis by using 2-factor ANOVA and with longitudinal mixed-effects models.
Results: At delivery, the LNS (n = 1184) and control (n = 1185) groups had similar mean weights and BMIs. Women receiving the LNS had less 0–28-wk weight loss (−1.97 compared with −2.56 kg, P = 0.003). This difference remained significant after adjustment for maternal antiretroviral drug therapy and baseline BMI. Women receiving antiretroviral drugs had more weight loss than did those not receiving antiretroviral drugs (−2.93 compared with −1.90 kg, P < 0.001). The benefit of the LNS for reducing weight loss was observed both in those receiving antiretroviral drugs (−2.56 compared with −3.32 kg, P = 0.019) and in those not receiving antiretroviral drugs (−1.63 compared with −2.16 kg, P = 0.034).
Conclusions: The LNS reduced weight loss among HIV-infected, breastfeeding women, both in those taking maternal antiretroviral prophylaxis to prevent postnatal HIV transmission and in those not receiving antiretroviral prophylaxis. Provision of an LNS may benefit HIV-infected, breastfeeding women in resource-limited settings.

URL

http://dx.doi.org/10.3945/ajcn.111.018812

Reference Type

Journal Article

Year Published

2012

Journal Title

American Journal of Clinical Nutrition

Author(s)

Kayira, Dumbani
Bentley, Margaret E.
Wiener, Jeffrey B.
Mkhomawanthu, Chimwemwe
King, Caroline C.
Chitsulo, Phindile
Chigwenembe, Maggie
Ellington, Sascha R.
Hosseinipour, Mina C.
Kourtis, Athena P.
Chasela, Charles S.
Tembo, Martin
Tohill, Beth Carlton
Piwoz, Ellen G.
Jamieson, Denise J.
van der Horst, Charles M.
Adair, Linda S.,
for the BAN Study Team

PMCID

PMC3278250

ORCiD

Adair - 0000-0002-3670-8073
Bentley - 0000-0002-1220-0208