October 7, 2009 -- Do nutritional supplements, fortified with micronutrients and essential fats, protect the health of HIV-positive women and their infants after weaning? Researchers at the University of North Carolina at Chapel Hill (UNC) will analyze data from a study in the African nation of Malawi to find out if the low-cost, locally-produced supplements make a difference.
Funded by the Bill & Melinda Gates Foundation, the study builds on a growing body of knowledge on the use of these ready-to-use supplements to prevent and treat malnutrition in breastfed children, but is the first to examine their use among HIV-infected mothers and their infants. The supplements contain ground peanuts, dried full cream, vegetable oil, and sugar; they are fortified with micronutrients, including vitamins like B6 and B12 and minerals like iron, selenium, and zinc, which are needed in small quantities.
"We have two primary goals with this study," said Margaret "Peggy" Bentley, PhD, principal investigator and professor of nutrition and associate dean for Global Health in the UNC Gillings School of Global Public Health. "First, we'll examine whether mothers who consumed the supplements while breastfeeding have better nutrition and health outcomes. When mothers weaned their infants at 6 months to prevent them from passing HIV to the infants through the breastmilk, they were provided with a similar micronutrient-fortified supplement to support the nutrition of their infants. The study will let us see what affect the supplements have on the infant's growth and development during the first 12 months."
The study will analyze data already gathered from a large HIV randomized breastfeeding intervention trial of HIV-infected women and their infants, the Breastfeeding, Antiretroviral, and Nutrition (BAN) study, which began in Lilongwe, Malawi in 2004. The parent study's principal investigators are Charles van der Horst, MD, UNC professor of medicine, and Denise Jamieson, MD, MPH, team leader of the Unintended Pregnancy, STD, HIV Intervention Research group, in the Women's Health and Fertility Branch at the Centers for Disease Control and Prevention.
More than 2,300 mother-infant pairs were enrolled in the trial. After giving birth, half of BAN-enrolled mothers were randomly assigned to receive the nutritional supplement for six months while they fed their infants breastmilk exclusively. When the infants were six months of age, all mothers were counseled to wean them from breastmilk, in order to prevent transmission of HIV via breastfeeding. All study infants then received the daily fortified supplement, in addition to available family foods.
The Gates-funded study will analyze maternal breastmilk and maternal and infant plasma for levels of vitamins and minerals that are important for maternal health and for infant growth and development.
Findings from the UNC study could have broader applications to other poor countries that experience high rates of malnutrition and mortality. The supplements are inexpensive and can be consumed at home during mealtime. Also, they do not require water, reducing the risk of introducing a water-borne disease. They also can be modified for a baby's changing nutritional needs.
Linda Adair, PhD, professor of nutrition in the UNC Gillings School of Global Public Health, will direct the analysis of the study. She and Bentley both are faculty fellows at UNC's Carolina Population Center, where the project will be housed. Bentley and Adair also led the nutrition team for the larger study. Principal scientific collaborators in Malawi are Dumbani Kayira, MBBS and Charles Chasela, MsC, PhD candidate, both affiliated with the University of North Carolina. Laboratory analyses for the nutrition biomarker data will be conducted by the USDA Agricultural Research Station, Davis, California, under the direction of Lindsay Allen, PhD.
"Other studies have shown that these micronutrient-fortified nutritional supplements are an excellent complement to breastmilk, especially in resource-poor countries," said Bentley, who is also associate director of the Institute for Global Health & Infectious Diseases at UNC. "This study gives us a unique opportunity to see how beneficial the supplements are when the infants are no longer breastfed. It's also the first to assess whether the supplements help HIV-positive mothers stay healthy."
For more information about the new study, go to http://www.cpc.unc.edu/projects/grants.php?show=167
For information about the original study, go to http://www.cpc.unc.edu/projects/grants.php?show=149
For more on the BAN study, go to http://thebanstudy.org
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