| Nutritional management of HIV/AIDS in the era of highly active antiretroviral therapy: a review
Marijka Batterham, Dannae Brown and Roger Garsia
Abstract HIV/AIDS is a major global health problem and is currently the fourth leading cause of death in the world. Nutritional management of people with HIV/AIDS has become increasingly complex since the introduction of new antiretroviral agents taken in combinations referred to as highly active antiretroviral therapy (HAART). HAART has resulted in improved survival times. However, side effects and complications are common. Prior to the introduction of HAART, weight loss was the major nutritional issue in people with HIV/AIDS and was associated with an increase in morbidity and mortality. Although weight loss continues to occur in the post HAART era, HAART side effects and lipodystrophy syndrome have become the major focus of the literature. Lipodystrophy syndrome refers to subcutaneous peripheral fat loss and/or visceral adiposity often accompanied by metabolic abnormalities, particularly hyperlipidaemia and insulin resistance, in people with HIV/AIDS taking HAART. A formal definition for this syndrome has not yet been established which makes determination of the prevalence of the syndrome difficult. The cause of the syndrome remains elusive. However, it has been found to occur only in those people with HIV/AIDS taking antiretroviral therapy. It is likely that the syndrome is a direct consequence of the antiretroviral drugs interfering with normal metabolism or it may be a result of the immune reconstitution on successful therapy. The syndrome is of concern because of the potential increase in metabolic disorders related to hyperlipidaemia and insulin resistance. (Aust J Nutr Diet 2001;58:211-223)
Nutritional management of HIV in the era of highly active antiretroviral therapy: a review of treatment strategies
Dannae Brown and Marijka Batterham
Abstract The introduction of highly active antiretroviral therapy (HAART) has resulted in marked improvements in HIV disease outcome with improved long-term survival. These changes in disease treatment have necessitated changes in nutritional management strategies. Weight loss continues to occur in the HAART era and dietary counselling, oral supplementation, enteral and parenteral nutrition and pharmacological agents are treatment options. The introduction of HAART has been complicated by drug and nutrient interactions, the load of pills to be taken and side effects that all need to be considered in a dietary assessment. HAART has been associated with peripheral lipodystrophy or fat redistribution syndrome--a syndrome characterised by various combinations of hyperlipidaemia, insulin resistance, loss of peripheral fat stores, visceral adiposity and/or dorso-cervical fat accumulation. This syndrome has complicated the nutritional management of HIV and potential treatments and may require dietary modification, exercise and pharmacological treatments. Each patient could have a combination of different abnormalities all requiring an individually modified treatment strategy. Nutritional management of people with HIV/AIDS has become extremely complex and knowledge of conventional and current issues is essential to assist people maximise nutritional status. (Aust J Nutr Diet 2001;58:224-235)
An evaluation of the impact of the folate and neural tube defects health claim pilot
Maxwell Watson and Lyndsey Watson
Abstract
Objective: To evaluate the impact of the pilot folate and neural tube defect health claim instituted by the Australia New Zealand Food Authority (ANZFA).
Design: Analysis of data, provided by ANZFA, from: 1. cross-sectional population-based telephone surveys conducted in 1998 prior to, and in 1999 after the implementation of, the pilot claim; 2. food industry data on implementation of the claim from the same time period; and 3. contemporaneous retail sales data.
Subjects: 2324 women of child-bearing age.
Setting: Australian population.
Main outcome measures: Changes in knowledge and attitudes to folate, uptake of the pilot health food claim and changes in consumption of foods over the period of the claim.
Statistical analyses: For survey data, binary and multinomial logistic regression was used to estimate odds ratios after adjustment for variations in socio-demographic characteristics and survey source.
Results: Over the survey period there was an increase in the proportion of women who had heard of folate (82% to 89%) and were aware of the association between folate and birth defects (33% to 41%), P < 0.001. Knowledge about foods containing folate increased for leafy green vegetables (40% to 52%), and for cereals (26% to 49%), P = 0.001 and P < 0.001 respectively. Although there was uptake of the claim by the food industry, there was no evidence for change in purchase of foods with folate messages.
Conclusions: This evaluation has shown that although there were increases in knowledge about folate over time, these may not be due solely to the folate health claim.
(Aust J Nutr Diet 2001;58:236-241)
Insight
Acting on Australia’s weight: a local areas focus on a national strategy
Fiona Collins and Katherine Pronk
Abstract Overweight and obesity are increasing. While life expectancy and some health statistics are improving, obesity is one of the few health problems that is moving in the wrong direction. Acting on Australia’s weight: a strategic plan for the prevention of overweight and obesity was developed by the National Health and Medical Research Council in 1997. An audit conducted in June 2000 in the Greater Bunbury area, Western Australia, determined what action was being taken in line with the national strategic plan. Interviews involving key government and non-government representatives at local, state and national levels, Internet searches and a literature search were conducted to identify current activity. Areas requiring action were identified and recommendations were made for intervention. Results showed that, of the eight strategies identified in the strategic plan, most had been actioned in the Greater Bunbury area, without a coordinated approach. The exceptions were strategy five, health care, and strategy eight, coordination of effort. The research reported in this paper has been useful to indicate the extent of the standards met and level of achievement in a local health service area towards the overall goal of the strategic plan. (Aust J Nutr Diet 2001;58:242-245)
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Australian Journal of Nutrition and Dietetics, Volume 58, Number 4, December 2001