Nutrition and Metabolic Insights

Background: Malnutrition is a major global public health issue and its impact on communities and individuals is more dramatic in ­Sub-Saharan­Africa,­where­it­is­compounded­by­widespread­poverty­and­generalized­high­prevalence­of­human­immunodeficiency­ virus (HIV). Therefore, malnutrition should be addressed through a multisectorial approach, and malnourished individuals should have­ access­ to­ nutritional­ rehabilitation­molecules­ that­ are­ affordable,­ accessible,­ rich­ in­nutrient­ and­ efficient.­We­ thus­ assessed­ the­ efficacy­of­ two­affordable­ and­accessible­nutritional­ supplements,­ spirulina platensis versus soya beans among malnourished HIV-infected adults. Methods: Undernourished patients, naïve of, but eligible to antiretroviral treatment (ART), aged 18 to 35 years were enrolled and randomly­assigned­to­two­groups.­The­first­group­received­spirulina­(Group­A)­as­food­supplement­and­the­second­received­soya­beans­ (Group­B).­Patients­were­initiated­ART­simultaneously­with­supplements.­Food­supplements­were­auto-administered­daily,­the­quantity being calculated according to weight to provide 1.5 g/kg body weight of proteins with 25% from supplements (spirulina and soya beans).­Patients­were­monitored­at­baseline­and­followed-up­during­twelve­weeks­for­anthropometric­parameters,­body­­composition,­ haemoglobin and serum albumin, CD4 count and viral load. Results:­Fifty-two­patients­were­enrolled­(Group­A:­26­and­Group­B:­26).­The­mean­age­was­26.4­±­4.9­years­(Group­A)­and­28.7­± 4.8 (Group­B)­with­no­significant­difference­between­groups­(P =­0.10).­After­12­weeks,­weight­and­BMI­significantly­improved­in­both­ groups (P ,­0.001­within­each­group).­The­mean­gain­in­weight­and­BMI­in­Group­A­and­B­were­4.8­vs.­6.5­kg,­(P =­0.68)­and­1.3­vs.­ 1.90 Kg/m2, (P =­0.82)­ respectively.­ In­ terms­of­body­composition,­ fat­ free­mass­ (FFM)­did­not­ significantly­ increase­within­each­ group (40.5 vs. 42.2 Kg, P =­0.56­for­Group­A;­39.2­vs.­39.0­Kg,­P =­0.22­for­Group­B).­But­when­compared­between­the­two­groups­ at­the­end­of­the­trial,­FFM­was­significantly­higher­in­the­spirulina­group­(42.2­vs.­39.0­Kg,­P = 0.01). The haemoglobin level rose Azabji-Kenfack et al 30 Nutrition and Metabolic Insights 2011:4 Introduction According­to­the­United­Nations­program­on­Acquired­ Immune­Deficiency­Syndrome­(UNAIDS),­about­68%­ of HIV-infected adults live in Sub-Saharan Africa.1 Despite the fact that antiretroviral treatment (ART) has spectacularly prolonged the life expectancy among these patients infected with HIV, malnutrition remains a major complication of the disease and a public­ health­ problem­ in­ low­ income­ countries;­ its­ influence­on­the­progression­of­HIV­infection­is­frequently­reported.2–6­In­Ghana­for­example,­Tabi et al7 reported that “most patients with HIV and AIDS die because of their poor nutritional status than from the disease itself ”. Protein-calorie­malnutrition­impairs­the­­anti-viral­ function of macrophages and is directly related to the severity of the HIV infection.8–13 Chronic infections generate­a­significant­energy­demand­including­protein­ catabolism for energy production via gluconeogenesis. This­ is­ worsened­ by­ protein­ intake­ deficiency.14 Besides,­ a­ range­ of­ metabolic abnormalities occur in HIV/AIDS patients on ART treatment, including dyslipidaemia, disorders of glucose metabolism, as well as changes in body composition.15–18 All these are indications that the management of HIV-infected individuals should include an assessment­of­their­nutritional­status.­WHO­­recommends­ that the diet of people living with HIV-AIDS should be supplemented with macronutrients and micronutrients.19 The above recommendation is yet to be fully implemented at national health care levels in Sub-Saharan Africa, in terms of nutritional intervention as complementary to ART, and as­­added-value­in­the­improvement­of­the­quality­of­ life of these subjects. Arthrospira platensis, also called spirulina plat­ ensis, is a blue-green alga with a very high protein content used in nutritional rehabilitation in undernourished/ malnourished people with excellent results.20–24 A more recent study conducted in Central African Republic25 reported that spirulina could be a strong candidate supplement if it has other potential than just nutritional benefits;­they­did­not­test­body­composition­nor­viral­ load,­ and­ failed­ to­ demonstrate­ benefits­ in­ terms­ of­ direct improvement on immune response, due to their limited experimental protocol. Spirulina is generally considered safe for human consumption supported by its long history of use as food source21 and its favorable­safety­profile­ in­animal­studies.26–28 Spirulina is locally available in sub-saharan Africa, inexpensive and exhibits some reported therapeutic functions.24,29 In addition spirulina supplementation does not change usual­food­intake.­We­therefore­carried­out­this­study­ to assess the impact of nutritional rehabilitation by spirulina platensis on HIV-associated undernutrition/ malnutrition. Methods Study hypothesis It was hypothesised that in HIV-infected and malnourished adults, nutritional supplementation with spirulina coupled­to­ART­would­be­more­efficient­than­ART­plus­ soya beans, on the nutritional status in terms of weight gain and body composition, and in improvement of the immune response due to good nutritional status. Study objectives The main objective of this study was to assess the impact of nutritional rehabilitation using spirul­ ina platensis versus soya beans on the nutritional ­significantly­within­groups­(P , 0.001 for each group) with no difference between groups (P =­0.77).­Serum­albumin­level­did­not­ increase­­significantly­within­groups­(P , 0.90 vs. P , 0.82) with no difference between groups (P = 0.39). The increase in CD4 cell count­within­groups­was­significant­(P ,­0.01­in­both­groups),­with­a­significantly­higher­CD4­count­in­the­spirulina­group­compared­to­ subjects on soya beans at the end of the study (P =­0.02).­Within­each­group,­HIV­viral­load­significantly­reduced­at­the­end­of­the­study­ (P , 0.001 and P =­0.04­for­spirulina­and­soya­beans­groups­respectively).­Between­the­groups,­the­viral­load­was­similar­at­baseline­ but­­significantly­reduced­in­the­spirulina­group­at­the­end­of­the­study­(P = 0.02). Conclusion:­We­ therefore­ conclude­ in­ this­ preliminary­ study,­ firstly,­ that­ both­ spirulina­ and­ soja­ improve­ on­ nutritional­ status­ of­ malnourished­HIV-infected­ patients­ but­ in­ terms­ of­ quality­ of­ nutritional­ improvement,­ subjects­ on­ spirulina­were­ better­ off­ than­ ­subjects­on­soya­beans.­Secondly,­nutritional­rehabilitation­improves­on­immune­status­with­a­consequent­drop­in­viral­load­but­further­ investigations on the antiviral effects of this alga and its clinical implications are strongly needed.