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Nutrition Treatment for HIV Wasting: A Prescription for Food as Medicine

Ann Yelmokas McDermott, PhD, LN^*,, Abby Shevitz, MD, MPH^,, Aviva Must, PhD^*,, Susan Harris, DSc^*, Ronenn Roubenoff, MD, MHS^*,, and Sherwood Gorbach, MD^,

^* The Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts; Tufts University School of Medicine Department of Family Medicine and Community Health, Boston, Massachusetts; and Tufts-New England Medical Center, Boston, Massachusetts

Correspondence and reprint requests: Ann Yelmokas McDermott, The Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Lipid Metabolism Laboratory, Room 528, 711 Washington Street, Boston, MA 02111. Electronic mail may be sent to ann.mcdermott{at}tufts.edu.

Background: The optimal nutrition approach for the promotion of weight gain in HIV-infected adults with wasting remains unclear. Previous dietary interventions report minimal success and provide inadequate information regarding the counseling approach, contact time, session format, and issues addressed with the subject. The methods we report were incorporated in a 12-week intervention trial for the reversal of HIV-wasting. Methods: All subjects involved in the intervention trial for the reversal of HIV-wasting received weekly, customized, one-on-one counseling and an oral nutrition supplement (480 kcal/d with 30 g protein). The nutrition aims were to (1) increase caloric intake to surpass daily energy requirements by 500 kcal/d (suggested caloric intake: 40 to 50 kcal/kg current weight); (2) increase protein intake (1.6 to 1.8 g/kg current weight per day); and (3) identify foods that may exacerbate or curtail side effects associated with HIV. Also assessed were preconceptions, nutrition knowledge level and primary information source, and obstacles to healthy eating. Sessions, conducted by a nutritionist in an interactive, action-oriented learning approach, ranged from 30 to 60 minutes. Results: At baseline, subjects harbored many misconceptions, reported numerous HIV-related side effects, and lacked practical nutrition strategies, all of which interfered with weight maintenance and health. The protocol strategies were acceptable to the patients (87% subjects completed all visits), with marked improvements in dietary intake, weight, and body composition, both during and after intervention. Conclusions: We describe a customized nutrition intervention that produces changes in energy intake, maintenance of appropriate protein intake, and the reversal of unintentional weight loss over 5 to 15 months. Sustained improvements occurred across a socioeconomically diverse population, despite persistent disease- and medication-associated side effects.

Nutrition in Clinical Practice, Vol. 18, No. 1, 86-94 (2003)
DOI: 10.1177/011542650301800186


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