Supplementary feeding with either ready-to-use fortified spread or corn-soy blend in wasted adults starting antiretroviral therapy in Malawi: randomised, investigator blinded, controlled trial

doi:10.1136/bmj.b1867

Published 22 May 2009, doi:10.1136/bmj.b1867
Cite this as: BMJ 2009;338:b1867

Research

Supplementary feeding with either ready-to-use fortified spread or corn-soy blend in wasted adults starting antiretroviral therapy in Malawi: randomised, investigator blinded, controlled trial

MacDonald J Ndekha, nutritionist¹, Joep J G van Oosterhout, associate professor², Eduard E Zijlstra, professor², Micah Manary, student⁴, Haroon Saloojee, research physician³, Mark J Manary, professor and senior scientist¹^,4^,5

¹ Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi, ² Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi, ³ Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa, ⁴ Department of Pediatrics, Washington University School of Medicine, St Louis, USA, ⁵ Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas, USA

Correspondence to: M Manary, Department of Pediatrics, St Louis Children’s Hospital, One Children’s Place, St Louis, MO 63110 USA manary{at}kids.wustl.edu

Objective To investigate the effect of two different food supplementson body mass index (BMI) in wasted Malawian adults with HIVwho were starting antiretroviral therapy.

Design Randomised, investigator blinded, controlled trial.

Setting Large, public clinic associated with a referral hospitalin Blantyre, Malawi.

Participants 491 adults with BMI <18.5.

Interventions Ready-to-use fortified spread (n=245) or corn-soyblend (n=246).

Main outcome measures Primary outcomes: changes in BMI and fat-freebody mass after 3.5 months. Secondary outcomes: survival, CD4count, HIV viral load, quality of life, and adherence to antiretroviraltherapy.

Results The mean BMI at enrolment was 16.5. After 14 weeks,patients receiving fortified spread had a greater increase inBMI and fat-free body mass than those receiving corn-soy blend:2.2 (SD 1.9) v 1.7 (SD 1.6) (difference 0.5, 95% confidenceinterval 0.2 to 0.8), and 2.9 (SD 3.2) v 2.2 (SD 3.0) kg (difference0.7 kg, 0.2 to 1.2 kg), respectively. The mortality rate was27% for those receiving fortified spread and 26% for those receivingcorn-soy blend. No significant differences in the CD4 count,HIV viral load, assessment of quality of life, or adherenceto antiretroviral therapy were noted between the two groups.

Conclusion Supplementary feeding with fortified spread resultedin a greater increase in BMI and lean body mass than feedingwith corn-soy blend.

Trial registration Current Controlled Trials ISRCTN67515515 [controlled-trials.com] .

© Ndekha et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Rx for Wasting: Hugh Mann
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Opportunistic infections confounding results?: Alexander JK Wilkinson, et al.
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Supplementary feeding can be dangerous.: Richard G Fiddian-Green
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Beware of randomizing patients to food: Richard A. Murphy, et al.
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