Characteristics and impacts ofSystematic review nutritional programmes to address undernutrition of adults living with HIV in sub-Saharan Africa: a systematic review of evidence

ObjectivesAlthough some studies have identified various challenges affecting nutritional programmes to effectively tackle undernutrition among people living with HIV, evidence about the characteristics and impacts of these programmes on weight-related nutritional outcomes varies based on country contexts, specific programme goals and the implementation processes. This systematic review sought to synthesise evidence on the characteristics and impact of nutritional programmes on weight-related nutritional outcomes of people living with HIV in sub-Saharan Africa.DesignSystematic review.Data sourcesWe searched for primary studies published in the following databases: Web of Science, Medline, Scopus, ScienceDirect, ProQuest and Google Scholar, supplemented by checking reference lists of included papers.Eligibility criteriaStudies published from 2005 to 10 July 2020 and reporting on the weight-related nutritional outcomes of undernourished people enrolled in nutritional programmes in HIV care in sub-Saharan Africa were included.Data extraction and synthesisData were extracted using a data extraction proforma. Weight-related nutritional outcomes of people living with HIV before and after enrolment in a nutritional programme were compared and narratively synthesised.ResultsSixteen studies assessing the impact of nutritional programmes in HIV care on weight-related nutritional outcomes were included. Of these, 13 examined nutritional programmes implemented in health facilities and the remaining three were delivered outside of health facilities. Nutritional recovery (defined differently in the studies) ranged from 13.1% to 67.9%. Overall programme failure rate, which included default after enrolment in a nutritional programme or non-response, ranged from 37.6% to 48.0%. More specifically, non-response to a nutritional programme ranged from 21.0% to 67.4% and default from the programme ranged from 19.0% to 70.6%. Key sociodemographic, clinical and nutritional characteristics that affect nutritional recovery, non-response and default were also identified.Conclusions and recommendationsNutritional programmes in HIV care have led to some improvements in weight-related nutritional outcomes among people living with HIV. However, the programmes were characterised by a high magnitude of default and non-response. To improve desired weight-related nutritional outcomes of people living with HIV, a holistic approach that addresses longer-term determinants of undernutrition is needed.PROSPERO registration numberCRD42020196827.

Community-Based Management of Acute Malnutrition for Infants Under 6 Months of Age Is Safe and Effective: Analysis of Operational Data

Objective: To assess the effectiveness of outpatient management with ready-to-use and supplementary foods for infants under 6 months (u6m) of age who were unable to be treated as inpatients due to social and economic barriers. Design: Review of operational acute malnutrition treatment records. Setting: 21 outpatient therapeutic feeding clinics in rural Malawi. Participants: Infants u6m with acute malnutrition treated as outpatients because of barriers to inpatient treatment. The comparison group consisted of acutely malnourished children 6-9 months of age who were being treated at the same time in the same location in the context of two different randomized clinical trials. Results: A total of 323 infants u6m were treated for acute malnutrition (130 severe and 193 moderate). A total of 357 infants 6-9 months old with acute malnutrition (74 severe and 283 moderate) were included as contemporaneous controls. Among infants u6m with severe acute malnutrition, 98 (75.4%) achieved nutritional recovery; in comparison, 56 (75.7%) of those with SAM 6-9 months old recovered. Among infants u6m with moderate acute malnutrition, 157 (81.3%) recovered; in comparison 241 (85.2%) of those aged 6-9 months recovered. Conclusions: In a rural Malawian population of infants u6m who had generally already stopped exclusive breastfeeding and were now acutely malnourished, treatment with therapeutic or supplementary foods under the community management of acute malnutrition model was safe and effective. In settings where social and financial factors make hospital admission challenging, consideration should be given to lowering the recommended age of ready-to-use therapeutic and supplementary foods to infants u6m.

Interview with Attaher Zacka Maïga

Attaher Zacka Maïga was born on 10 May 1963 in Bia, Bourem Cercle, Gao Region, Mali. He has spent his life in the service of the International Red Cross and Red Crescent Movement, joining the Mali Red Cross as a volunteer in 1987 before working for the International Federation of Red Cross and Red Crescent Societies as a nutritionist in a pilot centre for nutritional recovery and education in Bourem from January 1988 to June 1990. In 1990 and 1991 he acted as consultant to a number of organizations, including World Vision and UNICEF. In April 1992, Attaher Maïga joined the International Committee of the Red Cross (ICRC) as a “resident” (i.e. local) employee. Since then, he has held many positions. From 1996 to 2000, he was in charge of the Gao office, which employed almost 100 staff, both resident and “mobile” (expatriate). He then took charge of the ICRC's programmes in northern Mali from 2001 to 2006, ran the organization's office in the Malian capital Bamako from 2007 to 2008 and was responsible for the Mali communication programme between 2009 and 2011. From November 2011 to November 2014, he was head of the ICRC's northern Mali sub-delegation, one of the first resident employees to lead an ICRC sub-delegation. Since 2015, Attaher Maïga has been Networking Coordinator for the ICRC's Mali delegation. In 1996, Mr Maïga initiated the ICRC's post-conflict programmes in his country, covering the fields of agriculture, veterinary services and health. In 2009, he launched a pilot migrant project in Kidal, northern Mali. These much-appreciated initiatives resulted in his being invited to participate in the 2010 Montreuil meeting, which laid the foundations for the reforms currently underway. Attaher was the first Mali focal point for the ICRC's Unit for Global Affairs. This role gave him a deeper understanding of trends in the Islamic world and enabled him to help the ICRC adjust its dialogue with Jihadist armed groups. Our interview with Mr Maïga highlights his extensive experience with one of the oldest humanitarian organizations and is an opportunity for him to share his understanding of the ICRC's interaction with the armed groups that controlled northern Mali in 2012, when he was representing the ICRC in the region. Attaher Maïga holds a degree in public administration from the Institut de Gestion et des Langues Appliquées aux Métiers, Bamako.

Breastfeeding, Relactation, and High Impact Factors in Treating Moderately and Severely Malnourished Children Under Two Years of age in Colombia: A Mixed Community Study Protocol

Background: The prevalence of acute malnutrition in Columbia was 1.6% in 2015, which was significantly higher than that found in 2010 (0.9%). Further, the distribution by age shows a higher prevalence of malnutrition in children under 2 years of age. Low rates (36.1%) of exclusive breastfeeding (BF) were found in these children, and adequate BF rates (45.5%) were found for children between 6 and 23 months. These percentages were low compared to the world average of 46%. The objective was to evaluate breastfeeding practices, relactation and feeding processes related to the recovery of children between 0 and 24 months of age with a diagnosis of moderate or severe acute malnutrition (SAM) treated at prioritized health service provider institutions and in the Nutritional Recovery Centers of the Instituto Colombiano de Bienestar Familiar (ICBF).Methods: This research was a mixed-type observational descriptive design in the community with a quantitative and qualitative component in three phases. The first phase characterized the practices of breastfeeding and relactation among mothers seeking help for their infants through the Nutritional Recovery Centers of the Instituto Colombiano de Bienestar Familiar ICBF and health service provider institutions during the study period. In the second phase, a technical strengthening intervention will be carried out aimed at health professionals, and in the third phase, the care processes will be reviewed before and after the intervention. In addition, anthropometric variables and practices of breastfeeding on admission and discharge from care facilities were reviewed to identify potential factors related to the nutritional recovery process.Discussion: This research aims to provide a characterization of breastfeeding and relactation in the population treated for infants with severe acute malnutrition in the CRN and IPS, improve health professionals’ care processes for children with SAM, contribute to the achievement of relactation in mothers of children with moderate and severe acute malnutrition that graduate from the IPS and CRN and identify the potential factors related to the nutritional recovery of these children.Trial registration: Not aplicable

Effect of Moringa supplementation in the management of moderate malnutrition in children under 5 receiving ready-to-use supplementary foods in Niger: A randomized clinical trial

Each year in Niger, more than 40% of children under 5 years suffer from chronic malnutrition and more than 10% from acute malnutrition. The national nutrition rehabilitation protocol encourages the use of local foods. The objective of this work is to analyze the impact of supplementation in Moringa oleifera. We conducted a randomized double-blind clinical trial in 400 children with moderate acute malnutrition (MAM) aged 6 to 59 months admitted to outpatient nutritional recovery centers (CRENAM). The children were divided into two groups; one group received Ready-to-Use Supplemental Foods (RUSF) and dry leaf powder from Moringa oleifera and the other group received RUSF and placebo. We did not find any difference on average weight gain between the two groups or on mid-upper arm circumference and size. The median length of stay in CRENAM was 5 and 4 weeks for Moringa and placebo respectively, with no statistical difference (P=0.522). The cure rate was 82% (2.72) in the Moringa group with a RR of 1.03 (0.94 to 1.13) slightly in favor of Moringa. Renal and hepatic toxicity of Moringa was not observed. From this clinical trial, it could be held that Moringa supplementation, despite the presence of nutritional indices in favor of Moringa, does not have a significant effect on the nutritional recovery of MAM children but that Moringa has no renal or hepatic toxicity. Supplementation in subjects already on dietetic treatment, dose reduced to minimum and duration of supplementation seems to have played a role in this absence of effect of Moringa.

Exploring the Mechanisms of Recovery in Anorexia Nervosa through a Translational Approach: From Original Ecological Measurements in Human to Brain Tissue Analyses in Mice

Anorexia nervosa (AN) is a severe eating disorder where caloric restriction, excessive physical activity and metabolic alterations lead to life-threatening situations. Despite weight restoration after treatment, a significant part of patients experience relapses. In this translational study, we combined clinical and preclinical approaches. We describe preliminary data about the effect of weight gain on the symptomatology of patients suffering from acute AN (n = 225) and partially recovered (n = 41). We measured more precisely physical activity with continuous cardiac monitoring in a sub-group (n = 68). Using a mouse model, we investigated whether a long-term food restriction followed by nutritional recovery associated or not with physical activity may differentially impact peripheral and central homeostatic regulation. We assessed the plasma concentration of acyl ghrelin, desacyl ghrelin and leptin and the mRNA expression of hypothalamic neuropeptides and their receptors. Our data show an effect of undernutrition history on the level of physical activity in AN. The preclinical model supports an important role of physical activity in the recovery process and points out the leptin system as one factor that can drive a reliable restoration of metabolic variables through the hypothalamic regulation of neuropeptides involved in feeding behavior.

Leptin and adiponectin concentrations in infants with low birth weight: relationship with maternal health and postnatal growth

Health in pregnancy and infancy can affect the risk of chronic non-communicable diseases. We aimed to describe leptin and adiponectin concentrations in low birth weight (LBW) infants and identify possible associations with maternal nutritional status, adequacy for gestational age, nutritional recovery, and current dietary intake. A cross-sectional study with LBW infants (9–12 months) including maternal background and pre-pregnancy nutritional condition was performed. From the Infants: anthropometry at birth and current was expressed as z-score (weight: WAZ, length, head circumference), nutritional recovery, dietary intake, leptin, and adiponectin blood concentrations. The mean age of the 54 infants was 10.0 ± 1.5 months, 32 (59.3%) were female, 36 (66.7%) preterm, 23 (42.6%) small for gestational age (SGA), and 25 pregnancies (46.3%) were twin. Almost all (98%) of the infants intake energy and protein above the recommendation, and 47 (87.6%) consumed ultra-processed foods. At the time of the assessment, 8 (14.8%) were overweight and 4 (7.4%) had short stature. SGA infants showed faster weight recovery (WAZ 1.54; 95% CI 1.17, 1.91; p = 0.001), higher leptin’s concentration (3.0 ng/ml (1.7, 3.0) versus 1.6 ng/ml (0.9, 2.6); p = 0.032)), and leptin/adiponectin ratio (0.13 ± 0.08 versus 0.07 ± 0.07; p = 0.018). The pre-gestational BMI was a modifier of the effect of WAZ on leptin levels (p = 0.027) in LBW infants. Higher pre-gestational BMI increased the effect of WAZ variation (birth and current) on leptin levels. Concluding, LBW infants showed early changes in leptin and adiponectin concentrations, influenced by maternal (pre-gestational BMI), intrauterine (gestational age adequacy – SGA), and postnatal weight gain. This combination of factors may increase the risk of NCD for this group of children.