The role of diet and nutrition in

the management of People living with HIV/AIDS

Sessions Objectives

• To understand the importance of Nutrition in management of PLHA

• To understand the counseling strategies needed to food and nutrition habits

Exercise 1

• Brainstorm on the importance of diet and nutrition in the life of people living with HIV/AIDS

HIV/AIDS AND NUTRITIONEating correctly does make a

difference!

When your body gets enough of the right food, you will feel better and more positive about yourself and the future.

Eating the right food can help your immune system to fight infection. It can also help your body to stay stronger during any medical treatment that you may need.

Many of the physical symptoms of HIV/AIDS can be made better or worse by the foods you eat.

Objectives of nutrition Counseling

• Maintaining body weight and strength; • Replacing lost vitamins and minerals; • Improving the function of the immune system and the body's

ability to fight infection; • Extending the period from infection to the development of

the AIDS disease; • Improving response to treatment; reducing time and money

spent on health care; • Keeping HIV-infected people active, allowing them to take

care of themselves, their family and children; and • Keeping HIV-infected people productive, able to work, grow

food and contribute to the income of their families.

What is good nutrition?

Good nutrition means eating foods each day that will give you the nutrients (vitamins, minerals and proteins) that your body needs to keep it strong and healthy.

EnergyEnergy

• 40 kcal/kg body weight to maintain 40 kcal/kg body weight to maintain weightweight

(300 – 400 kcals above RDA for male & (300 – 400 kcals above RDA for male & female)female)

• 55 kcal/kg to increase wt or stop wt 55 kcal/kg to increase wt or stop wt lossloss

• Allows possibility of current or future Allows possibility of current or future hypermetabolismhypermetabolism

• Safety margin for decreased food Safety margin for decreased food intake during acute diseaseintake during acute disease

ProteinProtein

• Body buildingBody building

• To improve immunityTo improve immunity

• 0.8 – 1.0 g/kg body wt for normal person0.8 – 1.0 g/kg body wt for normal person

• 1.2 – 2.0 g/kg for HIV-infected person1.2 – 2.0 g/kg for HIV-infected person

FatFat

• Essential fatty acids (n-3)Essential fatty acids (n-3)– Alpha Linolenic acidAlpha Linolenic acid– Eicosapentanoic acid (EPA)Eicosapentanoic acid (EPA)– Docosahexanoic acid (DHA)Docosahexanoic acid (DHA)

Rich source – Fish oilsRich source – Fish oils

• Low fat diet - Avoid fried & oily foodsLow fat diet - Avoid fried & oily foods

• Avoid saturated fatAvoid saturated fat

Vitamin A• Accelerated HIV disease progression• Increased adult mortality• Increased mother to child transmission of HIV• Higher infant mortality & growth failure• Higher HIV load in breast milk• Presence of HIV-1 DNA in vagina contributes to

heterosexual transmission of HIVVitamin A: 5000 – 10000 IU/day Vitamin A: 5000 – 10000 IU/day

ββ-carotene: 50000 – 100000 IU/day-carotene: 50000 – 100000 IU/day

Vitamin D

• Low serum level of 1,25-Low serum level of 1,25-dihydroxyvitamin D3, was dihydroxyvitamin D3, was associated with decreased survivalassociated with decreased survival

•Deficiency shown to be a risk for Deficiency shown to be a risk for TBTB

100 – 200 µg/day100 – 200 µg/day

Vitamin EDeficiency compromises immunity –

damage to immune effector cells due to free radical reactions

Significant declines in CD4 cell count and increased progression to AIDS

Supplementation reverses oxidative damage to DNA caused by Zidovudine

200 – 400 IU/day200 – 400 IU/day

Vitamin CNo relationship was found

between plasma Vitamin C levels and HIV disease progression

Supplementation reverses oxidative damage to DNA caused by Zidovudine

Vitamin B12 deficiency

Causes:

- - Diarrhea due to Cryptosporidium & Diarrhea due to Cryptosporidium & Isospora belli Isospora belli

- HIV-associated gastric secretory failure - HIV-associated gastric secretory failure (low parietal cell secretion of intrinsic (low parietal cell secretion of intrinsic factor)factor)

- Zidovudine treatment- Zidovudine treatment• Neurological & psychiatric impairmentNeurological & psychiatric impairment• Decline in CD4 lymphocyte countDecline in CD4 lymphocyte count• 2-fold increased risk of progression to AIDS 2-fold increased risk of progression to AIDS

Iron

Both iron deficiency and iron

overload have been shown to

have a deleterious effect on

the immune system

Selenium

Three-fold increased risk of genital

mucosal shedding of HIV – possibility

of increased sexual transmission of

HIV in selenium deficient women

• The food pyramid gives an outline of what to eat every day.

• It shows a range of daily servings for each group.

• The number of servings required change from individual to individual and is influenced by age, gender, size and how active the person is.

The Food Pyramid

• Each food group in the pyramid provides some, but not all, of the nutrients needed

• Food in one group cannot replace those in another.

• One food group is not more important than another.

• For good health food from all the groups is needed.

What kind of food does the body need?

Food that builds the body – Dry beans, lentils, peas, – eggs, meat, fish, chicken, – milk, cheese, butter, Khoya

Food that gives energy:– Bread, porridge, rice, potatoes, oats, – Sugar, fatty foods

Food that protects you from diseases:– Fruit and vegetables.

Energy needs

– most women and older adults have low energy needs– children, teenage girls, active women and most men have average energy needs– active adults, teenagers and pregnant and breastfeeding women have high energy needs.

• People with a low energy need must select the lower number of servings from each food group.

• People with an average energy need should select the middle number of servings.

• People with a higher energy need have to select the higher number from the group.

• A slice of bread is 1 serving and a hamburger bun is 2 servings.

• A serving white rice is the same as a serving brown rice, but– brown rice has more nutrients than white rice.

MicronutrientsVitamin A: • cheese, eggs, butter, margarine, fish oil and liver. yellow

and green vegetables and yellow fruit, such as carrots, pumpkin and oranges

Vitamin B: • cereal foods, bread, nuts, peas, beans, bananas,

potatoes, eggs, milk productsVitamin C: • oranges, lemons, cauliflower, cabbage, tomatoes, lettuce,

guavas, green peppersVitamin D: • eggs, milk, butter, margarine

Exercise

Micronutrients

Their source

The role they play

Good eating habits

• Eat less meat• Eat less fat• Do not skip meals or eat only when you are

hungry.• Listen to your body: do not eat foods that make

certain symptoms worse.• Cut down on smoking.• Avoid drinking alcohol.• Try eating fruit and vegetables raw. If you have to

cook them use a low heat, or steam or bake them. • Avoid the use of drugs They lower the body’s

ability to fight off disease.

HIV/AIDS reduces food intake

People with HIV/AIDS often do not eat enough because:

• the illness and the medicines taken for it may reduce the appetite, modify the taste of food and prevent the body from absorbing it;

• symptoms such as a sore mouth, nausea and vomiting make it difficult to eat;

• tiredness, isolation and depression reduce the appetite and the willingness to make an effort to prepare food and eat regularly;

• there is not enough money to buy food.

• Buy fresh food every day, instead of weekly or monthly.

• Keep food in the fridge or airtight containers in a dark place.

• Store raw and cooked food separately in the fridge.• Keep raw meat away from other food.• Defrost food in the fridge and not at room temperature.• Use a separate chopping board for raw meat. A hard

plastic board is better than a wooden board. Disinfect the board every week using a weak solution of bleach.

• Always cook meat, fish and eggs well. Do not eat raw eggs.

• Keep leftovers in the fridge.• Eat only pasteurised dairy products and drink

pasteurised milk.• Wash fruit and vegetables well before eating.

Exercise

• Calculating Body Mass Index

• Measurement of weight

• Weight record form and its use

Dealing with weight loss

People with HIV/AIDS often lose weight although they eat healthy food.

Gain weight or keep it steady in the following way:• If you often vomit or suffer from diarrhea, try to eat yoghurt,

peanut butter, salad dressing, coconut and grated cheese.• Squeeze lemon juice over fatty foods to help digestion.• Drink fruit juices, milkshakes and hot chocolate.• Chew your food well before swallowing.• Eat four to five small meals instead of three big meals a

day.• Eat snacks between meals such as raisins, potato crisps,

peanuts, biscuits or dried fruit.• Patients must know what their right weight should be