| Objectives1. To evaluate the nutritional status and nutritional requirement via dietary survey, physical examination, clinical examination of nutrient deficiency diseases, and laboratory tests on HIV/AIDS patients who were mainly infected by commercial blood donation.2. To investigate the effects of micronutrient supplementation on plasma protein, serum mineral and vitamin levels and the immune system in HIV/AIDS patients. The effect of micronutrient supplementation on the development of nutrient deficiency disease was also assessed.Methods1. Subjects:The investigation spot was selected in Huaiyang County, Zhoukou city of Henan Province between year 2008 and 2009. The subjects were selected by cluster sampling from six villages with the highest HIV/AIDS incidence. Total of 184 HIV positive subjects and 105 AIDS patients included 196 males,180 females, aged between 30～60 years old. The route of their infection was through illegal commercial blood donation. Both of the HIV and AIDS subjects were randomly divided into control and experiment group. The experiment groups were supplemented with micronutrient. Each group was consisted of 24 subjects.2.The information collection and observation parameters of HIV/ AIDS:(1)General information:including gender, age, education, annual income; (2) Per capita food intake and diet pattern; (3)The weekly food frequency; (4)Physical examination:height, weight, BMI, skin fold thickness, body fat content;(5)The symptoms and signs of nutritional deficiency; (6)Total plasma protein and albumin level; (7) Mineral levels:zinc, calcium, magnesium, and iron; (8)Serum levels of VitA,VitD3, and VitE; (9) Immune indicators:CD4+, CD8+, CD3+ T lymphocyte and IgA, IgG, IgM; (10) Nutrition knowledge awareness rate.3. Study design:Using double-blind method, the micronutrient complex and placebo were distributed to the HIV/AIDS patients. The intervention trial lasted for six months.4.Data analysis:The database was set up using EPIDATA3.02. All data was analyzed using SPSS (Statistical Package for the Social Sciences) 12.0. Numeric variable were expressed as x±SD. SNK test was applied to compare the means between and within groups. Categorical variables were analyzed using Chi-Square test. One-way ANOVA was applied for the mean comparison of proteins, minerals, vitamins and immune indicators. The significant level was set atα=0.05.Results1 Nutritional Status of HIV/AIDS patients.1.1 Daily food intake and dietary pattern:Main food in three groups was cereal. By comparing with balanced diet pagoda of Chinese residents, only the daily intakes of cereal and vegetables, eggs reached to the recommended quantity. In control,HIV and AIDS groups, the intakes of cereal were 586.43±87g,631.57±46g, and 412.82±69g respectively, those of vegetables were 508.31±■76g,583.47±64g, and 432.55±62g respectively, those of eggs were 32.15±8.54g,37.66±6.69g, and 39.47±3.66g respectively, fruits were 26.43±4.54g,23.67±6.45g, and 24.54±2.45g respectively, meat were 19.76±5.84g,21.45±3.45g, and 23.43±4.33g respectively, seafood products were 1.95±2.87g,2.22±1.46g, and 2.16±1.66g respectively, milk were 1.23±0.27g,1.21±0.91g, and 1.11±0.56g respectively. The intakes of fruits, poultry, seafood product, and soy beans were far lower than those of the recommended levels. The intakes of cereal and vegetables in AIDS group were significantly lower than those of ontrol and HIV groups (P<0.05).1.2 Daily energy intake and micronutrients consumption:The intakes of total energy and carbohydrate in AIDS group was significantly lower than control and HIV groups (P<0.05). The intakes of Vitamins in all subjects did not reach RNI levels. The intakes of riboflavin, thiamine, niacin, and vitamin E were less than 50% of RNI levels and the intakes of vitamin A and vitamin C were less than 30% of RNI levels. Only Mn and P intakes met the recommended mount. The intakes of K,Cu,Fe reached to 80%, Mg, and Se reached to 66%, Zinc reached to 50%, Ca and Na only reached 30% of RNI levels.1.3 The energy proportion from energy producing nutrients and the sources of protein and fat:energy from carbohydrate was more than 70%, while from fat was far less than 20%.1.4 Physical examination:There is no significant difference in height, weight, arm muscle circumference in control, HIV and AIDS groups showed (P>0.05). Skin fold thickness and body fat content in control group were slightly higher than other two groups (P>0.05). Waist and hip circumference in AIDS group were significantly lower than control and HIV groups (P<0.05), but there is no significant difference in the waist to hip ratio among the groups (P>0.05).1.5 Laboratory test:The blood level of total protein, albumin, iron, zinc, calcium and magnesium in control group were within the normal range. Total protein, albumin, iron, zinc, calcium and magnesium in AIDS group were significantly lower than control and HIV groups (P<0.05).1.6 Nutrient deficiency diseases:among the 376 subjects, the common seen nutrient deficiency diseases or signs from high to low rate were anemia, follicular keratosis, brittle nails, niacin dermatitis, bleeding around hair follicles, night blindness, angular cheilitis, and cheilitis respectively and the incidence rate in AIDS group was much higher than those in control and HIV groups (P<0.05).1.7 Nutrition knowledge awareness rate:the average correct answer to the nutrition knowledge was in the order of 4.44,5.27, and 6.26 questions in control, HIV, and AIDS groups respectively. 2 Effect of micronutrient supplementation on health condition in HIV/AIDS patients2.1 Intervention trial (micronutrient supplementation) in HIV group:2.1.1 Before and after intervention, total blood protein, albumin were not significantly different between experimental (intervention) and control group (none intervention) in HIV group (P>0.05)2.1.2 The serum levels of zinc, calcium, magnesium, iron between control and trial groups was not significantly different before intervention (P>0.05). After the supplementation, the serum level of zinc, calcium, magnesium, iron in trial group were significantly higher than that in control group (P<0.05). The serum level of zinc, calcium, magnesium, iron in experimental group were significantly higher after intervention (P<0.05). The serum level of zinc, calcium, magnesium, iron in control group were not significantly higher after intervention (P>0.05)2.1.3 The serum levels of VitA, VitD3, and VitE between control and trial groups was not significantly different before intervention (P>0.05). After the supplementation, the serum level of VitA, VitD3, and VitE in trial group was significantly higher than that in control group (P<0.05). Before and after trial, there was no significant difference of serum level of VitA, VitD3, and VitE in control group (P>0.05).The serum levels of VitA, VitD3, and VitE in experimental group were significantly increased after intervention (P<0.05).2.1.4 Before intervention, CD4+, CD8+, and CD3+ T lymphocyte counts were not significantly different between experimental and control groups (P>0.05). After six month intervention, the numbers of immune cells in experimental group were significantly increased and much higher than that in control group (P<0.05). The trial had no significant impact on the cell count in control group (P>0.05). The levels of plasma IgA,IgG,IgM were no significantly affected by the supplementation in both control and intervention groups (P>0.05).2.1.5 After intervention, the number of anemia and night blindness was decreased in HIV group (P<0.05), While the number of anemia, brittle nails, niacin dermatitis, night blindness was increased in control (P<0.05).2.2 Intervention trial in AIDS group:2.2.1 Before and after intervention, total plasma protein and albumin were not significant different between experimental and control group in AIDS group (P> 0.05).2.2.2 The serum levels of zinc, calcium, magnesium, iron between control and trial groups was not significantly different before intervention (P>0.05). After the supplementation, the serum levels of zinc, calcium, magnesium, iron were significantly increased in trial group and significantly higher than that in control group (P<0.05). The trial had no significant impact on serum level of zinc, calcium, magnesium, iron in control group (P>0.05).2.2.3 The serum levels of VitA,VitD3,VitE between control and trial groups were not significantly different before intervention (P>0.05). After the supplementation, the serum levels of VitA, VitD3,VitE in trial group was significantly increased and much higher than that in control group (P<0.05). The serum level of VitA, VitD3, VitE in control group were not significantly higher after intervention (P>0.05).2.2.4 Before and after intervention, the levels of CD4+, CD8+, and CD3+ T lymphocyte counts were not significantly different between experimental and control groups (P>0.05).The levels of plasma IgA, IgG, and IgM were no significantly affected by the supplementation in both experimental and control groups in AIDS subjects (P>0.05).2.2.5 After intervention, there were less cases of anemia, brittle nails, niacin dermatitis, bleeding around hair follicles, night blindness than those before in trail group (P<0.05). Number of anemia, nails become brittle, night blindness, angular stomatitis and cheilitis in control group was more than the with trail group (P< 0.05). Conclusion1 HIV/AIDS patients in high prevalence epidemical area of Henan province had regular meals, but the intake of various nutrients was imbalanced. The daily intake of cereals was higher than the RNI levels, but the consumption of fruits was very limited. The intakes of beans, milk or dairy products, meat, and seafood were extremely low. The intakes of many vitamins and minerals were far less than enough, especially vitamin A, vitamin C and calcium. The proportions of energy producing nutrient were unreasonable. Carbohydrates accounted for more than 70% and fat accounted for less than 20% of total energy supply. The high quality protein was almost missing. The incidence of nutrient deficiency diseases was much higher in HIV/AIDS group than that in control group. The nutritional knowledge awareness rate in AIDS group and HIV group higher was high than that in control group.2 Micronutrient supplementation could increase the serum levels of immune cells, zinc, calcium, magnesium, iron, vitamin A, vitamin D3, vitamin E and decrease the rate of nutrient deficiency diseases in HIV subjects, but had no significant improvement on those parameters in AIDS patients.
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