Linear growth increased in young children in an urban slum of Haiti: a randomized controlled trial of a lipid-based nutrient supplement. Efficacy of meat and iron-fortified commercial cereal to prevent iron depletion in cow milk-fed infants 6 to 12 months of age: a randomized controlled trial. Food supplementation with encouragement to feed it to infants from 4 to 12 months of age has a small impact on weight gain. Three-month nutritional supplementation in Indonesian infants and toddlers benefits memory function 8 y later. Randomized controlled trial of nutritional supplementation in patients with newly diagnosed tuberculosis and wasting. Developmental effects of short-term supplementary feeding in nutritionally-at-risk Indonesian infants. Growth and micronutrient status in children receiving a fortified complementary food. Effect of early, short-term supplementation on weight and linear growth of 4-7-mo-old infants in developing countries: a four-country randomized trial. Effects of early childhood supplementation with and without stimulation on later development in stunted Jamaican children. Pilot randomized trial of nutritional supplementation in patients with tuberculosis and HIV-tuberculosis coinfection receiving directly observed short-course chemotherapy for tuberculosis. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. Evaluation of the impact of a nutritional program for undernourished children in Brazil. Effects of protein energy supplementation during pregnancy on fetal growth: a review of the literature focusing on contextual factors Animal source foods improve dietary quality, micronutrient status, growth and cognitive function in Kenyan school children: background, study design and baseline findings. Daily multi-micronutrient supplementation during tuberculosis treatment increases weight and grip strength among HIV-uninfected but not HIV-infected patients in Mwanza, Tanzania. Iron supplementation of breastfed infants from an early age. A lipid-based nutrient supplement but not corn-soy blend modestly increases weight gain among 6- to 18-month-old moderately underweight children in rural Malawi. A cholesterol-rich diet accelerates bacteriologic sterilization in pulmonary tuberculosis. Effects of an energy and micronutrient supplement on growth and development in undernourished children in Indonesia: methods Comparison of standard and immune-enhancing oral formulas in asymptomatic HIV-infected persons: a multicenter randomized controlled clinical trial. Impact of the Mexican program for education, health, and nutrition (Progresa) on rates of growth and anemia in infants and young children: a randomized effectiveness study. Nutritional supplementation, psychosocial stimulation, and mental development of stunted children: the Jamaican Study Limited impact of a targeted food supplementation programme in Bangladeshi urban slum children. A national evaluation of school breakfast clubs: evidence from a cluster randomized controlled trial and an observational analysis. Randomised controlled trial of food supplements in patients with newly diagnosed tuberculosis and wasting. Growth pattern of infants fed with a mixture of extruded malted maize and cowpea. Effect of preventive supplementation with ready-to-use therapeutic food on the nutritional status, mortality, and morbidity of children aged 6 to 60 months in Niger: a cluster randomized trial. Features of whey protein concentrate supplementation in children with rapidly progressive HIV infection. [Use of spirulina supplement for nutritional management of HIV-infected patients: study in Bangui, Central African Republic]. Intensive nutrition education with or without supplementary feeding improves the nutritional status of moderately-malnourished children in Bangladesh. Improvement of weight and fat-free mass with oral nutritional supplementation in patients with Alzheimer's disease at risk of malnutrition: a prospective randomized study. Nutritional Supplementation Increases Rifampin Exposure among Tuberculosis Patients Coinfected with HIV A randomized controlled trial evaluating nutrition counseling with or without oral supplementation in malnourished HIV-infected patients.
BACKGROUND Haiti has experienced rapid urbanization that has exacerbated poverty and undernutrition in large slum areas . Stunting affects 1 in 5 young children . OBJECTIVE We aim ed to test the efficacy of a daily lipid-based nutrient supplement ( LNS ) for increased linear growth in  young children . DESIGN Healthy , singleton infants aged 6 - 11 mo ( n = 589 ) were recruited from an urban slum of Cap Haitien and r and omly assigned to receive : 1 ) a control ; 2 ) a 3-mo LNS ; or 3 ) a 6-mo LNS . The LNS provided 108 kcal and other nutrients including vitamin A , vitamin B-12 , iron , and zinc at ≥80 % of the recommended amounts . Infants were followed monthly on growth , morbidity , and developmental outcomes over a 6-mo intervention period and at one additional time point 6 mo postintervention to assess sustained effects . The Bonferroni multiple comparisons test was applied , and generalized least-squares ( GLS ) regressions with mixed effects was used to examine impacts longitudinally . RESULTS Baseline characteristics did not differ by trial arm except for a higher mean age in the 6-mo LNS group . GLS modeling showed LNS supplementation for 6 mo significantly increased the length-for-age z score ( ±SE ) by 0.13 ± 0.05 and the weight-for-age z score by 0.12 ± 0.02 compared with in the control group after adjustment for child age ( P < 0.001 ) . The effects were sustained 6 mo postintervention . Morbidity and developmental outcomes did not differ by trial arm . CONCLUSION A low-energy , fortified product improved the linear growth  of young children in this urban setting . The trial was registered at clinical trials.gov as NCT01552512 OBJECTIVE To determine whether utilization of iron from infant cereal and pureed meat was sufficient to prevent iron depletion and /or anaemia in infants 6 to 12 months old fed whole cow milk ( WCM ) as their primary milk source . DESIGN Six-month-old infants were r and omized into a treatment group ( n = 43 ) receiving iron-fortified infant cereal ( 10.2 mg iron ) , pureed meat ( 0.75 - 1.7 mg iron ) and WCM for six months or a control group ( n = 54 ) receiving no dietary intervention .  Haemoglobin < 110 g/L or ferritin < 10 micrograms/L ( measured bi-monthly ) , confirmed in a second blood sample , defined end-points . RESULTS Proportion reaching end-point was similar between the treatment ( 3/43 ) and control infants ( 5/54 ) ( p = 0.66 ) . Infants not complying with the protocol were at greater risk of reaching end-point ( p = 0.0002 ) . Change in haemoglobin and ferritin across age was similar in both groups . CONCLUSIONS Iron deficiency is not a concern in WCM-fed infants after six months of age if iron-containing complementary foods are concurrently ingested It is unclear whether a substantial decline in malnutrition among infants in developing countries can be achieved by increasing food availability and nutrition counseling without concurrent morbidity-reducing interventions . The study was design ed to determine whether provision of generous amounts of a micronutrient-fortified food supplement supported by counseling or nutritional counseling alone would significantly improve physical growth between 4 and 12 mo of age . In a controlled trial , 418 infants 4 mo of age were individually r and omized to one of the four groups and followed until 12 mo of age . The first group received a milk-based cereal and nutritional counseling ; the second group monthly nutritional counseling alone . To control for the effect of twice-weekly home visits for morbidity ascertainment , similar visits were made in one of the control groups ( visitation group ) ; the fourth group received no intervention . The median energy intake from nonbreast milk sources was higher in the food supplementation group than in the visitation group by 1212 kJ at 26 wk ( P < 0.001 ) , 1739 kJ at 38 wk ( P < 0.001 ) and 2257 kJ at 52 wk ( P < 0.001 ) . The food supplementation infants gained 250 g ( 95 % confidence interval : 20 - -480 g ) more weight than did the visitation group . The difference in the mean increment in length during the study was 0.4 cm ( 95 % confidence interval : -0.1 - -0.9 cm ) . The nutritional counseling group had higher energy intakes ranging from 280 to 752 kJ at different ages ( P < 0.05 at all ages ) but no significant benefit on weight and length increments . Methods to enhance the impact of these interventions need to be identified Does short-term supplementary feeding during infancy and childhood have long-lasting effects ? In 1986 , 334 children aged 6 - 60 mo living on rural tea plantations in West Java , Indonesia , participated in a 3-mo r and omized trial to test the effects of a dietary supplement providing approximately 1672 kJ ( 400 kcal ) energy/d , with about the same nutrient density as local foods . We returned to the same communities in 1994 and enrolled 231 ( 125 supplemented , 106 control ) of the original subjects in a follow-up study of the long-term effects of supplementation . We assessed these subjects by using several measures : anthropometry , iron status , information processing , Peabody Picture Vocabulary Test , word fluency , and an arithmetic test . The supplemented group showed no differences from those in the control group . However , when the analysis was limited to subjects who had received the supplement before the age of 18 mo ( n = 73 ) , the supplemented children performed better than control children on the Sternberg test of working memory ( decision time intercept : probe absent , P = 0.002 ; probe present , P = 0.053 ) . After considering possible confounders , we concluded that the supplementation during infancy was responsible for the difference . This finding shows that supplementation can have long-lasting effects on a specific domain if the child receives it at the appropriate stage of development BACKGROUND Nutritional support is often recommended as part of the treatment of tuberculosis , but it has never been properly tested . OBJECTIVE We assessed the effects of early nutritional intervention on lean mass and physical function in patients with tuberculosis and wasting . DESIGN Patients who started antituberculous therapy within the previous 2 wk were r and omly assigned to receive st and ard nutritional counseling ( control group ) or nutritional counseling to increase their intake through diet and high-energy supplements ( nutritional supplement group ) for 6 wk . Body composition was measured by dual-energy X-ray absorptiometry , and physical function was assessed by maximum grip strength . RESULTS Patients in the nutritional supplement group ( n = 19 ) had a significantly greater increase in body weight ( 2.57 + /- 1.78 compared with 0.84 + /- 0.89 kg , P = 0.001 ) , total lean mass ( 1.17 + /- 0.93 compared with 0.04 + /- 1.26 kg , P = 0.006 ) , and grip strength ( 2.79 + /- 3.11 compared with -0.65 + /- 4.48 kg , P = 0.016 ) than did the control subjects ( n = 17 ) at week 6 . During subsequent follow-up , the increase in body weight remained greater in the nutritional supplement group , but this increase was due mainly to a greater gain in fat mass in the nutritional supplement group than in the control group . CONCLUSIONS Early intervention to increase nutritional intake increases lean mass and physical function . This adjunct to tuberculosis therapy could confer socioeconomic and survival benefits that deserve investigation in large-scale trials . Nutritional intervention after the initial phase of treatment could be less beneficial because it mainly increases fat This study assessed the developmental effects of supplementary feeding over 90 consecutive days on infants aged 6 - 20 mo at six tea plantations in West Java , Indonesia . Every day except Sunday , the infants attended day-care centers distributed throughout the plantations . Twenty centers and 113 infants were selected ; the infants in 9 centers received a dietary supplement , while the infants in 11 centers served as control subjects . Supplements were given twice a day providing , on average , 10.66 kJ ( 400 kcal ) and 5 g protein/d . Measurements of body growth , dietary intake , and mental and motor development were made on all infants . Supplementary feeding had significant effects on weight gain and on motor development . Changes in caloric intake were independently associated with changes in weight and in motor test scores . The data suggest that the effects of the supplement may not have followed a simple mechanistic relationship from intake to weight change to motor development , but , rather , intake may have affected both growth and development domains simultaneously Linear growth retardation and anemia are the most prevalent nutritional problems in the world ; effective interventions are urgently needed . We evaluated Ecuador 's National Food Nutrition Program ( PANN 2000 ) that included a micronutrient-fortified complementary food ( FCF ) , Mi Papilla , in poor periurban and rural communities of Ecuador . The program is preventive and targeted to all infants and young children living in poor communities and receiving government health services . We compared dietary intake , micronutrient status , and growth over 11 mo in a cohort of children from the catchment areas of the PANN 2000 with same-age control children in nearby communities eligible to enter the program 1 y later . PANN 2000 children enrolled in the program when they were age 9 - 14 mo and were age 20 - 25 mo at the final survey . They consumed significantly more energy , protein , fat , iron , zinc , vitamin A , and calcium than control children because of their FCF consumption . Anemia , 76 % in both groups at baseline , fell to 27 % in PANN 2000 children but only to 44 % in control children ( P < 0.001 ) . The odds of being anemic were 58 % lower for PANN 2000 children ( P = 0.003 ) . The effects on linear growth and weight were limited to children who were older when the program began ( 12 - 14 mo ) and were significant for weight ( interaction with age , 0.38 kg ; P = 0.029 ) and positive but not significant for length ( 0.66 cm ; P = 0.08 ) . An FCF , including ferrous sulfate , delivered through public health services , is highly effective in improving weight and hemoglobin and reducing anemia The effect of supplementation on growth was tested by means of four similar controlled r and omized trials in the Congo ( n = 120 ) , Senegal ( n = 110 ) , Bolivia ( n = 127 ) , and New Caledonia ( n = 90 ) . Four-month-old infants were r and omly allocated to supplement or control groups . A cereal-based precooked porridge was offered twice daily for 3 mo and consumption was monitored . Both groups were free to eat local food . At 7 mo of age , all infants were still breast-fed in the Congo , Senegal , and Bolivia compared with 47 % in New Caledonia . Mean daily consumption of the supplement varied among countries ( 558 - 790 kJ/d ) . Mean length at 4 mo was lowest in Bolivia , higher in Senegal and the Congo , and near the National Center for Health Statistics reference in New Caledonia . The mean 4 - 7 mo length increment was 0.48 cm higher for supplemented than for control infants in Senegal ( P < 0.05 ) , whereas weight increments did not differ . No significant effect was found in the other countries It is not known whether nutritional supplementation in early childhood has long-term benefits on  stunted children 's mental development . We followed up 127 7 - 8-y old children who had been stunted in early childhood and received supplementation , stimulation , or both .  At 9 - 24 mo of age , the children had been r and omly assigned to four treatment groups : nutritional supplementation , stimulation , both treatments , and control . After 2 y , supplementation and stimulation had independent benefits on the children 's development and the effects were additive . The group receiving both treatments caught up to a matched group of 32 nonstunted children . Four years after the end of the 2-y intervention 97 % of the children were given a battery of cognitive function , school achievement , and fine motor tests .  An additional 52 nonstunted children were included . Factor analyses of the test scores produced three factors : general cognitive , perceptual-motor , and memory . One , the perceptual-motor factor , showed a significant benefit from stimulation , and supplementation benefited only those children whose mothers had higher verbal intelligence quotients . However , each intervention group had higher scores than the control subjects on more tests than would be expected by chance ( supplemented and both groups on 14 of 15 tests , P = 0.002 ; stimulated group in 13 of 15 tests , P = 0.01 ) , suggesting a very small global benefit . There was no longer an additive effect of combined treatments at the end of the intervention . The stunted control group had significantly lower scores than the nonstunted children on most tests . Stunted children 's heights and head circumferences on enrollment significantly predicted intelligence quotient at follow-up OBJECTIVE To investigate the effects of nutritional supplementation on the outcome and nutritional status of south Indian patients with tuberculosis ( TB ) with and without human immunodeficiency virus ( HIV ) coinfection on anti-tuberculous therapy . METHOD R and omized controlled trial on the effect of a locally prepared cereal-lentil mixture providing 930 kcal and a multivitamin micronutrient supplement during anti-tuberculous therapy in 81 newly diagnosed TB alone and 22 TB-HIV-coinfected patients , among whom 51 received and 52 did not receive the supplement . The primary outcome evaluated at completion of TB therapy was outcome of TB treatment , as classified by the national programme . Secondary outcomes were body composition , compliance and condition on follow-up 1 year after cessation of TB therapy and supplementation . RESULTS There was no significant difference in TB outcomes at the end of treatment , but HIV-TB coinfected individuals had four times greater odds of poor outcome than those with TB alone . Among patients with TB , 1/35 ( 2.9 % ) supplemented and 5/42(12 % ) of those not supplemented had poor outcomes , while among TB-HIV-coinfected individuals , 4/13 ( 31 % ) supplemented and 3/7 ( 42.8 % ) non-supplemented patients had poor outcomes at the end of treatment , and the differences were more marked after 1 year of follow-up . Although there was some trend of benefit for both TB alone and TB-HIV coinfection , the results were not statistically significant at the end of TB treatment , possibly because of limited sample size . CONCLUSION Nutritional supplements in patients are a potentially feasible , low-cost intervention , which could impact patients with TB and TB-HIV . The public health importance of these diseases in re source -limited setting s suggests the need for large , multi-centre r and omized control trials on nutritional supplementation OBJECTIVE Our purpose was to measure the agreement , reliability , construct validity , and feasibility of a measurement tool to assess  systematic review s ( AMSTAR ) . STUDY DESIGN AND SETTING We r and omly selected 30 systematic review s from a data base . Each was assessed by two review ers using : ( 1 ) the enhanced quality assessment question naire ( Overview of Quality Assessment Question naire [ OQAQ ] ) ; ( 2 ) Sacks ' instrument ; and ( 3 ) our newly developed measurement tool ( AMSTAR ) . We report on reliability ( interobserver kappas of the 11 AMSTAR items ) , intraclass correlation coefficients ( ICCs ) of the sum scores , construct validity ( ICCs of the sum scores of AMSTAR compared with those of other instruments ) , and completion times . RESULTS The interrater agreement of the individual items of AMSTAR was substantial with a mean kappa of 0.70 ( 95 % confidence interval [ CI ] : 0.57 , 0.83 ) ( range : 0.38 - 1.0 ) . Kappas recorded for the other instruments were 0.63 ( 95 % CI : 0.38 , 0.78 ) for enhanced OQAQ and 0.40 ( 95 % CI : 0.29 , 0.50 ) for the Sacks ' instrument . The ICC of the total score for AMSTAR was 0.84 ( 95 % CI : 0.65 , 0.92 ) compared with 0.91 ( 95 % CI : 0.82 , 0.96 ) for OQAQ and 0.86 ( 95 % CI : 0.71 , 0.94 ) for the Sacks ' instrument . AMSTAR proved easy to apply , each review taking about 15 minutes to complete . CONCLUSIONS AMSTAR has good agreement , reliability , construct validity , and feasibility . These findings need confirmation by a broader range of assessors and a more diverse range of review To assess the effectiveness on child growth and body composition of a supplementary feeding program ( Milk Supplement Program ) , a prospect i ve , controlled study was conducted in Northeast Brazil . When entering the Program , children from 10 municipalities with the highest coverage rates in the Program ( intervention group ) were compared to non-beneficiary children from 10 municipalities with the lowest coverage rates ( control group ) . A total of 219 children aged 6 - 18 months were enrolled . At entry , both groups were comparable in terms of age , sex , and nutritional status . There were frequent gaps in delivery of the supplement , no extra milk was provided to siblings less than 5 years of age , intra-household redistribution of milk was high , and maternal compliance with recommendations was low . Adjusted analyses by multilevel modelling showed average changes in weight , length , weight-age and length-age Z-scores , and % body water ( deuterium method ) , at 6 months , of 1.53 kg , 6.34 cm , 0.33 , 0.05 , and 1.11 % respectively among supplemented children as compared to 1.54 kg , 6.5 cm , 0.26 , 0.07 , and 4.10 % among controls , with no statistically significant difference between groups . Thus , the Program failed to compensate for nutritional deficiencies in undernourished children in Northeast Brazil Background Maternal diet during pregnancy is one of the most important factors associated with adequate fetal growth . There are many complications associated with fetal growth restriction that lead to lifelong effects . The aim of this review was to describe the studies examining the effects of protein energy supplementation during pregnancy on fetal growth focusing on the context ual differences . Methods Relevant articles published between 2007 and 2012 were identified through systematic electronic search es of the PubMed , Science Direct , and EBSCO data base and the examination of the bibliographies of retrieved articles . The search aim ed to identify studies examining pregnant women receiving protein and /or energy during pregnancy and to assess fetal growth measures . Data of effectiveness and practical aspects of protein energy supplementation during pregnancy were extracted and compiled . Results Twenty studies ( 11 r and omized controlled trials , 8 controlled before and after , and 1 prospect i ve study ) were included in this review . Positive outcomes in infants and women can not be expected if the supplementation is not needed . Therefore , it is essential to correctly select women who will benefit from dietary intervention programs during pregnancy . However , there is currently no consensus on the most effective method of identifying these women . The content of protein in the supplements considering total diet is also an important determinant of fetal growth . Balanced protein energy supplementation ( containing up to 20 % of energy as protein ) given to pregnant women with energy or protein deficit appears to improve fetal growth , increase birth weight ( by 95–324 g ) and height ( by 4.6–6.1 mm ) , and decrease the percentage of low birth weight ( by 6 % ) . Supplements with excess protein ( > 20 % of energy as protein ) provided to women with a diet already containing adequate protein may conversely impair fetal growth . There is also no consensus on the best time to start supplementation . Conclusions Strong quality studies examining adequate criteria to screen women who would benefit from supplementation , time to start supplementation , and type of supplements are warranted A previous longitudinal three-country study in Egypt , Kenya and Mexico found significant positive associations between intake of animal source foods ( ASF ) and growth , cognitive development and physical activity . To test for a causal relationship , a controlled school feeding intervention study was design ed to test the hypotheses that ASF would improve micronutrient status , growth and cognitive function in Kenyan primary school children . Twelve rural Kenyan schools with 554 children were r and omized to four feeding interventions using a local vegetable stew as the vehicle . The groups were design ated as Meat , Milk , Energy and Control , who received no feedings . Feeding was carried out on school days for seven terms during 21 mo . Preintervention baseline measures included nutritional status , home food intake , anthropometry , biochemical measures of micronutrient status , malaria , intestinal parasites , health status and cognitive and behavioral measures . The measurements of each child were repeated at intervals over 2 y. Baseline data revealed stunting and underweight in approximately 30 % of children and widespread inadequate intakes and /or biochemical evidence of micronutrient deficiencies , particularly of iron , zinc , vitamins A and B-12 , riboflavin and calcium . Little or no ASF were eaten and fat intake was low . Malaria was present in 31 % of children , and hookworm , amebiasis and giardia were widely prevalent . The outcomes measured were rates of change or increase during the intervention in cognitive function , growth , physical activity and behavior and micronutrient status . Hierarchical linear r and om effects modeling was used for analysis of outcomes Undernutrition is common among tuberculosis ( TB ) patients . The objective of this study was to assess the effect of multi-micronutrient supplementation during TB treatment on weight , body composition , and h and grip strength . A total of 865 patients with smear-positive ( PTB+ ) or -negative ( PTB- ) pulmonary TB were r and omly allocated to receive a daily biscuit with or without multi-micronutrients for 60 d during the intensive phase of TB treatment . Weight , arm fat area , arm muscle area , and h and grip strength were assessed at baseline and after 2 and 5 mo . At 2 mo , the multi-micronutrient supplementation led to a higher h and grip gain ( 1.22 kg ; 95 % CI = 0.50 , 1.94 ; P = 0.001 ) but had no effects on other outcomes . The effects of multi-micronutrient supplementation were modified by HIV infection ( P-interaction = 0.002 ) . Among HIV- patients , multi-micronutrient supplementation  increased weight gain by 590 g ( 95 % CI = -40 , 1210 ; P = 0.07 ) and h and grip strength by 1.6 kg ( 95 % CI = 0.78 , 2.47 ; P < 0.001 ) , whereas among HIV+ patients , it reduced weight gain by 1440 g ( 95 % CI = 290 , 2590 ; P = 0.002 ) and had no effect on h and grip strength ( 0.07 kg ; 95 % CI = -1.30 , 1.46 ; P = 0.91 ) . The reduced weight gain among HIV+ patients receiving  multi-micronutrient supplementation seemed to be explained by a higher proportion of patients reporting fever . At 5 mo , the effects on weight were sustained , whereas there was no effect on h and grip strength . In conclusion , multi-micronutrient supplementation given as a biscuit is beneficial among HIV- PTB patients and may be recommended to TB programs . More research is needed to develop an effective supplement for HIV+ PTB patients BACKGROUND In breastfed infants , iron deficiency at < 6 mo of life , although uncommon , is observed in industrialized countries . Iron supplementation starting at an early age may prevent iron deficiency . OBJECTIVE The study assessed the effect of early iron supplementation of breastfed infants and tested the hypothesis that iron supplementation enhances iron status . Potential adverse effects ( tolerance and growth ) were monitored . DESIGN The prospect i ve , placebo-controlled study involved exclusively breastfed infants who were r and omly assigned at 1 mo of age to iron ( n = 37 ) or placebo ( n = 38 ) .  Iron ( 7 mg/d as multivitamin preparation with ferrous sulfate ) or placebo ( multivitamin preparation without iron ) was given from 1 to 5.5 mo of age . Complementary foods were allowed at > 4 mo . Infants were followed to 18 mo . Blood concentrations of ferritin , transferrin receptor , hemoglobin , and red cell indexes were determined at bimonthly intervals . Stool consistency and color and feeding behavior were recorded . RESULTS Iron supplementation caused modest augmentation of iron status during the intervention at 4 and 5.5 mo but not thereafter . Iron supplements were well tolerated and had no measurable effect on growth . One infant developed iron deficiency anemia by 5.5 mo of age . Plasma ferritin and hemoglobin tracked over time . CONCLUSION Early iron supplementation of breastfed infants is feasible and transiently increases iron status but not hematologic status . Iron is tolerated by most infants . The prevalence of iron deficiency anemia is low ( 3 % ) among unsupplemented breastfed infants in the first 6 mo of life Although widely used , there is little information concerning the efficacy of corn-soy blend ( CSB ) supplementation in the treatment of moderate underweight in African children .  Lipid-based nutrient supplements ( LNS ) , which have proven to be beneficial treatment for severely wasted children , could offer benefits to less severely affected individuals . We conducted a clinical r and omized trial to determine whether LNS or CSB supplementation improves weight gain of moderately underweight children . A total of 182 underweight [ weight-for-age Z-score ( WAZ ) < -2 ] 6- to 15-mo-old children were r and omized to receive for 12 wk a ration of 43 g/d LNS or 71 g/d CSB , providing 1189 and 921 kJ , respectively , or no supplementation ( control ) . The primary outcome was weight change ; secondary outcomes included changes in anthropometric indices , hemoglobin levels , and morbidity . The body weight increases ( mean ± SD ) did not differ and were 620 ± 470 , 510 ± 350 , and 470 ± 350 g in the LNS , CSB , and control groups , respectively ( P = 0.11 ) . Compared with controls , infants and children in the LNS group gained more weight [ mean ( 95 % CI ) = 150 g ( 0 - 300 g ) ; P = 0.05 ] and had a greater increase in WAZ [ 0.33 ( -0.02 - 0.65 ) ; P = 0.04 ] . Weight and WAZ changes did not differ between the control and CSB groups . In exploratory stratified analysis , the weight increase was higher in the LNS group compared with the control group among those with lower initial WAZ [ 250 g ( 60 - 430 g ; P = 0.01 ] . Supplementation with LNS but not CSB modestly increases weight gain among moderately underweight children and the effect appears most pronounced among those with a lower initial WAZ BACKGROUND Hypocholesterolemia is common among tuberculous patients and is associated with mortality in miliary cases . Some in vitro studies have shown that cholesterol is necessary for the good functioning of macrophages and lymphocytes . STUDY OBJECTIVES To determine whether a cholesterol-rich diet could accelerate sputum sterilization in patients with pulmonary tuberculosis . DESIGN An 8-week follow-up , r and omized , controlled trial carried out from March 2001 to January 2002 . SETTING A third-level hospital for respiratory diseases in Mexico City . PATIENTS AND INTERVENTIONS Adult patients with newly diagnosed pulmonary tuberculosis were hospitalized for 8 weeks and r and omly assigned to receive a cholesterol-rich diet ( 800 mg/d cholesterol [ experimental group ] ) or a normal diet ( 250 mg/d cholesterol [ control group ] ) . All patients received the same four-drug antitubercular regimen ( ie , isoniazid , rifampin , pyrazinamide , and ethambutol ) . MEASUREMENTS AND RESULTS Every week , a quantitative sputum culture and laboratory tests were done and respiratory symptoms were recorded . Patients in the experimental group ( 10 patients ) and the control group ( 11 subjects ) were HIV-negative and harbored Mycobacterium tuberculosis that was fully sensitive to antitubercular drugs . Sterilization of the sputum culture was achieved faster in the experimental group , as demonstrated either by the percentage of negative culture findings in week 2 ( 80 % ; control group , 9 % ; p = 0.0019 ) or by the Gehan-Breslow test for Kaplan-Meier curves ( p = 0.0037 ) . Likewise , the bacillary population decreased faster ( p = 0.0002 ) in the experimental group . Respiratory symptoms improved in both groups , but sputum production decreased faster in the experimental group ( p < 0.05 ) . Laboratory test results did not differ between the groups . CONCLUSIONS A cholesterol-rich diet accelerated the sterilization rate of sputum cultures in pulmonary tuberculosis patients , suggesting that cholesterol should be used as a complementary measure in antitubercular treatment Objectives : To describe the method ologies of a clinical trial on the effects of an energy and micronutrient supplement on the growth and development of undernourished children . Design : This trial included two cohorts of children classified as nutritionally-at-risk who were r and omly assigned to three treatments  ( condensed milk+micronutrients ( E ) ; skimmed milk+micronutrients ( M ) ; skimmed milk ( S ) ) . Supplements were given for a period up to 12 months . Setting : Six tea plantations in Pangalengan , West Java were the site for this study .Subjects : A 12-month-old ( N=53 ) and an 18-month-old ( N=83 ) cohort were recruited from 24 day-care-centers ( DCC ) . Twenty children that received the S supplement were part of the 12- and 18 month-old cohort . Criteria for case inclusion were absence of chronic disease ; length-for-age≤−1 st and ard deviation ( s.d . ) and weight-for-length between −1 and −2 s.d . of the median of the reference of the World Health Organization . Variables : Social variables included assessment of health facilities , childcare , housing , income and parental education . Nutrition and growth variables included dietary intake measured over a 24 hr period every 2 months ; hemoglobin and three iron indicators measured at baseline , 6 and 12 months ; anthropometry measured every 2 months and skeletal maturation measured every 6 months . Cognition and behavior included the assessment of mental and motor development and the behavior of the child under natural conditions . Data analysis : An ANOVA was the statistic most frequently used to test inter-group differences and structural equation modeling was used to test the internal validity of the conceptual model of the study .Sponsorship : Nestlé Foundation . European Journal of Clinical Nutrition ( 2000 ) 54 , Suppl 2 , BACKGROUND Both st and ard and immune-enhancing oral formulas are widely used to forestall HIV wasting and to promote immune function . However , there is little scientific evidence to support the differential effects of these formulas in asymptomatic HIV disease . The aim of this study was to compare the effects of an immune-enhancing oral formula and a st and ard oral formula on nutrition and immune measures in asymptomatic HIV-infected persons . A secondary aim was to evaluate the feasibility of maintaining a diverse sample of out patients on a long-term oral formula protocol . METHODS In this multicenter controlled nonblinded study , 90 asymptomatic HIV-infected persons with CD4 cell counts between 275 and 550 cells/mm3 were r and omized to a control group ; a st and ard oral formula group ( Ensure Plus ) ; or an immune-enhancing oral formula group ( Advera ) . All groups received basic nutrition counseling . Participants were evaluated on nutrition , immune , and feasibility measures at 3-month intervals during the 12-month study period . Differences in nutrition and immune measures among the 3 groups were analyzed using the Kruskal-Wallis and Wilcoxon tests . Wilcoxon tests and correlation coefficients were used to analyze feasibility data . RESULTS Sixty-six out patients completed the 12-month study protocol . Among the 3 groups , there were no significant differences with respect to body weight , bioelectrical impedance analysis (BIA)-derived body cell and fat mass , daily caloric intake , and serum albumin at any of the study visits . Moreover , absolute CD4 + T lymphocytes and percentages did not significantly differ at any time point among the 3 groups . Acceptability and tolerance of the formulas were high for both the st and ard and immune-enhancing oral formula groups . CONCLUSIONS Within the context and limitations of this study , st and ard and immune-enhancing oral formulas consumed daily for 1 year had no differential effects on nutrition or immune parameters in asymptomatic HIV-infected persons CONTEXT Malnutrition causes death and impaired health in millions of children . Existing interventions are effective under controlled conditions ; however , little information is available on their effectiveness in large-scale programs . OBJECTIVE To document the short-term nutritional impact of a large-scale , incentive-based development program in Mexico ( Progresa )  , which included a nutritional component . DESIGN , SETTING , AND PARTICIPANTS A r and omized effectiveness study of 347 communities r and omly assigned to immediate incorporation to the program in 1998 ( intervention group ; n = 205 ) or to incorporation in 1999 ( crossover intervention group ; n = 142 ) . A r and om sample of children in those communities was surveyed at baseline and at 1 and 2 years afterward . Participants were from low-income households in poor rural communities in 6 central Mexican states . Children ( N = 650 ) 12 months of age or younger ( n = 373 intervention group ; n = 277 crossover intervention group ) were included in the analyses . INTERVENTION Children and pregnant and lactating women in participating households received fortified nutrition supplements , and the families  received nutrition education , health care , and cash transfers . MAIN OUTCOME MEASURES Two-year height increments and anemia rates as measured by blood hemoglobin levels in participating children . RESULTS Progresa was associated with better growth in height among the poorest and younger infants . Age- and length-adjusted height was greater by 1.1 cm ( 26.4 cm in the intervention group vs 25.3 cm in the crossover intervention group ) among infants younger than 6 months at baseline and who lived in the poorest households . After 1 year , mean hemoglobin values were higher in the intervention group ( 11.12 g/dL ; 95 % confidence interval [ CI ] , 10.9 - 11.3 g/dL ) than in the crossover intervention group ( 10.75 g/dL ; 95 % CI , 10.5 - 11.0 g/dL ) who had not yet received the benefits of the intervention ( P = .01 ) . There were no differences in hemoglobin levels between the 2 groups at year 2 after both groups were receiving the intervention . The age-adjusted rate of anemia ( hemoglobin level < 11 g/dL ) in 1999 was higher in the crossover intervention group than in the intervention group ( 54.9 % vs 44.3 % ; P = .03 ) , whereas in 2000 the difference was not significant ( 23.0 % vs 25.8 % , respectively ; P = .40 ) . CONCLUSION Progresa , a large-scale , incentive-based development program with a nutritional intervention , is associated with better growth and lower rates of anemia in low-income , rural infants and children in Mexico There is little unequivocal evidence that nutritional supplementation of undernourished children has a beneficial effect on their mental development . The effects of nutritional supplementation , with or without psychosocial stimulation , of growth-retarded ( stunted ) children aged 9 - 24 months were assessed in a study in Kingston , Jamaica . 129 children from poor neighbourhoods were r and omly assigned to four groups -- control , supplemented only , stimulated only , and supplemented plus stimulated . A group of matched non-stunted children ( n = 32 ) was also included . The supplement comprised 1 kg milk-based formula per week for 2 years , and the stimulation weekly play sessions at home with a community health aide . The children 's development ( DQ ) was assessed on the Griffiths mental development scales . Initially the stunted groups ' DQs were lower than those of the non-stunted group , and those of the control group declined during the study , increasing their deficit . Stimulation and supplementation had significant independent beneficial effects on the children 's development . Estimates of the supplementation effect ranged from 2.2 ( 95 % confidence limits-1.4 , 5.7 ) for the h and and eye subscale to 12.4 ( 5.4 , 19.5 ) for the locomotor subscale and those for the stimulation effect from 6.4 ( 2.8 , 10.0 ) for h and and eye to 10.3 ( 3.3 , 17.3 ) for locomotor . The treatment effects were additive , and combined interventions were significantly more effective than either alone . These findings suggest that poor mental development in stunted children is at least partly attributable to undernutrition An energy-dense supplementary food , together with nutrition education , was given to a group of moderately malnourished children aged 6 - 12 months in a poor slum community of urban Bangladesh . An age- and sex-matched control group received only nutrition education . Both groups were followed monthly with respect to weight gain and morbidity . The purpose of the study was to assess the differential impact of a targeted supplementary feeding programme with nutrition education and a nutrition education programme alone on monthly weight gain during 6 months . During the 1st 3 months of the intervention , the monthly weight gain of the supplemented children was 205 g vs 159 g in the control children ( p less than 0.05 ) . In the following 3 months , differences in weight gain were no more significant . Several possible explanations for this transient impact are discussed . It is suggested that nutrition education in the control group may have been responsible for the limited difference between the two groups , but seasonal and epidemiological factors may also have played a part STUDY OBJECTIVE To measure the health , educational and social impacts of breakfast club provision in schools serving deprived areas across Engl and . DESIGN A cluster r and omized controlled trial and an observational analysis . SETTING Engl and , the UK . INTERVENTION funding to establish a school-based breakfast club vs. control ( no funding ) . MAIN RESULTS Intention to treat analysis showed improved concentration ( Trail Making Test Part A ) amongst the intervention group at 3 months . Fewer pupils within the intervention group reported having skipped classes within the last month and fewer pupils within the intervention group reported having skipped 1 or more days of school within the last month at 1 year . Observational analysis at 1 year showed a higher proportion of primary -aged breakfast club attendees reported eating fruit for breakfast in comparison to non-attendees . A higher proportion of breakfast club attendees had borderline or abnormal conduct and total difficulties scores ( primary -aged pupils ) and prosocial score ( secondary -aged pupils ) . CONCLUSIONS Analyses revealed a mixed picture of benefit and apparent disbenefit . This study illustrated the challenges of evaluating a complex intervention in which the evaluators had less control than is usual in r and omized trials over recruitment , eligibility checking and implementation . If the impact of new policy initiatives is to be assessed using the most robust forms of evaluation , social policy needs to be organized so that evaluations can be constructed as experiments . This is likely to prove most difficult where the perceived value of implementing an intervention rapidly is high INTRODUCTION Wasting is the cardinal feature of tuberculosis , but not much documentary evidence supporting food supplements exists . This study was done to assess the effects of food supplements on body weight , physical function , quality of life and treatment outcomes in patients with tuberculosis and wasting . METHODS The study was conducted in 30 Anganwadi centres of 16 villages in the catchment area of Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation and the Gannavaram Directly Observed Treatment Short Course chemotherapy centre from August 2005 to December 2005 . A total of 100 patients participated in the study . Patients who were started on anti-tubercular therapy within the previous two weeks were r and omly assigned to either the control or the food supplement group . At the end of three months , their body weight was measured and physical function and quality of life were assessed . Treatment outcomes were assessed at the one-year follow-up for both groups . RESULTS Patients who received supplements had a significant increase in body weight ( 8.6 percent versus 2.6 percent , p-value less than 0.001 ) and maximum grip strength ( p-value less than 0.001 ) , a higher sputum conversion rate ( p-value is 0.039 ) , a higher treatment completion rate ( p-value is 0.031 ) and improvements in the quality of life scores . CONCLUSION Intake of food supplements result ed in a definitive increase in body weight and physical function in our study sample . Improvements can be observed in all areas , including psychologically , physiologically , socially and in the treatment outcomes OBJECTIVE Breast milk alone is insufficient to support normal growth during the second half of infancy , so I investigated supplementary feeding for infants ' successful transition to solid food . METHODS The nutrition status of 30 infants from a low socioeconomic background weaned onto an extruded formulated complementary diet from maize and cowpea ( L(1)A(1 ) ) were compared with 30 infants with a similar socioeconomic background ( L(2)N , control group ) and 30 infants from an above-average socioeconomic background ( HN , reference group ) without the supplementary diet .  Infants within the control and reference groups were weaned onto different foods of the mothers ' choice . The formulated diet was analyzed for nutrient composition . RESULTS The results showed similarity in the estimated annual family income of the L(1)A(1 ) and L(2)N groups , which ranged from N 25 000 to 74 000 ( US $ 208.30 to 616.70 ) , whereas the estimated family income for the HN group was above N 225 000 ( US $ 1875.00 ) annually . The formulated blend contained 17.3 % protein , 5.0 % fat , and 2106 kJ of energy . Mean weight at birth and 4 mo before the feeding intervention in HN infants was statistically ( P < 0.05 ) higher than in L(1)A(1 ) and L(2)N infants . At the end of the study , L(1)A(1 ) and HN infants had a mean length within -1 st and ard deviation of the st and ard length for age . The mean length of L(2)N infants was within -3 st and ard deviations of the st and ard length for age . The effectiveness of the formulated diet  was expressed in terms of similarity in anthropometric measurements of L(1)A(1 ) ) and HN infants . CONCLUSIONS Based on similarities in socioeconomic background and weight at birth and 4 mo in the L(1)A(1 ) and L(2)N infants , the better nutrition status of the L(1)A(1 ) is attributed to the formulated complementary diet . The contribution of this mixture to total nutrient intake seemed substantial enough to meet the infants ' nutritional requirements . The use of a cheaply available plant protein will go a long way in reducing protein-energy malnutrition among children in developing countries . However , because of the low purchasing power of the low-income family , the costs of this product should be studied CONTEXT Ready-to-use therapeutic foods ( RUTFs ) are an important component of effective outpatient treatment of severe wasting . However , their effectiveness in the population -based prevention of moderate and severe wasting has not been evaluated . OBJECTIVE To evaluate the effect of a 3-month distribution of RUTF on the nutritional status , mortality , and morbidity of children aged 6 to 60 months in Niger . DESIGN , SETTING , AND PARTICIPANTS A cluster r and omized trial of 12 villages in Maradi , Niger . Six villages were r and omized to intervention and 6 to no intervention . All children in the study villages aged 6 to 60 months were eligible for recruitment . INTERVENTION Children with weight-for-height 80 % or more of the National Center for Health Statistics reference median in the 6 intervention villages received a monthly distribution of 1 packet per day of RUTF ( 92 g [ 500 kcal/d ] ) from August to October 2006 . Children in the 6 nonintervention villages received no preventive supplementation . Active surveillance for conditions requiring medical or nutritional treatment was conducted monthly in all 12 study villages from August 2006 to March 2007 . MAIN OUTCOME MEASURES Changes in weight-for-height z score ( WHZ ) according to the World Health Organization Child Growth St and ards and incidence of wasting ( WHZ < -2 ) over 8 months of follow-up . RESULTS The number of children with height and weight measurements in August , October , December , and February was 3166 , 3110 , 2936 , and 3026 , respectively . The WHZ difference between the intervention and nonintervention groups was -0.10 z ( 95 % confidence interval [ CI ] , -0.23 to 0.03 ) at baseline and 0.12 z ( 95 % CI , 0.02 to 0.21 ) after 8 months of follow-up . The adjusted effect of the intervention on WHZ from baseline to the end of follow-up was thus 0.22 z ( 95 % CI , 0.13 to 0.30 ) . The absolute rate of wasting and severe wasting , respectively , was 0.17 events per child-year ( 140 events/841 child-years ) and 0.03 events per child-year ( 29 events/943 child-years ) in the intervention villages , compared with 0.26 events per child-year ( 233 events/895 child-years ) and 0.07 events per child-year ( 71 events/1029 child-years ) in the nonintervention villages . The intervention thus result ed in a 36 % ( 95 % CI , 17 % to 50 % ; P < .001 ) reduction in the incidence of wasting and a 58 % ( 95 % CI , 43 % to 68 % ; P < .001 ) reduction in the incidence of severe wasting . There was no reduction in mortality , with a mortality rate of 0.007 deaths per child-year ( 7 deaths/986 child-years ) in the intervention villages and 0.016 deaths per child-year ( 18 deaths/1099 child-years ) in the nonintervention villages ( adjusted hazard ratio , 0.51 ; 95 % CI , 0.25 to 1.05 ) . CONCLUSION Short-term supplementation of nonmalnourished children with RUTF reduced the decline in WHZ and the incidence of wasting and severe wasting over 8 months . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00682708 HIV infection is associated with subnormal GSH levels . An increase in glutathione levels has been observed in HIV-infected adults under oral whey protein supplementation .  We studied the features associated with a whey protein concentrate supplementation in children with rapidly progressive AIDS . A prospect i ve double-blind clinical trial was carried out for 4 months with 18 vertically HIV-infected children ( 1.98 - 6.37 years ) , under antiretroviral therapy , who had received whey protein , maltodextrin ( placebo ) or none .  Erythrocyte glutathione concentration , T lymphocyte counts ( CD4 + and CD8 + ) and occurrence of associated co-infections were evaluated . Wilcoxon 's and Fischer 's Exact tests were used to assess differences between whey protein-supplemented and control ( placebo and non-supplemented ) groups . A significant median increase of 16.14 mg/dl ( p = 0.018 ) in erythrocyte glutathione levels was observed in the whey protein-supplemented group ; the TCD4/CD8 lymphocyte ratio showed a non significant increase and lower occurrence of associated co-infections was also observed . In conclusion , whey protein concentrate supplementation can stimulate glutathione synthesis and , possibly , decrease the occurrence of associated co-infections Treatment of HIV-infected persons including nutritional management is a major concern in Africa and in particular in the Central African Republic ( CAR ) . This six-month r and omized prospect i ve longitudinal study was carried out at the Friends of Africa Center that was a facility for comprehensive management of persons infected and affected by HIV in Banqui , CAR . The purpose of the study was to assess the impact of spirulina supplement on clinical and laboratory findings in HIV-infected patients who were not indications for ARV treatment . A total of 160 patients were r and omly assigned to two groups . Patients in group 1 ( n=79 ) received 10 grams of spirulina per day on a regular basis while patients in group 2 ( n = 81 ) received a placebo . In addition patients in both groups received dietary products supplied by the World Food Program ( WFP ) . Follow-up of the 160 patients at three and six months showed that 16 patients had been lost from follow-up and 16 had died , with no difference in distribution between the two groups . A significant improvement in the main follow-up criteria , i.e. , weight , arm girth , number of infectious episodes , CD4 count , and protidemia , was observed in both groups . No difference was found between the two groups except with regard to protidemia and creatinemia that were higher in the group receiving spirulina supplement . From a clinical st and point results were less clear-cut since the Karnofsky score was better in the group receiving spirulina than in the group receiving the placebo at 3 months but not at 6 months and fewer patients presented pneumonia at six months . Further study over a longer period will be needed to determine if spirulina is useful and to evaluate if higher doses can have beneficial nutritional and immunitary effects without adverse effects , in particular renal problems This prospect i ve r and omized trial was carried out to test the efficacy of a specific intervention for reducing the extent of their malnutrition and to change behaviour of mothers relating to child-feeding practice s , care-giving , and health-seeking practice s under the Bangladesh Integrated Nutrition Project ( BINP ) . The study was conducted in rural Bangladesh among 282 moderately-malnourished ( weight-for-age between 61 % and 75 % of median of the National Center for Health Statistics st and ard ) children aged 6 - 24 months . Mothers of the first intervention group received intensive nutrition education ( INE group ) twice a week for three months . The second intervention group received the same nutrition education , and their children received additional supplementary feeding ( INE+SF group ) . The comparison group received nutrition education from the community nutrition promoters twice a month according to the st and ard routine service of BINP . The children were observed for a further six months . After three months of interventions , a significantly higher proportion of children in the INE and INE+SF groups improved ( 37 % and 47 % respectively ) from moderate to mild or normal nutrition compared to the comparison group ( 18 % ) ( p < 0.001 ) . At the end of six months of observation , the nutritional status of children in the intervention groups improved further from moderate to mild or normal nutrition compared to the comparison group ( 59 % and 86 % vs 30 % , p < 0.0001 ) . As the intensive nutrition education and supplementation given were highly effective , more children improved from moderate malnutrition to mild or normal nutritional status despite a higher incidence of morbidity . The frequency of child feeding and home-based complementary feeding improved significantly ( p < 0.001 ) in both the intervention groups after three months of interventions and six months of observation . Body-weight gain was positively associated with age , length-for-age , weight-for-length , frequency of feeding of khichuri , egg , and potato ( p < 0.05 ) . Ability of mothers to identify malnutrition improved from 15 % to 99 % in the INE group and from 15 % to 100 % in the INE+SF group , but reduced from 24 % to 21 % in the comparison group . Use of separate feed pots , frequency of feeding , and cooking of additional complementary feeds improved significantly in the INE and INE+SF groups compared to the comparison group after three months of interventions and six months of observation . It can be concluded from the findings of the study that intensive nutrition education significantly improves the status of moderately-malnourished children with or without supplementary feeding OBJECTIVES To study the effects of oral nutritional supplements ( OS ) on body weight , body composition , nutritional status , and cognition in elderly patients with Alzheimer 's disease ( AD ) . DESIGN Prospect i ve , r and omized , controlled study . SETTING Geriatric wards and day care centers in the Toulouse area , France . PARTICIPANTS Ninety-one subjects with AD aged 65 and older at risk of undernutrition as evaluated using the Mini Nutritional Assessment . INTERVENTION After r and omization , 46 patients ( intervention group ) received 3-month OS . The other 45 patients ( control group ) received usual care . MEASUREMENTS Weight , body composition ( evaluated using dual-energy x-ray absorptiometry ) , cognitive function , activities of daily living , eating behavior , and dietary intakes were evaluated at the beginning of the study and at 3 months and 6 months . Supplement compliance was recorded each day . RESULTS Between baseline and 3 months , energy and protein intakes significantly improved in the intervention group , result ing in a significant increase in weight and fat-free mass , but no significant changes were found for dependence , cognitive function , or biological markers . The nutritional benefit was maintained in the intervention group after discontinuation of OS at 3 months . CONCLUSION Three-month daily OS significantly improves body weight . It is practicable and effective , and the patients accepted it well . The improvement that was observed even in the control group showed that caregiver education is an important factor in maintaining the nutritional status of patients with AD . Moreover , regular courses of OS may help to maintain the increase in fat-free mass and improve the nutritional status of these patients ABSTRACT Nutritional supplementation to tuberculosis ( TB ) patients has been associated with increased weight and reduced mortality , but its effect on the pharmacokinetics of first-line anti-TB drugs is unknown . A cohort of 100 TB patients ( 58 men ; median age , 35 [ interquartile range { IQR } , 29 to 40 ] years , and median body mass index [ BMI ] , 18.8 [ 17.3 to 19.9 ] kg/m2 ) were r and omized to receive nutritional supplementation during the intensive phase of TB treatment . Rifampin plasma concentrations were determined after 1 week and 2 months of treatment . The effects of nutritional supplementation , HIV , time on treatment , body weight , and SLCO1B1 rs4149032 genotype were examined using a population pharmacokinetic model . The model adjusted for body size via allometric scaling , accounted for clearance autoinduction , and detected an increase in bioavailability ( + 14 % ) for the patients in the continuation phase . HIV coinfection in patients not receiving the supplementation was found to decrease bioavailability by 21.8 % , with a median maximum concentration of drug in serum ( Cmax ) and area under the concentration-time curve from 0 to 24 h ( AUC0–24 ) of 5.6 μg/ml and 28.6 μg · h/ml , respectively . HIV-coinfected patients  on nutritional supplementation achieved higher Cmax and AUC0–24 values of 6.4 μg/ml and 31.6 μg · h/ml , respectively , and only 13.3 % bioavailability reduction . No effect of the SLCO1B1 rs4149032 genotype was observed . In conclusion , nutritional supplementation during the first 2 months of TB treatment reduces the decrease in rifampin exposure observed in HIV-coinfected patients but does not affect exposure in HIV-uninfected patients . If confirmed in other studies , the use of defined nutritional supplementation in HIV-coinfected TB patients should be considered in TB control programs . ( This study has the controlled trial registration number IS RCT N 16552219 . OBJECTIVE To evaluate the effects of nutrition counseling with or without oral supplementation in malnourished patients infected with the human immunodeficiency virus ( HIV ) . DESIGN R and omized controlled trial . SUBJECTS HIV-infected men ( n=118 ) who were less than 90 % of usual weight for height or who had lost more than 10 % of body weight . INTERVENTION Nutrition counseling alone ( control group ) vs nutrition counseling plus enteral supplementation ( supplement group ) for 6 weeks . All patients were instructed to consume a diet that exceeded estimated total energy expenditure by 960 kcal/day . MAIN OUTCOME MEASURES Weight , skinfold thickness , fat-free mass , grip strength , quality of life , and cognitive function ( Buschke test ) . STATISTICAL ANALYSES Differences in baseline variables and outcomes were evaluated using analysis of variance or the Wilcoxon rank sum test . RESULTS Ninety-nine men completed at least 4 weeks of treatment , 49 in the supplement group and 50 in the control group . Half the patients in each treatment group achieved at least 80 % of their energy target . No differences in weight , skinfold thickness measurements , or quality of life were observed . Compared with the control group , the supplement group had larger increases in fat-free mass and grip strength , although the differences did not reach statistical significance . APPLICATIONS In the short term , nutrition counseling with or without oral supplementation can achieve a substantial increase in energy intake in about 50 % of malnourished HIV-infected patients . Although further study is needed to evaluate long-term effects , these findings suggest that nutrition counseling has an important role in the management of malnourished HIV-infected patients
BACKGROUND Supplementary feeding may help food insecure and vulnerable people by optimising the nutritional value and adequacy of the diet , improving quality of life and improving various health parameters of disadvantaged families .
In low- and middle-income countries ( LMIC ) , the problems supplementary feeding aims to address are entangled with poverty and deprivation , the programmes are expensive and delivery is complicated .
To summarise the evidence from systematic review s of supplementary feeding for food insecure , vulnerable and malnourished population s , including children under five years of age , school-aged children , pregnant and lactating women , people with HIV or tuberculosis ( or both ) , and older population s.2 .
To describe and explore the effects of supplementary feeding given to people in these groups , and to describe the range of outcomes between review s and range of effects in the different groups .