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Abstract In sub-Sahara Africa, micronutrient deficiency, especially of antioxidant micronutrients including vitamins A, C, and E, beta-carotene, selenium, zinc, and polyphenols is very common in HIV-positive patients. Amongst adults, women are the most vulnerable. Antioxidants are known to play a vital role in the immune system, reducing oxidative stress. Oxidative stress is induced by excess production of reactive oxygen species (ROS), due to the HIV infection. Such damage may be prevented or moderated through adequate oral intake of antioxidants, scavenging ROS, as well as protecting cells and tissues against oxidative stress. Antioxidants can be provided to the body through locally available antioxidant rich-diets such as fruit-and-vegetable-based diets and/or dietary supplements. Provision of antioxidants through local diets or dietary supplements exercise beneficial effects on biological markers of the immune system (CD4 and viral load). However, while dietary supplements represent a costly and short-term strategy to limiting antioxidant deficiency, local diets, combined with adequate nutritional education, can provide a low-cost and long-term strategy to reduce oxidative stress, prevent micronutrient deficiency, and slow down HIV disease progression. The former can be applicable in countries around the West, Central, and South coast of Africa, which are rich in natural food resources. In contrast with significant evidence that dietary supplements confer benefits in HIV patients, fewer data are available relating to the benefits of local diets. Thus the need to do more research in this area arises. This review compares available data on effects of antioxidants on CD4 and viral load in HIV-positive women noneligible for antiretroviral therapy. Intake of antioxidants though dietary supplements and local diet, associated with nutritional education, is compared. Studies conducted in sub-Sahara Africa are considered.
Abstract This study extends previous research evaluating the association between the CHIP intervention, change in body weight, and change in psychological health. A randomized controlled health intervention study lasting 4 wk. was used with 348 participants from metropolitan Rockford, Illinois; ages ranged from 24 to 81 yr. Participants were assessed at baseline, 6 wk., and 6 mo. The Beck Depression Inventory (BDI) and three selected psychosocial measures from the SF-36 Health Survey were used. Significantly greater decreases in Body Mass Index (BMI) occurred after 6 wk. and 6 mo. follow-up for the intervention group compared with the control group, with greater decreases for participants in the overweight and obese categories. Significantly greater improvements were observed in BDI scores, role-emotional and social functioning, and mental health throughout follow-up for the intervention group. The greater the decrease in BMI through 6 wk., the better the chance of improved BDI score, role-emotional score, social functioning score, and mental health score, with odds ratios of 1.3 to 1.9. Similar results occurred through 6 mo., except the mental health variable became nonsignificant. These results indicate that the CHIP intervention significantly improved psychological health for at least six months afterwards, in part through its influence on lowering BMI.
ABSTRACT Background: To determine the accuracy of patient self-reports of specific cardiovascular diagnoses and to identify individual patient characteristics that influence the accuracy. Methods: This investigation was conducted as a part of the randomized controlled ORBITAL study. Patients with hypercholesterolemia were enrolled in 1961 primary-care centers all over Germany. Self-reported questionnaire data of 7640 patients were compared with patients' case report forms (CRFs) and medical records on cardiovascular diseases, using k statistics and binomial logit models. Results: k values ranged from 0.89 for diabetes to 0.04 for angina. The percentage of overreporting varied from 1 percent for diabetes to 17 percent for angina, whereas the percentage of underreporting varied from 8.0 percent for myocardial infarction to 57 percent for heart failure. Individual characteristics such as choice of individual general practitioner, male gender and age were associated with the accuracy of self-report data. Conclusion: Since the agreement between patient self-report and CRFs/medical records varies with specific cardiovascular diagnoses in patients with hypercholesterolemia, the adequacy of this tool seems to be limited. However, the authors recommend additional data validation for certain patient groups and consideration of individual patient characteristics associated with over- and underreporting. Keywords agreement, cardiovascular disease, case report forms, general practitioner information, medical records, orbital study, overreporting, patient self-report, underreporting
Einfluss eines HIV-Care-Programms auf den Ernährungsstatus von HIV- infizierten Patienten in Kamerun
(2012)
Einfluss eines HIV-Care-Programms auf den Ernährungsstatus von HIV- infizierten Patienten in Kamerun B. Sc. Marion Czech, G. Nkengkfack, H. Englert, Oerlinghausen Zusammenfassung Weltweit sind über 33,3 Millionen Menschen mit dem HI-Virus infiziert (vgl. WHO, 2009). Die Subsahara zählt mit 24,5 Millionen Infizierten zu den Ländern mit der größten HIV-Rate. Allein in Kamerun sind ca. 5,5 prozent der Bevölkerung betroffen (vgl. UNAIDS, 2007). Die Ernährung kann hierbei den Krankheitsverlauf positiv beeinflussen und somit das Auftreten der charakteristischen Symptome von Aids sowie den Beginn der teuren antiretroviralen Therapie verzögern (vgl. Eckert, 2006, Immel, 2006). Durch zahlreiche Faktoren der HIV- Infektion ist bei 20-30 prozent der Patienten bereits in der asymptomatischen Phase der Infektion eine Mangelernährung zu beobachten. Neben dem Absinken des Körpergewichtes kommt es häufig zu einem reduziertem Plasmavitaminspiegel Proteinmangel sowie zu vermehrtem oxidativen Stress (vgl. Biesalski,Fürst, Kasper et. al., 1995, S. 417). Ziel dieser Arbeit ist es die Auswirkungen eines HIV- Care- Programmes auf den Ernährungszustand von HIV- Infizierten Personen in Kamerun im Vergleich zu einer Kontrollgruppe darzulegen. Dafür erfolgt eine Messung des Ernährungszustands vor Beginn des HIV- Care- Programmes, sowie nach drei- monatiger Durchführung des Programmes. Parallel finden diese Erhebungen auch bei den Patienten der Kontrollgruppe statt. Für die Erfassung des Body- Mass. Index werden Daten von 30 Patienten der Interventionsgruppe vor Beginn und nach 3- monatiger Durchführung des HIV- Care- Programmes miteinander verglichen. Anhand eines 3- Tage- Protokolls werden von 31 Patienten der Interventionsgruppe, sowie von 31 Patienten der Kontrollgruppe jeweils vor Beginn der Schulungen und nach drei Monaten der Durchführung die Parameter Gesamtenergiezufuhr und Zufuhr der Antioxidantien Vitamin A, C, E, sowie Zink miteinander verglichen. Parallel erfolgt von diesen je 31 Patienten je Gruppe auch die Beurteilung der Verzehrshäufigkeit einzelner Lebensmittelgruppen anhand eines Food Frequency Questionnaires. Der Body- Mass. Index von den 30 Personen der Interventionsgruppe verringerte sich zwischen T0 und T1 nur minimal um 0,33. Bei der Auswertung des 3- Tage- Protokolles zeigte sich eine Erhöhung der Zufuhr der Antioxidantien. Die Vitamine A und C wurden nach drei- monatiger Durchführung des HIV- Care Programms in höheren Mengen zu sich genommen, während sich die Aufnahme dieser Mikronährstoffe innerhalb der Kontrollgruppe nicht in größerem Ausmaß veränderte. Hinsichtlich der Verzehrshäufigkeit lässt sich nach drei Monaten.
The Effects of Lifestyle Modification on Glycemic Levels and Medication Intake:The Rockford CHIP
(2012)
Introduction: The high prevalence of cardiovascular disease (CVD) in the past 50 years has led to intense research, resulting in many improvements in treatment. At the same time, type 2 diabetes, with its concomitant increase in vascular complications, has become a serious, exploding and costly public health concern . Diabetes now affects 285 million adults worldwide and 344 million with pre-diabetes. Of these, 25.8 million diabetics and 79 million pre-diabetics are found in the United States alone.The current cost of diabetes in the US is likely to exceed the $174 billion estimate, which includes 2/3 for direct medical costs and 1/3 for indirect costs, such as disability, work loss, and premature death, but omits the social cost of intangibles (e.g. pain, suffering, lower quality of life). The diabetes epidemic has been accompanied by a similarly drastic increase in obesity. Although the relationship between the two developments is a matter of debate, both are presumably caused by changes in dietary habits and an increasingly sedentary modern lifestyle . Compelling evidence has shown that lifestyle changes can effectively prevent or delay the occurrence of type 2 diabetes. Because individuals at risk for this disease can usually be identified during the pre-diabetic phase of impaired glucose tolerance, early intervention and lifestyle change offer a logical approach to preventing this disease and its devastating vascular complications. Additionally, community-based lifestyle interventions for high risk groups and for the general population are a cost-effective way of curbing the growing burden of the disease. Solidifying the scientific basis for the prevention, treatment and control of this disease and its implementation on a national level, however, remains a difficult challenge. Moreresearch is needed to provide comprehensive and more effective strategies for weight-loss,especially over time. Therefore, the objectives of this study were to identify diabetics and those at risk (prediabetics) out of the total cohort of 1,517 who selected themselves into an intensive community-based lifestyle intervention program, and to assess its clinical efficacy ineffecting medication status as determined and managed by their personal physicians.
