National Nutrition and HIV/AIDS Guidelines for Service Providers of ...

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clients, preference should be given to multiple micronutrient supplements which contain amounts of nutrients not exceeding 100% of the RDA. 4.1.3 Symptomatic Protein: Symptomatic HIV positive persons present with several opportunistic infections that affect their nutritional status. These opportunistic infections increase their nutritional requirements and may also impair nutrient intake as explained in chapter 3. Therefore the protein needs of symptomatic HIV infected persons may increase significantly due to opportunistic infections, depletion of stores and impaired dietary intake. To address this situation, It is generally recommended that protein intake be increased by 10% in symptomatic HIV infected persons. However, where there is capacity to perform nutrition assessment, it is best for dietitians to assess and estimate the protein needs because the needs differ from one individual to another depending on the severity of infections In less severe situations, protein needs may be met through a regular balanced diet with additional 2 3 servings of protein rich foods. Energy: HIV infected persons displaying symptoms require between 20-30% more energy to meet the elevated needs due to infections and changed metabolism. These extra energy needs may also be met by additional servings across the various food groups. The energy increases remain the same whether or not the HIV-infected person takes ARV treatment. In some situations such as impaired oral intake and/or poor food tolerance a modified diet may be more appropriate. In such situations clients should be referred to a dietitian. Micronutrients: In symptomatic HIV infected persons the need for some micronutrients are higher. Examples of some of the micronutrients that may be needed in higher amounts are; Vitamin A, E, B- complex, Copper, selenium and Zinc. A client's need for these should be established first by a medical provider who will also prescribe as he finds appropriate. A dietitian should be consulted for more information on the dietary sources of specific micronutrients. 4.1.4 Advanced Stage Protein: Protein requirements for people with advanced HIV infection are 10% higher than the needs of uninfected people of the same age, sex, weight and height. Energy: Energy requirements for people with advanced HIV infection are 20-30% higher than their seronegative counterparts. However, given the numerous medical and nutritional complications in people with advanced HIV infection, their nutritional needs should be established by an experienced health professional. Preferably, a team of medical professionals and dietitians should be involved in the care of people with advanced HIV infection. Micronutrients: Micronutrient requirements are also higher for the advanced stage as compared to the asymptomatic stage. While, it has also been established that the requirements for some micronutrients is higher compared to others, it is still recommended that if supplements are deemed necessary, they should be provided as multiple micronutrient supplements instead of single nutrients supplements. In addition, supplement should be provided in amounts not exceeding 100% of the RDA. NB: Single micronutrient supplements need to be used with caution and proper guidance 18
from medical providers as large doses can be harmful. As such clients should be cautioned against obtaining and using these without medical advice. PLWHA should be - Counseled to consume a balanced diet. - Encouraged to increase their energy intake by 10% if they are asymptomatic or by 20 30% if they are symptomatic and without co- morbidities. If clients have co-morbidities refer them to a dietitian. - Referred to a dietitian if they fall in the vulnerable population groups (elderly, adolescents, children, pregnant women etc). - Counseled to increase the frequency or number of times they eat per day (i.e. have small, frequent meals) - To enhance their diet by using nutrient-rich foods - To increase consumption of fruits and vegetables - To increase consumption of foods fortified with the essential nutrients such as vitamin A, iron, the B vitamins, and vitamins K and E. - To use locally available foods to diversify their diets - Encouraged to keep exercising regularly - Advised to identify and monitor symptoms or conditions that affect their appetite or ability to eat. - Encouraged to check their weight periodically and if possible they should have necessary laboratory tests. 4.2 Nutrition Screening Nutrition screening and nutrition assessments are methods used to identify nutritional needs of people. Nutrition screening is a rapid and economical way of identifying people at risk for poor nutrition. Tools for nutrition screening can be administered by most service providers because they do not require high skill level in nutrition. Typically, screening tools are designed to identify people with symptoms that are suggestive of poor dietary intake, presence of an illnesses or condition that may precipitate malnutrition. Common examples of people who are likely to be found at risk for poor nutrition include those with poor appetites, gastrointestinal symptoms that might affect nutrient absorption or oral symptoms that might interfere with food intake. PLWHA found at high risk for poor nutrition through the use of nutrition screening tools should be referred to a dietitian for more extensive nutrition assessment while those with low scores should be assisted using information in the relevant sections of these guidelines. Several screening tools are available for use. Some screening tools can be completed by PLWHA themselves or with the help of the providers. Examples of nutrition screening tools include the Quick Nutrition Screening and the subjective global assessment tool. The most commonly used screening tool for PLWHA is the Subjective Global Assessment. This screening tool is preferred because it has been used successfully before in people with wasting conditions. Amongst criteria found in screening tools, unintentional weight loss of more than 10% of usual weight within 4-6 months, chronic infections especially diarrhea and the presence of co-morbidities normally place PLWHA at high risk for poor 19
Page 1: NATIONAL NUTRITION AND HIV/AIDS GUI
Page 5: ACKNOWLEDGEMENTS Developing these g
Page 8 and 9: 4.1.3 Symptomatic 18 4.1.4 Advanced
Page 10 and 11: TECHNICAL WORKING TEAM MEMBERS 1 Mr
Page 12 and 13: GLOSSARY LIST Asymptomatic: When a
Page 14 and 15: declining though still high, from 4
Page 16 and 17: 1.8 Layout of the Guidelines Each c
Page 18 and 19: Table 2.1: Summary table for the fo
Page 20 and 21: provide fiber. Nutrients found in v
Page 22 and 23: 2.3.5 Milk and Dairy Foods Milk and
Page 24 and 25: social and health effects. Some of
Page 26 and 27: CHAPTER 3 THE RELATIONSHIP BETWEEN
Page 28 and 29: Table 3.1 WHO Clinical classificati
Page 32 and 33: nutrition. PLWHA found to fit in th
Page 34 and 35: 4.3.3 Clinical The key in clinical
Page 36 and 37: 5.1.1 Nutritional Screening It is r
Page 38 and 39: ° Ensure that all immunizations an
Page 40 and 41: neglect children, have mental healt
Page 42 and 43: Table 6.1 Specific feeding recommen
Page 44 and 45: 7.1.2 Protein Requirements The prot
Page 46 and 47: CHAPTER 8 PROTECT THE QUALITY AND S
Page 48 and 49: 8.5 Hygiene in the Kitchen ° Keep
Page 50 and 51: CHAPTER 9 PLWHA may take various ty
Page 52 and 53: As the effect of food on the effica
Page 54 and 55: Medication Purpose Recommendation/
Page 56 and 57: Appropriate dietary responses Appro
Page 58 and 59: that are presently marketed in Bots
Page 60 and 61: ° For PLWHA living in areas where
Page 62 and 63: HERB Sore mouth and throat Recommen
Page 64 and 65: CHAPTER 11 NUTRITION EDUCATION AND
Page 66 and 67: warmth, understanding, and respect
Page 68 and 69: CHAPTER 12 HIV/AIDS, NUTRITION AND
Page 70 and 71: younger siblings. ° Sale of key as
Page 72 and 73: ° Emphasize and support small scal
Page 74 and 75: ° Are there any dietary changes am
Page 76 and 77: ANNEXES ANNEX 1: Scientific Or Engl
Page 78 and 79: ANNEX 3: Nutrient Composition of a
Page 81 and 82:
Annex 5: National Nutrition and HIV
Page 83:
12.6. Strongly Disagree 13. During
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