Nutrition and HIV/AIDS: A Training Manual - Linkages Project

The use of high levels of supplements (usually greater than 10 times therecommended daily allowance) is not recommended because it can lead to nutrienttoxicity that can be harmful to the body. Nutrients that may become toxic if takenin large amounts include iron, zinc, selenium, and vitamins A, B, C and D. For theHIV-infected pregnant or lactating woman, a high intake of these nutrients could domore harm. For example, studies have shown that high intakes of iron maycontribute to HIV-disease progression (Semba and Gary 2001), and that for thelactating HIV-infected mother, vitamin A supplementation may increase the risk ofHIV-1 transmission (Fawzi et al 2002).Note: Almost all the studies mentioned have shown that multivitaminsupplementation is associated with health benefits for both HIV-infected mothersand their infants and should therefore be provided where available.Nutritional recommendations for healthy adolescents duringpregnancy and lactationThe nutritional requirements of healthy pregnant and lactating adolescents areknown, but energy, protein, and other nutrient requirements to compensate for HIVinfection in pregnant and lactating adolescents have not been determined.What is known (slides 24, 25)The risk of malnutrition increases in teenage pregnancies because of the combinedneeds of the growing adolescent and the growing fetus, especially if the pregnancyoccurs less than 2 years after the start of menses. Nutrition requirements shouldconsider energy needs for normal growth of the adolescent and weight gain neededfor the pregnancy. Pregnant adolescents need an extra 300 kcal/day in the secondand third trimesters.The American Dietetic Association and Dietitians of Canada (2000) recommend thatpregnant adolescents eat at least 2,000 kcal/day. In many developing countriesadolescent girls who are not pregnant or HIV infected may not get adequate energyfor growth and development. Therefore, chances are that many pregnant adolescentgirls are already undernourished. Getting more than the recommended 2,000kcal/day to meet the demands of adolescent pregnancy may be difficult, especiallywhere food security is a significant concern. See Session 4 for what can be done to137