Micronutrient supplementation has limited effects on intestinal infectious disease and mortality in a Zambian population of mixed HIV status: a cluster randomized trial
| Autor: | Rose Banda, Vera Yambayamba, Max Katubulushi, Paul Kelly, Andrew Tomkins, Emmanuel Kafwembe, Felistah Yavwa, Ian R. Sanderson, Isaac Zulu, Mildred Fwoloshi, Jim Todd |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2008 |
| Předmět: |
Adult
Diarrhea Male medicine.medical_specialty Micronutrient deficiency Population Medicine (miscellaneous) Nutritional Status Zambia HIV Infections Kaplan-Meier Estimate Article law.invention Randomized controlled trial Double-Blind Method law Internal medicine Outcome Assessment Health Care Clinical endpoint Medicine Cluster Analysis Humans Micronutrients Mortality education Respiratory Tract Infections education.field_of_study Nutrition and Dietetics Cross-Over Studies business.industry Mortality rate Case-control study Respiratory infection Micronutrient CD4 Lymphocyte Count Immunology Dietary Supplements Female business Follow-Up Studies |
| ISSN: | 0002-9165 |
| Popis: | BACKGROUND: Diarrheal disease remains a major contributor to morbidity and mortality in Africa, but host defense against intestinal infection is poorly understood and may depend on nutritional status. OBJECTIVE: To test the hypothesis that defense against intestinal infection depends on micronutrient status, we undertook a randomized controlled trial of multiple micronutrient supplementation in a population where there is borderline micronutrient deficiency. DESIGN: All consenting adults (> or =18 y) living in a carefully defined sector of Misisi, Lusaka, Zambia, were included in a cluster-randomized (by household), double-blind, placebo-controlled trial with a midpoint crossover. There were no exclusion criteria. Participants were given a daily tablet containing 15 micronutrients at just above the recommended nutrient intake or placebo. The primary endpoint was the incidence of diarrhea; secondary endpoints were severe episodes of diarrhea, respiratory infection, nutritional status, CD4 count, and mortality. RESULTS: Five hundred participants were recruited and followed up for 3.3 y (10,846 person-months). The primary endpoint, incidence of diarrhea (1.4 episodes/y per person), did not differ with treatment allocation. However, severe episodes of diarrhea were reduced in the supplementation group (odds ratio: 0.50; 95% CI: 0.26, 0.92; P = 0.017). Mortality was reduced in HIV-positive participants from 12 with placebo to 4 with supplementation (P = 0.029 by log-rank test), but this was not due to changes in CD4 count or nutritional status. CONCLUSION: Micronutrient supplementation with this formulation resulted in only modest reductions in severe diarrhea and reduced mortality in HIV-positive participants. The trial was registered as ISRCTN31173864. |
| Databáze: | OpenAIRE |
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