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LESSON 3 NUTRITION AND HIV (Participant EN)

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RELATIONSHIP BETWEEN NUTRITION AND HIV

The relationship between nutrition and HIV is complex. HIV weakens body’s defense system against disease and infection. Persons with HIV are at increased risk of malnutrition (poor nutrition) through various mechanisms, some of which are not related to food intake. Poor nutrition increases vulnerability to infection and weakens the immune system. Frequent infections and diseases make the body weaker and may accelerate the progression of the disease.

In order to fight infections, the immune system needs more energy and nutrients. When HIV weakens the immune system, other infections start to arise, and fighting them also increases the needs for nutrients and energy.

There are three ways in which HIV can affect the nutritional status of PLHIV:

  • Increasing energy needs;
  • Reducing food intake; and
  • Lowering food absorption.

ENERGY REQUIREMENTS AND PERCENTAGE INCREASE

GROUP

ENERGY REQUIREMENT

% INCREASE

Men

2500 Cal*/day

Women

2000 Cal/day

Pregnant Women

Extra 200 – 500 Cal/day

10 (2nd trimester)
25 (3rd trimester)

Breastfeeding Women

Extra 500 Cal/day

25

Children and adolescents
(0-19 years)

Various (520 – 2755 Cal/day)

PEOPLE WITH HIV

Men + HIV

Extra 250 Cal/day

10

Women +HIV

Extra 200 Cal/day

10

Children + HIV

Various + 10%

10

Pregnant Women + HIV

Extra 700 Cal/day

35

Breastfeeding Women + HIV

Extra 700 Cal/day

35

PEOPLE WITH HIV WHO ARE SICK

Children + HIV + poor weight gain/other symptoms

Various + 20%

20

Men + HIV + illness

Extra 500-750 Cal/day

20-30

Women + HIV + illness

Extra 400-600 Cal/day

20-30

Children + HIV + illness (severely malnourished)

Various + 50-100%

50-100

Source: FAO 2001, WHO 2004, WHO 2005

TRANSLATING INCREASE ENERGY NEEDS TO ACTUAL FOOD INTAKE

Examples of foods providing the extra 10% (~250 calories) per day for your PLHIV clients:

FOOD

AMOUNT

Banana

2 medium size (~170grams)

Mung bean porridge

1 cup

Soy milk

2 cups

Pumpkin custard

1 cup

Mango

1 ½ medium size (~300grams)

1 cup = ~250ml

Examples of foods providing the extra 20-30% (~500 calories) per day for your PLHIV clients who are sick:

FOOD

  1. Mung bean porridge (~250grams/1cup)
  2. Banana fritter (2 small size)
  3. Boiled egg (2 large)
  4. Soy milk (2 cups)

PLUS any one of these:

  • Banana (2 medium size) OR,
  • Mango (1 ½ medium size) OR,
  • Jackfruit (1 cup sliced, ~250grams)
  1. Roasted pumpkin seed (~100g)
  2. Dried cashew nut/peanut (~100g)
  3. 1 ½ cups (200grams) rice + medium sized bowl of fish and vegetable soup

Examples of foods providing the extra 35% (~700calories) per day for your pregnant and breastfeeding women with HIV:

FOOD

  1. Banana (2 medium size)
  2. Mango (2 medium size)
  3. Jackfruit (2 cups sliced, ~300 grams)
  4. Pineapple (2 cups sliced, ~300 grams)

PLUS any one of these:

  • Mung bean porridge (~250grams/1cup)
  • Banana fritter (2 small size)
  • Boiled egg (3 large)
  • Soy milk (2 cups)
  • Spring roll (2 medium pieces)
  1. Roasted pumpkin seed (~150g)
  2. Dried cashew nut/peanut (~150g)
  3. 2 cups (250grams) rice + 16 tablespoons cooked fish + 1 cup cooked green vegetables plus add an extra 1 ½ tablespoons of oil while cooking to increase the energy content

Recommended frequency meals for pregnant and breastfeeding women with HIV:

FREQUENCY OF MEALS AND SNACKS

Pregnant women

3 meals plus an extra snack

Pregnant women with HIV

1st Trimester

3 meals plus an extra snack

2nd and 3rd Trimesters

3 meals and 2 snacks OR at least 4 meals

Pregnant women with HIV and sick

At least 4 meals and 2 snacks

Breastfeeding women with HIV

3 meals and 2 snacks OR at least 4 meals

Breastfeeding women with HIV and sick

At least 4 meals and 2 snacks

Daily food guide for babies and children (6-24 months) withouth and with HIV

Age

Child without HIV

Healthy child with HIV
(10% more energy needed)
Child with HIV
who is sick
(20-30% more energy needed)

Child with HIV who is sick and losing weight
(50-100% more energy needed)

 Texture

 Drink (frequency/day)

6 month

Introduction of solid foods

2 times/day

2-3 tablespoons per feed

2 times/day of energy dense foods

2-3 tablespoons per feed

2 times/day of energy dense foods

2-3 tablespoons per feed

2 times/day of energy dense foods

3-4 tablespoons per feed

Thick enriched bobor/ well mashed foods e.g. mashed cooked banana, sweet potato, pumpkin etc

Continued frequent breastfeeds or any kind of milk at least 8x/day

7-8 months

3 meals of ½ chan chang koeh (bowl)

3 to 4 meals of ½ chan chang koeh (bowl) foods

5 to 6 meals of ½ chan chang koeh (bowl) foods

5 to 6 smaller frequent meals of ½ bowl food

Thick enriched bobor/ well mashed foods

Continued frequent breastfeeds at least 8x/day or 1-2 cups of any kind of milk

Adequate intake clean boiled water

9-11 months

3 meals of nearly full bowl foods

+ 1 snack between meals

4 meals of nearly full bowl foods

+ 1-2 snacks between meals

4 to 5 meals of nearly full bowl foods

+ 1-2 snacks between meals

5 to 6 meals of nearly full bowl foods

+ 2-3 snacks between meals

Thick enriched bobor/ mashed foods and foods that baby can pick up

Continued frequent breastfeeds at least 6x/day or 1-2 cups of any kind of milk

Adequate intake clean boiled water

12-24 months

3 meals of full bowl foods

+ 2 snack between meals

4 meals of full bowl foods

+ 2 snacks between meals

5 to 6 meals of full bowl foods

+ 2 snacks between meals

6 to 8 meals of full bowl foods

+ 2 snacks between meals

6 to 8 meals of full bowl foods

+ 2 snacks between meals

Continued breastfeeds on the demand at least 3x/day

or 1-2 cups of any kind of milk

Adequate intake clean boiled water

If baby is not breastfeed, give in addition 1-2 extra meals per day.
One bowl =250 ml

Daily food guide for children aged 2-5 years old, withouth and with HIV

 Age

 Child without HIV

Healthy child with HIV

Child with HIV who is sick

Child with HIV who is sick and losing weight

Additional energy needs

10% more energy to maintain growth

Plus extra ~150 cal/day (i.e. an extra snack/small meal/day)

20-30% more energy needed

Plus extra 300 -500 kcal/day (i.e. an extra full meal + extra snack /day)

50-100% more energy needed

Plus extra 600 – 1600 kcal/day
(i.e. extra two to four full meals)

Frequency & amount/day

3 meals and 2 snacks in between meals

3 meals and 3 snacks in between meals

4 main meals + 3 snacks in between meals

6 to 8 small energy dense meals/snacks

Note: Extra food needs for this group can be obtained by eating small frequent high energy meals. It is recommended to enrich the meals by adding ’enhancer foods’

Example of extra serve foods

Example of extra serve foods (~150 cal) include:

1 cup soy/cows milk, 2 boiled eggs, 2 small fried bananas, 1 cup mango or 3 small bananas OR

~ ¼ plate of rice/noodles (125grams) with ¼ cup (4 tablespoons) of cooked fish and vegetables.

Example of extra serve foods
(~300 -500 cal ) include:

An extra full meal (~400cal):

¼ plate of rice (125grams) with 8 tablespoons of fish and 8 tablespoons mix of green vegetables and beans plus 1 small banana

An extra snack (~150 cal):

1 cup soy milk, 2 boiled eggs, 2 small fried bananas, 1 cup mango or 3 small bananas

Increase the energy of meals/snacks by adding one of following high energy food s at each meal/snacks (~100cal):

2 teaspoons oil

4 teaspoons honey

1.5 tables

 

CYCLE OF HIV, POOR NUTRITION AND INFECTION

SEVEN WAYS TO MAINTAIN OR GAIN BODY WEIGHT:

  1. Eat more meals – aim for three meals a day (four for pregnant and breastfeeding).
  2. Eat more food at each meal from each of the 3 food groups.
  3. Eat snacks and desserts after and between meals – at least two times a day.
  4. Improve the quality of your food with “enhancers” (by adding coconut, peanuts, oil, or soya beans) or by thickening watery soups etc.
  5. Have drinks with energy in them (e.g. juice, soy milk etc) rather than just water, coffee or tea for all drinks.
  6. If an infant or young child, increase the frequency of milk feeds (breast milk or infant formula) and ensure the formula is prepared safely and not diluted.
  7. Have infections and illnesses treated quickly and properly and increase food intake after illness until the weight lost during illness is regained.

 

 

NEGATIVE CYCLE OF MALNUTRITION

THE CIRCLE OF HEALTH

SOME COMMON MISINFORMATION ABOUT NUTRITION FOR PLHIV

1. PLHIV should avoid uncooked vegetables.
Correct information:

Fresh vegetables have vitamins and can help protect a person from illness. They should always be cleaned very well with boiled/clean water before eating to remove any dirt or bacteria.

2. PLHIV should avoid seafood because it will cause a skin rash.
Correct information:

Seafood is a body-building food and can help keep the body strong. Seafood can cause a skin rash in people who are already allergic to seafood. If a person was able to eat seafood before they became HIV-positive, they should still be able to eat seafood with no problem.

Like eggs and meat, seafood should always be cooked very well before eating and be fresh.

NOTE ON MERCURY IN FISH:

Fish can be regular part of healthy eating plan but pregnant and breastfeeding women and young children should choose wisely. Women who might become pregnant, women who are pregnant or are breastfeeding and young children should avoid or rarely eat fish that are high in mercury such as shark, swordfish, king mackerel and tilefish. If they do eat a small portion of this fish (~100g), they should not eat any other fish during the same week.

3. PLHIV should avoid fermented or sour foods.

  • Correct information:

    If a food causes someone to have diarrhea or an upset stomach, that person should avoid that kind of food. But other people should not be encouraged to avoid the food because of another person’s experience. If a person can tolerate and enjoy fermented or sour foods, there is no reason to avoid them.

    4. PLHIV should avoid spicy food or chilili.

  • Correct information:

    Spicy foods can irritate the stomach. If someone is suffering from stomach problems or diarrhea due to infection, or mouth sores (thrush), he/she should avoid spicy food and chili. However, if a person is healthy, he/she can still enjoy chili or moderately spicy food as long as it does not upset his/her stomach.

    Spices can make food more appetizing by adding more flavor – there are alternatives to using chili. Other spices to consider are lemon grass, ginger, coriander leaves, spring onions and garlic.

    5. PLHIV should avoid fatty or fried foods.

  • Correct information:

    Oil and fat are important sources of energy, and the foods that are normally fried (fish, chicken, pork, frog, etc) are important sources of protein and their consumption should be encouraged.

    People with moderate to severe diarrhea can benefit from temporarily avoiding fatty or fried foods. For PLHIV with no diarrhea who are underweight, eating more fried food can be a good way to gain weight.

    For PLHIV who are overweight, eating less fatty or fried foods may help those wanting to lose weight.

    6. Eating chicken or beef will prevent a wound from healing.

  • Correct information:

    Body building foods (including eggs, fish, chicken, pork, beef, and beans) are very beneficial for a person with open wounds, because they help the body to repair tissues like muscle and skin.

    If a wound does not heal, it is normally because it has become infected with bacteria. If PLHIV have an open wound that will not heal or becomes infected, they should seek medical treatment immediately.

    7. PLHIV should avoid sweet foods (mango, longanberry, sticky rice) because they can cause fever.

  • Correct information:

    Sweet foods can be eaten by PLHIV. Eating sweet fruit and sweets (desserts) in fact can help add energy (and also weight), so it is especially important for PLHIV who are losing weight. Sticky rice and ripe mango are great for a high energy snack/dessert. Eating fruit after meals should be also encouraged.

    8. Pregnant woman should avoid eating more food because it can make her baby much bigger that leads to a difficult delivery.

  • Correct information:

    Pregnant women need to eat more food because they need extra energy for the growth of the baby and to be able to produce enough milk after delivery. The energy needs increase especially for the second and third trimester of pregnancy, which equates to about two boiled eggs and one large banana.

    For pregnant women with HIV, the energy needs are greatly increased because they need extra energy for the baby’s growth and breast milk production as well as for fighting the virus. This extra energy can be achieved by eating an extra meal daily or eat more frequently throughout the day (i.e. every 2 to 4 hours).

    9. Post partum women are recommended to drink plenty of wine to help fast recovery from labour and the birth.

  • Correct information:

    It took the body months to prepare to give birth and it takes time to recover. Adequate rest and eating well is required for the mothers to recover quickly. Mothers need to eat well and drink plenty of fluids to have adequate milk for their babies. Doing so will help them to regain energy and strength. Healthy mother can produce better quality and quantity of milk.

    Alcohol should be avoided during breastfeeding, particularly in the first month when it is important to establish breastfeeding patterns for the baby. If a mother drinks alcohol, alcohol will get into her breastmilk from her blood, moving freely from the blood to the breast milk (and back out again). How much alcohol gets into the breast milk depends on the strength and amount of alcohol in the drink.

    10. Breastfeeding women should not eat sour soup, fish, pickle and uncooked vegetables.
    Correct information:

    Breastfeeding uses a lot of energy and nutrients so it is important that the mothers need to eat a wide variety of foods to supply nutrients for their health and wellbeing. Breastfeeding women should not be afraid of eating certain fruits, vegetables, pickles and meats as long as they are prepared hygienically. There is little evidence that certain foods cause diarrhea for the mother or upset babies and give them diarrhea. It is important for breastfeeding women to eat locally available energy giving, protein (body building food), fruit and vegetables (protective food), particularly foods rich in calcium (e.g. milk or soy milk) and iron (e.g. meat, green leafy vegetables etc). They also need to drink plenty of fluids such as water. All fluids count but water is the best source of fluid and helps to prevent dehydration.

    11. Sick children should avoid certain fruits (guava, watermelon, longanberry, young mango), soups with meats or fish
    Correct information:

    When a child is sick, he/she needs more food than usual so it is important to continue feeding to maintain the child’s strength and appetite during illness. Chicken, duck, frog, eggs, crab, pork or fish are part of the “body-building” group of foods. These foods are important food for a sick child because they provide protein for good growth and recovery from illness. Rice soup or porridge is good for sick children but mothers should add fish or egg to it. Different vegetables and fruits such as pumpkin, yellow sweet potato, ripe papaya, and ripe mango give a lot of vitamins that help children get better faster.

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