NUTRITIONAL EVALUATION AND INTERVENTIONS OF HIV INFECTED INFANTS AND CHILDREN

尽管大多数感染艾滋病毒的儿童会发育发育和营养不良 异常，艾滋病毒对身体成分的纵向影响和 营养需求尚不清楚。目前，营养疗法 通常是经验性的，而且不一致。这项提议的目的是 检测感染艾滋病毒儿童的身体成分变化，以开发一种 预测即将到来的营养不良的算法，确定两个休息时间 和感染不同阶段的总能量需求，并发展 适合于临床的营养干预方式 疾病的阶段。我们预计，早期发现的组合 身体成分的变化，代谢需求的确定，以及 成功的营养康复将显著改善 对感染的抵抗力、发病率、生活质量，可能 艾滋病毒感染儿童的死亡率。我们的第一个目标是研究艾滋病毒-- 早期纵向感染的儿童以及 目前正在跟进，并且是有症状的。比较组将 是那些感染艾滋病毒的妇女所生的孩子，但他们的血清检测结果出现了逆转。 儿童将定期接受营养评估和膳食 摄入量、传统人体测量、生物电阻抗、全身 水、生活质量评估和选定的生物化学研究。 一部分儿童将接受细胞因子分析，间接 量热法，以及双标记水的研究。到时候我们就能 为了使身体成分与外周细胞因子的产生相关联， 新陈代谢需求和生活质量评估。这方面的第二个目标 建议是确定有效的营养干预措施， 促进增长。儿童将被纳入干预研究 当他们达到轻度、中度和重度营养标准时 赤字。第一项干预将随机选择患有轻度至中度以下疾病的儿童 适度的营养缺乏症，要么只吃高能量饮食，要么 高能量饮食加上欧米茄-3-脂肪酸补充剂。第二 对严重营养缺乏的干预将是纵向的 肠内饲管补充的效果评价。人体测量学 参数，生物电阻抗，全身水分，营养摄入量， 生活质量评估和住院频率 营养干预将是人们感兴趣的。

Although most children with HIV will develop growth and nutritional abnormalities, the longitudinal effects of HIV on body composition and nutritional requirements are not known. Currently, nutritional therapy is often empiric and not consistent. The aims of this proposal are to detect body composition changes in HIV-infected children, to develop an algorithm to predict impending malnutrition, to determine both resting and total energy needs at different stages of infection, and to develop nutritional intervention modalities that are appropriate for the clinical stage of disease. We expect that the combination of early detection of body composition changes, determination of metabolic requirements, and successful nutritional rehabilitation will significantly improve resistance to infection, morbidity, quality of life, and possibly mortality of HIV-infected children. Our first goal is to study HIV- infected children longitudinally in early life as well as children who are currently followed and are symptomatic. The comparison group will be those children born to HIV-infected women, but who sero-revert. Children will periodically undergo nutritional evaluations with dietary intakes, traditional anthropometry, bioelectrical impedance, total body water, quality of life assessments, and selected biochemical studies. A subset of children will undergo cytokine analysis, indirect calorimetry, and studies with doubly labeled water. We will then be able to correlate in body composition with peripheral cytokine production, metabolic needs, and quality of life estimates. The second goal of this proposal is to determine effective nutritional interventions that will promote growth. Children will be enrolled in the intervention studies when they meet criteria for mild, moderate and severe nutritional deficits. The first intervention will randomize children with mild to moderate nutritional deficits to either a high energy diet alone or to a high energy diet plus omega-3-fatty acid supplement. The second intervention for severe nutritional deficits will be a longitudinal assessment of enteral feeding tube supplementation. Anthropometric parameters, bioelectric impedance, total body water, nutrient intake, quality of life assessment and frequency of hospitalizations with nutritional interventions will be of interest.