Changes in macronutrient intake among HIV-infected children between 1995 and 2004

BACKGROUND: Nutritional concerns in HIV-infected children have evolved, from wasting to obesity and insulin resistance. However, little is known about the diet of these children during this evolution. OBJECTIVE: We analyzed dietary macronutrient intake in HIV-infected children over nearly 10 y. DESIGN: HIV-infected children underwent periodic longitudinal nutritional assessments between 1995 and 2004. Sex-specific initial and final means or proportions and time trends in macronutrient intakes were estimated with regression analyses. RESULTS: Three hundred thirty nutritional records from 49 males and 411 from 67 females were analyzed. Caloric intake exceeded the estimated energy requirement (EER) for ideal body weight in 1995 by 62% for males and 39% for females and decreased by 3% of the EER per year in males (P = 0.02) and by 2% in females (P = 0.004). In 2004, caloric intake still remained >19% above the EER in both groups. Protein intake was nearly 400% of the recommended dietary allowance (RDA) for ideal body weight in 1995 among both males and females and decreased by 13% of the RDA per year for males (P = 0.001) and by 21% per year for females (P < 0.001). However, daily protein intake still exceeded the RDA by >60% in both groups in 2004. Females consumed more energy from carbohydrates (P = 0.05) and sugar (P = 0.10) and less from monounsaturated (P = 0.04), polyunsaturated (P = 0.05), saturated (P = 0.03), and total (P = 0.10) fat in 2004 than in 1995. CONCLUSION: Excessive caloric intake and a shift in dietary composition toward carbohydrates in females suggest that continued monitoring of diet in HIV-infected children is important to avoid increased nutritional risk