Influence of vitamin D supplementation on bone mineral content, bone turnover markers and fracture risk in South African schoolchildren: Multicentre double-blind randomised placebo-controlled trial (ViDiKids)

Randomised controlled trials (RCT) to determine the influence of vitamin D on bone mineral content (BMC) and fracture risk in children of Black African ancestry are lacking. We conducted a sub-study (n=450) nested within a Phase 3 RCT of weekly oral supplementation with 10,000 IU vitamin D3 vs. placebo for 3 years in HIV- uninfected Cape Town schoolchildren aged 6-11 years. Outcomes were BMC at the whole body less head (WBLH) and lumbar spine (LS) and serum 25-hydroxyvitamin D3 (25[OH]D3), parathyroid hormone (PTH), alkaline phosphatase, C-terminal telopeptide and procollagen type 1 N propeptide. Incidence of fractures was a secondary outcome of the main trial (n=1682). At baseline, mean serum 25(OH)D3 concentration was 70.0 nmol/L (s.d. 13.5), and 5.8% of participants had serum 25(OH)D3 concentrations <50 nmol/L. Among sub-study participants, end-trial serum 25(OH)D3 concentrations were higher for participants allocated to vitamin D vs. placebo (adjusted mean difference [aMD] 39.9 nmol/L, 95% CI 36.1 to 43.6) and serum PTH concentrations were lower (aMD -0.55 pmol/L, 95% CI -0.94 to -0.17). However, no interarm differences were seen for WBLH BMC (aMD -8.0 g, 95% CI - 30.7 to 14.7) or LS BMC (aMD -0.3 g, 95% CI -1.3 to 0.8) or serum concentrations of bone turnover markers. Fractures were rare among participants in the main trial randomised to vitamin D vs. placebo (7/755 vs. 10/758 attending at least one follow- up; adjusted odds ratio 0.70, 95% CI 0.27 to 1.85). In conclusion, a 3-year course of weekly oral vitamin D supplementation elevated serum 25(OH)D3 concentrations and suppressed serum PTH concentrations in HIV-uninfected South African schoolchildren of Black African ancestry but did not influence BMC or serum concentrations of bone turnover markers. Fracture incidence was low, limiting power to detect an effect of vitamin D on this outcome

Nutritional management in HIV/AIDS infection

Key Message "Nutritional support is one of the most immediate and critical needs of people living with HIV and AIDS, and nutritional management is integral to the care and management of the disease. " "The virus and its associated conditions and symptoms negatively influence nutritional status through decreased intake, increased requirements, and malabsorption, resulting in malnutrition. Adequate nutrient intakes are therefore essential. " Comprehensive nutritional assessments should be performed regularly to ensure optimal nutritional intervention.  "Optimal nutrition could assist to maintain lean body mass, reduce the severity of HIV–associated symptoms, support antiretroviral therapy, and improve quality of life." ESPEN guidelines state energy requirements to be increased by 20–30% during the recovery phase after opportunistic infections. The guidelines recommend protein intake of 1.2 g/kg in stable phases of the disease and 1.5 g/kg/day during episodes of acute illness.  "In general, there is conflicting evidence on the optimal protocols for nutrition support of these patients. Nutritional recommendations are guidelines only, and should always be viewed on a case–by–case basis alongside the individual patient's clinical presentation.

Effects of a multi-micronutrient-fortified beverage, with and without sugar, on growth and cognition in South African schoolchildren: a randomised, double-blind, controlled intervention

Little is known about the effects of combined micronutrient and sugar consumption on growth and cognition. In the present study, we investigated the effects of micronutrients and sugar, alone and in combination, in a beverage on growth and cognition in schoolchildren. In a 2 £ 2 factorial design, children (n 414, 6–11 years) were randomly allocated to consume beverages containing (1) micronutrients with sugar, (2) micronutrients with a non-nutritive sweetener, (3) no micronutrients with sugar or (4) no micronutrients with a non-nutritive sweetener for 8·5 months. Growth was assessed and cognition was tested using the Kaufman Assessment Battery for Children version II (KABC-II) subtests and the Hopkins Verbal Learning Test (HVLT). Micronutrients decreased the OR for Fe deficiency at the endpoint (OR 0·19; 95% CI 0·07, 0·53). Micronutrients increased KABC Atlantis (intervention effect: 0·76; 95% CI 0·10, 1·42) and HVLT Discrimination Index (1·00; 95% CI 0·01, 2·00) scores. Sugar increased KABC Atlantis (0·71; 95% CI 0·05, 1·37) and Rover (0·72; 95% CI 0·08, 1·35) scores and HVLT Recall 3 (0·94; 95% CI 0·15, 1·72). Significant micronutrient £ sugar interaction effects on the Atlantis, Number recall, Rover and Discrimination Index scores indicated that micronutrients and sugar in combination attenuated the beneficial effects of micronutrients or sugar alone. Micronutrients or sugar alone had a lowering effect on weight-for-age z-scores relative to controls (micronutrients 20·08; 95% CI 20·15, 20·01; sugar 20·07; 95% CI 20·14, 20·002), but in combination, this effect was attenuated. The beverages with micronutrients or added sugar alone had a beneficial effect on cognition, which was attenuated when provided in combination