UNC Project, Lilongwe, Malawi.
Am J Clin Nutr. 2012 Mar;95(3):759-65. doi: 10.3945/ajcn.111.018812. Epub 2012 Jan 18.
Breastfeeding increases metabolic demands on the mother, and excessive postnatal weight loss increases maternal mortality.
We evaluated the efficacy of a lipid-based nutrient supplement (LNS) for prevention of excess weight loss in breastfeeding, HIV-infected women.
The BAN (Breastfeeding, Antiretrovirals, and Nutrition) Study was a randomized controlled trial in Lilongwe, Malawi. At delivery, HIV-infected mothers and their infants were randomly assigned according to a 2-arm (with and without LNS) by 3-arm (maternal triple-antiretroviral prophylaxis, infant-nevirapine prophylaxis, or neither) factorial design. The 28-wk LNS intervention provided daily energy (700 kcal), protein (20 g), and micronutrients (except for vitamin A) to meet lactation needs. Women were counseled to breastfeed exclusively for 24 wk and to wean by 28 wk. Weight change (0-28 wk) was tested in an intent-to-treat analysis by using 2-factor ANOVA and with longitudinal mixed-effects models.
At delivery, the LNS (n = 1184) and control (n = 1185) groups had similar mean weights and BMIs. Women receiving the LNS had less 0-28-wk weight loss (-1.97 compared with -2.56 kg, P = 0.003). This difference remained significant after adjustment for maternal antiretroviral drug therapy and baseline BMI. Women receiving antiretroviral drugs had more weight loss than did those not receiving antiretroviral drugs (-2.93 compared with -1.90 kg, P < 0.001). The benefit of the LNS for reducing weight loss was observed both in those receiving antiretroviral drugs (-2.56 compared with -3.32 kg, P = 0.019) and in those not receiving antiretroviral drugs (-1.63 compared with -2.16 kg, P = 0.034).
The LNS reduced weight loss among HIV-infected, breastfeeding women, both in those taking maternal antiretroviral prophylaxis to prevent postnatal HIV transmission and in those not receiving antiretroviral prophylaxis. Provision of an LNS may benefit HIV-infected, breastfeeding women in resource-limited settings. This trial was registered at clinicaltrials.gov as NCT00164762.
母乳喂养会增加母亲的代谢需求，而产后体重过度下降会增加产妇死亡率。
我们评估了一种脂类营养素补充剂（LNS）对预防 HIV 感染产妇母乳喂养期间体重过度下降的效果。
BAN（母乳喂养、抗逆转录病毒和营养）研究是在马拉维利隆圭进行的一项随机对照试验。在分娩时，根据母婴三重复方抗逆转录病毒预防、婴儿奈韦拉平预防或两者均不预防的三臂（母亲、婴儿）设计，将 HIV 感染的母亲及其婴儿随机分为 LNS 组（有 LNS 和无 LNS）。28 周的 LNS 干预提供了每日 700 千卡能量、20 克蛋白质和微量营养素（除维生素 A 外），以满足哺乳需求。妇女被建议纯母乳喂养 24 周，并在 28 周时断奶。体重变化（0-28 周）通过使用 2 因素方差分析和纵向混合效应模型进行意向治疗分析进行测试。
分娩时，LNS 组（n = 1184）和对照组（n = 1185）的平均体重和 BMI 相似。服用 LNS 的女性 0-28 周体重减轻较少（-1.97 千克与-2.56 千克，P = 0.003）。调整了母亲抗逆转录病毒药物治疗和基线 BMI 后，这种差异仍然显著。服用抗逆转录病毒药物的女性比未服用抗逆转录病毒药物的女性体重减轻更多（-2.93 千克与-1.90 千克，P < 0.001）。LNS 减少体重减轻的益处，在服用抗逆转录病毒药物的女性中（-2.56 千克与-3.32 千克，P = 0.019）和未服用抗逆转录病毒药物的女性中（-1.63 千克与-2.16 千克，P = 0.034）均有观察到。
LNS 减少了 HIV 感染、母乳喂养女性的体重下降，既包括接受预防产后 HIV 传播的母婴抗逆转录病毒预防的女性，也包括未接受抗逆转录病毒预防的女性。在资源有限的环境中，提供 LNS 可能对 HIV 感染、母乳喂养的女性有益。该试验在 clinicaltrials.gov 注册，编号为 NCT00164762。
