Comparative Weight Gain with Ready-to-Use Therapeutic Food in Stunted HIV-Infected and -Uninfected Children in a Nigerian Hospital

Objective. To bridge the management gap between nutritional rehabilitation for severe acute malnutrition (SAM) and chronic malnutrition; this study investigated to what extent ready-to-use therapeutic food (RUTF) promotes growth in children with long-term nutrition deficit with superimposed SAM. Methods. A total of 225 (164 HIV-negative and 61 HIV-positive) chronically malnourished children (aged 6 - 60 months) with superimposed SAM were enrolled. Children were provided 92 g packets of an RUTF; Plumpy'Nut; based on an estimated requirement of 200 kcal/kg body weight (BW)/day. Children were fed Plumpy'Nut over a 2-week period; and weight was assessed weekly. Weight gain was compared for HIV-positive children and HIV-negative children.Results. On day 15; the HIV-positive group had a median weight gain of 645 g compared with 670 g in the HIV-negative group (difference 25 g; p=0.784). Similarly; rate of weight gain per kilogram BW per day was comparable for both groups of children (13.2 g/kg BW per day for HIV-negative children v. 11.9 g/kg BW per day for HIV-positive children; p=0.353). On day 15; the proportions of HIV-positive and HIV-negative children who had sustained weight gain were not significantly different. Conclusion. Chronically malnourished children with superimposed SAM benefit from the use of RUTF as much as children without chronic nutritional deprivation; regardless of HIV status

Optimal Utilisation of Sulphonylureas in Resource-Constrained Settings :Review

Sulphonylureas (SUs) are oral anti-diabetic drugs (OADs) that were introduced more than 60 years ago. Clinicians are familiar with their use and they remain extensively used. However; the SU class is associated with adverse effects of weight gain and hypoglycaemia. In addition; their effects on cardiovascular events remain contentious. Newer classes of anti-diabetic agents have been developed and these agents are weight neutral (di-peptidyl peptidase IV inhibitors); while others reduce weight (glucagon-like peptide analogues and sodium glucose co-transporter inhibitors). Furthermore; the newer agents are less likely to cause hypoglycaemia and have a potentially better cardiovascular safety profile. However; the newer agents are more costly than SUs and their long-term safety is unknown. It is therefore likely that SUs will continue to be used; and more so in resource-limited settings. One may mitigate the adverse effects of weight gain and hypoglycaemia associated with the SU class by using members within this class that are less probable to cause these adverse effects. Furthermore; the specific SU must be used at the lowest effective therapeutic dose. In patients at high risk of SU-induced hypoglycaemic episodes (frail; clinically significant renal impairment); or patients in whom hypoglycaemic episodes may have devastating effects (bus drivers); newer anti-diabetic agents may be a justifiable alternative option