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Dietary Inadequacies in HIV-infected and Uninfected School-aged Children in Johannesburg, South Africa

Shiau, Stephanie*,†,‡; Webber, Acadia§; Strehlau, Renate; Patel, Faeezah; Coovadia, Ashraf; Kozakowski, Samantha§; Brodlie, Susan||; Yin, Michael T.; Kuhn, Louise*,†,‡; Arpadi, Stephen M.*,†,‡,||

Journal of Pediatric Gastroenterology & Nutrition: September 2017 - Volume 65 - Issue 3 - p 332–337
doi: 10.1097/MPG.0000000000001577
Original Articles: Nutrition

Objectives: The World Health Organization recommends that human immunodeficiency virus (HIV)-infected children increase energy intake and maintain a balanced macronutrient distribution for optimal growth and nutrition. Few studies have evaluated dietary intake of HIV-infected children in resource-limited settings.

Methods: We conducted a cross-sectional analysis of the dietary intake of 220 perinatally HIV-infected children and 220 HIV-uninfected controls ages 5 to 9 years in Johannesburg, South Africa. A standardized 24-hour recall questionnaire and software developed specifically for the South African population were used to estimate intake of energy, macronutrients, and micronutrients. Intake was categorized based on recommendations by the World Health Organization and Acceptable Macronutrient Distribution Ranges established by the IOM.

Results: The overall mean age was 6.7 years and 51.8% were boys. Total energy intake was higher in HIV-infected than HIV-uninfected children (1341 vs 1196 kcal/day, P = 0.002), but proportions below the recommended energy requirement were similar in the 2 groups (82.5% vs 85.2%, P = 0.45). Overall, 51.8% of the macronutrient energy intake was from carbohydrates, 13.2% from protein, and 30.8% from fat. The HIV-infected group had a higher percentage of their energy intake from carbohydrates and lower percentage from protein compared with the HIV-uninfected group. Intakes of folate, vitamin A, vitamin D, calcium, iodine, and selenium were suboptimal for both groups.

Conclusions: Our findings suggest that the typical diet of HIV-infected children and uninfected children in Johannesburg, South Africa, does not meet energy or micronutrient requirements. There appear to be opportunities for interventions to improve dietary intake for both groups.

*Gertrude H. Sergievsky Center, Columbia University, New York, NY

Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Mailman School of Public Health, Columbia University, New York, NY

§Institute of Human Nutrition

||Department of Pediatrics, College of Physicians and Surgeons

Department of Medicine, Division of Infectious Diseases, College of Physicians and Surgeons, Columbia University, New York, NY.

Address correspondence and reprint requests to Stephen M. Arpadi, MD, MS, Gertrude H. Sergievsky Center, Columbia University, 630 W. 168th Street, PH 19-114, New York, NY 10032 (e-mail:

Received 21 October, 2016

Accepted 27 February, 2017

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (

Funding for this study was provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD073977 and HD073952).

The authors report no conflicts of interest.

© 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,