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Antiretroviral Therapy Provided to HIV-Infected Malawian Women in a Randomized Trial Diminishes the Positive Effects of Lipid-Based Nutrient Supplements on Breast-Milk B Vitamins

Citation

Allen, Lindsay H.; Hampel, Daniela; Shahab-Ferdows, Setareh; York, Emily R.; Adair, Linda S.; Flax, Valerie L.; Tegha, Gerald; Chasela, Charles S.; Kamwendo, Deborah D.; & Jamieson, Denise J., et al. (2015). Antiretroviral Therapy Provided to HIV-Infected Malawian Women in a Randomized Trial Diminishes the Positive Effects of Lipid-Based Nutrient Supplements on Breast-Milk B Vitamins. American Journal of Clinical Nutrition, 102(6), 1468-1474. PMCID: PMC4658457

Abstract

BACKGROUND: Little information is available on B vitamin concentrations in human milk or on how they are affected by maternal B vitamin deficiencies, antiretroviral therapy, or maternal supplementation.
OBJECTIVE: The objective was to evaluate the effects of antiretroviral therapy and/or lipid-based nutrient supplements (LNSs) on B vitamin concentrations in breast milk from HIV-infected women in Malawi.
DESIGN: Breast milk was collected from 537 women recruited within the Breastfeeding, Antiretrovirals, and Nutrition study at 2 or 6 wk and 24 wk postpartum. Women were assigned to receive antiretrovirals and LNSs, antiretrovirals only, LNSs only, or a control. Antiretrovirals and LNSs were given to the mothers from weeks 0 to 28. The antiretrovirals were zidovudine/lamivudine and nelfinavir or lopinavir/ritonavir. LNSs provided 93-118% of the Recommended Dietary Allowances of thiamin, riboflavin, niacin, pyridoxine, and vitamin B-12. Infants were exclusively breastfed.
RESULTS: LNSs increased milk concentrations of all vitamins except thiamin, whereas antiretrovirals lowered concentrations of nicotinamide, pyridoxal, and vitamin B-12. Although antiretrovirals alone had no significant effect on riboflavin concentrations, they negatively affected the LNS-induced increase in this vitamin. Thiamin was not influenced by the study interventions. Concentrations of all B vitamins were much lower than usually accepted values.
CONCLUSIONS: All B vitamins were low in milk, and all but thiamin were increased by maternal supplementation with LNSs. Antiretrovirals alone decreased concentrations of some B vitamins in milk. When LNS was given in addition to antiretrovirals, the negative effect of antiretrovirals offset the positive effect of LNSs for all vitamins except thiamin.

URL

http://dx.doi.org/10.3945/ajcn.114.105106

Reference Type

Journal Article

Year Published

2015

Journal Title

American Journal of Clinical Nutrition

Author(s)

Allen, Lindsay H.
Hampel, Daniela
Shahab-Ferdows, Setareh
York, Emily R.
Adair, Linda S.
Flax, Valerie L.
Tegha, Gerald
Chasela, Charles S.
Kamwendo, Deborah D.
Jamieson, Denise J.
Bentley, Margaret E.

PMCID

PMC4658457