Nutritional status of adult inpatients in Bujumbura, Burundi (impact of HIV infection)

Objective: To determine the prevalence and analyse the characteristics and causes of malnutrition among inpatients in an HIV highly endemic area. Design: Prospective cross-sectional study. Setting: Department of Internal Medicine, University Hospital, Bujumbura, B urundi. Subjects: 226 adult inpatients. Main outcomes measures: Evaluation of nutritional status using anthropometr y. Degree of malnutrition defined by the percentage of body weight loss (BW L), calculated by reference to the usual body weight. Results: Among the 226 patients recruited (mean age: 34.4 +/- 11.9 y, M:F s ex ratio: 1.72), 102 (45.1%) were HIV seropositive. 62 (60.8%) of these HIV seropositive were AIDS cases. The AIDS defining criterion was 'wasting syn drome' for 25 (40.3%) and opportunistic infection (OI) for 37 (59.7%) inclu ding 34 cases of tuberculosis (TB). The nutritional status of 119/226 patie nts (52.7%) was normal (BWL less than or equal to 10%). Moderate malnutriti on (10% less than or equal to BWL less than or equal to 20%) was observed i n 47 (20.8%) and severe malnutrition (BWL > 20%) was observed in 60 (26.5%) . HIV seroprevalence and, among HIV seropositive subjects, the percentage o f AIDS cases increased according to decreasing level of nutrition (Chi2 for trends: P < 0.001 in both instances). The fat free mass mass of malnourish ed subjects was lower and the fat body mass was higher among HIV seropositi ve subjects than HIV seronegative subjects. Among HIV seropositive subjects , malnutrition was associated with TB (P < 0.001) and dysphagia (P < 0.05). Among HIV seronegative subjects, malnutrition was associated with decrease d food availability (P < 0.003) and TB (P < 0.05). One week after admission , the mortality rate was higher among HIV seropositive subjects (10.8%) tha n seronegative subjects (2.4%, P = 0.009). Other factors associated with de ath were decreased fat free mass (P < 0.01) and tricipital skinfold thickne ss (P < 0.04). Conclusions: The prevalence of malnutrition is high among the inpatients in vestigated. Main factors are HIV infection and TB. Strategies adapted to th e African context should be developed to prevent, detect and treat malnutri tion and associated factors, particularly among HIV seropositive subjects.