The effects of Malnutrition as a comorbid factor on neurocognitive functioning in HIV positive adults in Lusaka

Abstract

Aims: Nutrition is an important aspect of life. It has been established in literature that there exists a relationship between nutritional status (either good or poor) and cognitive functioning. Most of the studies in literature are focused on children and adults. Most studies have reported that nutrition has an effect on cognitive functioning in children and the elderly population. However the relationship between malnutrition as a co-morbid factor in HIV positive adults between the ages of 20 and 65 is not a well known factor. It is important to determine the effect of malnutrition as a co- morbid factor in HIV positive adults on cognitive functioning. Methods: A cross- sectional study was carried out to determine the effects of malnutrition as a co-morbid factor in HIV positive adults on cognitive functioning. A sample of 263 was recruited. The sample comprised of 109 (40.2 %) males and 162 (59.8%) females with an age range of between 20 and 65 years. All the participants were able to speak and understand the English language. Levels of education ranged from 5 to 20 years of education. Medical practitioners identified eligible participants. The International Neurohavioural Test Battery was administered only on participants who gave their informed consent. The Neurobehavioural Test Battery measured domain scores as well as deficit scores. The domains include the following: Executive Functioning, Verbal Fluency, Motor Dexterity, Speed of Information Processing, Learning, Recall and Working Memory. For the assessment of malnutrition as a co-morbid factor, the following markers were used: Body Mass Index (BMI), Hemoglobin, Glucose and Total protein. The following statistical analysis was used: Multiple Regression Analysis was used to determine the effects of malnutrition as a co-morbid factor on neurocognitive performance; MANOVA was used to determine which neurocognitive domains are more affected by malnutrition as a co-morbid factor.MANOVA was also used to determine the effects of both gender and nutritional status. Results: The results indicate significant effects of malnutrition as a co-morbid factor were observed when haemoglobin entered in the regression. Haemoglobin accounted for a significant portion of the variance ( R² = 0.040, F = 9.252, p< 0.05). Haemoglobin has the strongest relationship with global mean T-scores (neurocognitive test performance) ( = 0.204, p<0.05. When ANOVA was run similar results were obtained. The results indicate that the there is a statistically significant difference on neurocognitive test performance for the 3 levels of haemoglobin (F (2,255) = 5.588, p = 0.004). Conclusion: Results obtained in the study seem to suggest that there is generally an effect of malnutrition as a co-morbid factor on neurocognitive functioning in HIV positive adults in Lusaka particularly in low haemoglobin states.