World Food Prize Symposium 2003
KEYNOTE BREAKFAST
Thursday, October 16, 2003
Opening Comments: Cade Fields-Gardner
Introduction
Ambassador Kenneth Quinn
I would like to express my appreciation to the WISHH people, to the Soy Foods Council, and the Iowa Soybean Association. And Jim Hershey and Kirk Leads are here, and with their support you’re having soy sausage for breakfast this morning, and there’s soy cheese in the burrito, and they were both delicious, and I liked it very much. But Jim and Kirk, if you could stand up so we could just express our appreciation to you for sponsoring breakfast this morning. You keep eating. I know many of you haven’t finished your breakfast, but our first speaker is addressing one of the critical issues in the world.
We at the World Food Prize have been taken for several years about the issue of the impact of HIV/AIDS on agriculture and food production. And there weren’t many people talking about that. They certainly talked about the disease and its terrible ravages, but the other connection wasn’t being made. And I remember being on a commission in Washington and discussing it, and I said this is an important connection, and it sort of didn’t get picked up.
And so in 2001 in our World Food Prize Symposium on Risks to the World Food Supply, we had a list there of agroterrorism and HIV/AIDS, two of the most prominent topics, and this was before 9/11. So we had speakers here from around the world, and so this today is a follow-up on that.
And I want to introduce to you Cade Fields-Gardner, who is a nutrition advisor with the WISHH program, the World Initiative for Soy and Human Health, who are addressing one of the critical problems and how can you fortify the immune system of people around the world with this terrible affliction. Cade.
Opening Comments
Ms. Cade Fields-Gardner
HIV/AIDS Nutrition Advisor
World Initiative for Soy in Human Health (WISHH)
Well, good morning, and it’s nice to see everybody eating soy sausage so heartily.
First, I’d like to express my gratitude for the Iowa soybean farmers for sponsoring this lovely breakfast, and to the World Initiative for Soy in Human Health for the opportunity to share some thoughts from a medical community perspective on HIV/AIDS and nutrition and food.
By way of background, WISHH is a soybean farmer funded program with the mission to explore the role of soy foods in human health and to efficiently address the anticipated shortfalls in meeting protein needs for the world’s population over the next few decades. As such, their mission coincides very well with the mission of those of us who work in healthcare in HIV and AIDS.
Jim Hershey, whom you saw a few minutes ago, will be manning the WISHH booth over on the side and has some samples of soy food products that we’re using in some of our work.
In many situations we say that practice precedes science. That is, we decide to take action without a clear idea of what works best or what the impact is going to be. However, practice and actions without the development of evidence to support them, isn’t likely to last, and it could have us headed down exactly the wrong road.
In 1987 I worked at the center that was called the standard of care for HIV/AIDS, San Francisco General Hospital. And I was told many times in many ways that the wasting that I saw in my patients was just a part of the disease; it was part of the natural history of AIDS. But after spending many potluck dinners and Dominoes Pizza delivery evenings in the AIDS wards, it just didn’t make sense to me.
Given the opportunity, we fed people with AIDS. We got them off the expensive respirators, and we sent them home. We helped to extend their lives for an average of one and a half to two years beyond what was considered long-term survival at that time.
But it wasn’t until 1989 that evidence was provided to us in the form of peer review journal literature. This evidence showed us that the timing of death in HIV infection is more related to nutritional status than it is to the virus or opportunistic infection. It’s more related to specifically protein stores in the body – you call them muscle and organ tissues. And these are the important parts to make sure that somebody survives.
So what we found is that wasting is not a part of the disease. It is not a part of the natural history of HIV infection. But nutritional status will determine when a person with HIV dies. That was a very profound moment for me.
While the introduction of anti-HIV drugs is a crucial part of addressing the pandemic, it’s not the full answer. People on anti-HIV drugs still reduce their food intake and still waste. We even have some new problems: accelerated diabetes, cardiovascular disease and osteoporosis in some of our very young patients with HIV. We need to remember that you need to treat the body as well as the bug.
Survival is most closely related to the maintenance of weight and protein stores in the body, and without adequate supplies of these body proteins, a body won’t process medications as effectively and as efficiently as it should.
We know that to hang onto muscle and organs, with chronic HIV infection, you have to have enough calories and protein. Recent studies suggest that quality protein is directly related to the ability to maintain these types of tissues and support survival in people with HIV infection. We know that preventing losses of these tissues is a lot better than trying to recover them after the loss has already happened.
We know that the choices for nutrient-dense foods and quality protein are important to maintain health in HIV infection. In the United States and Canada, we’ve been recommending high-protein diets since the very beginning. This is not a hard thing for our patients to do, because we tend to consume about twice the recommendation every day – a little harder to do in other situations.
We continue to make these recommendations for high-protein diet in chronic HIV infection. And we have also added a preference for soy protein as a preferred protein source, because of the other potential health benefits that soy has.
While it’s true that we badly need vaccines, we don’t see one close enough on the horizon to stem the tide of HIV transmission. We do know that keeping a person nutritionally sound – something that we can do – can extend survival in chronic HIV infection, which is the highest priority.
As the speakers yesterday emphasized, more than talk is needed. And at WISHH we’ve been collaboratively with several groups to take action toward problem-solving, program development and implementation and supporting the process of gathering evidence. WISHH agrees with the efforts of farmers in developing countries to improve their productivity, and hopes to complement these efforts by addressing the common shortfalls that we find in quality protein and improving their survival.
We’re looking at creative ways to enhance the food supply in resource-limited settings and show how soy can meet that need. The example I’d like to share with you is an example from Uganda. USAID has funded an effort to augment food in feeding with corn/soy blended vegetable oil for 12,000 people infected with HIV, and their families, for a total of 60,000 people over a period of five years.
WISHH has worked with program managers at ACDI VOCA and its partners to develop and implement a study that determines the impact of this program on health, quality of life, living situations and a survival of a subset of these beneficiaries. The project is a rigorous look at these criteria that has been reviewed and approved by the Institute of Public Health at... University and the Uganda National Center for Science and Technology.
Specific improvements that we hope to see include improved weight and strength, improved growth and catch-up growth in children, improved quality of life and overall improved health. The serial measures that we take on the impact of food intervention will allow us to determine which aspects of health, a food program and food intervention can impact for those people living with infection and who are affected by HIV.
The HIV pandemic has confounded many of our efforts in recent years to tackle world hunger. Working to address the issues related to HIV/AIDS is essential to achieving our overriding goal and defeating hunger and famine.
Though there is a lot more to share, I know my time is up, but I’d like to thank you for this opportunity and also for your kind attention.