A limitation of this study was the specific QoL questionnaire
that might not adequately address other important
dimensions of QoL such as sexual, affective and cognitive
dimensions, deemed not suitable in this study. A further
limitation is the fact that HIV-positive adults needing
ambulatory care were excluded from the study resulting
in low QoL impairment, better health and perhaps
low prevalence of underweight. Other limitations included
measurements such as skin fold thickness and fat area
that were initially planned, but were eliminated as most
participants were overweight reducing the sensitivity and
specificity of these measurements. Moreover, screening for
loss of subcutaneous fat and muscle wasting that required
expertise that is not available in community settings
were excluded. Results may vary if, different equipment,
methods and reference population are used. Self-reported
weight loss, cannot be confirmed, as baseline weights were
not available. Similarly the other self-reported health status
indicators may have been subject to recall bias. The
duration of NCS included those who had received NCS for
1 month and above; one would expect that the newly
enrolled NCS recipients to have severe illness and underweight
compared to non-NCS recipients as reported in our
study. The study design also did not allow for an investigation
of biochemical nutritional status among nutritional
supplementation NCS recipients, which could be important
with regard to micronutrient supplementation. A limitation
that may reduce the generalization of the result
is the unavoidable over representation of HIV-positive
females in the sample which makes strong conclusions
regarding HIV-positive male adults difficult to draw. Moreover,
the participants were from two support groups
within two socio-economic environments (informal semiurban
settlement and rural area) in KwaZulu-Natal. This
might not be a true representation of different socioeconomic
status in South Africa. We also acknowledge the
limitation of observational cross-sectional studies, strong
evidence on the impact of NCS will require a longitudinal
study.