Early changes of body composition in human immunodeficiency virus-infected patients: tetrapolar body impedance analysis indicates significant malnutrition

Ott, M.; Lembcke, B.; Fischer, H; Jäger, Ralf; Polat, Hatice Beyazal; Geier, Hermann Andreas; Rech, M; Staszeswki, S; Helm, E. B.; Caspary, W. F.

doi:10.1093/ajcn/57.1.15

Cited by 172 publications

(56 citation statements)

References 15 publications

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“…50 kHz unifrequency BIA is the most commonly used BIA method and has been validated in HIV-infected patients (Kotler et al, 1996). Using this method, Ott et al (1993) observed, as in this study, a decrease in lean body mass and an increase in total body water during the early stages of HIV infection. However, 50 kHz unifrequency BIA does not allow intra and extra cellular water to be measured contrary to 5 kHz and 100 kHz bifrequency BIA.…”

Section: Discussionsupporting

confidence: 72%

Nutritional status of HIV-seropositive subjects in an AIDS clinic in Paris

et al. 1997

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Objective: To measure the prevalence and analyse the characteristics of malnutrition among subjects attending an AIDS outpatient clinic and a day care center, to improve the nutritional management of HIV-infected subjects. Design: Prospective cross-sectional study. Setting: AIDS clinic in a University Hospital in Paris. Subjects: 124 HIV-seropositive adults attending the clinic. Main outcome measures: Evaluation of nutritional status using anthropometry, impedancemetry, plasma albumin and pre-albumin assays. Degree of malnutrition, de®ned by the percentage of body weight loss (BWL), calculated by reference to the usual body weight. Results: Among the 124 subjects recruited (M:F sex ratio: 3.3, mean age: 36.3 AE 7.2 y), 77 (62.1%, 95%CI: 53.9±70.3) had normal nutritional status (BWL 5%), 16 (12.9%, 95%CI: 7.0±18.2) moderate malnutrition (5%`BWL 10%), 21 (16.9%, 95%CI: 10.3±23.5) intermediate malnutrition (10%`BWL 20%), and 10 (8.1%, 95%CI: 3.3±12.9) severe malnutrition (BWL b 20%). BWL was related to the CDC class (variance analysis, P`9 6 10 75 ) and CD4 cell count (P`3 6 10 75 ). Malnutrition was observed even among CDC class A subjects (14.9%). BWL was also related to the body mass index (P`3 6 10 76 ), lean body mass (P`3 6 10 75 ), body fat (P`7 6 10 76 ) and, as assessed by impedancemetry, body cell mass (P`10 75 ) and the extra/intra cellular water ratio (P`2 6 10 74 ). The decrease in lean body mass was related to the decrease in body cell mass. Conclusions: Given its high frequency, malnutrition should be prevented, detected, monitored and treated from the early stages of HIV infection among patients attending AIDS clinics in order to improve survival and quality of life.

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Section: Discussionsupporting

confidence: 72%

Nutritional status of HIV-seropositive subjects in an AIDS clinic in Paris

et al. 1997

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“…HIV disease is associated with loss of lean (Kotler et al, 1985;Ott et al, 1993) and fat (Mulligan et al, 1997b;Sharpstone et al, 1996) body mass, as a result of opportunistic infections (Paton et al, 1997), metabolic (Melchior et al, 1991;Mulligan et al, 1997a) and hormonal (Strawford & Hellerstein, 1998) changes, decreased food intake and nutrient malabsorption (Kotler, 1998). In women, HIV-related weight loss occurs largely at the expense of body fat (Grinspoon et al, 1997;Kotler et al, 1999), and mean prepregnancy weight of HIV-positive women has been found to be lower than that of HIV-negatives in African settings (Castetbon et al, 1999).…”

Section: Discussionmentioning

confidence: 99%

HIV status and sociodemographic correlates of maternal body size and wasting during pregnancy

et al. 2002

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Objective: To examine HIV status and sociodemographic variables as correlates of body size (height, body mass index (BMI), and mid-upper-arm circumference (MUAC)) and wasting (MUAC < 22 cm) in pregnant women. Design: Cross-sectional study. Setting: Four antenatal clinics in Dar es Salaam, Tanzania. Subjects: Women presenting for first prenatal visit before the 23rd week of gestation, between April 1995 and July 1997 (n ¼ 13 760). Results: Mean MUAC, BMI and height were 25.5 cm, 23.5 kg=m 2 and 155.1 cm, respectively. The prevalence of HIV infection was 13.1% and the overall prevalence of wasting was 4.7%. Wasting was 34% (95% CI ¼ 3%, 73%) more prevalent among HIVinfected than in uninfected mothers, after adjusting for week of gestation, height and sociodemographic indicators. The risk of wasting associated with HIV infection was highest among women with low level of education or unable to contribute to the household income. From a multiple linear regression model, BMI was positively associated with mother's age, level of education and money spent on food, but not with HIV infection, after adjusting for week of gestation. In multivariate analysis, height increased monotonically by categories of maternal age and level of education, and was also positively correlated with the ability to contribute to household income, the amount of money spent on food per person per day, and having a professional partner. Conclusion: HIV infection is a significant risk factor for wasting among pregnant women, particularly in groups of low socioeconomic status (SES). SES indicators are strongly correlated with maternal height and with BMI during the first and second trimesters of pregnancy independently of HIV status.

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“…Studies done since the beginning of the AIDS epidemic, mostly in industrialised countries, showed the impact of HIV infection on nutritional status from the early stages of HIV infection (Graham et al, 1993;Ott et al, 1993) and its deleterious prognostic signi®cance (Kotler et al, 1989;Guenter et al, 1993). Recently, malnutrition has become much less frequent among HIV-infected subjects in industrialised countries due to the introduction of more effective antiretroviral treatments (Carbonnel et al, 1998), but countries with limited resources such as Burundi barely bene®t from these expensive drugs.…”

Section: Discussionmentioning

confidence: 99%

“…Malnutrition among HIV infected patients is mostly related to the development of opportunistic infections (OI) (Graham et al, 1983), tuberculosis (TB) being the most frequent in Africa (Aubry et al, 1992;Colebunders & Latif 1991), Independently of OI, HIV infection is, by itself, a cause of malnutrition, which therefore affects many patients from the early stages of HIV infection (Ott et al, 1993). In addition, malnutrition is an independent cause of immunodepression (Kotler et al 1989), adding its deleterious effects to those of HIV and facilitating the development of OI.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 1999

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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, Burundi. Subjects: 226 adult inpatients. Main outcomes measures: Evaluation of nutritional status using anthropometry. Degree of malnutrition de®ned by the percentage of body weight loss (BWL), calculated by reference to the usual body weight. Results: Among the 226 patients recruited (mean age: 34.4 AE 11.9 y, M:F sex ratio: 1.72), 102 (45.1%) were HIV seropositive. 62 (60.8%) of these HIV seropositive were AIDS cases. The AIDS de®ning criterion was wasting syndrome' for 25 (40.3%) and opportunistic infection (OI) for 37 (59.7%) including 34 cases of tuberculosis (TB). The nutritional status of 119a226 patients (52.7%) was normal (BWL 10%). Moderate malnutrition (10% BWL 20%) was observed in 47 (20.8%) and severe malnutrition (BWL b 20%) was observed in 60 (26.5%). HIV seroprevalence and, among HIV seropositive subjects, the percentage of AIDS cases increased according to decreasing level of nutrition (Chi2 for trends: P`0.001 in both instances). The fat free mass mass of malnourished subjects was lower and the fat body mass was higher among HIV seropositive 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 decreased 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%) than seronegative subjects (2.4%, P 0.009). Other factors associated with death were decreased fat free mass (P`0.01) and tricipital skinfold thickness (P`0.04). Conclusions: The prevalence of malnutrition is high among the inpatients investigated. Main factors are HIV infection and TB. Strategies adapted to the African context should be developed to prevent, detect and treat malnutrition and associated factors, particularly among HIV seropositive subjects.

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Early changes of body composition in human immunodeficiency virus-infected patients: tetrapolar body impedance analysis indicates significant malnutrition

Cited by 172 publications

References 15 publications

Nutritional status of HIV-seropositive subjects in an AIDS clinic in Paris

Nutritional status of HIV-seropositive subjects in an AIDS clinic in Paris

HIV status and sociodemographic correlates of maternal body size and wasting during pregnancy

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

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