Comparison of Body Composition Assessment Methods in Patients with Human Immunodeficiency Virus-Associated Wasting Receiving Growth Hormone

Abstract

Bioelectrical impedance spectroscopy (BIS) and skinfold anthropometry (SKF) have been used to monitor body composition among patients with HIV wasting; however, validation of these techniques during recombinant human GH (rhGH) treatment has not been performed. Our objective was to evaluate the degree of agreement between criterion measurements of dual-energy x-ray absorptiometry (DXA) and those of BIS and SKF in patients with HIV wasting treated with rhGH. We conducted a randomized, double-blinded, placebo-controlled, two-period crossover trial at the University of Toronto and Mount Sinai Hospital (Toronto, Canada). A referred sample of 27 community-dwelling men with HIV-associated weight loss (> or =10% over preceding 12 months) despite optimal antiretroviral therapy participated in the study. Intervention was one daily injection of rhGH (6 mg) or placebo self-administered for 3 months in a crossover fashion with a 3-month washout. Fat-free mass (FFM) and fat mass (FM) were measured by BIS, SKF, and DXA before and after rhGH and placebo treatment. FFM(BIS) was not significantly different from FFM(DXA) after rhGH treatment (P = 0.10). Mean differences (bias +/- sd) according to Bland-Altman analysis were smaller for SKF than for BIS (P < 0.05) at all time points, yet treatment-induced change in FM was better detected with BIS than with SKF. BIS estimates of FFM and FM showed better agreement with those of DXA after rhGH treatment (1.6 +/- 4.6 kg and -2.1 +/- 3.9 kg) compared with baseline (3.8 +/- 3.5 kg and -4.1 +/- 3.6 kg) and placebo (2.7 +/- 4.4 kg and -3.1 +/- 4.6) (P < 0.05). BIS overestimated and SKF underestimated the treatment-induced changes in FFM and FM. SKF was more accurate than BIS when measuring body composition in patients with HIV wasting before and after rhGH treatment; nonetheless, the accuracy of BIS increased after treatment. Change in FM because of treatment was not accurately assessed with SKF.