Cross-Sectional Study of Body Composition and Related Disease Management Factors

Abstract

Since the introduction of highly active antiretroviral therapy it has been assumed that nutrition issues and wasting processes were on the decline. To test this perception a cross-sectional look of patients in a large outpatient HIV clinic was undertaken. Forty-three male and seven female patients enrolled in a cross-sectional study of body composition and medical profiles. Bioelectrical impedance testing was completed and evaluation consisted of weight, body mass index (BMI), and percentage of desired body cell mass (actively metabolizing protein stores). The mean age was 40 ± 20 years. Females weighed a mean of 148.4 pounds (range 110-260) and males weighed a mean of 164.8 pounds (range 115-232). 20/50 patients were below 100% of their ideal weight (IBW) and 12 of these weighed less than 95% of IBW. BMI fell below 19 for 7/50 and above 25 for 13/50 patients. 17/50 were below the minimum desired level for body cell mass (BCM) while 11/50 were documented with a significant buffer in BCM. Of the 17 patients who had a low BCM, only 7 had a low BMI. Body fat was higher than the maximum optimal level for 11/50 and low in only 1/50. 4/11 with higher levels of weight and fat mass had lower than minimum desired levels of BCM. Previous wasting syndrome was documented for 37/50. 23 of these patients brought their BCM to normal levels while 14 remained at low levels. 8/50 were below their usual body weight (UBW) along with more than minimum optimal levels of BCM. Diarrhea reported by 16/50 did not predict weight or BCM, but was strongly related to the use of nelfmavir (an anti-HIV drug). HIV and CD4 levels did not predict body composition alterations. Conclusions: Weight and BMI were inconsistent in predicting levels of BCM. Normal rehabilitation of body composition did not occur in many of the previously wasted patients. Sarcopenic obesity (wasted BCM with high fat levels) occurred in 4 patients. Other altered body composition suggests continued metabolic abnormality despite effective antiretroviral therapy