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Recommendations Summary

H/A: Anthropometric Assessment 2010

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    HIV/AIDS: Anthropometric Assessment

    The registered dietitian (RD) should include the following anthropometric measurements in the initial assessment:  Weight, height and body mass index; for children, growth pattern indices.

    In addition, measurements of body compartment estimates should also be included, such as circumference measurements (mid-arm muscle, waist, hip and waist-to-hip ratio) or measurements of body cell mass and body fat [measured with skinfold thickness measurements, dual energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), or bioimpedance spectroscopy].

    Baseline anthropometric measurements provide information for the nutrition assessment and the majority of research in men,  women,  children and adolescents reports that fat-free mass and fat mass are altered in people with HIV infection.

    Rating: Strong
    Imperative

    • Risks/Harms of Implementing This Recommendation

      None.

    • Conditions of Application

      • Privacy or chaperones may be required for certain anthropometric measurements, such as waist circumference and body composition
      • RDs or other clinic staff should be appropriately trained to measure and interpret body compartment estimates
      • Studies report that dual-energy X-ray absorptiometry, bioelectrical impedance analysis, bioimpedance spectroscopy and skinfold thickness measurements provide acceptable estimations of body composition if properly calibrated
      • Special bioelectrical impedance analysis equations for use in children with HIV infection are needed
      • Results from various methodologies may not be comparable.

    • Potential Costs Associated with Application

      • Costs of medical nutrition therapy (MNT) sessions and reimbursement vary, however MNT sessions are essential for improved outcomes
      • Assessment of body composition may be costly depending on the time required and methodology.

         

    • Recommendation Narrative

      • 27 studies were reviewed to evaluate the assessment of body composition of people with HIV infection
      • The majority of research in men,  women,  children and adolescents reports that fat-free mass and fat mass are altered in people with HIV infection (Ott et al, 1995; Grady et al, 1996; Schwenk et al, 1996; Sharpstone et al, 1996; Mulligan et al, 1997; Paton et al, 1997; Arpadi et al, 1998; Henderson et al, 1998; Engelson et al, 1999; Fontana et al, 1999; Kotler et al, 1999; Arpadi et al, 2000; Batterham et al, 2000; Forrester et al, 2000; Saint-Marc et al, 2000; McDermott et al, 2001; Meininger et al, 2002; Wilson et al, 2002; Ramirez-Marrero et al, 2004; Karmon et al, 2005; Smit et al, 2005; Visnegarwala et al, 2005; Brown et al, 2006; Moscicki et al, 2006;  Papathakis et al, 2006; Study of Fat Redistribution and Metabolic Change, 2006; Visnegarwala et al, 2007)
      • 18 studies were reviewed to evaluate certain methodologies in the measurement of body composition of people with HIV infection
      • Six studies in men, two studies in women and six studies in men and women report that dual energy X-ray absorptiometry, bioelectrical impedance analysis, bioimpedance spectroscopy and skinfold thickness measurements provide acceptable estimations of body composition and for measuring change in body composition (Risser et al, 1995; Kotler et al, 1996; Paton et al, 1997; Paton et al, 1998; Batterham et al, 1999; Kotler et al, 1999; Niyongabo et al, 1999; Corcoran et al, 2000; Gerrior et al, 2001; Andrade et al, 2002; Cavalcanti et al, 2005; Ludy et al, 2005; Papathakis et al, 2005; Aghdassi et al, 2007)
      • Results of bioelectrical impedance analysis vary with the prediction equation used and the equipment manufacturer (Smith et al, 2003; Yang et al, 2004). Studies in children report the need for bioelectrical impedance analysis equations developed for use in children with HIV infection (Arpadi et al, 1996; Fontana et al, 1999).
      • Results in skinfold thickness measurements vary with the number of sites measured and the prediction equation used 
      • Further research is needed regarding methodology for body composition measurement in women and children, as well as in conditions of lipodystrophy, areas of the body and different ethnic groups.

    • Recommendation Strength Rationale

      Conclusion statements received Grades I and II.

    • Minority Opinions

      Consensus reached.