HIV/AIDS

H/A: Body Composition Measurement (2009)

• Assessment
  What is the evidence regarding assessment of body composition for people with HIV infection?

  • Conclusion

    Twenty-seven studies were reviewed to evaluate the assessment of body composition of people with HIV infection. Most of rthe esearch in men, women, children and adolescents reports that fat-free mass and fat mass are altered in people with HIV infection. 

  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Assessment of body composition for people with HIV infection
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Arpadi SM, Horlick MN, Wang J, Cuff P, Bamji M, Kotler DP.  Body composition in prepubertal children with human immunodeficiency virus type 1 infection.  Arch Pediatr Adolesc Med. 1998 Jul; 152(7): 688-693.
      • Arpadi SM, Cuff PA, Kotler DP, Wang J, Bamji M, Lange M, Pierson RN, Matthews DE. Growth velocity, fat-free mass and energy intake are inversely related to viral load in HIV-infected children. J Nutr. 2000; 130: 2,498-2,502.
      • Batterham MJ, Garsia R, Greenop PA.  Dietary intake, serum lipids, insulin resistance and body composition in the era of highly active antiretroviral therapy "Diet FRS Study".  AIDS. 2000; 14: 1839-1843.
      • Brown T, Wang Z, Chu H, Palella FJ, Kingsley L, Witt MD, Dobs AS. Longitudinal anthropometric changes in HIV-infected and HIV-uninfected men. J Acquir Immune Defic Syndr. 2006; 43(3): 356-362.
      • Engelson ES, Kotler DP, Tan Y, Agin D, Wang J, Pierson RN Jr, Heymsfield SB. Fat distribution in HIV-infected patients reporting truncal enlargement quantified by whole-body magnetic resonance imaging. Am J Clin Nutr. 1999; 69(6): 1162-1169.
      • Fontana M, Zuin G, Plebani A, Bastoni K, Visconti G, Principi N. Body composition in HIV-infected children: Relations with disease progression and survival. Am J Clin Nutr. 1999; 69: 1282-1286.
      • Forrester JE, Woods MN, Knox TA, Spiegelman D, Skinner SC, Gorbach SL. Body composition and dietary intake in relation to drug abuse in a cohort of HIV-positive persons. J Acquir Immune Defic Syndr. 2000; 25 Suppl 1: S43-S48. 
      • Grady C, Ropka M, Anderson R, Lane HC. Body composition in clinically stable men with HIV infection. J Assoc Nurses AIDS Care. 1996; 7(6): 29-38.
      • Henderson RA, Talusan K, Hutton N, Yolken RH, Caballero B. Resting energy expenditure and body composition in children with HIV infection. J Acquir Immune Defic Syndr Hum Retrovirol. 1998; 19(2): 150-157.
      • Karmon SL, Moore RD, Dobs AS, Keruly J, Barnett S, Cofrancesco J Jr. Body shape and composition in HIV-infected women: An urban cohort. HIV Medicine 2005; 6: 245-252. 
      • Kotler DP, Rosenbaum K, Wang J, Pierson RN. Studies of body composition and fat distribution in HIV-infected and control subjects. J Acquir Immune Defic Syndr Hum Retrovirol 1999; 20 (3): 228-237.
      • McDermott AY, Shevitz A, Knox T, Roubenoff R, Kehayias J, Gorbach S. Effect of highly active antiretroviral therapy on fat, lean, and bone mass in HIV-seropositive men and women. Am J Clin Nutr. 2001; 74: 679-686.
      • Meininger G, Hadigan C, Rietschel P, Grinspoon S. Body-composition measurements as predictors of glucose and insulin abnormalities in HIV-positive men. Am J Clin Nutr. 2002; 76: 460-465. 
      • Moscicki AB, Ellenberg JH, Murphy DA, Jiahong X. Associations among body composition, androgen levels, and human immunodeficiency virus status in adolescents. J Adolesc Health. 2006; 39(2): 164-173. 
      • Mulligan K, Tai VW, Schambelan M. Cross-sectional and longitudinal evaluation of body composition in men with HIV infection. J Acquir Immune Defic Syndr Hum Retrovirol. 1997; 15(1): 43-48. 
      • Ott M, Fischer H, Polat H, Helm EB, Frenz M, Caspary WF, Lembcke B. Bioelectrical impedance analysis as a predictor of survival in patients with human immunodeficiency virus infection. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology. 1995; 9(1): 20-25. 
      • Papathakis PC, Van Loan MD, Rollins NC, Chantry CJ, Bennish ML, Brown KH. Body composition changes during lactation in HIV-infected and HIV-uninfected South African women. J Acquir Immune Defic Syndr. 2006, 43: 467-474.
      • Paton NIJ, Macallan DC, Jebb SA, Noble C, Baldwin C, Pazianas M, Griffin GE. Longitudinal changes in body composition measured with a variety of methods in patients with AIDS. J Acquir Immune Defic Syndr Hum Retrovirol. 1997; 14(2): 119-127.
      • Ramirez-Marrero FA, Smith BA, Melendez-Brau N, Santana-Bagur JL. Physical and leisure activity, body composition, and life satisfaction in HIV-positive Hispanics in Puerto Rico.  J Assoc Nurses AIDS Care. 2004; 15(4): 68-77.
      • Saint-Marc T, Partisani M, Poizot-Martin I, Rouviere O, Bruno F, Avellaneda R, Lang JM, Gastaut JA, Touraine JL. Fat distribution evaluated by computed tomography and metabolic abnormalities in patients undergoing antiretroviral therapy: preliminary results of the LIPOCO study. AIDS. 2000; 14: 37-49.
      • Schwenk A, Hoffer-Belitz E, Jung B, Kremer G, Burger B, Salzberger B, Diehl V, Schrappe M. Resting energy expenditure, weight loss, and altered body composition in HIV infection. Nutrition, 1996; 12: 595-601. 
      • Sharpstone DR, Murray CP, Ross HM, Hancock MR, Phelan MS, Crane RC, Menzies IS, Reaveley DA, Lepri AC, Nelson MR, Gazzard BG. Energy balance in asymptomatic HIV infection. AIDS, 1996; 10: 1,377-1,384. 
      • Smit E, Semba RD, Pilibosian E, Vlahov D, Tun W, Purvis L, Tang AM. Body habitus in a cohort of HIV-seropositive and HIV-seronegative injection drug users. AIDS Patient Care STDS. 2005; 19(1): 19-30.
      • Study of Fat Redistribution and Metabolic Change in HIV Infection (FRAM). Fat distribution in women with HIV infection. J Acquir Immune Defic Syndr. 2006: 42(5): 562-571.
      • Visnegarwala F, Raghavan SS, Mullin CM, Bartsch G, Wang J, Kotler D, Gibert CL, Shlay J, Grunfeld C, Carr A, El-Sadr W, for the Terry Beirn Community Program for Clinical Research on AIDS. Sex differences in the associations of HIV disease characteristics and body composition in antiretroviral-naive persons. Am J Clin Nutr.  2005; 82(4): 850-856.
      • Visnegarwala F, Shlay JC, Barry V, Gibert CL, Xiang Y, Wang J, Kotler D, Raghavan S, El-Sadr WM, for Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA). Effects of HIV infection on body composition changes among men of different racial/ethnic origins. HIV Clin Trials. 2007; 8(3): 145-154. 
      • Wilson IB, Jacobson DL, Roubenoff R, Spiegelman S, Knox TA, Gorbach SL. Changes in lean body mass and total body weight are weakly associated with physical functioning in patients with HIV infection. HIV Medicine. 2002; 3: 263-270.
  • Search Plan and Results: Assessment of Body Composition 2007
     
  What methodologies are appropriate in the measurement of body composition of people with HIV infection?

  • Conclusion

    Eighteen 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. Results of bioelectrical impedance analysis vary with the prediction equation used and the equipment manufacturer; studies in children report the need for bioelectrical impedance analysis equations developed for use in children with HIV infection. 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.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Methodologies in the measurement of body composition of people with HIV infection
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Aghdassi E, Arendt B, Salit IE, Allard JP.  Estimation of body fat mass using dual-energy x-ray absorptiometry, bioelectric impedance analysis, and anthropometry in HIV-positive male subjects receiving highly active antiretroviral therapy.  JPEN J Paren Enteral Nutr. 2007; 31: 135-141.
      • Andrade S, Lan SJJ, Engelson ES, Agin D, Wang J, Heymsfield SB, Kotler DP. Use of a Durnin-Womersley formula to estimate change in subcutaneous fat content in HIV-infected subjects. Am J Clin Nutr. 2002; 75: 587-592.
      • Arpadi SM, Wang J, Cuff PA, Thornton J, Horlick M, Kotler DP, Pierson RN.  Application of bioimpedance analysis for estimating body composition in prepubertal children infected with human immunodeficiency virus type 1.  J Pediatr. 1996; 129(5): 755-757.
      • Batterham MJ, Garsia R, Greenop P. Measurement of body composition in people with HIV/AIDS: A comparison of bioelectrical impedance and skinfold anthropometry with dual-energy x-ray absorptiometry. J Am Diet Assoc 1999; 99 (9): 1109-1111.
      • Cavalcanti RB, Cheung AM, Raboud J, Walmsley S. Reproducibility of DXA estimations of body fat in HIV lipodystrophy. Journal of Clinical Densitometry 2005; 8(3): 293-297.
      • Corcoran C, Anderson EJ, Burrows B, Stanley T, Walsh M, Poulos AM, Grinspoon S. Comparison of total body potassium with other techniques for measuring lean body mass in men and women with AIDS wasting. Am J Clin Nutr. 2000; 72: 1053-1058.
      • Fontana M, Zuin G, Plebani A, Bastoni K, Visconti G, Principi N. Body composition in HIV-infected children: Relations with disease progression and survival. Am J Clin Nutr. 1999; 69: 1282-1286.
      • Gerrior J, Kantaros J, Coakley E, Albrecht M, Wanke C. The fat redistribution syndrome in patients infected with HIV: Measurements of body shape abnormalities. J Am Diet Assoc. 2001; 101: 1175-1180.
      • Kotler DP, Burastero S, Wang J, Pierson RN. Prediction of body cell mass, fat-free mass, and total body water with bioelectrical impedance analysis: Effects of race, sex and disease. Am J Clin Nutr. 1996; 64(suppl): 489S-497S.
      • Kotler DP, Rosenbaum K, Allison DB, Wang J, Pierson RN. Validation of bioimpedance analysis as a measure of change in body cell mass as estimated by whole-body counting of potassium in adults. JPEN. 1999; 23(6): 345-349.
      • Ludy MJ, Hendricks K, Houser R, Chetchotisakd P, Mootsikapun P, Anunnatsiri S, Price E, Wanke CA. Body composition in adults infected with human immunodeficiency virus in Khon Kaen, Thailand. Am J Trop Med Hyg. 2005; 73(4): 815-819.
      • Niyongabo T, Melchior JC, Henzel D, Bouchard O, LaRouze B. Comparison of methods for assessing nutritional status in HIV-infected adults. Nutrition. 1999; 15(10): 740-743.
      • Papathakis PC, Rollins NC, Brown KH, Bennish ML, Van Loan MD. Comparison of isotope dilution with bioimpedance spectroscopy and anthropometry for assessment of body composition in asymptomatic HIV-infected and HIV-uninfected breastfeeding mothers. Am J Clin Nutr. 2005; 82: 538-546. 
      • Paton NIJ, Macallan DC, Jebb SA, Noble C, Baldwin C, Pazianas M, Griffin GE. Longitudinal changes in body composition measured with a variety of methods in patients with AIDS. J Acquir Immune Defic Syndr Hum Retrovirol. 1997; 14(2): 119-127.
      • Paton NI, Elia M, Jennings G, Ward LC, Griffin GE. Bioelectrical impedance analysis in human immunodeficiency virus-infected patients: Comparision of single frequency with multifrequency, spectroscopy, and other novel approaches. Nutrition. 1998; 14: 658-666.
      • Risser JMH, Rabeneck L, Foote LW, Klish WJ. A comparison of fat-free mass estimates in men infected with the human immunodeficiency virus. JPEN. 1995; 19: 28-32.
      • Smith DE, Hudson J, Martin A, Freund J, Griffiths MR, Kalnins S, Law M, Carr A, Cooper DA, for the PIILR DEXA Group and Investigators. Centralized assessment of dual-energy X-ray absorptiometry (DEXA) in multicenter studies of HIV-associated lipodystrophy. HIV Clin Trials. 2003; 4(1): 45-49.
      • Yang Y, Zhu WDJ, Paton NI. Comparison of dual-energy X-ray absorptiometry machines for measuring fat distribution changes of HIV-associated lipodystrophy. Antivir Ther. 2004; 9(5): 771-778. 
  • Search Plan and Results: Methods for Body Composition Measurement 2007