H/A: Body Composition Measurement (2009)

Citation:
 
Study Design:
Class:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:

To investigate differences in dietary fat and energy intake between those reporting and those not reporting fat redistribution syndrome (FRS) and the relationship between dietary fat, total energy intake, serum biochemistry and the clinical characteristics of the syndrome.

Inclusion Criteria:

None specifically mentioned. Patients entered study on "all comers" basis.

Exclusion Criteria:

None specifically mentioned.

Description of Study Protocol:

Recruitment

Subjects were receiving treatment by HIV clinic staff in Central Sydney Area Health Service between November 1997 and January 1999.

Design

Cross-sectional study.

Statistical Analysis

Independent sample T-tests were used to assess significance of difference between groups. Analysis of covariance was used to account for potential confounding variables. Partial correlation analysis was done to investigate relationships between diet and the serum and body composition measurements. 

Data Collection Summary:

Timing of Measurements

Dietary intake, serum lipids, insulin resistance and body composition were determined. 

Dependent Variables

  • Fat redistribution status classified on the basis of self-report of body composition changes
  • Body composition verified with bioelectrical impedance 
  • Weight, height, BMI
  • Waist and hip girth.

Independent Variables

  • Dietary intake measured with validated self-administered, semi-quantitative food-frequency questionnaire especially designed for HIV-positive population
  • Fasting glucose, total cholesterol, HDL cholesterol, triglycerides, insulin and total testosterone   
  • Insulin resistance
  • CD4 count

Control Variables

  • Age tertile
  • BMI tertile
  • Smoking
  • Exercise
  • Antiretroviral therapy.
Description of Actual Data Sample:

Initial N: 100 consecutive subjects

Attrition (final N): 100 subjects (96 men, 4 women)

Age: Mean age, 40.52 years±8.91 years

Ethnicity: Not mentioned

Anthropometrics: Mean BMI, 22.97±3.34

Location: Sydney, Australia.

 

Summary of Results:

 

 

FRS

No FRS

P-value

Adjusted P-value

Age (years) 42.48±7.94 38.98±9.39 0.051  

BMI

24.14±2.98

22.06±3.35

0.002

0.002

FFM (kg)

59.71±8.09

55.60±7.23

0.009

0.006

Adjusted fat mass (kg) 11.86±2.26 12.80±1.73 0.022 <0.001
WHR 0.97±0.08 0.90±0.06 <0.001 <0.001
Glucose (mmol/l) 5.15±0.53 4.78±0.51  0.001 0.008
Cholesterol (mmol/l) 6.60±2.92 4.62±1.30 <0.001 <0.001
Triglycerides (mmol/l) 5.83±7.72 1.75±1.15 <0.001  <0.001
HDL cholesterol (mmol/l) 0.87±0.31 1.32±1.24 0.001 0.001
LDL cholesterol (mmol/l) 3.10±1.35 2.72±1.16 0.291 0.228
Insulin (pmol/l) 216.40±726.92 50.60±43.05 <0.001 <0.001
Insulin resistance 3.35±2.20 1.47±1.17 <0.001 <0.001
Viral load (log10) (copies/ml) 3.34±0.89 3.66±1.15 0.123  
CD4 cell count 324±294 331±333 0.837  
Saturated fat intake (g/day) 57.42±30.10 48.04±28.20 0.028  
Saturated fat intake (%) 14.19±2.75 14.04±2.97 0.799  
Saturated fat adjusted (g/day) 46.82±8.64 47.88±9.76 0.637  
Total fat intake (g/day) 143.13±64.98 118.80±63.71 0.017  
Total fat intake (%) 35.55±6.73 35.34±6.70 0.879  
Total fat adjusted (g/day) 117.84±18.29 118.79±20.50 0.811 0.685
Energy intake (kJ/day) 14,575±4936 12,283±4987 0.008 0.037 
Estimated energy intake (kJ/day) 11,486±1926 11,133±447 0.299  
EEE (%) 129.90±51.49 111.40±44.81 0.025  

Other Findings

There was no significant difference in total or saturated dietary fat intake when grouped by FRS status.

There was no significant correlation between dietary saturated or total fat intake and the serum or body composition parameters measured.

Total energy intake was higher in those patients reporting FRS (14,575kJ vs. 12,283kJ, P=0.037) after adjustment for age, smoking and exercise status.

Author Conclusion:

The relationship between total energy intake and FRS requires further investigation, although it is our view that this increase in intake is likely to be a consequence rather than a cause of FRS. Whether it represents a behavioral response to a perceived body image or a centrally mediated hypothalamic response to changes in biochemical processes is worthy of ongoing research.

Funding Source:
Reviewer Comments:

Authors note that dietary fat intake in this population was higher than Australian recommendations.

Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) N/A
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) N/A
 
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? Yes
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? ???
  2.2. Were criteria applied equally to all study groups? ???
  2.3. Were health, demographics, and other characteristics of subjects described? Yes
  2.4. Were the subjects/patients a representative sample of the relevant population? Yes
3. Were study groups comparable? N/A
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) N/A
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? N/A
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? N/A
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? Yes
  4.1. Were follow-up methods described and the same for all groups? Yes
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) Yes
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? Yes
  4.4. Were reasons for withdrawals similar across groups? N/A
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? Yes
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? N/A
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) Yes
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? N/A
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? Yes
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? N/A
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? Yes
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? Yes
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? Yes
  6.6. Were extra or unplanned treatments described? Yes
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? N/A
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? Yes
  7.1. Were primary and secondary endpoints described and relevant to the question? Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern? Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? Yes
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? Yes
  7.5. Was the measurement of effect at an appropriate level of precision? Yes
  7.6. Were other factors accounted for (measured) that could affect outcomes? Yes
  7.7. Were the measurements conducted consistently across groups? Yes
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? Yes
  8.1. Were statistical analyses adequately described and the results reported appropriately? Yes
  8.2. Were correct statistical tests used and assumptions of test not violated? Yes
  8.3. Were statistics reported with levels of significance and/or confidence intervals? Yes
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? Yes
  8.6. Was clinical significance as well as statistical significance reported? Yes
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? Yes
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? Yes
10. Is bias due to study's funding or sponsorship unlikely? Yes
  10.1. Were sources of funding and investigators' affiliations described? Yes
  10.2. Was the study free from apparent conflict of interest? Yes