FNCE 2023
Session 357. Providing MNT for the Pediatric Type 1 Diabetes Population: What Does the Evidence Show?
Monday, October 9, 8:30 AM - 9:30 AM

See session information ♦ See EAL review results

H/A: Body Composition Measurement (2009)

Study Design:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:
  • To describe physical and leisure-time activity, body composition, life satisfaction and depression in HIV-positive Hispanic men and women living in Puerto Rico
  • To compare body composition, leisure time, CD4 counts, life satisfaction and depression of those individuals classified as physically active or inactive.
Inclusion Criteria:
  • HIV-seropositive men and women
  • Some individuals had a CD4 count less than 200 cells per mm3, but none presented clinical symptoms or had an AIDS-defining illness
  • All participants were on highly active antiretroviral therapy (HAART).


Exclusion Criteria:

None specifically mentioned.

Description of Study Protocol:


Subjects recruited from the AIDS Clinical Trial Unit.  Methods not specified.


Cross-sectional, descriptive study. 

Statistical Analysis

  • Descriptive statistics including medians, means and standard deviations were used to describe the sample
  • Independent T-tests (two-tailed) were used to identify differences by sex in the variables of interest
  • Analysis of covariance was used to assess differences between the physically active and not physically active, using age and sex as covariates when appropriate.
Data Collection Summary:

Timing of Measurements

Individuals were evaluated using questionnaires and biophysical measurements.

Dependent Variables

  • Life satisfaction measured with Life Satisfaction Index
  • Depression measured with Beck Depression Inventory
  • Physical and leisure-time activity measured with Leisure Activity Inventory and Seven-Day Physical Activity Recall
  • Height, weight and body mass index (BMI)
  • Body composition measured based on seven skinfold thicknesses: biceps, triceps, subscapular, suprailiac, abdomen, thigh and calf
  • Body circumferences measured: neck, arm, hip, waist and thigh
  • CD4 counts.

Independent Variable

HIV infection.


Description of Actual Data Sample:

Initial N: 68 individuals (43 men, 25 women)

Attrition (final N): 68 individuals

Age: Mean age, 40.4 years±8.0 years

Ethnicity: Hispanics.

Other relevant demographics: Mean CD4 count, 311.1 cells per mm3±222.2 cells per mm3

Location: Puerto Rico.

Summary of Results:



Active (>300 kcal/day, n=40)

Inactive (<300 kcal/day, n=28)

Statistical Significance of Group Difference

Age (years)

41.8±8.1 38.5±7.6 NS 
CD4 counts (cells/mm3) 322.0±224.2 295.5±222.5 NS
Television watching (hours/day) 4.5±2.4 5.9±2.9 P<0.05
Life satisfaction (score) 25.5±7.1 20.7±8.2 P<0.05
Leisure time (score) 45.0±10.8 41.1±9.9 NS
Beck Depression Inventory (score) 10.6±7.8 12.4±7.9 NS
Weight (kg) 71.2±14.1 82.1±19.1 P<0.05
Height (cm) 168.3±9.8 167.8±11.3 NS
BMI 25.7±4.9 29.4±5.8 P<0.05
Sum of trunk skinfolds (mm) 61.8±20.8 75.0±20.6 P<0.05
Sum of limb skinfolds (mm) 62.6±29.3 68.9±33.3 P<0.05
Sum of trunk circumferences (cm) 218.7±21.8 241.7±41.2 P<0.05

Sum of limb circumferences (cm)




Other Findings

There were no sex differences observed in the Leisure Activity Inventory scores, Life Satisfaction Index scores, physical activity or CD4 counts.

The Beck Depression Inventory yielded a median score of 10.0, with women having a higher score than men.

Women also had a higher sum of trunk and limb skinfolds and sum of limb circumferences compared with men.

The physically active group had lower body weight, lower BMI, lower limb and trunk skinfolds, lower trunk circumference and spent less time watching television.

Physically active participants had higher life satisfaction scores and more healthful body composition as compared with those who were physically inactive, but there were no group differences observed in the following variables: age, height, CD4 counts, leisure time and depression.

Author Conclusion:

In conclusion, physical activity can positively influence the general physical and emotional well-being of people living with HIV in Puerto Rico. These findings highlight the need for a clear medical consensus regarding the recommended levels of physical activity in this population. Programs involving physical and recreational activities should be included in all clinical, social and community interventions designed to improve the health and quality of life of HIV-positive individuals.

Funding Source:
Government: Research Center for Minority Institutions (NIH-RCMI G12RR03641-S)
University/Hospital: Institutional Fund for Research at the University of Puerto Rico, Rio Piedras Campus
Foundation associated with industry:
Reviewer Comments:

Recruitment methods and inclusion/exclusion criteria not well-described. Authors note that the reported amount of time spent watching television suggests a possible over-reporting of physical activity levels in this study; they also noted the fact that nutrient intake was not measured.

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? ???
  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? ???
3. Were study groups comparable? Yes
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) Yes
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? Yes
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) Yes
  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? Yes
  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.) Yes
  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? N/A
  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.) N/A
  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? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? Yes
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? N/A
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? N/A
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? N/A
  6.6. Were extra or unplanned treatments described? N/A
  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? ???
  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? N/A
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? ???
  7.5. Was the measurement of effect at an appropriate level of precision? ???
  7.6. Were other factors accounted for (measured) that could affect outcomes? No
  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)? ???
  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