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Whole body protein turnover in children with human immunodeficiency virus (HIV) infection
R A Henderson1, K Talusan, N Hutton
1Department of Pediatrics and Center for Human Nutrition, Johns Hopkins Schools of Medicine and Public Health, Baltimore, Maryland, USA. robinh@dhmh.state.md.us
Insights
Children with human immunodeficiency virus (HIV) show higher whole body protein turnover (WBPT) rates, especially those with growth issues. Adequate nutrient intake may help achieve positive protein balance in these children.
Area of Science:
- Biochemistry
- Pediatrics
- Immunology
Background:
- Human immunodeficiency virus (HIV) infection can impact nutritional status and growth in children.
- Understanding protein metabolism is crucial for managing growth and overall health in pediatric populations.
Purpose of the Study:
- To determine whole body protein turnover (WBPT) rates in children with HIV.
- To investigate the relationship between WBPT and growth parameters in HIV-infected children.
- To compare WBPT in HIV-infected children with growth retardation, HIV-infected children with normal growth, and uninfected children.
Main Methods:
- Whole body protein turnover (WBPT) was calculated using the 15N-glycine method, measuring cumulative urinary ammonia excretion.
- Three groups of children (2-11 years) were studied: HIV+ with growth retardation (n=10), HIV+ with normal growth (n=12), and HIV- (n=4).
- Nutritional intake (energy, protein) and anthropometric measures (height, weight-for-age Z scores) were assessed.
Main Results:
- Mean WBPT rates were higher in HIV+ children (10.7 g/kg/d) and HIV+ with growth retardation (12.2 g/kg/d) compared to HIV- children (8.6 g/kg/d), though not statistically significant.
- Significant correlations were observed between WBPT and lower height-for-age Z scores (r=-0.39) and weight-for-age Z scores (r=-0.51).
- Protein balance was positively correlated with adequate energy and protein intake, suggesting nutritional support can influence protein metabolism.
Conclusions:
- Increased whole body protein turnover is associated with impaired growth (low height and weight Z scores) in children with HIV.
- Adequate dietary intake of energy and protein is essential for achieving positive protein balance in HIV-infected children.
- Further research into nutritional interventions may be beneficial for improving growth outcomes in pediatric HIV.
Abstract:
The purpose of this study was to determine the rate of whole body protein turnover (WBPT) in human immunodeficiency virus (HIV)-infected children, and to determine the relationship between WBPT and growth. The rate of WBPT was calculated from the cumulative excretion of labeled urinary ammonia after a single intravenous dose of 15N-glycine in three groups of children: 1) HIV+ with growth retardation (HIV+ Gr); 2) HIV+ with normal growth (HIV+); and 3) HIV-uninfected with normal growth (HIV-). Twenty-six children between 2 and 11 y of age were studied (10 HIV+ Gr, 12 HIV+, 4 HIV-). All children were afebrile and free of acute infection during the study. Rates of WBPT (mean +/- SD) for the study groups were: HIV+ Gr, 12.2 +/- 4.8; HIV+, 10.7 +/- 5.1; and HIV-, 8.6 +/- 2.1 g.protein.kg-1.d-1 (NS, P > 0.05). Although not statistically significant, mean WBPT was 42% greater in HIV+ Gr, and 24% greater in HIV+ compared to HIV-. Statistically significant correlations were found between WBPT and Z scores for height (r = -0.39, P = 0.05) and weight-for-age (r = -0.51, P = 0.01) and dietary intake of protein (r = 0.39, P = 0.05), and between protein balance (synthesis-catabolism) and intakes of energy (r = 0.47, P = 0.02) and protein (r = 0.40, P = 0.04). There was no statistically significant correlation between WBPT and resting energy expenditure (r = 0.27, P = 0.19), or CD4 cell number (r = 0.05, P = 0.82). These data suggest an association between increased rates of protein turnover and low weight and height-for-age Z scores, and that it may be possible to achieve positive protein balance given an adequate intake of nutrients.