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Resting energy expenditure and body composition in pediatric HIV infection
M P Alfaro1, R M Siegel, R C Baker
1Department of Pediatrics, Children's Hospital Research Foundation, Cincinnati, Ohio, USA.
Insights
Perinatally HIV-infected children can achieve normal growth with adequate nutrition. These children are not hypermetabolic when free of secondary infections, challenging previous assumptions about HIV wasting syndrome.
Area of Science:
- Pediatric Infectious Diseases
- Nutritional Science
- Human Immunodeficiency Virus (HIV) Research
Background:
- HIV infection in children often leads to
Purpose of the Study:
- Assess resting energy expenditure (REE), body composition, and nutrient intake in perinatally HIV-infected children.
- Investigate factors contributing to failure to thrive in pediatric HIV disease.
Main Methods:
- Indirect calorimetry for REE
- Dual-energy X-ray absorptiometry (DEXA) and skinfolds for body composition
- 24-hour recall for nutrient intake analysis
- Serum protein levels assessment
Main Results:
- Resting energy expenditure correlated well with WHO predicted values.
- Body fat measurements by skinfolds showed good correlation with DEXA.
- All children met recommended dietary allowances for calories and protein.
- Adequate visceral protein stores were observed in all subjects.
Conclusions:
- Perinatally HIV-infected children are not hypermetabolic when free of secondary infections.
- Adequate nutrition supports normal growth in these children.
- The "wasting syndrome" may be manageable with appropriate nutritional support.
Abstract:
One of the most striking features of HIV disease is the "wasting syndrome" or failure to thrive. Eighty percent of all perinatally HIV-infected children fail to grow normally. OBJECTIVE. Because severe malnutrition increases the morbidity of HIV infection and may shorten the already limited life expectancy of this population, we assessed resting energy needs, body composition, and nutrient intake in nine children perinatally HIV-infected, age 4 months to 4 years. DESIGN. Subjects were studied using measurements of resting energy expenditure (REE) by indirect calorimetry, body composition measurements by dual-energy X-ray absorptiometry (DEXA) and skinfolds, nutrient intake analysis by 24-hour recall, and serum protein levels. The HIV-infected children were free of secondary opportunistic infection at the time of the study. Subjects were reevaluated within the following year. RESULTS. REE correlated well (r = .856) with the predicted value from the World Health Organization (WHO) equation for basal energy expenditure. Measurement of percent body fat by skinfolds correlated well with DEXA percent body fat (r = .61). There was no significant difference between body fat assessed from skinfolds compared to published age-matched standards. All subjects met their recommended dietary allowance (RDA) for calories and protein. All subjects had adequate visceral protein stores for age. CONCLUSION. Perinatally infected children were not hypermetabolic when not secondarily infected and were able to maintain normal growth with the provision of adequate nutrition.