Resting energy expenditure is increased in stable, malnourished HIV-infected patients

Abstract

Resting energy expenditure (REE) was measured by reference to body composition in 50 malnourished patients with human immunodeficiency virus (HIV) infection and compared with that of 14 healthy subjects. Among HIV patients, 40 had acquired immune deficiency syndrome (AIDS) and 10 had AIDS-related complex (ARC). All were in stable condition and had a previous history of progressive wasting, ie, a mean body weight loss of 14.2 +/- 8.1 kg over 16.6 mo (range 2-49 ms). The mean REE was 14% higher than estimated basal energy expenditure (EBEE), according to the Harris and Benedict formula. Thirty-four patients (68%) were classified as hypermetabolic (REE greater than 110% EBEE). The best predictable variable for REE was fat-free mass (FFM), as determined by an anthropometric method (r = 0.72; P less than 0.001). The mean REE was 12% higher in HIV patients than in the control group FFM (156 +/- 19 vs 124 +/- 17 kJ.kg FFM-1.d-1). We concluded that in stable and malnourished HIV patients, the progressive wasting may be partly related to an increase in REE. The mechanism of this hypermetabolic state remains to be established.

HIV status and sociodemographic correlates of maternal body size and wasting during pregnancy

“…HIV disease is associated with loss of lean (Kotler et al, 1985;Ott et al, 1993) and fat (Mulligan et al, 1997b;Sharpstone et al, 1996) body mass, as a result of opportunistic infections (Paton et al, 1997), metabolic (Melchior et al, 1991;Mulligan et al, 1997a) and hormonal (Strawford & Hellerstein, 1998) changes, decreased food intake and nutrient malabsorption (Kotler, 1998). In women, HIV-related weight loss occurs largely at the expense of body fat (Grinspoon et al, 1997;Kotler et al, 1999), and mean prepregnancy weight of HIV-positive women has been found to be lower than that of HIV-negatives in African settings (Castetbon et al, 1999).…”

Which equation should be used to measure energy expenditure in HIV-infected patients?

“…Within this context, the equations of Melchior et al 12,13 were the only ones showing strong concordance with IC values, having been developed for HIV-infected individuals and considering muscle mass as the variable. The equation published in 1991 13 was based on 50 HIV-infected individuals with a diagnosis of AIDS, with the presence of opportunistic infections or Kaposi sarcoma, with the presence of cachexia and the absence of antiretroviral use.…”

“…Predictive equations of resting energy expenditure for HIV-infected individuals. 14 Cunningham 10 Melchior et al 13 Melchior et al 12 Resting Harris-Benedict 11 Schofield 14 Cunningham 10 Melchior et al 13 Melchior et al were observed between IC and the Cunningham 10 and Harris & Benedict 11 equations. …”

“…The resting energy expenditure values obtained by IC were compared to those of the predictive values listed in Table 1 [10][11][12][13][14] . Depending on the equations available in the literature, the results can be reported in different energy units, i.e., calories, kilo joules or mega joules.…”

“…Continuous variables are reported as mean, standard desviation. To achieve the main objective of the study the St. Schofield 14 Cunnigham 10 Melchior et al 13 Melchior et al 12 Table 1. Predictive equations of resting energy expenditure for HIV-infected individuals.…”