Body composition in HIV-infected children: relations with disease progression and survival.
BACKGROUND
Malnutrition is common in HIV-infected children, but the body compartment that is most affected has been ill defined.


OBJECTIVE
Our objectives were to 1) compare the fat-free mass (FFM) of children with HIV infection with that of control children, 2) assess the contribution of FFM to body weight in HIV-infected children compared with that of control children, and 3) study the relations between body weight, FFM, and mortality.


METHODS
A cross-sectional study was performed in 86 HIV-infected and 113 uninfected children (mean ages: 6.9 and 7.7 y, respectively). FFM was estimated from single-frequency bioelectrical impedance analysis by using 3 different published equations; a further estimate was obtained from triceps-skinfold-thickness measurements.


RESULTS
All 4 estimates of body composition showed that FFM in HIV-infected children was significantly less than in control children of similar age. However, FFM as a percentage of body weight was not significantly different between groups. In the whole group of infected children, an age-specific z score < -2 for weight and for FFM was significantly associated with an increased risk of death [relative risk (95% CI) = 11.4 (3.1, 41.0) and 5.1 (1.5, 18.2), respectively]; when only children with more severe disease were considered, only z score for weight was significantly associated with an increased risk [4.6 (1.4, 14.9)].


CONCLUSIONS
These findings suggest that no preferential catabolism of FFM occurs in HIV-infected children and that body weight for age is a better prognostic indicator than is FFM estimated by bioelectrical impedance analysis.
Fontana
M
M
Fourth Pediatric Department, University of Milan Medical School, Italy. fontana@imiucca.csi.unimi.it
Zuin
G
G
Plebani
A
A
Bastoni
K
K
Visconti
G
G
Principi
N
N
D000704:Analysis of Variance; D000886:Anthropometry; D001823:Body Composition; D002648:Child; D003430:Cross-Sectional Studies; D018450:Disease Progression; D017097:Electric Impedance; D005260:Female; D015658:HIV Infections / Q000145:classification / Q000401:mortality / Q000503:physiopathology* / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D011379:Prognosis