title: Nutritional supplements combined with dietary counselling diminish whole body protein catabolism in HIV-infected patients.
abstract: BACKGROUND
  Weight loss and protein malnutrition are frequent complications in HIV-infected patients. The effect of an oral nutritional supplement combined with nutritional counselling on whole body protein metabolism was assessed.
  
  
  METHODS
  HIV-infected individuals with a body mass index < 21 kg m-2 or CD4-T cells < 500 micro L-1 in stable clinical condition were randomly allocated to [1] receive either oral nutritional supplements (containing 2510 kJ, complete macro- and micronutrients) and dietary counselling (n = 8), or [2] identical monitoring but no supplements or specific nutritional advice (controls, n = 7). Whole body leucine kinetics and leucine oxidation rate were determined by [1-13C]-leucine infusions and lean and fat mass were measured before and 12 weeks after intervention.
  
  
  RESULTS
  Leucine oxidation (protein catabolism) decreased in the group receiving nutritional intervention from 0.33 +/- 0.02 to 0.26 +/- 0.02 micromol kg-1 min-1 after 12 weeks (P < 0.05; P < 0.05 vs. control group) but remained unchanged in the control group. Whole body leucine flux showed a tendency to decrease in the intervention group from 1.92 +/- 0.19 to 1.73 +/- 0.14 micromol kg-1 min-1 (P = 0.07) and remained unchanged in the control group (2.21 +/- 0.16 and 2.27 +/- 0.14 micromol kg-1 min-1, respectively). Lean body mass determined by bioelectrical impedance analysis increased in the nutritional intervention group from 84 +/- 2 to 86 +/- 2 per cent (P < 0.05) and fat mass decreased from 17 +/- 2 to 14 +/- 2 per cent (P < 0.05) of total body weight whereas neither mass changed in the control group. Nutritional intervention had no significant effect on lymphocyte CD4 counts, on plasma TNFR 55, TNFR 75 and ILR 2 concentrations and on quality of life.
  
  
  CONCLUSIONS
  The data demonstrate an anticatabolic effect of nutritional supplements combined with dietary counselling in HIV-infected subjects. They suggest that diminished whole body protein catabolism resulted in a change of body composition (increased lean mass, decreased fat mass).
authors.affiliation: University Hospital Basel, Switzerland.
authors.forename: K
authors.initials: K
authors.lastname: Berneis
authors.forename: M
authors.initials: M
authors.lastname: Battegay
authors.forename: S
authors.initials: S
authors.lastname: Bassetti
authors.forename: R
authors.initials: R
authors.lastname: Nuesch
authors.forename: A
authors.initials: A
authors.lastname: Leisibach
authors.forename: S
authors.initials: S
authors.lastname: Bilz
authors.forename: U
authors.initials: U
authors.lastname: Keller
mesh_terms: D001823:Body Composition; D001835:Body Weight; D003376:Counseling; D004734:Energy Metabolism; D005260:Female; D005934:Glucagon / Q000097:blood; D015658:HIV Infections / Q000378:metabolism / Q000628:therapy*; D006801:Humans; D007328:Insulin / Q000097:blood; D007930:Leucine / Q000378:metabolism; D008297:Male; D018529:Nutritional Support; D011506:Proteins / Q000378:metabolism*; D018124:Receptors, Tumor Necrosis Factor / Q000032:analysis
chemical_list: D007328:Insulin; D011506:Proteins; D018124:Receptors, Tumor Necrosis Factor; D005934:Glucagon; D007930:Leucine