Evaluation of high-protein supplementation in weight-stable HIV-positive subjects with a history of weight loss: a randomized, double-blind, multicenter trial.
BACKGROUND
HIV patients with wasting are at increased risk of opportunistic complications and fatality.


OBJECTIVE
We hypothesized that augmenting dietary intake with high-biologic-value protein would enhance weight and lean tissue in weight-stable subjects with a prior unintentional weight loss of >3%.


METHODS
Fifty-nine subjects with HIV RNA concentrations <5000 copies/mL were randomly assigned to receive a 280-kcal supplement containing 40 g whey protein or a matched isocaloric control supplement without added protein twice daily for 12 wk.


RESULTS
Before the study, intake of total energy and protein exceeded estimated requirements (44.3 +/- 12.6 kcal x kg(-1) x d(-1) and 1.69 +/- 0.55 g x kg(-1) x d(-1), respectively). Both supplements failed to increase total energy intake because of decreases in self-selected food intake. Changes in weight (0.8 +/- 2.4 and 0.7 +/- 2.4 kg) and lean body mass (0.3 +/- 1.4 and 0.3 +/- 1.5 kg) did not differ significantly between the whey protein and control groups, respectively. Waist-to-hip ratio improved more with whey protein (-0.02 +/- 0.05) than with the control (0.01 +/- 0.03; P = 0.025) at week 6 but not at week 12. Fasting triacylglycerol increased by 39 +/- 98 mg/dL with the control supplement and decreased by 16 +/- 62 mg/dL with whey protein at week 12 (P = 0.03). CD4 lymphocytes increased by 31 +/- 84 cells/mm(3) with whey protein and decreased by 5 +/- 124 cells/mm(3) with the control supplement at 12 wk (P = 0.03). Gastrointestinal symptoms occurred more often with whey protein.


CONCLUSIONS
A whey protein supplement did not increase weight or lean body mass in HIV-positive subjects who were eating adequately, but it did increase CD4 cell counts. The control supplement with rapidly assimilable carbohydrate substituted for protein increased cardiovascular disease risk factors. Careful dietary and weight history should be obtained before starting nutritional supplements in subjects with stable weight loss and good viral control.
Sattler
Fred R
FR
Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA. fsattler@usc.edu
Rajicic
Natasa
N
Mulligan
Kathleen
K
Yarasheski
Kevin E
KE
Koletar
Susan L
SL
Zolopa
Andrew
A
Alston Smith
Beverly
B
Zackin
Robert
R
Bistrian
Bruce
B
D000328:Adult; D000368:Aged; D001823:Body Composition / Q000187:drug effects; D018791:CD4 Lymphocyte Count; D004044:Dietary Proteins / Q000008:administration & dosage* / Q000009:adverse effects; D019587:Dietary Supplements; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D002149:Energy Intake / Q000187:drug effects / Q000502:physiology; D005260:Female; D015658:HIV Infections / Q000276:immunology* / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008894:Milk Proteins / Q000008:administration & dosage* / Q000009:adverse effects; D018482:Muscle, Skeletal / Q000187:drug effects* / Q000378:metabolism; D009751:Nutritional Requirements; D016896:Treatment Outcome; D019562:Viral Load; D015430:Weight Gain / Q000187:drug effects / Q000502:physiology; D015431:Weight Loss; D000067816:Whey Proteins
D004044:Dietary Proteins; D008894:Milk Proteins; D000067816:Whey Proteins