title: Evaluation of high-protein supplementation in weight-stable HIV-positive subjects with a history of weight loss: a randomized, double-blind, multicenter trial.
abstract: 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.
authors.affiliation: Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA. fsattler@usc.edu
authors.forename: Fred R
authors.initials: FR
authors.lastname: Sattler
authors.forename: Natasa
authors.initials: N
authors.lastname: Rajicic
authors.forename: Kathleen
authors.initials: K
authors.lastname: Mulligan
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Yarasheski
authors.forename: Susan L
authors.initials: SL
authors.lastname: Koletar
authors.forename: Andrew
authors.initials: A
authors.lastname: Zolopa
authors.forename: Beverly
authors.initials: B
authors.lastname: Alston Smith
authors.forename: Robert
authors.initials: R
authors.lastname: Zackin
authors.forename: Bruce
authors.initials: B
authors.lastname: Bistrian
mesh_terms: 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
chemical_list: D004044:Dietary Proteins; D008894:Milk Proteins; D000067816:Whey Proteins