Hellerstein M, Hoh R, Neese R, Pelfini A, Faix D, Clinton R, Cope F; International Conference on AIDS.
Int Conf AIDS. 1992 Jul 19-24; 8: B207 (abstract no. PoB 3696).
SF General Hospital, CA.
OBJECTIVES--(1) To compare a peptide-based formula to a standard crystalline amino acid (aa) formula on body composition, gut histology, symptoms, and nutritional status in HIV-associated wasting. (2) To determine whether in vivo metabolic parameters predict non-responsivity to nutritional supplementation. METHODS--Subjects were HIV+ with greater than 5% body weight loss. Most had diarrhea. Supplementation was for 6 weeks, with randomization (blinded) between the crystalline aa formula (Ensure) and a peptide-based formula containing n-3 amino acids (Ross Laboratories). Body composition, 7 day weight diet records, and laboratory measurements were performed before and after supplementation. A subset underwent upper endoscopy with distal duodenal biopsy. Others had stable isotope infusions to measure gluconeogenesis (GNG) or lipogenesis. RESULTS--For all subjects combined, baseline energy intake of 2160 +/- 914 Kcal/day (mean +/- S.D., n = 10) rose to 2,920 +/- 1,000 Kcal/d (560 Kcal/d as supplement), while protein intake was 82 +/- 29 g/d to 113 +/- 35 g/d (23 g as supplement). Weight (67.1 +/- 6.7 kg to 66.4 +/- 7.2 kg) and lean body mass (56.6 +/- 5.4 kg to 56.8 +/- 4.8 kg) did not change (n = 14). Albumin, Hct, CD4 count did not change. Comparison between formulae is still blinded. Diarrhea improved for the group (6 subjects better, 1 worse, 3 unchanged). EM revealed reduction on inclusion bodies, increased villous and microvillous density. Villous functional organization was enhanced, with better defined crypts and increased goblet cells and secretory vesicles. Light microscopy suggested reduction in apoptotic bodies. Interestingly, subjects with abnormal baseline GNG or lipogenesis lost weight despite supplementation and increased energy intake. CONCLUSIONS--Two factors continue to impede successful oral repletion of lean tissue in HIV wasting: an abnormal metabolic milieu (fat anabolism, protein catabolism) and exacerbation of diarrhea. These data support the central role of the former problem and suggests a predictive role of metabolic measurements (for selection of non-responsive patients). Diarrhea is manageable, and gut architecture may improve. Comparison of formulae awaits unblinding of study. Treatment strategies to oppose metabolic abnormalities need to be developed.
Publication Types:
Keywords:
- Acquired Immunodeficiency Syndrome
- Body Composition
- Body Weight
- CD4 Lymphocyte Count
- Diarrhea
- Dietary Supplements
- Energy Intake
- HIV Infections
- HIV Seropositivity
- Humans
- Nutritional Status
- Weight Loss
- abnormalities
Other ID:
UI: 102199138
From Meeting Abstracts