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Comparison of Body Composition Assessment Methods in Patients with Human Immunodeficiency Virus-Associated Wasting Receiving Growth Hormone

Graduate Department of Rehabilitation Science (J.G.E., S.G.T.), University of Toronto, Toronto, Ontario, Canada M5G 1V7; Department of Medicine (S.E.), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada, M5G 2C4; Graduate Department of Exercise Sciences (S.G.T.), Faculty of Physical Education and Health, University of Toronto, Toronto, Ontario, Canada M5S 2W6; and Freeman Centre for Endocrine Oncology (L.K., S.E.), Mount Sinai Hospital, Toronto, Ontario, Canada M5G 1X5

Address all correspondence and requests for reprints to: Shereen Ezzat, M.D., FRCP(C), FACP, Freeman Centre for Endocrine Oncology, Mount Sinai Hospital, 600 University Avenue, Room 437, Toronto, Ontario, Canada M5G 1X5. E-mail: sezzat{at}mtsinai.on.ca.

Context: Bioelectrical impedance spectroscopy (BIS) and skinfold anthropometry (SKF) have been used to monitor body composition among patients with HIV wasting; however, validation of these techniques during recombinant human GH (rhGH) treatment has not been performed.

Objective: Our objective was to evaluate the degree of agreement between criterion measurements of dual-energy x-ray absorptiometry (DXA) and those of BIS and SKF in patients with HIV wasting treated with rhGH.

Design and Setting: We conducted a randomized, double-blinded, placebo-controlled, two-period crossover trial at the University of Toronto and Mount Sinai Hospital (Toronto, Canada).

Patients: A referred sample of 27 community-dwelling men with HIV-associated weight loss (10% over preceding 12 months) despite optimal antiretroviral therapy participated in the study.

Intervention: Intervention was one daily injection of rhGH (6 mg) or placebo self-administered for 3 months in a crossover fashion with a 3-month washout.

Main Outcome Measures: Fat-free mass (FFM) and fat mass (FM) were measured by BIS, SKF, and DXA before and after rhGH and placebo treatment.

Results: FFM_BIS was not significantly different from FFM_DXA after rhGH treatment (P = 0.10). Mean differences (bias ± SD) according to Bland-Altman analysis were smaller for SKF than for BIS (P < 0.05) at all time points, yet treatment-induced change in FM was better detected with BIS than with SKF. BIS estimates of FFM and FM showed better agreement with those of DXA after rhGH treatment (1.6 ± 4.6 kg and –2.1 ± 3.9 kg) compared with baseline (3.8 ± 3.5 kg and –4.1 ± 3.6 kg) and placebo (2.7 ± 4.4 kg and –3.1 ± 4.6) (P < 0.05). BIS overestimated and SKF underestimated the treatment-induced changes in FFM and FM.

Conclusions: SKF was more accurate than BIS when measuring body composition in patients with HIV wasting before and after rhGH treatment; nonetheless, the accuracy of BIS increased after treatment. Change in FM because of treatment was not accurately assessed with SKF.