Resting energy expenditure and body composition in pediatric HIV infection.

One of the most striking features of HIV disease is the "wasting syndrome" or failure to thrive. Eighty percent of all perinatally HIV-infected children fail to grow normally. OBJECTIVE. Because severe malnutrition increases the morbidity of HIV infection and may shorten the already limited life expectancy of this population, we assessed resting energy needs, body composition, and nutrient intake in nine children perinatally HIV-infected, age 4 months to 4 years. DESIGN. Subjects were studied using measurements of resting energy expenditure (REE) by indirect calorimetry, body composition measurements by dual-energy X-ray absorptiometry (DEXA) and skinfolds, nutrient intake analysis by 24-hour recall, and serum protein levels. The HIV-infected children were free of secondary opportunistic infection at the time of the study. Subjects were reevaluated within the following year. RESULTS. REE correlated well (r = .856) with the predicted value from the World Health Organization (WHO) equation for basal energy expenditure. Measurement of percent body fat by skinfolds correlated well with DEXA percent body fat (r = .61). There was no significant difference between body fat assessed from skinfolds compared to published age-matched standards. All subjects met their recommended dietary allowance (RDA) for calories and protein. All subjects had adequate visceral protein stores for age. CONCLUSION. Perinatally infected children were not hypermetabolic when not secondarily infected and were able to maintain normal growth with the provision of adequate nutrition.