Determinants of increased energy expenditure in HIV-infected women123

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ABSTRACT

BACKGROUND

Little is known about sex-specific effects of HIV infection on energy expenditure.

OBJECTIVE

We investigated the determinants of energy expenditure in HIV-infected women.

DESIGN

Resting energy expenditure (REE), body composition, and hormonal and nutritional indexes were compared in 33 ambulatory, premenopausal HIV-infected women and 26 weight-matched, healthy premenopausal control subjects. REE was determined by indirect calorimetry and body composition by dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis, and skinfold-thickness analysis. Hormonal indexes included leptin, testosterone, estradiol, and insulin-like growth factor I.

RESULTS

HIV-infected subjects had a higher REE than control subjects [6794 ± 1374 compared with 6011 ± 607 kJ/d (1624 ± 329 compared with 1437 ± 145 kcal/d), P = 0.0096]. On average, REE was 119 ± 23% of Harris-Benedict predictions in HIV-infected subjects compared with 102 ± 9% for control subjects (P = 0.0007). In HIV-infected subjects, REE was highly correlated with fat-free mass (FFM) by DXA (R = 0.641, P < 0.001), but not with weight or disease status. The slope of the regression equation for REE and FFM was significantly greater (P = 0.027, analysis of covariance) for HIV-infected subjects [REE (kJ/d) = 203.5 (kg FFM) − 1237] than for control subjects [REE (kJ/d) = 77.4 (kg FFM) + 2923]. In a stepwise regression analysis, FFM was the most significant variable (P = 0.005), followed by free testosterone (P = 0.029), which together explained 49% of the variation in REE. The final equation was REE (kJ/d) = 230.8 (kg FFM) + 395.9 (free testosterone, pmol/L) − 3304.

CONCLUSIONS

Energy expenditure was higher in HIV-infected women than in control women. FFM is the primary determinant of REE in HIV-infected women, but energy expenditure is greater per kg FFM in HIV-infected subjects than in control subjects, which may contribute to the wasting syndrome. Am J Clin Nutr 1998;68:720–5.

Keywords

Energy expenditure
HIV
human immunodeficiency virus
women
leptin
weight
fat-free mass
resting energy expenditure

Cited by (0)

1

From the Neuroendocrine Unit, the Infectious Disease Unit, and the General Clinical Research Center, Massachusetts General Hospital and Harvard Medical School, Boston.

2

Supported in part by NIH grants R01-DK49302, M01-RR01066, P32-DK07028, and F32-DK09218.

3

Address reprint requests to S Grinspoon, Neuroendocrine Unit, Bulfinch 457B, Massachusetts General Hospital, Boston, MA 02114. E-mail: [email protected].