Monitoring changes in fat-free mass in HIV-positive men with hypotestosteronemia and AIDS wasting syndrome treated with gonadal hormone replacement therapy
- Resource Type
- Authors
- M. Jacob; M D Van Loan; Marc K. Hellerstein; A. Strawford
- Source
- AIDS. 13:241-248
- Subject
- Male
Nitrogen balance
medicine.medical_specialty
Hormone Replacement Therapy
Urinary system
Immunology
Population
Physiology
HIV Wasting Syndrome
Placebo
law.invention
Excretion
Anabolic Agents
Double-Blind Method
Randomized controlled trial
law
Internal medicine
medicine
Humans
Nandrolone
Immunology and Allergy
Testosterone
education
education.field_of_study
business.industry
Repeated measures design
Infectious Diseases
Endocrinology
Nandrolone Decanoate
Body Composition
Lean body mass
business
- Language
- ISSN
- 0269-9370
The objective was to compare methods for assessing changes in body composition during gonadal hormone replacement therapy in a group of HIV-positive men with AIDS wasting syndrome. The study included a 21-day double-blind randomized placebo-controlled inpatient intervention and a 12-week open-label intervention. The inpatient intervention included 18 men who were confined to a metabolic ward. Days 1--7 comprised weight stabilization and body composition measures followed by 14 days of nandrolone decanoate at either 65 or 195 mg weekly or placebo and repeat testing. The open-label intervention comprised 12 weeks of 200 mg nandrolone decanoate fortnightly with measurements of fat-free mass at 6 and 12 weeks. The inpatient intervention measured nitrogen balance from 24 h urine and fecal collections and fat-free mass by dual energy x-ray absorptiometry (DEXA) bioimpedance spectroscopy (BIS) and D2O dilution. Nitrogen balance was calculated as the difference between dietary intake and urinary and fecal nitrogen excretion. Nitrogen was converted to fat-free mass using the constant of 32.5 g. Repeated measures analysis of variance was used to determine which methods were significantly different from the reference nitrogen balance technique. Nitrogen accretion of lean tissue was 0.55 and 0.85 kg weekly for low and high-dose groups respectively. Estimated nitrogen retention during the open-label study was 0.42 kg weekly. Body weight increased with the estimated lean tissue accretion. DEXA BIS and D2O methods demonstrated improvements in fat-free mass although the BIS estimate of fat-free mass most closely matched the results of the nitrogen retention method. DEXA BIS and D2O techniques demonstrated increases in fat-free mass. The BIS method is less costly more convenient to use and had results that more closely matched those from nitrogen balance and retention methods. BIS may be the preferred method to monitor changes in fat-free mass in AIDS patients and patients with malnutrition. (authors)