Nutritional supplements combined with dietary counselling diminish whole body protein catabolism in HIV-infected patients

Background Weight loss and protein malnutrition are frequent complications in HIV-infected patients. The effect of an oral nutritional supplement comb ined with nutritional counselling on whole body protein metabolism was asse ssed. Materials and methods HIV-infected individuals with a body mass index < 21 kg m(-2) or CD4-T cells < 500 mu L-1 in stable clinical condition were rand omly allocated to [1] receive either oral nutritional supplements (containi ng 2510 kJ, complete macro- and micronutrients) and dietary counselling (n = 8), or [2] identical monitoring but no supplements or specific nutritiona l advice (controls, n = 7). Whole body leucine kinetics and leucine oxidati on rate were determined by [1-C-13]-leucine infusions and lean and fat mass were measured before and 12 weeks after intervention. Results Leucine oxidation (protein catabolism) decreased in the group recei ving nutritional intervention from 0.33 +/- 0.02 to 0.26 +/- 0.02 mu mol kg (-1) min(-1) after 12 weeks (P < 0.05; P < 0.05 vs. control group) but rema ined unchanged in the control group. Whole body leucine flux showed a tende ncy to decrease in the intervention group from 1.92 +/- 0.19 to 1.73 +/- 0. 14 mu mol kg(-1) min(-1) (P = 0.07) and remained unchanged in the control g roup (2.21 +/- 0.16 and 2.27 +/- 0.14 mu mol kg(-1) min(-1), respectively). Lean body mass determined by bioelectrical impedance analysis increased in the nutritional intervention group from 84 +/- 2 to 86 +/- 2 per cent (P < 0.05) and fat mass decreased from 17 +/- 2 to 14 +/- 2 per cent (P < 0.05) of total body weight whereas neither mass changed in the control group. Nu tritional intervention had no significant effect on lymphocyte CD4 counts, on plasma TNFR 55, TNFR 75 and ILR 2 concentrations and on quality of life. Conclusions The data demonstrate an anticatabolic effect of nutritional sup plements combined with dietary counselling in HIV-infected subjects. They s uggest that diminished whole body protein catabolism resulted in a change o f body composition (increased lean mass, decreased fat mass).