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Comparison of isotope dilution with bioimpedance spectroscopy and anthropometry for assessment of body composition in asymptomatic HIV-infected and HIV-uninfected breastfeeding mothers^1,2,3

¹ From the Africa Centre for Health and Population Studies, Somekele, South Africa (PCP, NCR, and MLB); the Program in International Nutrition, University of California, Davis, Davis, CA (PCP, KHB, and MVL); the Department of Paediatrics, Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa (NCR); the Division of Geographic Medicine and Infectious Diseases, Tufts-New England Medical Center, Boston, MA (MLB); the Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom (MLB); and the Western Human Nutrition Research Center, United States Department of Agriculture, Davis, CA (MVL)

Background: The effect of breastfeeding on the nutrition of HIV-infected (HIV+) mothers is unknown. Simple, valid methods are needed for body-composition assessment of HIV+ women.

Objective: We compared the ability of bioimpedance spectroscopy (BIS) and anthropometry with that of isotope dilution (²H₂O) to measure fat-free mass (FFM) and fat mass (FM) in HIV+ and HIV-uninfected (HIV–) breastfeeding South African mothers.

Design: Total body water (TBW) content of 68 lactating mothers (20 HIV+, 48 HIV–) was measured 10 wk after delivery by using BIS and ²H₂O to measure FFM and FM. Anthropometric measurements included body mass index (BMI; in kg/m²), midupper arm circumference (MUAC), and 4 skinfold thicknesses.

Results: TBW, FFM, and FM measurements determined by BIS were correlated with ²H₂O measurements in HIV+ (r = 0.664, 0.621, and 0.872, respectively; P < 0.01) and HIV– (r = 0.876, 0.868, and 0.932, respectively; P < 0.001) mothers. TBW measured by BIS was greater than that measured by the ²H₂O method in both HIV+ (1.8 L) and HIV– (1.5 L) women; FM or FFM did not differ significantly by method. BMI, MUAC, and all skinfold-thickness measurements correlated strongly (r > 0.62, P < 0.001) with FM measured by ²H₂O in both groups. BMI and MUAC correlated (r > 0.64, P < 0.001) with FFM in HIV– mothers but not in HIV+ mothers.

Conclusions: In HIV+ and HIV– breastfeeding mothers, BIS provides an estimate of body composition comparable to that obtained with the ²H₂O method. BMI and MUAC are useful in predicting FM in both groups but are not valid measures of FFM in HIV+ mothers.

Key Words: HIV • breastfeeding • body composition • South Africa • fat mass • fat-free mass • anthropometry • isotope dilution • women • AIDS • lactation • bioimpedance spectroscopy

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