Wasting Is Not Over

Estimating Body Composition, Body Cell and Fat Mass: Do You Know Your Numbers?

Prior to the use of protease inhibitors, one of the greatest fears of a person living with HIV/AIDS was having the "look" of a person with HIV-associated wasting.

Loss of lean body mass and fat caused this skeletal appearance. Even in the era of HAART, HIV-associated wasting still occurs and has a significant effect on quality of life, illness and death.

The fact that wasting is not talked about much, not recognized or even monitored may be due to the focus placed on the body shape or metabolic (elevated blood fats, insulin resistance) changes occurring today. Wasting still occurs and to properly manage wasting, early detection and frequent monitoring is necessary.

A Bioelectrical Impedance Analysis (BIA) test is one tool to estimate body composition and monitor for wasting. For more than four years, AIDS Project Los Angeles' HIV & Nutrition Program has performed BIA tests on people with HIV/AIDS.

Body Composition

Part of a person's body weight is comprised of bone, water, muscle, organs, blood and other materials and is referred to as lean body mass or sometimes called fat free mass. The rest of a person's body weight is fat.

A specific part of the lean body mass plays a crucial role in fighting infections and performing the day-to-day chores the body must do to keep functioning. This part is called body cell mass and includes skeletal muscle, organs, other cells and fluid. A minimal amount of body cell mass must be maintained by the body to support its day-to-day activities plus fight infection. Loss of body cell mass is wasting.

Q&A on BIA

What about taking a scale weight or using those scales that give body fat percentage?

Scale weight alone is not an adequate indicator of internal health. When someone loses, gains or even maintains weight, the composition of that weight needs to be frequently assessed and monitored.

If weight gain has occurred, was it in fat or body cell mass? If weight loss has taken place, was it in fat or body cell mass? And if weight has remained stable, has the makeup of that weight changed internally?

Frequent monitoring with a BIA test can provide answers to these questions. Other machines on the market may only give weight and fat percentage and not provide the body cell mass component. Not to downplay the need to monitor fat stores and at the same time satisfy everyone's curiosity, the body cell mass is the component associated with wasting and survival.

How can I preserve and increase body cell mass?

Adequate intake of calories from protein, carbohydrates and fats, plus adequate fluid, are part the solution. Viral suppression, exercise, hormonal regulation and absence of opportunistic infections are also needed to maintain and increase body cell mass. If you are experiencing loss of appetite or side effects that interfere with food intake, speak to your doctor and dietitian for suggestions. Not eating enough leads to weight loss and can further compromise your health.

Does the test hurt?

No, the test is painless. A person lies on a massage table and electrodes are placed on your hand, wrist, foot and ankle. The test requires less than 2-3 minutes to perform. No blood is drawn for a BIA test.

Where Can I Get a Test?

Ask your doctor for a BIA test. Some doctors are doing BIA tests and that way your test results get put into your medical chart to help direct the course of your medical care. If your doctor does not do BIAs, APLA offers a Preserve Lean Body Mass Class with BIA workshop twice each month. During this workshop, measurements of the waist, mid-arm, chest, plus a tricep skinfold measurement are taken to track changes associated with body shape. A BIA test should be done more than once to monitor any changes over time. Clients are urged to return and repeat the test every 4 months.

If you are interested in attending the class and having a BIA test or any other classes, please call Janelle L'Heureux, M.S., R.D. at (213) 201-1556 or Marcy Fenton, M.S., R.D. at (213) 201-1611.

Janelle L'Heureux, M.S., R.D.  Janelle L'Heureux, M.S., R.D., is a nutritionist in APLA's Treatment Education Program. She can be reached by calling (213) 201-1556 or by e-mail at janelleh@apla.org.
Back to the December 2001/January 2002 issue of Positive Living.

This article has been reprinted at The Body with the permission of AIDS Project Los Angeles (APLA).