Validity of impedance-based predictions of total body water as measured by 2H dilution in African HIV/AIDS outpatients

Abstract

Measurements of body composition are crucial in identifying HIV-infected patients at risk of malnutrition. No information is available on the validity of indirect body composition methods in African HIV-infected outpatients. Our first aim was to test the validity of fifteen published equations, developed in whites, African-Americans and/or Africans who were or not HIV-infected, for predicting total body water (TBW) from bioelectrical impedance analysis (BIA) in HIV-infected patients. The second aim was to develop specific predictive equations. Thirty-four HIV-infected patients without antiretroviral treatment and oedema at the beginning of the study (age 39 (sd 7) years, BMI 18.7 (sd 3.7) kg/m2, TBW 30.4 (sd 7.2) kg) were measured at inclusion then 3 and 6 months later. In the resulting eighty-eight measurements, we compared TBW values predicted from BIA to those measured by 2H dilution. Range of bias values was 0.1-4.3 kg, and errors showed acceptable values (2.2-3.4 kg) for fourteen equations and a high value (10.4) for one equation. Two equations developed in non-HIV-infected subjects showed non-significant bias and could be used in African HIV-infected patients. In the other cases, poor agreement indicated a lack of validity. Specific equations developed from our sample showed a higher precision of TBW prediction when using resistance at 1000 kHz (1.7 kg) than at 50 kHz (2.3 kg), this latter precision being similar to that of the valid published equations (2.3 and 2.8 kg). The valid published or developed predictive equations should be cross-validated in large independent samples of African HIV-infected patients.