Body composition, energy expenditure and physical activity

A longitudinal study of systemic inflammation and recovery of lean body mass among malnourished HIV-infected adults starting antiretroviral therapy in Tanzania and Zambia


  • A Corrigendum to this article was published on 06 April 2016



The effects of inflammation on nutritional rehabilitation after starting antiretroviral therapy (ART) are not well understood. We assessed the relationship between inflammation and body composition among patients enrolled in the Nutritional Support for African Adults Starting Antiretroviral therapy (NUSTART) trial in Tanzania and Zambia from 2011 to 2013.


HIV-infected, ART-eligible adults with body mass index (BMI) of <18.5 kg/m2 enrolled in the NUSTART trial were eligible for this study. Anthropometric and body composition data were collected at recruitment and 6 and 12 weeks post ART and C-reactive protein (CRP) was measured at recruitment and 6 weeks. The relationships between CRP and body composition were assessed using multiple regression.


Of the 1815 trial participants, 838 (46%) had baseline and 6-week CRP measurements. Median age was 36 years, 55% were females and median CD4 count was 135 cells/μl. A one-log reduction in CRP at 6 weeks was associated with increased mid-upper arm circumference (0.45 cm; 95% CI: 0.30, 0.61), calf circumference (0.38 cm; 0.23, 0.54), waist circumference (0.98 cm; 0.59, 1.37), BMI (0.37 kg/m2; 0.24, 0.50) and fat-free mass (0.58 kg; 0.26, 0.91), but not with fat mass (0.09 kg; −0.17, 0.34). Fat-free mass gains persisted at 12 weeks and were more closely associated with 6-week CRP values than with baseline values.


Reduction in CRP shortly after ART initiation was associated with higher fat-free mass gains. Further studies are warranted to determine whether interventions to reduce systemic inflammation will enhance gains in fat-free mass.

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This study was funded by the European and Developing Countries Clinical Trials Partnership Grant No. IP.2009.33011.004. The funding body had no role in the design, conduct, interpretation or decision to publish results of this study. This study was prepared from data arising from the NUSTART trial. We are therefore grateful to the NUSTART study team that includes: principal investigator: Suzanne Filteau; senior investigators: Aase Bengaard Andersen, John Changalucha, Henrik Friis, Douglas C Heimburger, Lackson Kasonka, Paul Kelly; statisticians and other senior research fellows: John R Koethe, Daniela Manno, Natasha Larke, Andrea M Rehman, Susannah Woodd, Daniel Yilma; steering group: David Thurnham, Andrew Tomkins; Mwanza trial manager: George PrayGod; Lusaka trial managers: Molly Chisenga, Joshua Siame; Mwanza senior clinic team: Jeremiah Kidola, Denna Michael, Kelvin Mussa, Charles Masilingi, Elizabeth Fue, Eva Masesa, Neema Mpandachalo; Lusaka senior clinic team: Anne Kanunga, Likando Munalula, Brenda Kapinda, Nellie Sikanyika; laboratory technicians: Julius Mngara, George Ogweno, Piu Ikigo, Mutinta Muchimba, Memory Samwinga, Leo Beacroft, Harry Black, Celeste Gregg Smith; postgraduate students: Caroline Chisenga, Marlene Hebie, Derek Munkombwe, Gemma Sampson; administrators and data managers: Yolanda Fernandez, Gunda Wandore, Aswile Jonas, Hildah Banda Mabuda, Wakwoya Adugna; pharmacists: Stephen Makandilo, Mwangana Mubita, Jessy Mulenga. We are also grateful to nurses, data entry clerks, drivers and other support staff at both NUSTART sites.

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Correspondence to G PrayGod.

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PrayGod, G., Blevins, M., Woodd, S. et al. A longitudinal study of systemic inflammation and recovery of lean body mass among malnourished HIV-infected adults starting antiretroviral therapy in Tanzania and Zambia. Eur J Clin Nutr 70, 499–504 (2016).

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