• New York State Department of Health. Growth, body composition, and metabolism. New York (NY): New York State Department of Health; 2007 Nov. Various p. [24 references]

This is the current release of the guideline.

This guideline updates a previous version: New York State Department of Health. Growth, body composition, and metabolism. New York (NY): New York State Department of Health; 2004. 25 p.

Clinicians should perform an annual nutritional assessment as part of routine care for all human immunodeficiency virus (HIV)-infected children

Elements of a Nutritional and Dietary Assessment

• Anthropometric data, including height, weight, and head circumference
• Biochemical data with lipid panel and albumin or pre-albumin
• Medications with nutritional side effects and interactions with foods
• Appetite and intake (24-hour recall or 3-day record)
• Family food access issues
• Social history/behavior issues/cultural practices
• Oral health
• Supplement use (including multivitamins, herbal therapies, teas)
• Activity level
• Food allergies
• Medical diagnoses, symptoms, and HIV classification
• Developmental problems

Growth Abnormalities in Perinatally HIV-Infected Children and Adolescents

Clinicians should obtain weight and height (or length) measurements every 3 to 4 months until children have reached full adult height.

Clinicians should assess children who are experiencing suboptimal growth for potentially reversible causes of poor growth.

Refer to Figure 1 in the original guideline document for causes of malnutrition.

Restoration of Growth

Energy Intake

Clinicians should carefully evaluate the dietary intake of children with growth failure or wasting syndrome, and dietary counseling should be provided by a health professional with expertise in pediatric nutrition.

Clinicians should increase total caloric intake as needed for growth, and potential causes of growth failure should be treated when possible.

Caloric intake should be nutritionally balanced: 50% to 55% of total calories from carbohydrate; 15% to 20% from protein; and 20% to 30% from fat (with less than 10% of total calories as saturated fatty acids).

Refer to Table 2 in the original guideline document for information on common antiretroviral (ARV) side effects that may affect appetite and nutrition.

Viral Suppression

Clinicians should assess the ARV regimen of patients with poor growth and high viral load to ensure optimal efficacy of the ARV regimen.

Micronutrients

Clinicians should prescribe multivitamin and mineral supplements for HIV-infected children with growth problems but should be careful of the potential for overdose.

Clinicians should ensure that any micronutrient supplements that are used conform to the specific recommended dietary allowances (RDA) for age.

The clinician should obtain a history of use of over-the-counter supplements and herbal supplements.

Anabolic Agents

Anabolic agents should only be prescribed for children in consultation with a pediatric HIV specialist.

Neuroendocrine Disorders and Growth

In patients with unexplained growth failure, clinicians should obtain thyroid function tests.

Clinicians should refer patients to an endocrinologist when growth failure remains unexplained after initial evaluation or when the evaluation suggests an endocrine abnormality.

Association of Growth Abnormalities with Gastrointestinal Infections and Malabsorption

Clinicians should carefully screen HIV-infected children with poor growth for gastrointestinal infection and malabsorption.

When lactose and fat intolerance is suspected, the clinician should consult with a pediatric gastroenterologist for screening and diet adjustment.

Lipodystrophy and Abnormalities of Lipid Metabolism

Clinicians should screen serum cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein in HIV-infected children initiating highly-active antiretroviral therapy (HAART) 3 to 6 months after initiation and approximately every 6 months thereafter. Abnormal results warrant repeat studies performed in the fasting state.

Refer to Table 3 in the original guideline document for classification of cholesterol levels in children and to the Table below for information on management of hypercholesterolemia in HIV-infected children and adolescents.

Management of HIV-infected Children with Abnormal Cholesterol

Clinicians should use dietary and behavioral interventions to manage HIV-infected children and adolescents with abnormal cholesterol. Monitoring and dietary management should be in accordance with the guidelines published by the American Academy of Pediatrics (for adolescents, the Adult Acquired Immunodeficiency Syndrome [AIDS] Clinical Trials Group Preliminary Guidelines).

Clinicians should consider the use of pharmacologic interventions for patients with markedly abnormal cholesterol; however, there is the potential for drug-drug interactions, particularly between ARV agents and bile acid sequestering agents.

Clinicians should refer HIV-infected children with borderline or high cholesterol to a pediatric nutritionist or dietitian.

Table: Management of Hypercholesterolemia in HIV-Infected Children and Adolescents

Abnormalities of Glucose Metabolism

Clinicians should screen for risk factors for diabetes mellitus, including obesity and family history.

None provided

The type of evidence supporting the recommendations is not specifically stated.

• New York State Department of Health. Growth, body composition, and metabolism. New York (NY): New York State Department of Health; 2007 Nov. Various p. [24 references]

Not applicable: The guideline was not adapted from another source.

2004 (revised 2007 Nov)

New York State Department of Health - State/Local Government Agency [U.S.]

New York State Department of Health

Medical Care Criteria Committee

Committee Chair: Jessica E Justman, MD, Columbia University, New York, New York

Vice-Chair: Barry S Zingman, MD, Montefiore Medical Center, Bronx, New York

Members: Judith A Aberg, MD, New York University School of Medicine, New York, New York; Bruce D Agins, MD, MPH, New York State Department of Health AIDS Institute, New York, New York; Barbara H Chaffee, MD, MPH, Binghamton Family Care Center, Binghamton, New York; Steven M Fine, MD, PhD, University of Rochester Medical Center, Rochester, New York; Barbara E Johnston, MD, Saint Vincent's-Manhattan Comprehensive HIV Center, New York, New York; Jason M Leider, MD, PhD, North Bronx Healthcare Network of Jacobi and North Central Bronx Hospitals, Bronx, New York; Joseph P McGowan, MD, FACP, Center for AIDS Research & Treatment, North Shore University Hospital, Manhasset, New York; Samuel T Merrick, MD, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York; Rona M Vail, MD, Callen-Lorde Community Health Center, New York, New York

Liaisons: Sheldon T Brown, MD, Liaison to the Department of Veterans Affairs Medical Center, Bronx Veteran Affairs Medical Center, Bronx, New York; Douglas G Fish, MD, Liaison to the New York State Department of Corrections, Albany Medical College, Albany, New York; Peter G Gordon, MD, Liaison to the HIV Quality of Care Advisory Committee, Columbia University College of Physicians and Surgeons, New York, New York; Fabienne Laraque, MD, MPH, Liaison to the New York City Department of Health and Mental Hygiene, Treatment and Housing Bureau of HIV/AIDS Prevention and Control, New York, New York; Joseph R Masci, MD, Liaison to New York City Health and Hospitals Corporation, Elmhurst Hospital Center, Elmhurst, New York

AIDS Institute Staff Physician: Charles J Gonzalez, MD, New York State Department of Health AIDS Institute, New York, New York

Principal Investigator: John G Bartlett, MD, the Johns Hopkins University, Baltimore, Maryland

Not stated

This is the current release of the guideline.

This guideline updates a previous version: New York State Department of Health. Growth, body composition, and metabolism. New York (NY): New York State Department of Health; 2004. 25 p.

None available

This NGC summary was completed by ECRI on January 13, 2005. This NGC summary was updated by ECRI Institute on June 26, 2008.