Serum Phosphate Predicts Early Mortality among Underweight Adults Starting ART in Zambia: A Novel Context for Refeeding Syndrome?
Background. Low body mass index (BMI) at antiretroviral therapy (ART) initiation is associated with early mortality, but the etiology is not well understood. We hypothesized that low pretreatment serum phosphate, a critical cellular metabolism intermediate primarily stored in skeletal muscle, may pr...
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| Format: | Article |
| Language: | English |
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Wiley
2013-01-01
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| Series: | Journal of Nutrition and Metabolism |
| Online Access: | http://dx.doi.org/10.1155/2013/545439 |
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| author | John R. Koethe Meridith Blevins Christopher K. Nyirenda Edmond K. Kabagambe Janelle M. Chiasera Bryan E. Shepherd Isaac Zulu Douglas C. Heimburger |
| author_facet | John R. Koethe Meridith Blevins Christopher K. Nyirenda Edmond K. Kabagambe Janelle M. Chiasera Bryan E. Shepherd Isaac Zulu Douglas C. Heimburger |
| author_sort | John R. Koethe |
| collection | DOAJ |
| description | Background. Low body mass index (BMI) at antiretroviral therapy (ART) initiation is associated with early mortality, but the etiology is not well understood. We hypothesized that low pretreatment serum phosphate, a critical cellular metabolism intermediate primarily stored in skeletal muscle, may predict mortality within the first 12 weeks of ART. Methods. We prospectively studied 352 HIV-infected adults initiating ART in Lusaka, Zambia to estimate the odds of death for each 0.1 mmol/L decrease in baseline phosphate after adjusting for established predictors of mortality. Results. The distribution of phosphate values was similar across BMI categories (median value 1.2 mmol/L). Among the 145 participants with BMI <18.5 kg/m2, 28 (19%) died within 12 weeks. Lower pretreatment serum phosphate was associated with increased mortality (odds ratio (OR) 1.24 per 0.1 mmol/L decrement, 95% CI: 1.05 to 1.47; P=0.01) after adjusting for sex, age, and CD4+ lymphocyte count. A similar relationship was not observed among participants with BMI ≥18.5 kg/m2 (OR 0.96, 95% CI: 0.76 to 1.21; P=0.74). Conclusions. The association of low pretreatment serum phosphate level and early ART mortality among undernourished individuals may represent a variant of the refeeding syndrome. Further studies of cellular metabolism in this population are needed. |
| format | Article |
| id | doaj-art-838c7ef85d604c8abd4db9c65c1295c3 |
| institution | Kabale University |
| issn | 2090-0724 2090-0732 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Nutrition and Metabolism |
| spelling | doaj-art-838c7ef85d604c8abd4db9c65c1295c32025-08-20T03:37:52ZengWileyJournal of Nutrition and Metabolism2090-07242090-07322013-01-01201310.1155/2013/545439545439Serum Phosphate Predicts Early Mortality among Underweight Adults Starting ART in Zambia: A Novel Context for Refeeding Syndrome?John R. Koethe0Meridith Blevins1Christopher K. Nyirenda2Edmond K. Kabagambe3Janelle M. Chiasera4Bryan E. Shepherd5Isaac Zulu6Douglas C. Heimburger7Centre for Infectious Diseases Research in Zambia, Plot 1275 Lubuto Road, P.O. Box 34681, Lusaka 10101, ZambiaDepartment of Biostatistics, Vanderbilt University Medical Center, S2323 MCN, 1161 21st Avenue South, Nashville, TN 37232-2582, USACentre for Infectious Diseases Research in Zambia, Plot 1275 Lubuto Road, P.O. Box 34681, Lusaka 10101, ZambiaSchools of Medicine and Public Health, University of Alabama at Birmingham, 1900 University Boulevard, Birmingham, AL 35294, USASchools of Medicine and Public Health, University of Alabama at Birmingham, 1900 University Boulevard, Birmingham, AL 35294, USADepartment of Biostatistics, Vanderbilt University Medical Center, S2323 MCN, 1161 21st Avenue South, Nashville, TN 37232-2582, USACentre for Infectious Diseases Research in Zambia, Plot 1275 Lubuto Road, P.O. Box 34681, Lusaka 10101, ZambiaCentre for Infectious Diseases Research in Zambia, Plot 1275 Lubuto Road, P.O. Box 34681, Lusaka 10101, ZambiaBackground. Low body mass index (BMI) at antiretroviral therapy (ART) initiation is associated with early mortality, but the etiology is not well understood. We hypothesized that low pretreatment serum phosphate, a critical cellular metabolism intermediate primarily stored in skeletal muscle, may predict mortality within the first 12 weeks of ART. Methods. We prospectively studied 352 HIV-infected adults initiating ART in Lusaka, Zambia to estimate the odds of death for each 0.1 mmol/L decrease in baseline phosphate after adjusting for established predictors of mortality. Results. The distribution of phosphate values was similar across BMI categories (median value 1.2 mmol/L). Among the 145 participants with BMI <18.5 kg/m2, 28 (19%) died within 12 weeks. Lower pretreatment serum phosphate was associated with increased mortality (odds ratio (OR) 1.24 per 0.1 mmol/L decrement, 95% CI: 1.05 to 1.47; P=0.01) after adjusting for sex, age, and CD4+ lymphocyte count. A similar relationship was not observed among participants with BMI ≥18.5 kg/m2 (OR 0.96, 95% CI: 0.76 to 1.21; P=0.74). Conclusions. The association of low pretreatment serum phosphate level and early ART mortality among undernourished individuals may represent a variant of the refeeding syndrome. Further studies of cellular metabolism in this population are needed.http://dx.doi.org/10.1155/2013/545439 |
| spellingShingle | John R. Koethe Meridith Blevins Christopher K. Nyirenda Edmond K. Kabagambe Janelle M. Chiasera Bryan E. Shepherd Isaac Zulu Douglas C. Heimburger Serum Phosphate Predicts Early Mortality among Underweight Adults Starting ART in Zambia: A Novel Context for Refeeding Syndrome? Journal of Nutrition and Metabolism |
| title | Serum Phosphate Predicts Early Mortality among Underweight Adults Starting ART in Zambia: A Novel Context for Refeeding Syndrome? |
| title_full | Serum Phosphate Predicts Early Mortality among Underweight Adults Starting ART in Zambia: A Novel Context for Refeeding Syndrome? |
| title_fullStr | Serum Phosphate Predicts Early Mortality among Underweight Adults Starting ART in Zambia: A Novel Context for Refeeding Syndrome? |
| title_full_unstemmed | Serum Phosphate Predicts Early Mortality among Underweight Adults Starting ART in Zambia: A Novel Context for Refeeding Syndrome? |
| title_short | Serum Phosphate Predicts Early Mortality among Underweight Adults Starting ART in Zambia: A Novel Context for Refeeding Syndrome? |
| title_sort | serum phosphate predicts early mortality among underweight adults starting art in zambia a novel context for refeeding syndrome |
| url | http://dx.doi.org/10.1155/2013/545439 |
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