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Observational Study
. 2019 Mar;73(3):474-482.
doi: 10.1038/s41430-018-0285-9. Epub 2018 Sep 5.

HIV infection and increased food insecurity are associated with adverse body composition changes among pregnant and lactating Kenyan women

Elizabeth M Widen  1 , Irene Tsai  2 , Shalean M Collins  3 , Pauline Wekesa  4 , Joy China  4 , Natalie Krumdieck  5 , Joshua D Miller  3 , Sheri D Weiser  6 , Maricianah Onono  4 , Sera L Young  7   8
Affiliations
Observational Study

HIV infection and increased food insecurity are associated with adverse body composition changes among pregnant and lactating Kenyan women

Elizabeth M Widen et al. Eur J Clin Nutr. 2019 Mar.

Abstract

Background/objectives: Body composition changes markedly during reproduction. In sub-Saharan Africa, impacts of HIV infection on body composition across pregnancy and lactation in the context of Option B+ antiretroviral therapy are unknown. Therefore, we sought to evaluate the role of HIV infection on body composition during pregnancy and lactation among Kenyan women.

Subjects/methods: A cohort of pregnant women (n = 333; 50.5% HIV+, receiving ART) were enrolled at seven clinics in western Kenya. Two prenatal (mean ± SD: 23.6 ± 4.4 and 33.4 ± 2.0 weeks gestation) and three postpartum (6, 14, and 36 weeks) measurements included: individual-level food insecurity, height, weight, fat mass (FM), and fat-free mass (FFM) by bioimpedance analysis (BIA), mid-upper arm circumference (MUAC), and triceps skinfold (TSF), allowing for AMA (arm muscle area) and AFA (arm fat area) derivation. Multivariable longitudinal regression models were used to relate HIV to body composition changes.

Results: In longitudinal models, HIV-infected women had lower weight (ß = -3.0 kg, p = 0.003), fat mass (ß = -1.5 kg, p = 0.02), fat-free mass (ß = -1.5 kg, p = 0.01), TSF (ß = -2.6 mm, p < 0.001), AFA (ß = -3.9 cm3, p < 0.001), and MUAC (ß = -1.0 cm, p = 0.001), but not AMA (p = 0.34), across all observations. Food insecurity was inversely associated with AMA and MUAC postpartum (AMA ß-range = -0.47 to -0.92 cm3; MUAC ß-range = -0.09 to -0.15 cm, all p < 0.05).

Conclusions: HIV infection was associated with lower weight, fat mass, fat-free mass, TSF, AFA, and MUAC values during pregnancy and lactation, while food insecurity was intermittently associated with body composition. This suggests that pregnant and lactating women living with HIV and food insecurity could benefit from nutritional support.

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Conflict of interest statement

Conflict of interest. Research activities and Sera Young were supported by the National Institute of Mental Health. Elizabeth Widen has received funding from the National Institutes of Health, and the Thrasher Research Fund. From August 2014-July 2015, Widen was supported by an unrestricted postdoctoral fellowship from PepsiCo Global R+D. Sheri Weiser has received funding from NIMH, NIAID, and Kaiser Community Benefits. Tsai, Collins, Wekesa, China, Krumdieck, Miller, and Onono declare no conflicts of interest.

Figures

Figure 1.
Figure 1.
Participant flow diagram of HIV+ and HIV- Kenyan Women. HIV-, HIV-uninfected; HIV+, HIV-infected.
Figure 2.
Figure 2.
Predicted ß (95% CI) effects of HIV (A) and food insecurity (B) on maternal body composition over time across pregnancy and lactation. Results shown are estimated from multivariable random-effects longitudinal models that adjust for maternal height and covariates. Results for food insecurity include an interaction term between study visit timing and food insecurity. (A) Predicted effects comparing women with HIV+ infection to HIV- women on body composition across pregnancy and lactation. (B) Predicted effects of a 1-unit increase in individual food insecurity access score on TSF, AMA and MUAC at each observation.
See this image and copyright information in PMC

References

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