Food insecurity, but not HIV-infection status, is associated with adverse changes in body composition during lactation in Ugandan women of mixed HIV status

Abstract

Background: Body composition is an important indicator of nutritional status and health. How body composition changes during 12 mo of breastfeeding in HIV-infected women receiving antiretroviral therapy (ART) is unknown.

Objective: We assessed whether HIV or food insecurity was associated with adverse postpartum body-composition changes in Ugandan women.

Design: A cohort of 246 women [36.5% of whom were HIV positive (HIV+) and were receiving ART] were followed to 12 mo postpartum. Repeated measures included weight, fat mass, fat-free mass, midupper arm circumference, triceps skinfold thickness [which allowed for the derivation of arm muscle area (AMA) and arm fat area (AFA)], breastfeeding, and individual food insecurity. Longitudinal regression models were constructed to assess associations between HIV and food insecurity and changes in body composition over time.

Results: At baseline, HIV+ women compared with HIV-negative women had a higher mean ± SD food-insecurity score (11.3 ± 5.5 compared with 8.6 ± 5.5, respectively; P < 0.001) and lower AMA (40.6 ± 5.7 compared with 42.9 ± 6.9 cm3, respectively; P = 0.03). Participants were thin at 1 wk postpartum [body mass index (BMI; in kg/m2): 22.9 ± 2.9]. From 1 wk to 12 mo, the weight change was -1.4 ± 4.4 kg. In longitudinal models of body-composition outcomes, HIV was not associated with body composition (all P > 0.05), whereas food insecurity was inversely associated with body weight and BMI at 6, 9, and 12 mo and with AFA at 6 and 12 mo (all P < 0.05). At 6 mo, every 1-unit increase in the food-insecurity score was associated with a 0.13-kg lower body weight (P < 0.001) and a 0.26-cm3 lower AFA (P < 0.01).

Conclusions: Body-composition changes are minimal during lactation. HIV is not associated with body composition; however, food insecurity is associated with changes in body composition during lactation. This trial was registered at clinicaltrials.gov as NCT02922829 and NCT02925429.

Keywords: BMI; Uganda; body composition; postpartum; pregnancy.

© 2017 American Society for Nutrition.

Figures

FIGURE 1

Participant flow diagram from prenatal recruitment to postnatal follow-up of HIV+ and HIV− Ugandan women. HIV−, HIV negative; HIV+, HIV positive; IRB, institutional review board; PostNAPS, Postnatal Nutrition and Psychosocial Health Outcomes Study; PreNAPS, Prenatal Nutrition and Psychosocial Health Outcomes Study.

FIGURE 2

Mean body-composition values from 1 wk to 12 mo in HIV-positive and HIV-negative Ugandan women (n = 246). Values are for AMA, fat-free mass, and weight (A); BMI, MTSF, and MUAC (B); and ICSF, TDF, SSF, fat mass, and AFA (C). AFA, arm fat area; AMA, arm muscle area; ICSF, iliac crest skinfold thickness; MTSF, midthigh skinfold thickness; MUAC, midupper arm circumference; SSF, subscapular skinfold thickness; TSF, triceps skinfold thickness.

FIGURE 3

Predicted β (95% CI) effects of food insecurity (A) and hunger season (B) on maternal body composition over time. Results shown are estimates from multivariate random-effects longitudinal models that were adjusting for maternal height and covariates and included interaction terms between the study visit with food insecurity and hunger exposure in the previous month. (A) Predicted effects for a 1-unit increase in individual food-insecurity access score on body composition at each observation. (B) Predicted effects of exposure to hunger season in the month before the study visit on body composition at each observation. The hunger season was defined as dates that were inclusive of 1 April to 30 June. Sample sizes for each outcome were as follows: weight, BMI, and MUAC (n = 246); AMA and AFA (n = 244); and fat-free mass and fat mass (n = 243). AFA, arm fat area; AMA, arm muscle area; MUAC, midupper arm circumference.