Gender differences in diet and nutrition among adults initiating antiretroviral therapy in Dar es Salaam, Tanzania

Abstract

Human immunodeficiency virus (HIV)-infected males have poor treatment outcomes after initiation of antiretroviral therapy (ART) compared to HIV-infected women. Dietary factors might mediate the association between sex and disease progression. However, the gender difference in diet among HIV-infected individuals in sub-Saharan Africa is largely unknown. The objective of this study was to examine differences in dietary intake among HIV-infected men and women. We conducted a cross-sectional analysis of dietary questionnaire data from 2038 adults initiating ART in Dar es Salaam, Tanzania to assess whether nutrient adequacy differed by sex. We dichotomized participants' nutrient intakes by whether recommended dietary allowances (RDAs) were met and estimated the relative risk (RR) of meeting RDAs in males using binomial regression models. We also estimated the mean difference in intake of foods and food groups by gender. We found poorer dietary practices among men compared to women. Males were less likely to meet the RDAs for micronutrients critical for slowing disease progression among HIV patients: niacin (RR = 0.39, 95% confidence interval [CI]: 0.27 to 0.55), riboflavin (RR = 0.81, 95% CI: 0.73 to 0.91), vitamin C (RR = 0.94, 95% CI: 0.89 to 1.00), and zinc (RR = 0.06, 95% CI: 0.01 to 0.24). Intake of thiamine, pantothenate, vitamins B6, B12, and E did not vary by gender. Males were less likely to eat cereals (mean difference [servings per day] = −0.21, 95% CI: −0.44 to 0.001) and vegetables (mean difference = −0.47, 95% CI: −0.86 to −0.07) in their diet, but more likely to have meat (mean difference = 0.14, 95% CI: 0.06 to 0.21). We conclude that male HIV patients have poorer dietary practices than females, and this may contribute to faster progression of the disease in males.

Keywords:

• HIV
• acquired immunodeficiency syndrome
• nutritional sciences
• nutritional status
• food policy

Acknowledgment

We thank the study participants and field teams, including physicians, nurses, supervisors, laboratory staff, and administrative staff who made the study possible and the Muhimbili National Hospital, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam City and the Municipal Medical Offices of Health, and the Ministry of Health and Social Welfare for their institutional support and guidance.

The authors’ responsibilities were as follows – AIA, SI, EL, RSM, RAN, FMM, and WWF: designed the research; FMM and WWF: conducted the research; AIA, SI, and EL: analyzed data; AIA: wrote the manuscript; AIA and WWF: had primary responsibility for the final content of the manuscript; and all authors: contributed to and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The parent trial (Clinical trials.gov identifier: NCT00383669) was sponsored by the National Institute of Health (NIH). This particular analysis received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The National Institute of Health had no role in the design, analysis, or writing of this article.