Severe food insecurity is associated with overweight and increased body fat among people living with HIV in the Dominican Republic

ABSTRACT

Food insecurity is an important risk factor for overweight and obesity among low-income populations in high income countries, but has not been well-studied among people living with HIV (PLHIV), particularly in resource-poor settings. To explore the association between food insecurity and overweight and obesity among PLHIV in the Dominican Republic, we conducted a cross-sectional study of 160 HIV-infected adults between March-December 2012 in four geographically-dispersed health centers (Santo Domingo, Puerto Plata, San Juan, and Higuey). We collected information on household food insecurity, anthropometric measurements, and socio-demographic data and ran descriptive and multivariate analyses, controlling for fixed effects of clinics and using robust standard errors. Mean age ± SD of participants was 39.9 ± 10.5 years; 68% were women, and 78% were on antiretroviral therapy (ART). A total of 58% reported severe household food insecurity. After controlling for age, gender, income, having children at home, education, and ART status, severe food insecurity was associated with increased body mass index (BMI) (β = 1.891, p = 0.023) and body fat (β = 4.004, p = 0.007). Age and female gender were also associated with increased body fat (β = 0.259, p < 0.001 and β = 8.568, p < 0.001, respectively) and age and ART status were associated with increased waist circumference (β = 0.279, p = 0.011 and β = 5.768, p = 0.046, respectively). When overweight was examined as a dichotomous variable (BMI ≥ 25.0), severe food insecurity was associated with an increased odds of 3.060 (p = 0.013); no other covariates were independently associated with overweight. The association of severe food insecurity with increased BMI, body fat, and overweight among PLHIV has important implications for clinical care as well as food security and nutrition interventions in resource-poor settings. Integrated programs that combine nutrition education or counseling with sustainable approaches to addressing food insecurity among PLHIV are needed to improve long-term health outcomes of this vulnerable population.

KEYWORDS:

• HIV
• food insecurity
• nutrition
• overweight
• obesity

Acknowledgements

The authors thank Ramón Acevedo, Luz Aída Cruz, and Danilda Soto for helping to collect the data and Dr. Salvador Quiñones for managing data collection. They also graciously acknowledge the participants for their generosity in giving of their time and the four HIV clinics that participated. This work also benefited greatly from the support of Edith Rodríguez, former Country Director for WFP in the DR, and whose untimely death before completion of this study left a huge hole in the hearts of many.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Kathryn P. Derose http://orcid.org/0000-0001-7742-6024

Additional information

Funding

This work was supported by Agency for Healthcare Research and Quality [grant number T32HS00046]; National Institute of Diabetes and Digestive and Kidney Diseases [grant number K01 DK107335]; National Institute of Mental Health [grant number R34MH110325]; OPEC Fund for International Development [grant number N/A]. The contents of the manuscript are solely the responsibility of the authors and do not represent the official views of any of the funding agencies.