Poverty, Health, and Nutrition Division, International Food Policy Research Institute, 2033 K Street, NW, Washington, DC 20006-1002, USA.
Public Health Nutr. 2013 Jan;16(1):164-70. doi: 10.1017/S136898001200050X. Epub 2012 Feb 21.
Although undernutrition is recognized as a risk factor for mortality among people living with HIV (PLWHIV), even among those initiating antiretroviral therapy, few studies have explored the underlying determinants of undernutrition. The objectives of the present study were to: (i) examine the independent association between household food security, individual diet quality and nutritional status; and (ii) determine if any association between food security and nutritional status is mediated through diet quality.
Cross-sectional baseline survey.
Gulu and Soroti districts, Uganda.
Nine hundred and two PLWHIV recruited into a study evaluating the impact of a food assistance programme supported by the World Food Programme.
Food security and diet quality were measured using the Household Food Insecurity Access Scale (HFIAS) and the Individual Dietary Diversity Score (IDDS), respectively. Multivariate regression results demonstrated that HFIAS and IDDS independently predict BMI (P < 0.01) and mid upper-arm circumference (P < 0.05). The adjusted odds ratio of being underweight (BMI < 18.5 kg/m2) among individuals living in severely food-insecure households was 1.92 (P < 0.0 0 1); individuals consuming a highly diverse diet had an adjusted odds ratio of being underweight of 0.56 (P < 0.05) compared with those consuming a diet of low diversity. Similar results were observed when mid upper-arm circumference and wasting were modelled as outcomes. Using path analysis, we observed that the indirect effect of food insecurity on BMI mediated through dietary diversity is negligible, and mostly a result of the direct effect of food insecurity on BMI.
Our results provide an empirical basis for focused efforts on improving food access and diet quality among PLWHIV. Addressing the broader structural determinants of food security of people infected and affected by HIV is crucial.
尽管营养不良被认为是艾滋病毒感染者（PLHIV）死亡的一个风险因素，但即使是在开始接受抗逆转录病毒治疗的人群中，也很少有研究探讨营养不良的根本决定因素。本研究的目的是：（i）研究家庭粮食安全、个体饮食质量和营养状况之间的独立关联；（ii）确定粮食安全与营养状况之间的任何关联是否通过饮食质量产生中介作用。
横断面基线调查。
乌干达的古卢和索罗蒂地区。
902 名参加世界粮食计划署支持的粮食援助方案影响评估研究的 PLHIV。
采用家庭粮食不安全获取尺度（HFIAS）和个体饮食多样性得分（IDDS）分别衡量粮食安全和饮食质量。多变量回归结果表明，HFIAS 和 IDDS 独立预测 BMI（P < 0.01）和中上臂围（P < 0.05）。居住在严重粮食不安全家庭的个体，体重不足（BMI < 18.5 kg/m2）的调整比值比为 1.92（P < 0.001）；与饮食多样性低的个体相比，饮食多样化的个体体重不足的调整比值比为 0.56（P < 0.05）。当将中上臂围和消瘦作为结果模型时，观察到了类似的结果。通过路径分析，我们发现粮食不安全通过饮食多样性对 BMI 的间接影响可以忽略不计，并且主要是粮食不安全对 BMI 的直接影响的结果。
我们的研究结果为有针对性地努力改善 PLHIV 的粮食获取和饮食质量提供了经验依据。解决受 HIV 感染和影响人群粮食安全的更广泛结构决定因素至关重要。
