Widen Elizabeth M, Collins Shalean M, Khan Hijab, Biribawa Claire, Acidri Daniel, Achoko Winifred, Achola Harriet, Ghosh Shibani, Griffiths Jeffrey K, Young Sera L
Institute of Human Nutrition, Department of Epidemiology and Medicine, New York Obesity Research Center, Columbia University Medical Center, New York, NY.
Department of Population Medicine, Program in International Nutrition, Cornell University, Ithaca, NY.
Am J Clin Nutr. 2017 Feb;105(2):361-368. doi: 10.3945/ajcn.116.142513. Epub 2017 Jan 4.
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.
We assessed whether HIV or food insecurity was associated with adverse postpartum body-composition changes in Ugandan women.
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.
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 cm, respectively; P = 0.03). Participants were thin at 1 wk postpartum [body mass index (BMI; in kg/m): 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-cm lower AFA (P < 0.01).
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.
身体组成是营养状况和健康的重要指标。接受抗逆转录病毒疗法（ART）的感染艾滋病毒妇女在12个月母乳喂养期间身体组成如何变化尚不清楚。
我们评估了艾滋病毒或粮食不安全状况是否与乌干达妇女产后不良身体组成变化相关。
对246名妇女（其中36.5%为艾滋病毒阳性（HIV+）且正在接受ART）组成的队列进行随访直至产后12个月。重复测量包括体重、脂肪量、去脂体重、上臂中部周长、三头肌皮褶厚度（由此可得出手臂肌肉面积（AMA）和手臂脂肪面积（AFA））、母乳喂养情况以及个体粮食不安全状况。构建纵向回归模型以评估艾滋病毒和粮食不安全状况与身体组成随时间变化之间的关联。
在基线时，与艾滋病毒阴性妇女相比，HIV+妇女的平均±标准差粮食不安全得分更高（分别为11.3±5.5和8.6±5.5；P<0.001），AMA更低（分别为40.6±5.7和42.9±6.9厘米；P = 0.03）。参与者在产后1周时体重较轻[体重指数（BMI；单位：kg/m）：22.9±2.9]。从产后1周到产后12个月，体重变化为-1.4±4.4千克。在身体组成结果的纵向模型中，艾滋病毒与身体组成无关（所有P>0.05），而粮食不安全状况与产后6、9和12个月时的体重和BMI以及产后6和12个月时的AFA呈负相关（所有P<0.05）。在产后6个月时，粮食不安全得分每增加1个单位，体重降低0.13千克（P<0.001），AFA降低0.26厘米（P<0.01）。
哺乳期身体组成变化极小。艾滋病毒与身体组成无关；然而，粮食不安全状况与哺乳期身体组成变化相关。本试验在clinicaltrials.gov上注册，注册号为NCT02922829和NCT02925429。
