title: Food insecurity and perceived stress but not HIV infection are independently associated with lower energy intakes among lactating Ghanaian women.
abstract: Human immunodeficiency virus (HIV) seropositive women living in low-income communities may have difficulty meeting the increased energy requirements that are associated with both lactation and HIV infection. Data on household food security and maternal socio-demographic characteristics, perceived stress, anthropometry, reported illness, dietary intakes and preferences, and exposure to nutrition education were collected from 70 lactating women [16 seropositive (HP), 27 seronegative (HN), and 27 who refused to be tested and had unknown HIV status (HU)]. Diet was assessed with three 24-h recalls (one market day, one weekend day, and one non-market weekday). Data were collected at 8.4 (SD = 4.7) months postpartum. Most women (74.3%) reported being in good health at the time of study. Three-day mean energy intakes did not differ by HIV status [HP: 12,000 kJ (SD = 3600), HN: 12,600 kJ (SD = 5100), and HU: 12,300 kJ (SD = 4800); P = 0.94]. Protein, fat, vitamin A, thiamin, riboflavin, niacin, vitamin C, calcium, iron, and zinc intakes also did not differ by group (P > 0.10). There was a higher proportion of women with high stress levels in food insecure households compared with food secure households (55.6% vs. 26.5%; P = 0.01). Energy intake was independently negatively associated with food insecurity [high: 11,300 kJ (SD = 3500) vs. low: 13,400 kJ (SD = 5400), respectively; P = 0.050] and stress [high: 10,800 kJ (SD = 2800) vs. low: 13,400 kJ (SD = 5300), P = 0.021]. These results suggest the need to integrate multi-dimensional interventions that address economic and mental health constraints which may limit some women's ability to meet their dietary needs.
authors.affiliation: Department of Nutrition, School of Public Health & Health Sciences, University of Massachusetts, Amherst, Massachusetts 01003, USA.
authors.forename: Adolphina A
authors.initials: AA
authors.lastname: Addo
authors.forename: Grace S
authors.initials: GS
authors.lastname: Marquis
authors.forename: Anna A
authors.initials: AA
authors.lastname: Lartey
authors.forename: Rafael
authors.initials: R
authors.lastname: Pérez-Escamilla
authors.forename: Robert E
authors.initials: RE
authors.lastname: Mazur
authors.forename: Kimberly B
authors.initials: KB
authors.lastname: Harding
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004032:Diet / Q000523:psychology; D002149:Energy Intake; D005191:Family Characteristics; D005260:Female; D005869:Ghana / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000453:epidemiology; D007774:Lactation / Q000523:psychology; D044342:Malnutrition / Q000150:complications / Q000453:epidemiology* / Q000523:psychology*; D009751:Nutritional Requirements; D011204:Poverty Areas; D012307:Risk Factors; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000150:complications*; D055815:Young Adult