title: Poor diet quality is associated with low CD4 count and anemia and predicts mortality among antiretroviral therapy-naive HIV-positive adults in Uganda.
abstract: BACKGROUND
  We assessed the association between dietary diversity and CD4 count, moderate anemia, and mortality among 876 antiretroviral therapy-naive people living with HIV/AIDS infection (PLHIV) in Uganda.
  
  
  METHODS
  Participants were interviewed and followed for an average of 21.6 months. Dietary diversity was measured using the Individual Dietary Diversity Score (IDDS) (range, 0-12) and summarized into an overall measure and disaggregated into nutrient-rich food groups (range, 0-7), cereals, roots, and tubers (range, 0\x{2013} 2); and oils, fats, sugars, and condiments (range, 0\x{2013} 3). We determined the cross-sectional associations between dietary diversity and (1) immunosuppression (CD4 count ≤ 350 cells/μL) and (2) moderate anemia (hemoglobin < 10 g/dL) at baseline with logistic regression. We assessed the association between IDDS and mortality using Cox proportional hazards regression.
  
  
  RESULTS
  The mean IDDS score was 6.3 (SD 1.7) food groups per day, with a mean of 2.7 (SD 1.1) nutrient-rich food groups per day. Each additional nutrient-rich food group consumed was associated with a 16% reduction in the likelihood of having a CD4 count ≤350 cells/μL [adjusted odds ratio, 0.84; 95% confidence interval (CI): 0.72 to 0.97] at baseline. Among those with >350 CD4 cells per microliter, but not those with CD4 count ≤350 cells per microliter, consumption of nutrient-rich food groups was associated with a lower odds of moderate anemia (adjusted odds ratio, 0.57; 95% CI: 0.34 to 0.96). During follow-up, 48 participants (5.6%) died (mortality rate of 3.1 per 100 person-years). IDDS was inversely associated with mortality [adjusted hazard ratio, 0.76; 95% CI: 0.63 to 0.91].
  
  
  CONCLUSIONS
  These results suggest that diet quality is an important determinant of HIV disease severity and mortality in antiretroviral therapy-naive PLHIV.
authors.affiliation: Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA.
authors.forename: Rahul
authors.initials: R
authors.lastname: Rawat
authors.forename: Sandra I
authors.initials: SI
authors.lastname: McCoy
authors.forename: Suneetha
authors.initials: S
authors.lastname: Kadiyala
mesh_terms: D000328:Adult; D000740:Anemia / Q000209:etiology; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D004032:Diet / Q000009:adverse effects*; D005247:Feeding Behavior; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009753:Nutritive Value; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D014454:Uganda / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents; D006454:Hemoglobins