title: Gender differences in diet and nutrition among adults initiating antiretroviral therapy in Dar es Salaam, Tanzania.
abstract: Human immunodeficiency virus (HIV)-infected males have poor treatment outcomes after initiation of antiretroviral therapy (ART) compared to HIV-infected women. Dietary factors might mediate the association between sex and disease progression. However, the gender difference in diet among HIV-infected individuals in sub-Saharan Africa is largely unknown. The objective of this study was to examine differences in dietary intake among HIV-infected men and women. We conducted a cross-sectional analysis of dietary questionnaire data from 2038 adults initiating ART in Dar es Salaam, Tanzania to assess whether nutrient adequacy differed by sex. We dichotomized participants' nutrient intakes by whether recommended dietary allowances (RDAs) were met and estimated the relative risk (RR) of meeting RDAs in males using binomial regression models. We also estimated the mean difference in intake of foods and food groups by gender. We found poorer dietary practices among men compared to women. Males were less likely to meet the RDAs for micronutrients critical for slowing disease progression among HIV patients: niacin (RR = 0.39, 95% confidence interval [CI]: 0.27 to 0.55), riboflavin (RR = 0.81, 95% CI: 0.73 to 0.91), vitamin C (RR = 0.94, 95% CI: 0.89 to 1.00), and zinc (RR = 0.06, 95% CI: 0.01 to 0.24). Intake of thiamine, pantothenate, vitamins B6, B12, and E did not vary by gender. Males were less likely to eat cereals (mean difference [servings per day] = -0.21, 95% CI: -0.44 to 0.001) and vegetables (mean difference = -0.47, 95% CI: -0.86 to -0.07) in their diet, but more likely to have meat (mean difference = 0.14, 95% CI: 0.06 to 0.21). We conclude that male HIV patients have poorer dietary practices than females, and this may contribute to faster progression of the disease in males.
authors.affiliation: a Department of Global Health and Population , Harvard School of Public Health , Boston , MA , USA.
authors.forename: Ajibola I
authors.initials: AI
authors.lastname: Abioye
authors.forename: Sheila
authors.initials: S
authors.lastname: Isanaka
authors.forename: Enju
authors.initials: E
authors.lastname: Liu
authors.forename: Ramadhani S
authors.initials: RS
authors.lastname: Mwiru
authors.forename: Ramadhani A
authors.initials: RA
authors.lastname: Noor
authors.forename: Donna
authors.initials: D
authors.lastname: Spiegelman
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Mugusi
authors.forename: Wafaie
authors.initials: W
authors.lastname: Fawzi
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004032:Diet / Q000706:statistics & numerical data*; D015930:Diet Records; D018450:Disease Progression; D002149:Energy Intake; D005247:Feeding Behavior; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D012737:Sex Factors; D013636:Tanzania / Q000453:epidemiology; D014815:Vitamins / Q000008:administration & dosage
chemical_list: D019380:Anti-HIV Agents; D014815:Vitamins
keywords: HIV; acquired immunodeficiency syndrome; food policy; nutritional sciences; nutritional status