title: Food insecurity, but not HIV-infection status, is associated with adverse changes in body composition during lactation in Ugandan women of mixed HIV status.
abstract: 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 cm3, respectively; P = 0.03). Participants were thin at 1 wk postpartum [body mass index (BMI; in kg/m2): 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-cm3lower 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.
authors.affiliation: Institute of Human Nutrition, Department of Epidemiology and Medicine, New York Obesity Research Center, Columbia University Medical Center, New York, NY.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Widen
authors.affiliation: Department of Population Medicine, Program in International Nutrition, Cornell University, Ithaca, NY.|Department of Anthropology, Northwestern University, Evanston, IL.
authors.forename: Shalean M
authors.initials: SM
authors.lastname: Collins
authors.affiliation: Department of Biology, Cornell University, Ithaca, NY.
authors.forename: Hijab
authors.initials: H
authors.lastname: Khan
authors.affiliation: Prenatal Nutrition and Psychosocial Health Outcomes Study Uganda, Gulu, Uganda; and.
authors.forename: Claire
authors.initials: C
authors.lastname: Biribawa
authors.affiliation: Prenatal Nutrition and Psychosocial Health Outcomes Study Uganda, Gulu, Uganda; and.
authors.forename: Daniel
authors.initials: D
authors.lastname: Acidri
authors.affiliation: Prenatal Nutrition and Psychosocial Health Outcomes Study Uganda, Gulu, Uganda; and.
authors.forename: Winifred
authors.initials: W
authors.lastname: Achoko
authors.affiliation: Prenatal Nutrition and Psychosocial Health Outcomes Study Uganda, Gulu, Uganda; and.
authors.forename: Harriet
authors.initials: H
authors.lastname: Achola
authors.affiliation: Friedman School of Nutrition Science and Policy and.
authors.forename: Shibani
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: Friedman School of Nutrition Science and Policy and.|School of Medicine, Tufts University, Medford, MA.
authors.forename: Jeffrey K
authors.initials: JK
authors.lastname: Griffiths
authors.affiliation: Department of Population Medicine, Program in International Nutrition, Cornell University, Ithaca, NY; sera.young@northwestern.edu.|Department of Anthropology, Northwestern University, Evanston, IL.
authors.forename: Sera L
authors.initials: SL
authors.lastname: Young
mesh_terms: D050154:Adiposity; D000328:Adult; D001823:Body Composition; D015992:Body Mass Index; D001835:Body Weight; D001942:Breast Feeding; D015331:Cohort Studies; D005260:Female; D005523:Food Supply; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D007774:Lactation; D008137:Longitudinal Studies; D039382:Maternal Nutritional Physiological Phenomena; D009752:Nutritional Status; D049590:Postpartum Period; D014454:Uganda; D055815:Young Adult
keywords: BMI; Uganda; body composition; postpartum; pregnancy