Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Body composition, energy expenditure and physical activity

HIV infection and increased food insecurity are associated with adverse body composition changes among pregnant and lactating Kenyan women

European Journal of Clinical Nutrition volume 73, pages 474–482 (2019)Cite this article

Subjects

Abstract

Background/objectives

Body composition changes markedly during reproduction. In sub-Saharan Africa, impacts of HIV infection on body composition across pregnancy and lactation in the context of Option B+ antiretroviral therapy are unknown. Therefore, we sought to evaluate the role of HIV infection on body composition during pregnancy and lactation among Kenyan women.

Subjects/methods

A cohort of pregnant women (n = 333; 50.5% HIV+, receiving ART) were enrolled at seven clinics in western Kenya. Two prenatal (mean ± SD: 23.6 ± 4.4 and 33.4 ± 2.0 weeks gestation) and three postpartum (6, 14, and 36 weeks) measurements included: individual-level food insecurity, height, weight, fat mass (FM), and fat-free mass (FFM) by bioimpedance analysis (BIA), mid-upper arm circumference (MUAC), and triceps skinfold (TSF), allowing for AMA (arm muscle area) and AFA (arm fat area) derivation. Multivariable longitudinal regression models were used to relate HIV to body composition changes.

Results

In longitudinal models, HIV-infected women had lower weight (ß = −3.0 kg, p = 0.003), fat mass (ß = −1.5 kg, p = 0.02), fat-free mass (ß = −1.5 kg, p = 0.01), TSF (ß = −2.6 mm, p < 0.001), AFA (ß = −3.9 cm3, p < 0.001), and MUAC (ß = −1.0 cm, p = 0.001), but not AMA (p = 0.34), across all observations. Food insecurity was inversely associated with AMA and MUAC postpartum (AMA ß-range = −0.47 to −0.92 cm3; MUAC ß-range = −0.09 to −0.15 cm, all p < 0.05).

Conclusions

HIV infection was associated with lower weight, fat mass, fat-free mass, TSF, AFA, and MUAC values during pregnancy and lactation, while food insecurity was intermittently associated with body composition. This suggests that pregnant and lactating women living with HIV and food insecurity could benefit from nutritional support.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Widen EM, Gallagher D. Body composition changes in pregnancy: measurement, predictors and outcomes. Eur J Clin Nutr. 2014;68:643–52. https://doi.org/10.1038/ejcn.2014.40. e-pub ahead of print 2014/03/29

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Butte NF, Hopkinson JM. Body composition changes during lactation are highly variable among women. J Nutr. 1998;128(2 Suppl):381s–385s. e-pub ahead of print 1998/03/21

    Article  CAS  Google Scholar 

  3. Adair LS, Pollitt E, Mueller WH. Maternal anthropometric changes during pregnancy and lactation in a rural Taiwanese population. Hum Biol. 1983;55:771–87. e-pub ahead of print 1983/12/01

    CAS  PubMed  Google Scholar 

  4. Ramlal RT, Tembo M, Soko A, Chigwenembe M, Tohill BC, Kayira D, et al. Patterns of body composition among HIV-infected, pregnant Malawians and the effects of famine season. Matern Child Health J. 2013;17:265–73. https://doi.org/10.1007/s10995-012-0970-6. e-pub ahead of print 2012/03/08

    Article  PubMed  Google Scholar 

  5. Ramlal RT, Tembo M, Soko A, Chigwenembe M, Ellington S, Kayira D, et al. Maternal mid-upper arm circumference is associated with birth weight among HIV-infected Malawians. Nutr Clin Pract. 2012;27:416–21. https://doi.org/10.1177/0884533611435991. e-pub ahead of print 2012/04/19

    Article  PubMed  Google Scholar 

  6. Villamor E, Dreyfuss ML, Baylin A, Msamanga G, Fawzi WW. Weight loss during pregnancy is associated with adverse pregnancy outcomes among HIV-1 infected women. J Nutr. 2004;134:1424–31. e-pub ahead of print 2004/06/03

    Article  CAS  Google Scholar 

  7. Young S, Murray K, Mwesigwa J, Natureeba P, Osterbauer B, Achan J. et al. Maternal nutritional status predicts adverse birth outcomes among HIV-infected rural Ugandan women receiving combination antiretroviral therapy. PLoS ONE. 2012;7:e41934 https://doi.org/10.1371/journal.pone.0041934. e-pub ahead of print 2012/08/11

    Article  CAS  Google Scholar 

  8. Widen EM, Bentley ME, Kayira D, Chasela CS, Jamieson DJ, Tembo M, et al. Maternal weight loss during exclusive breastfeeding is associated with reduced weight and length gain in daughters of HIV-infected Malawian women. J Nutr. 2013;143:1168–75. https://doi.org/10.3945/jn.112.171751. e-pub ahead of print 2013/05/24

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Villamor E, Saathoff E, Msamanga G, O’Brien ME, Manji K, Fawzi WW. Wasting during pregnancy increases the risk of mother-to-child HIV-1 transmission. J Acquir Immune Defic Syndr. 2005;38:622–6. e-pub ahead of print 2005/03/29

    Article  Google Scholar 

  10. Kayira D, Bentley ME, Wiener J, Mkhomawanthu C, King CC, Chitsulo P, et al. A lipid-based nutrient supplement mitigates weight loss among HIV-infected women in a factorial randomized trial to prevent mother-to-child transmission during exclusive breastfeeding. Am J Clin Nutr. 2012;95:759–65. https://doi.org/10.3945/ajcn.111.018812

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. World Health Organization. Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. WHO Press: Geneva, Switzerland, 2015.

  12. Phillips T, Thebus E, Bekker LG, McIntyre J, Abrams EJ, Myer L. Disengagement of HIV-positive pregnant and postpartum women from antiretroviral therapy services: a cohort study. J Int AIDS Soc. 2014;17:19242 https://doi.org/10.7448/ias.17.1.19242. e-pub ahead of print 2014/10/11

    Article  PubMed  PubMed Central  Google Scholar 

  13. Young SL, Plenty AH, Luwedde FA, Natamba BK, Natureeba P, Achan J, et al. Household food insecurity, maternal nutritional status, and infant feeding practices among HIV-infected Ugandan women receiving combination antiretroviral therapy. Matern Child Health J. 2014;18:2044–53. https://doi.org/10.1007/s10995-014-1450-y. e-pub ahead of print 2014/03/04

    Article  PubMed  PubMed Central  Google Scholar 

  14. Weiser SD, Young SL, Cohen CR, Kushel MB, Tsai AC, Tien PC, et al. Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS. Am J Clin Nutr. 2011;94:1729s–1739s. https://doi.org/10.3945/ajcn.111.012070. e-pub ahead of print 2011/11/18

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Widen EM, Collins SM, Khan H, Biribawa C, Acidri D, Achoko W, et al. Food insecurity, but not HIV-infection status, is associated with adverse changes in body composition during lactation in Ugandan women of mixed HIV status. Am J Clin Nutr. 2017;105:361–8. https://doi.org/10.3945/ajcn.116.142513. e-pub ahead of print 2017/01/06

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Natamba BK, Kilama H, Arbach A, Achan J, Griffiths JK, Young SL. Reliability and validity of an individually focused food insecurity access scale for assessing inadequate access to food among pregnant Ugandan women of mixed HIV status. Public Health Nutr. 2015;18:2895–905. https://doi.org/10.1017/s1368980014001669. e-pub ahead of print 2014/08/30

    Article  PubMed  Google Scholar 

  17. Keino S, van den Borne B, Plasqui G. Body composition, water turnover and physical activity among women in Narok County, Kenya. BMC Public Health. 2014;14:1212 https://doi.org/10.1186/1471-2458-14-1212. e-pub ahead of print 2014/11/26

    Article  PubMed  PubMed Central  Google Scholar 

  18. Krumdieck NR, Collins SM, Wekesa P, Mbullo P, Boateng GO, Onono M, et al. Household water insecurity is associated with a range of negative consequences among pregnant Kenyan women of mixed HIV status. J Water Health. 2016;14:1028–31. https://doi.org/10.2166/wh.2016.079. e-pub ahead of print 2016/12/14

    Article  PubMed  PubMed Central  Google Scholar 

  19. Thompson DL, Thompson WR, Prestridge TJ, Bailey JG, Bean MH, Brown SP, et al. Effects of hydration and dehydration on body composition analysis: a comparative study of bioelectric impedance analysis and hydrodensitometry. J Sports Med Phys Fit. 1991;31:565–70. e-pub ahead of print 1991/12/01

    CAS  Google Scholar 

  20. Kenya Ministry of Planning and National Development CBoS. Kenya Integrated Household Budget Survey (KIHBS), 2004/05, Household Questionnaire. In, 2004.

  21. Natamba BK, Achan J, Arbach A, Oyok TO, Ghosh S, Mehta S, et al. Reliability and validity of the center for epidemiologic studies-depression scale in screening for depression among HIV-infected and -uninfected pregnant women attending antenatal services in northern Uganda: a cross-sectional study. BMC Psychiatry. 2014;14:303 https://doi.org/10.1186/s12888-014-0303-y. e-pub ahead of print 2014/11/25

    Article  PubMed  PubMed Central  Google Scholar 

  22. Food and Agriculture Organization. Guidelines for measuring household and individual dietary diversity. Rome, Italy: Food and Agriculture Organization; 2010.

    Google Scholar 

  23. World Health Organization. WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. In: WHO Press, 2007.

  24. Papathakis PC, Van Loan MD, Rollins NC, Chantry CJ, Bennish ML, Brown KH. Body composition changes during lactation in HIV-infected and HIV-uninfected South African women. J Acquir Immune Defic Syndr. 2006;43:467–74. https://doi.org/10.1097/01.qai.0000243094.42276.92. e-pub ahead of print 2006/09/19

    Article  PubMed  Google Scholar 

  25. Villamor E, Msamanga G, Spiegelman D, Peterson KE, Antelman G, Fawzi WW. Pattern and predictors of weight gain during pregnancy among HIV-1-infected women from Tanzania. J Acquir Immune Defic Syndr. 2003;32:560–9. e-pub ahead of print 2003/04/08

    Article  Google Scholar 

  26. Robinson JJ. Changes in body composition during pregnancy and lactation. Proc Nutr Soc. 1986;45:71–80. e-pub ahead of print 1986/02/01

    Article  CAS  Google Scholar 

  27. Cames C, Cournil A, de Vincenzi I, Gaillard P, Meda N, Luchters S, et al. Postpartum weight change among HIV-infected mothers by antiretroviral prophylaxis and infant feeding modality in a research setting. AIDS (Lond, Engl). 2014;28:85–94. https://doi.org/10.1097/01.aids.0000433243.24481.c3. e-pub ahead of print 2014/01/15

    Article  CAS  Google Scholar 

  28. Toro-Ramos T, Sichieri R, Hoffman DJ. Maternal fat mass at mid-pregnancy and birth weight in Brazilian women. Ann Human Biol. 2016;43:212–8. https://doi.org/10.3109/03014460.2015.1032348. e-pub ahead of print 2015/09/24

    Article  Google Scholar 

  29. Fattah C, Farah N, Barry SC, O’Connor N, Stuart B, Turner MJ. Maternal weight and body composition in the first trimester of pregnancy. Acta Obstet Et Gynecol Scand. 2010;89:952–5. https://doi.org/10.3109/00016341003801706. e-pub ahead of print 2010/04/13

    Article  Google Scholar 

  30. Kent E, O’Dwyer V, Fattah C, Farah N, O’Connor C, Turner MJ. Correlation between birth weight and maternal body composition. Obstet Gynecol. 2013;121:46–50. https://doi.org/10.1097/AOG.0b013e31827a0052. e-pub ahead of print 2012/12/13

    Article  PubMed  Google Scholar 

  31. Larciprete G, Valensise H, Vasapollo B, Altomare F, Sorge R, Casalino B, et al. Body composition during normal pregnancy: reference ranges. Acta Diabetol. 2003;40(Suppl 1):S225–232. https://doi.org/10.1007/s00592-003-0072-4. e-pub ahead of print 2003/11/18

    Article  PubMed  Google Scholar 

  32. Lukaski HC, Siders WA, Nielsen EJ, Hall CB. Total body water in pregnancy: assessment by using bioelectrical impedance. Am J Clin Nutr. 1994;59:578–85. e-pub ahead of print 1994/03/01

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We would like to thank the Kenya Medical Research Institute (KEMRI) for providing space within the FACES clinics for the work to be conducted, ethical and logistic support to conduct this research, and oversight in Kenya. We would also like to warmly thank our study nurses: Joyce Boke, and Tobias Odwar, and our study trackers: Benter Ogwana, Teresa Owade, and Sarah Obaje, as well as the mothers and their infants who participated in this study. Research activities and SLY were supported by the National Institute of Mental Health (NIH/NIMH K01MH098902). EW was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NIH/NICHD K99HD086304), the National Institute of Diabetes and Digestive and Kidney Diseases (NIH/NIDDK T32DK091227; T32 DK007559), and by an unrestricted grant to support research in maternal and child health from PepsiCo Global R + D. This trial was registered at clinicaltrials.gov as NCT02974972.

Author information

Authors and Affiliations

  1. Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA

    Elizabeth M. Widen

  2. School of General Studies, Columbia University, New York, NY, USA

    Irene Tsai

  3. Department of Anthropology, Northwestern University, Evanston, IL, USA

    Shalean M. Collins, Joshua D. Miller & Sera L. Young

  4. Kenya Medical Research Institute, Nairobi, Kenya

    Pauline Wekesa, Joy China & Maricianah Onono

  5. Weill Cornell Medical College, New York, NY, USA

    Natalie Krumdieck

  6. School of Medicine, University of California San Francisco, San Francisco, CA, USA

    Sheri D. Weiser

  7. Institute for Policy Research, Northwestern University, Evanston, IL, USA

    Sera L. Young

Authors
  1. Elizabeth M. Widen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Irene Tsai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shalean M. Collins
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pauline Wekesa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joy China
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Natalie Krumdieck
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Joshua D. Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sheri D. Weiser
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Maricianah Onono
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Sera L. Young
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sera L. Young.

Ethics declarations

Conflict of interest

Research activities and Sera Young were supported by the National Institute of Mental Health. EMW has received funding from the National Institutes of Health, and the Thrasher Research Fund. From August 2014 to July 2015, Widen was supported by an unrestricted postdoctoral fellowship from PepsiCo Global R+D. SDW has received funding from NIMH, NIAID, and Kaiser Community Benefits. The other authors declare no conflict of interest.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Widen, E.M., Tsai, I., Collins, S.M. et al. HIV infection and increased food insecurity are associated with adverse body composition changes among pregnant and lactating Kenyan women. Eur J Clin Nutr 73, 474–482 (2019). https://doi.org/10.1038/s41430-018-0285-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-018-0285-9

This article is cited by

Search

Advanced search

Quick links