Ntalo, Robert; (2019) Food security, anthropometric status and body composition of people living with HIV: a case study of HIV positive adults in refugee settlements in Uganda. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background and study objectives: Studies done to assess the prevalence and interaction of malnutrition, dietary practices, and food security among HIV positive refugees in Uganda are limited. There is also little information about the use of direct Bioelectrical Impedance Analysis (BIA) parameters for assessing or monitoring body composition among HIV positive adults in resource poor settings. The overarching goals for my study were: to assess the prevalence of HIV-related food insecurity and malnutrition, describe the body composition of HIV positive adults, and investigate the potential utility of using BIA parameters as prognostic indicators among HIV positive refugee adults. / Study methods and data collected: First, I conducted a cross-sectional study involving 368 HIV positive and 368 HIV negative adults recruited from two refugee settlements. Secondly, I conducted a prospective observational longitudinal study following up for 16 weeks 74 malnourished HIV positive adults who were attending a nutritional rehabilitation clinic as part of their routine HIV treatment and care. Data was collected on: the demographic characteristics and socioeconomic status of the participants; Individual Dietary Diversity and Household Food Insecurity; anthropometric indices; and Hand Grip Strength. I also collected bioelectrical impedance data – and used phase angle, resistance, reactance and bioelectrical impedance vector analysis – to assess the body composition of the participants. / Key results from the two studies: Overall, 57% of participants were food insecure with those from Nakivale being worse affected compared to those from Kyaka settlement – 75% and 38% of participants respectively. Multivariable regression indicated that HIV infection was not a risk factor to food insecurity but the participants’ location significantly affected their food security status. 13% of the participants were underweight with those who were HIV positive more affected than those who were HIV negative – 15.2% compared to 10.3% respectively. HIV infection was found to be a risk factor for being underweight (BMI≤18.49kg/m2) with those infected with HIV being nearly three times of becoming underweight. Underweight male and female participants had significantly lower BIA values for phase angle, and reactance and resistance normalized for height. Malnourished HIV positive adults gained over 1.60kg of weight and 5Kg force for Hand Grip Strength during the 16 weeks of nutritional rehabilitation; males gained more weight and HGS compared to female participants. Phase angle, reactance and resistance normalized for height also increased during the 16 weeks of follow up but female participants had lower values. / Conclusion: Food insecurity and malnutrition are high among refugees in these areas of Uganda but due to a range of causes on top of HIV infection. Nutritional supplementation of malnourished HIV positive adults improves their nutritional status and BIA parameters. However, the gender variations observed need to be explored further.

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