Doctoral Degrees (Nutrition and Dietetics)

Permanent URI for this collection

http://hdl.handle.net/11660/308

Browse

Browsing Doctoral Degrees (Nutrition and Dietetics) by Author "Pienaar, Michelle"

Now showing 1 - 1 of 1
  • Thumbnail Image
    ItemOpen Access
    Nutritional factors associated with HIV-infected adults in the Free State
    (University of the Free State, 2013) Pienaar, Michelle; Walsh, C. M.; Joubert, G.
    English: HIV-infection has a significant impact on health and quality of life. Nutritional factors can be described as those directly related to food and nutrition (such as diet) and those indirectly related to food and nutrition (such as poverty). Dietary diversity is associated with improved socio-economic status and household food security, both of which impact on nutritional status and health. Poor nutritional status is characterised amongst other indicators, by fatigue, physical inactivity, weight loss and wasting, which are associated with poor prognosis in HIV-infection. All of these factors impact on people living with HIV/AIDS, but remain largely undetermined in the Free State. The objective of the present study was to determine significant independent nutritional factors associated with HIV status in rural and urban communities in the cross-sectional Assuring Health for All (AHA) study, which aimed to determine how living in rural and urban communities can influence lifestyle and health. The AHA study was undertaken in rural Trompsburg, Philippolis and Springfontein during 2007 and in urban Mangaung during 2009. Adults between 25-64 years were eligible to participate. The study was approved by the Ethics Committee of the Faculty of Health Sciences at the University of the Free State (ETOVS 21/07) as well as the Free State Department of Health and local municipalities. The venues where data was collected included stations for the collection of blood and urine samples; a food station; medical examination; as well as anthropometric measurements. Thereafter, questionnaires related to the following were completed: socio-demography (one per household); household food security (one per household); diet (one for each participant); physical activity (one for each participant); and reported health (one for every participant). Logistic regression with forward selection (p < 0.05) was used to select significant independent factors (socio-demography, household food security, dietary diversity, physical activity, anthropometry, reported health) associated with HIV status. Variables with a p-value of < 0.15 were considered for inclusion in the model. Of the 570 rural participants, 567 had HIV results. Of these 97 (17.1%) were HIV-infected. Of the 426 urban participants, 424 had HIV results. Of these 172 (40.6%) were HIV-infected. As expected, in rural areas, HIV-infected participants were significantly younger (median age 40.5 years) than HIV-uninfected participants (median age 51 years) (p = 0.001). The same was found in urban areas, with HIV-infected participants having a median age of 38 years compared to 49 years in HIV-uninfected participants (p = 0.0001). In this sample, the odds of having HIV consistently decreased as age increased. In rural areas more HIV-infected participants were female (73.0%) compared to male (27.0%). The same was found in urban areas where 78.0% of the HIV-infected respondents were women and only 22.0% men. As far as socio-demographic and household food security indicators are concerned, in the rural sample HIV-infection was negatively associated with having a microwave oven (odds ratio 0.15, 95% CI 0.06; 0.42); having access to vegetables from local farmers or shops (odds ratio 0.43, 95% CI 0.21; 0.89); and being married (odds ratio 0.20, 95% CI 0.09; 0.41). On the other hand, HIV-infection was positively associated in the rural sample with spending less than R50 on food per week versus R101+ (odds ratio 3.29, 95% CI 1.58; 6.87) or spending less than R100 on food per week versus R101+ (odds ratio 1.22, 95% CI 0.68; 2.20). In the urban sample, HIV-infection was also negatively associated with being married (odds ratio 0.54, 95% CI 0.33; 0.89), while HIV-infection was positively associated with experiencing periods of food shortages (odds ratio 2.14, 95% CI 0.91; 0.95). In the rural sample, one out of five participants had low and medium dietary diversity scores. HIV-infection was negatively associated with a person consuming no eggs (odds ratio 0.41, 95% CI 0.20; 0.82) and consuming no sweets (odds ratio 0.19, 95% CI 0.04; 0.85). On the other hand, HIV-infection was positively associated with being sedentary versus very active (odds ratio 3.18, 95% CI 1.31; 7.70); low active versus very active (odds ratio 2.27, 95% CI 1.08; 4.77); and active versus very active (odds ratio 2.44, 95% CI 1.31; 4.55). No significant dietary diversity or physical activity factors were identified in the urban sample. As far as anthropometric indicators in the rural sample are concerned, HIV-infection was positively associated with a low versus high body fat percentage (odds ratio 15.56, 95% CI 0.80; 303.81); an acceptable low versus high body fat percentage (odds ratio 4.21, 95% CI 2.13; 8.31); and acceptable high versus high body fat percentage (odds ratio 1.85, 95% CI 0.81; 4.22). In the urban sample, HIV-infection was negatively associated with male gender (odds ratio 0.29, 95% CI 0.15; 0.53) and positively associated with a low or acceptable low versus high body fat percentage (odds ratio 9.18, 95% CI 4.89; 17.23) and acceptable high versus high body fat percentage (odds ratio 2.73, 95% CI 1.46; 5.12). When indicators of reported health and coping strategies were considered, a negative association was found between being a member of a church and HIV-infection [odds ratio 0.22 (95% CI 0.06; 0.76) in the rural sample and odds ratio 0.46 (95% CI 0.23; 0.91) in the urban sample]. In rural areas, HIV-infection was positively associated with losing weight involuntarily (>3kg in the past 6 months) (odds ratio 1.86, 95% CI 1.08; 3.20); ever being diagnosed with TB (odds ratio 2.50, 95% CI 1.18; 5.23); being on TB treatment (odds ratio 3.29, 95% CI 1.00; 10.80); and having experienced death of a spouse during the past year (odds ratio 4.91, 95% CI 2.06; 11.73). In the urban sample, HIV-infection was positively associated with having diarrhoea for at least 3 days in the past 6 months (odds ratio 2.04, 95% CI 1.23; 3.41) and having ever been diagnosed with TB (odds ratio 2.49, 95% CI 1.37; 4.53). When all factors identified above were considered for the final model, the odds of having HIV decreased as age increased. In rural areas, HIV-infection was negatively associated with microwave oven ownership (odds ratio 0.20, 95% CI 0.07; 0.57) and being married (odds ratio 0.17, 95% CI 0.08; 0.36). HIV-infection was positively associated with spending less than R50 per week on food versus R101+ (odds ratio 3.15, 95% CI 1.43; 6.95); having a body fat percentage of <5% versus 25%+ (odds ratio 4.41, 95% CI 1.69; 11.51); or having been diagnosed with tuberculosis (odds ratio 3.81, 95% CI 1.93; 7.52). In the urban sample, HIV-infection was negatively associated with male gender (odds ratio 0.29, 95% CI 0.15; 0.57). On the other hand, HIV-infection was positively associated with experiencing periods of food shortage (odds ratio 2.34, 95% CI 1.26; 4.37) and having a body fat percentage of <15% versus 25%+ (odds ratio 8.62, 95% CI 4.42; 16.84). Lower socio-economic status [spending very little on food (rural); and food shortage (urban)], was positively associated with HIV-infection. Being physically inactive [indicated by being sedentary versus very active; low active versus very active; and active versus very active], was positively associated with HIV-infection in the rural sample of this study, probably because lower levels of physical activity are an outcome of HIV-infection. In addition, HIV-infection was positively associated with decreasing body fat percentage (rural and urban). These results confirm the higher prevalence of opportunistic infection and associated symptoms (such as diarrhoea and weight loss) that are outcomes of HIV-infection. Indicators related to wasting, previous tuberculosis and a lower socio-economic status [indicated by being female (urban) and unmarried (rural); spending very little on food (rural); and food shortage (urban)], were associated with HIV-infection, either as outcomes of the disease or as exposures. A vicious cycle develops, with poverty increasing the likelihood of contracting HIV/AIDS and HIV/AIDS contributing to poverty. Interventions that focus on poverty alleviation can make a significant contribution to addressing HIV in South Africa. Interventions of this nature have the potential to improve food security and nutritional status which in turn will assist in preventing weight loss, promoting physical activity and improving quality of life. The social and moral support offered by organisations such as churches is invaluable in the fight against HIV.