In the Journals Plus

Food insecurity associated with inflammation in US women with HIV

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September 17, 2018

Anna Leddy, PhD, MHS
Anna Leddy
Sheri Weiser, MD, MPH, MA
Sheri Weiser

Food insecurity in women with HIV is associated with elevated levels of inflammation regardless of HIV control, according to study findings from the United States published in The Journal of Infectious Diseases.

“Food insecurity and hunger are a huge problem in this country, with approximately 40 million Americans who are food insecure,” Anna Leddy, PhD, MHS, postdoctoral scholar at the University of California, San Francisco, told Infectious Disease News. “People living with HIV are disproportionately affected with food insecurity, and those who are food insecure are more likely to die than people who are food secure.”

“The more we learn about food insecurity and all the ways it is bad for people’s health, the more that we are alerted to the urgency of addressing this important problem,” added Sheri Weiser, MD, MPH, MA, associate professor of medicine in the division of HIV, infectious diseases and global medicine at UCSF.

According to Leddy, prior studies have explored the association between food insecurity and poor health including chronic disease. For their study, Leddy and Weiser and colleagues investigated the relationship between food insecurity and inflammation, which is a critical factor in the development of chronic disease.

“It’s important to understand whether food insecurity is associated with some of the key biologic mechanisms that drive chronic disease,” Leddy said.

The researchers analyzed data collected between April and September 2015 as part of the Women’s Interagency HIV Study, a large, multisite prospective cohort study of women with HIV. They included 421 HIV-positive participants from 10 sites across the United States. The primary outcome was inflammation measured by pro-inflammatory cytokine interleukin-6 and tumor necrosis factor 1 (TNFR1) levels.

“We found that food insecurity was associated with elevated levels of two clinical markers of inflammation after adjusting for sociodemographic characteristics and HIV-related clinical outcomes, as well as nutritional factors,” Leddy said. “We also found that food insecurity is associated with elevated levels of inflammation regardless of HIV control.”

According to the study, 79% of participants were black/African American, 71% had a high school education or higher and 52% had an average household income of $12,000 or less. The median age of the participants was 47 years (interquartile range [IQR]: 40, 52).

Almost one-third — 31% — of participants were food insecure, 79% were virally suppressed and 70% had a CD4 count greater than or equal to 500 cells/mm3.

In an adjusted analysis, the researchers found that food insecurity was associated with 1.23 times the level of interleukin-6 (95% CI, 1.06-1.44) and 1.13 times the level of TNFR1 (95% CI, 1.05-1.21).

“These findings suggest that food insecurity may be impacting a core mechanism of disease through inflammation and this not only has implications for HIV morbidity and mortality, but it also has implications for chronic diseases,” Leddy said.

Leddy, Weiser and colleagues said their findings support a need for programs addressing food insecurity among women living with HIV.

“Programs could ultimately address food insecurity among this population and the downstream effects, such as inflammation and the negative health outcomes associated with that,” Leddy said. “One model in the San Francisco area, where we are based, is Project Open Hand, which provides food support for people living with HIV.”

“Thinking about addressing food insecurity, you’re not just thinking about improving health for HIV,” Weiser said. “It is going to affect health much more broadly because inflammation, for instance, affects diabetes, hypertension, cancer and many other diseases. We’re really addressing one of the root causes of many health problems related to food insecurity.” – by Marley Ghizzone

Disclosures: Leddy and Weiser report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.