Food Insecurity and Frailty among Women Living with or At...
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10/15/19 Judy Y. Tan 1 , Edward A. Frongillo, PhD 2 , Lila Sheira, MPH 3 , Leah H. Rubin 4 , Kathryn Anastos, MD 5 , Daniel Merenstein, MD 6 , Mardge H. Cohen, MD 7 , Adaora A. Adimora, MD 8 , Ighovwerha Ofotokun, MD, MSc 9 , and Sheri D. Weiser, MD, MPH 1,4 1 University of California, San Francisco (UCSF), Center for AIDS Prevention Studies, USA 2 University of South Carolina, Department of Health Promotion, Education, and Behavior, USA 3 UCSF, Division of HIV, ID and Global Medicine, 4 Johns Hopkins University, Departments of Neurology and Epidemiology, USA 5 Albert Einstein College of Medicine, Departments of Medicine, USA 6 Georgetown University Medical Center, USA; 7 Department of Medicine, Stroger Hospital, USA 8 University of North Carolina at Chapel Hill, 9 School of Medicine, Emory University, USA Food Insecurity and Frailty among Women Living with or At-risk for HIV in the U.S.
Transcript of Food Insecurity and Frailty among Women Living with or At...
10/15/19
Judy Y. Tan1, Edward A. Frongillo, PhD2, Lila Sheira, MPH3, Leah H. Rubin4, Kathryn Anastos, MD5, Daniel Merenstein, MD6, Mardge H. Cohen, MD7, Adaora A. Adimora, MD8, Ighovwerha Ofotokun, MD, MSc9,
and Sheri D. Weiser, MD, MPH1,4
1University of California, San Francisco (UCSF), Center for AIDS Prevention Studies, USA2University of South Carolina, Department of Health Promotion, Education, and Behavior, USA
3UCSF, Division of HIV, ID and Global Medicine, 4Johns Hopkins University, Departments of Neurology and Epidemiology, USA5Albert Einstein College of Medicine, Departments of Medicine, USA
6Georgetown University Medical Center, USA; 7Department of Medicine, Stroger Hospital, USA8University of North Carolina at Chapel Hill, 9School of Medicine, Emory University, USA
Food Insecurity and Frailty among Women Living with or At-risk for HIV in the U.S.
HIV and Frailty
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• Vulnerability marker for PLWH.
• Frailty is associated with low CD4+ T-cell count and high HIV viral load, key contributor to depression, decreased ability for self-care, and poor quality of life.
• Food insecurity is associated with frailty in the general population – a potential pathway?
• Frailty = meeting three out of five criteria: unintentional weight loss, self-reported fatigue, low physical activity levels, weakness, and slow walking speed.
• Frailty is frequently observed in people living with HIV (PLWH) of all ages.
Fried et al. (2001); Brothers, Kirkland, & Guaraldi (2014); Brothers & Rockwood (2019); Willig, Overton, & Saag(2016); Guaraldi et al. (2019); Terzian, Holman, & Nathwani et al. (2009)
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§ Food insecurity is defined as having uncertain or limited availability of nutritionally adequate or safe food or the inability to procure food in socially acceptable ways.1
§ Affects 16% of U.S. households,>1 billion people worldwide.2
§ Contributes to a vicious cycle via multiple pathways across individual, household, and neighborhood levels.1
§ Highly prevalent among PLWH.3
§ More prevalent among women living with or at risk for HIV (vs. men).4
1Weiser et al. (2011); 2Coleman-Jensen, Gregory, and Singh. (2014); 3Tsegaye et al. (2017); 4Sharkey (2003)
Food Insecurity as Potential Pathway
HIV and Frailty in Women
4 1Brothers, Kirkland, Theou et al. (2017)
• HIV, gender, and frailty.
‒ Among PLWH, lower risk of frailty among women living with HIV.1
• HIV, gender, and frailty – impacts of food insecurity?
‒ Women living with or at-risk for HIV may be particularly vulnerable to the impacts of food insecurity.
Understanding food insecurity as an underlying mechanism of frailty in women:
Methods§ Cross sectional data from Women’s Interagency HIV Study (WIHS), 2017 – 2018
§ n=1,324 (900 HIV-seropositive) from San Francisco/Bay Area, CA; Bronx/Manhattan, Brooklyn, NY; Washington, DC; Chicago, IL; Chapel Hill, NC; Miami, FL; and Atlanta, GA.
§ Food Security: Household Food Security Survey Module
• “In the last 12 months, did you or other adults in your household ever not eat for a whole day because there wasn’t enough money for food?”
• High, marginal, low, very low
§ Frailty: Fried Frailty Index - Not frail, Pre-frail, or Frail.
§ Multinomial logistic regression models were conducted to examine cross-sectional associations between food insecurity and frailty after adjusting for socio-demographic, behavioral, and HIV status.
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Adjusted Model: Summary
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Among women with very low food security:
• Relative risk of pre-frailty was 3.63 times higher vs. women with food security.
• Relative risk (RR) of frailty was 3.37 times higher vs. women with food security.
Tan, Frongillo, Sheira et al. (in prep)
Pre-Frail (vs. Not frail)
Frail (vs. Not frail)
Food Security (high FS ref) Relative risk ratio (95% CI)
Marginal 1.07 (0.72 - 1.59)
1.24 (0.72 - 1.59)
Low 0.88 (0.57 - 1.36)
0.91 (0.47 - 1.73)
Very low 3.63*** (1.76 - 7.51)
3.37** (1.38 - 8.24)
*** p<0.001, ** p<0.01, * p<0.05
Adjusted Model: Summary
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§ Women living with HIV were not more or less at risk for frailty compared to HIV-negative women.
§ Older age was associated with higherrisk of frailty.
§ Substance use, smoking independently associated with higher risk of frailty.
§ [Higher income associated with lowerrisk of frailty or pre-frailty (p<0.01)]
Tan, Frongillo, Sheira et al. (in prep)
Pre-Frail (vs. Not frail)
Frail (vs. Not frail)
HIV Status (HIV- ref)
0.97 (0.71 - 1.31)
0.75 (0.48 - 1.16)
Age 1.01 (1.00 - 1.03)
1.06*** (1.00 - 1.03)
Smoking (nonsmoking ref)
1.29 (0.96 - 1.72)
1.63* (0.96 - 1.72)
Substance use (no use ref)
0.93 (0.54 - 1.60)
1.61 (0.54 - 1.60)
*** p<0.001, ** p<0.01, * p<0.05
Discussion
• Risk of frailty and pre-frailty was three and a half times higher among women with very lowfood security.
§ Consistent with available evidence: Food insecurity associated with frailty in PLWH (vs. not frail; e.g., Smit et al., 2015).
• Risks for frailty did not differ by HIV-status.
• Substance use, smoking, lower income, older age – greater frailty risks.
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Discussion
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Nutritional pathway: From food insecurity to frailty.• Food insecurity contributes to macronutrient
and micronutrient deficiencies on the one hand,1 and to obesity on the other hand.2
• Undernutrition3 and obesity4 have both been associated with frailty.
• Lower daily energy intake5 and low albumin6
have also been associated with frailtyindependent of body mass index.
1Lee & Frongillo. (2001), J Nutrition; 2Adams, Grummer-Strawn, & Chavez (2003); 3Fugate, LaCroix, Gray et al. (2005); 4Smit, Wanke, Dong et al. (2013); 5Smit E, Winters-Stone KM, Loprinzi et al. (2013); 6Bartali, Frongillo, Bandinelli et al. (2006)
DiscussionNext Steps: Examining associations longitudinally to elucidate mechanistic paths.
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Acknowledgements
Women’s Interagency HIV Study
NIMH K24AI134326 (Weiser)
NIAID P30AI027763 (Volberding) UCSF Gladstone Center for AIDS Research (CFAR) Pilot Grant
Data in this manuscript were collected by the Women’s Interagency HIV Study. The contents of this publication are
solely the responsibility of the authors and do not represent the official views of the National Institutes of Health.
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Email: [email protected]
