Maternal Food Insecurity is Associated with Loss of Fat, but not Lean Mass during Lactation among Ugandans of Mixed‐HIV Status

HIV‐infected women lose more weight during lactation than HIV‐uninfected women. Whether this loss is fat‐mass (FM) or fat‐free mass (FFM) is unknown, but important, as lean mass loss accelerates HIV progression. Thus, we studied FM and FFM changes in HIV+ and HIV‐ lactating women in the PostNAPS Study in Gulu, Uganda. Postpartum women (n=168; 38% HIV+, receiving antiretroviral therapy) were assessed at 1 and 6 mo. Body composition was assessed with bioelectrical impedance (Biodynamics BIA‐450). Weight, FM and FFM change from 1‐6 mo did not differ by HIV status (all p>0.1). In multivariate models of FM change, controlling for FM at 1 mo and covariates, higher food insecurity access (FI) and agricultural labor (AL, hours/d) were associated with greater FM loss (FI: β ‐0.20 kg, p=0.01; AL: β ‐0.25 kg, p=0.02), but not HIV. In similar FFM models, HIV, FI, and AL were not associated with FFM loss, but higher CES‐D depression scores predicted greater FFM loss (β ‐0.06 kg, p=0.03). Strikingly, FM and FFM changes did not differ by HIV status. Food insecurity predicted FM loss, but not FFM; suggesting that FFM is conserved with FI during lactation. Maternal depression predicted loss of FFM. Further research to elucidate mechanisms of these relationships and develop strategies to reduce postnatal depression and food insecurity may have lasting implications for maternal nutrition. Support: USAID (OAA‐L‐10‐00006)