Food insecurity and frailty among women with and without HIV in the United States: a cross‐sectional analysis

Abstract

Introduction Frailty is frequently observed among people with HIV, and food insecurity is associated with frailty in the general population. Evidence is scarce on the associations between food insecurity and frailty among women with HIV who may be particularly vulnerable to the impacts of food insecurity. The goal of this study was to assess associations between food insecurity and frailty among women with and without HIV. Methods There were 1265 participants from the Women’s Interagency HIV Study who participated in frailty assessments in 2017. Frailty was measured using the Fried Frailty Phenotype, and women were subsequently categorized as robust, pre‐frail or frail. Food insecurity was assessed using the U.S. Household Food Security Survey Module, with women categorized as having high, marginal, low or very low food security. Multinomial logistic regression models were conducted to examine cross‐sectional associations between food insecurity and frailty while adjusting for socio‐demographic, behavioural and HIV status covariates. Results and discussion Approximately one‐third (31.9%) of the women had marginal, low or very low food security, and the proportions of women who met the criteria for frailty or pre‐frailty were 55.6% and 12.4% respectively. In the adjusted model, the relative risk ratio (RRR) of frailty for women with very low food security versus women with high food security was 3.37 (95% CI [1.38 to 8.24], p < 0.01); the corresponding RRR of pre‐frailty was 3.63 (95% CI [1.76 to 7.51], p < 0.001). Higher annual household income was associated with lower RRRs of frailty or pre‐frailty ( p < 0.01). Similarly, older age was associated with more frequent frailty (RRR=1.06, 95% CI [1.03 to 1.09], p < 0.001). HIV serostatus was not significantly associated with either pre‐frailty (RRR=0.97, 95% CI [0.71 to 1.31]) or frailty (RRR=0.75, 95% CI [0.48 to 1.16]). Conclusions Very low food security was associated with more frequent frailty and pre‐frailty among women with and without for HIV. HIV serostatus was not associated with frailty.

Longitudinal Relationship Between Food Insecurity, Engagement in Care, and ART Adherence Among US Women Living with HIV

“…To understand the independent association of food insecurity with non-adherence, we used longitudinal multinomial logistic regression with the 4-category adherence variable as the outcome and food insecurity as the explanatory variable, controlling for covariates and using complete case analysis. The resulting adjusted relative-risk ratios (RRRs) [52][53][54], as described in our previous published work [55], are interpreted as the association of food insecurity with each non-adherence category (< 75%, 75-94%, and 95-99% adherence) versus 100% adherence. All regressions included random effects to allow for unexplained individual-level variation.…”

Frailty in people living with HIV: an update

“…The prevalence of frailty amongst people living with HIV remains unclear though a recent systematic review of people over 50 years living with HIV (26 studies, 6584 cases) using the FFP reported a pooled prevalence of 10.9% for frailty and 47.2% for prefrailty comparable with 11% and 42% of community-dwelling older adults without HIV, though heterogeneity between studies was high making comparison challenging [19 ▪ ]. Further studies have been conducted since using various frailty diagnostic tools with the results summarized below (Table 1) [20–24,25 ▪▪ ,26,27 ▪ ,28–30,31 ▪▪ ].…”

Impact of Food Insecurity and Undernutrition on Frailty and Physical Functioning in Aging People With HIV in the United States

“…Although we only detected an association with overall frailty and weak grip strength in our sample, data in the general population indicate that undernutrition can adversely affect each criterion used in the FFP (e.g., weight loss, exhaustion, physical activity, slow gait speed and grip strength; Bonnefoy et al, 2015). In the limited data among PWH, very low food security (i.e., high food insecurity) was associated with prefrailty and frailty among women regardless of HIV status (Tan et al, 2021). Very low food security is defined as various indications of disrupted eating patterns and decreased food consumption (Tan et al, 2021).…”

“…In the limited data among PWH, very low food security (i.e., high food insecurity) was associated with prefrailty and frailty among women regardless of HIV status (Tan et al, 2021). Very low food security is defined as various indications of disrupted eating patterns and decreased food consumption (Tan et al, 2021). Ensuring access to healthy food options may be an important component of prevention or reversing numerous components of physical function and frailty, beyond simply weight loss (Willig et al, 2016).…”