Judy Y Tan1, Lila A Sheira2, Edward A Frongillo3, Adaora A Adimora4, Phyllis C Tien5,6, Deborah Konkle-Parker7, Elizabeth T Golub8, Daniel Merenstein9, Susanna Levin10, Mardge Cohen11, Igho Ofotokun12, Margaret A Fischl13, Leah H Rubin8,14, Sheri D Weiser2. 1. Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA. 2. Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA. 3. Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA. 4. School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 5. Department of Medicine, University of California, San Francisco, San Francisco CA, USA. 6. Department of Veterans Affairs Medical Center, San Francisco, CA, USA. 7. Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA. 8. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 9. Department of Family Medicine, Georgetown University Medical Center, Washington, DC, USA. 10. Department of Medicine, Montefiore Medical Center, Bronx, NY, USA. 11. Department of Medicine, Stroger Hospital of Cook County, Chicago, IL, USA. 12. Emory University School of Medicine, Department of Medicine, Division of Infectious Disease, Atlanta, GA, USA. 13. Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA. 14. Departments of Neurology and Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Abstract
BACKGROUND: Neurocognitive impairment (NCI) persists among women living with HIV. Food insecurity is also common among women and may be an important modifiable contributor of NCI. OBJECTIVE: The goal of this study was to determine the association of food insecurity with neurocognitive function among women living with or without HIV. METHODS: From 2013 to 2015, we analyzed data from a cross-sectional sample from the Women's Interagency HIV Study (WIHS). Measures included food insecurity and a comprehensive neuropsychological test battery assessing executive function, processing speed, attention/working memory, learning, memory, fluency, and motor function. We conducted multivariable linear regressions to examine associations between food insecurity and domain-specific neurocognitive performance, adjusting for relevant sociodemographic, behavioral, and clinical factors. RESULTS: Participants (n = 1,324) were predominantly HIV seropositive (68%), Black/African-American (68%) or Hispanic (16%), and low income (48% reported <$12,000/y), with a median age of 49.6 y (IQR = 43.1, 55.5). Approximately one-third (36%, n = 479) were food insecure. Food insecurity was associated with poorer executive function (b = -1.45, SE = 0.58, P ≤ 0.01) and processing speed (b = -1.30, SE = 0.59, P ≤ 0.05). HIV serostatus modified the association between food insecurity and learning, memory, and motor function (P values <0.05). Food insecurity was positively associated with learning among women living with HIV (b = 1.58, SE = 0.77, P ≤ 0.05) and negatively associated with motor function among HIV-negative women (b = -3.57, SE = 1.08, P ≤ 0.001). CONCLUSIONS: Food insecurity was associated with domain-specific neurocognitive function in women, and HIV serostatus modified associations. Food security may be an important point of intervention for ethnically diverse women with low socioeconomic status. Longitudinal studies are warranted to determine potential pathways by which food insecurity is associated with neurocognitive function among women living with or at risk for HIV.
BACKGROUND: Neurocognitive impairment (NCI) persists among women living with HIV. Food insecurity is also common among women and may be an important modifiable contributor of NCI. OBJECTIVE: The goal of this study was to determine the association of food insecurity with neurocognitive function among women living with or without HIV. METHODS: From 2013 to 2015, we analyzed data from a cross-sectional sample from the Women's Interagency HIV Study (WIHS). Measures included food insecurity and a comprehensive neuropsychological test battery assessing executive function, processing speed, attention/working memory, learning, memory, fluency, and motor function. We conducted multivariable linear regressions to examine associations between food insecurity and domain-specific neurocognitive performance, adjusting for relevant sociodemographic, behavioral, and clinical factors. RESULTS: Participants (n = 1,324) were predominantly HIV seropositive (68%), Black/African-American (68%) or Hispanic (16%), and low income (48% reported <$12,000/y), with a median age of 49.6 y (IQR = 43.1, 55.5). Approximately one-third (36%, n = 479) were food insecure. Food insecurity was associated with poorer executive function (b = -1.45, SE = 0.58, P ≤ 0.01) and processing speed (b = -1.30, SE = 0.59, P ≤ 0.05). HIV serostatus modified the association between food insecurity and learning, memory, and motor function (P values <0.05). Food insecurity was positively associated with learning among women living with HIV (b = 1.58, SE = 0.77, P ≤ 0.05) and negatively associated with motor function among HIV-negative women (b = -3.57, SE = 1.08, P ≤ 0.001). CONCLUSIONS: Food insecurity was associated with domain-specific neurocognitive function in women, and HIV serostatus modified associations. Food security may be an important point of intervention for ethnically diverse women with low socioeconomic status. Longitudinal studies are warranted to determine potential pathways by which food insecurity is associated with neurocognitive function among women living with or at risk for HIV.
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