Abstract
Metabolic disease is increasing in people with HIV (PWH) in South Africa, but little is known about self-perceptions of body size, health, and nutritional behavior in this population. We performed a cross-sectional analysis of individual-level data from the 2016 South Africa Demographic and Health Survey. This survey measured HIV serostatus and body mass index (BMI). We categorized participants into six BMI groups: 18.5–22 kg/m2, 22–25 kg/m2, 25–27.5 kg/m2, 27.5–30 kg/m2, 30–35 kg/m2, and ≥ 35 kg/m2 and stratified them by HIV serostatus. Our outcomes were self-reported (1) body size and (2) health status among all participants, and intake of (3) chips and (4) sugar-sweetened beverages (SSB) in PWH. We described these metrics and used multivariable regression to evaluate the relationship between the nutritional behaviors and BMI ≥ 25 kg/m2 in PWH only, adjusting for age, sex, educational attainment, and household wealth quintile. Of 6138 participants, 1163 (19.7%) were PWH. Among PWH, < 10% with a BMI 25–30 kg/m2, < 20% with a BMI 30–35 kg/m2 and < 50% with a BMI ≥ 35 kg/m2 self-reported as overweight or obese. PWH reported being in poor health at higher rates than those without HIV at each BMI category except ≥ 35 kg/m2. In adjusted models, SSB consumption was associated with BMI ≥ 25 kg/m2 (1.13 [1.01–1.25], t-statistic = 2.14, p = 0.033) in PWH. Perceptions of body size may challenge efforts to prevent weight gain in PWH in South Africa. SSB intake reduction should be further explored as a modifiable risk factor for obesity.
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References
ICF. The DHS Program: Demographic and Health Surveys. 2021. https://dhsprogram.com/ Accessed 25 Mar 2021.
Flood D, Seiglie JA, Dunn M, et al. The state of diabetes treatment coverage in 55 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 680 102 adults. Lancet Healthy Longev. 2021;2(6):e340–51.
Manne-Goehler J, Atun R, Stokes A, et al. Diabetes diagnosis and care in sub-Saharan Africa: pooled analysis of individual data from 12 countries. Lancet Diabetes Endocrinol. 2016;4(11):903–12.
Stokes A, Berry KM, McHiza Z, et al. Prevalence and unmet need for diabetes care across the care continuum in a national sample of South African adults: evidence from the SANHANES-1, 2011–2012. PLoS ONE. 2017;12(10): e0184264.
Statistics South Africa. TB tops leading causes of death in SA in 2018. 2021. https://www.statssa.gov.za/?p=14435. Accessed 17 Oct 2022.
Venter WDF, Moorhouse M, Sokhela S, et al. Dolutegravir plus two different prodrugs of tenofovir to treat HIV. N Engl J Med. 2019;381(9):803–15.
Verburgh ML, Wit F, Boyd A, Verboeket SO, Reiss P, van der Valk M. One in 10 virally suppressed persons with HIV in the Netherlands experiences >/=10% weight gain after switching to tenofovir alafenamide and/or integrase strand transfer inhibitor. Open Forum Infect Dis. 2022;9(7):ofac91.
Popkin BM. Nutrition transition and the global diabetes epidemic. Curr Diab Rep. 2015;15(9):64.
Milic J, Renzetti S, Ferrari D, et al. Relationship between weight gain and insulin resistance in people living with HIV switching to integrase strand transfer inhibitors-based regimens. AIDS. 2022;36(12):1643–53.
Herrin M, Tate JP, Akgun KM, et al. Weight gain and incident diabetes among HIV-infected veterans initiating antiretroviral therapy compared with uninfected individuals. J Acquir Immune Defic Syndr. 2016;73(2):228–36.
Esber AL, Chang D, Iroezindu M, et al. Weight gain during the dolutegravir transition in the African Cohort Study. J Int AIDS Soc. 2022;25(4): e25899.
Bailin SS, Koethe JR. Diabetes in HIV: the Link to Weight Gain. Curr HIV/AIDS Rep. 2022;20(1):9–18.
McCann K, Shah S, Hindley L, et al. Implications of weight gain with newer anti-retrovirals: 10-year predictions of cardiovascular disease and diabetes. AIDS. 2021;35(10):1657–65.
Manne-Goehler J, Ogbuoji O, Barnighausen TW. Converting HIV programmes into chronic-care platforms. Lancet HIV. 2020;7(9):e600–1.
Manne-Goehler J, Siedner MJ, Montana L, et al. Hypertension and diabetes control along the HIV care cascade in rural South Africa. J Int AIDS Soc. 2019;22(3): e25213.
Magodoro IM, Okello S, Dungeni M, Castle AC, Mureyani S, Danaei G. Association between HIV and prevalent hypertension and diabetes mellitus in South Africa: analysis of a nationally representative cross-sectional survey. Int J Infect Dis. 2022;121:217–25.
Okop KJ, Mukumbang FC, Mathole T, Levitt N, Puoane T. Perceptions of body size, obesity threat and the willingness to lose weight among black South African adults: a qualitative study. BMC Public Health. 2016;16:365.
Gradidge PJ, Golele P, Cohen E. Body weight perceptions and obesity amongst university employed South African women. Women Health. 2020;60(8):851–62.
Teufel F, Seiglie JA, Geldsetzer P, et al. Body-mass index and diabetes risk in 57 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 685 616 adults. Lancet. 2021;398(10296):238–48.
Motala AA, Esterhuizen T, Pirie FJ, Omar MA. The prevalence of metabolic syndrome and determination of the optimal waist circumference cutoff points in a rural South african community. Diabetes Care. 2011;34(4):1032–7.
Caleyachetty R, Barber TM, Mohammed NI, et al. Ethnicity-specific BMI cutoffs for obesity based on type 2 diabetes risk in England: a population-based cohort study. Lancet Diabetes Endocrinol. 2021;9(7):419–26.
Essman M, Taillie LS, Frank T, Ng SW, Popkin BM, Swart EC. Taxed and untaxed beverage intake by South African young adults after a national sugar-sweetened beverage tax: a before-and-after study. PLoS Med. 2021;18(5): e1003574.
Malik VS, Hu FB. The role of sugar-sweetened beverages in the global epidemics of obesity and chronic diseases. Nat Rev Endocrinol. 2022;18(4):205–18.
Bosire EN, Cohen E, Erzse A, Goldstein SJ, Hofman KJ, Norris SA. “I’d say I’m fat, I’m not obese”: obesity normalisation in urban-poor South Africa. Public Health Nutr. 2020;23(9):1515–26.
Manafe M, Chelule PK, Madiba S. Views of own body weight and the perceived risks of developing obesity-66 and NCDs in South African adults. Int J Environ Res Public Health. 2021;18(21):11265.
Acknowledgements
We would like to thank both the survey teams and participants in the 2016 South Africa Demographic and Health Survey.
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This research was supported by the National Institutes of Health/National Institute on Diabetes, Digestive and Kidney Diseases (NIH/NIDDK) grant K23DK125162 (PI: Manne-Goehler).
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The 2016 South Africa Demographic and Health Survey protocol was reviewed and approved by the SAMRC Ethics Committee and the ICF Institutional Review Board.
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Informed consent was conducted per the survey’s procedures. This analysis of the secondary deidentified survey data was exempt from additional ethical clearance.
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Manne-Goehler, J., Rahim, N., van Empel, E. et al. Perceptions of Health, Body Size, and Nutritional Risk Factors for Obesity in People with HIV in South Africa. AIDS Behav 28, 367–375 (2024). https://doi.org/10.1007/s10461-023-04152-7
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DOI: https://doi.org/10.1007/s10461-023-04152-7