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Community and International Nutrition

HIV Infection Is Associated with Decreased Dietary Diversity in South African Children^1,2

³ Pharmaceutical Product Development, CB2168Q Cambridge, UK; ⁴ Epidemiology Research Unit, Tropical Medicine Research Institute, University of the West Indies, Kingston-7, Jamaica; ⁵ Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban 4041 South Africa; ⁶ Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA 02155; ⁷ Africa Centre for Health and Population Studies, 3935 Somkhele, South Africa; ⁸ Ministry of Health, Kingston, Jamaica; ⁹ Mpilonhle, 3935 Mtubatuba, South Africa; and ¹⁰ Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205

Little is known about dietary diversity of children residing in areas of high HIV prevalence. This study examined dietary diversity in 381 children ages 6–24 mo in rural South Africa. Twenty-eight (7.3%) children and 170 mothers (44.6%) were HIV infected. Home visits were conducted weekly and a detailed history of dietary intake obtained. A dietary diversity score was computed based on the weekly consumption of 8 food classes. Low dietary diversity was defined as falling within the lowest quartile of the diversity scale. There were 22,772 child weeks of observation: 1369 for HIV-infected children, 8876 for HIV-uninfected children born to HIV-infected mothers, and 12,527 for HIV-uninfected children born to HIV-uninfected mothers. Low dietary diversity was more common in HIV-infected children [crude odds ratio (OR), 2.59; 95% CI, 1.52 to 4.41) compared with children born to HIV-uninfected mothers. In a multiple logistic regression analysis adjusting for socioeconomic and health status, HIV-infected children had lower dietary diversity (conditional OR, 1.76; 95% CI, 1.06 to 2.94) than HIV-uninfected children. HIV-infected children consumed less in 6 of 8 food classes compared with HIV-uninfected children, with the 2 exceptions being breast milk and formula milk. In rural South Africa, HIV-infected children's diets are significantly less diverse than those of HIV-uninfected children. This may be a factor contributing to increased morbidity and poorer survival in these children.

^* To whom correspondence should be addressed. E-mail: jvdbroeck1959{at}gmail.com.

Manuscript received 18 January 2008. Initial review completed 15 March 2008. Revision accepted 9 June 2008.