Skip to main content

Declines in dietary macronutrient intake in persons with HIV infection who develop depression

  • Rita Isaac (a1), Denise Jacobson (a1), Christine Wanke (a1), Kristy Hendricks (a1), Tamsin A Knox (a1) (a2) and Ira B Wilson (a3)...

The effect of depression on dietary intake has not, to our knowledge, been examined in persons with HIV infection.


We conducted a longitudinal analysis of participants in the Nutrition for Healthy Living Study (NFHL). We measured changes in dietary macronutrient intake in participants who developed depression and, using multiple regression analysis, compared the changes with a control group of patients who did not become depressed.


Ninety patients developed depression during the observation period, and we compared these with 152 non-depressed controls. The two groups had similar age and body mass index (BMI) at baseline, but those who developed depression were more likely to be female, less educated and had lower incomes. After adjustment, compared with non-depressed participants, those who developed depression had significantly greater decreases in the following daily intakes: total energy (−341 kcal, P = 0.006), protein (−12.3 g, P = 0.02), total fat (−18.5 g, P = 0.008), carbohydrate (−36.8 g, P = 0.02), total fibre (−4.3 g, P = 0.001) and saturated fat (−6.7 g, P = 0.01). There were no significant differences in the daily intakes of simple sugars and long-chain n−3 fatty acids, or BMI.


Depression is associated with decreases in total daily energy intake and in six of the eight dietary components we measured. Clinicians should be aware that depression-associated nutritional deficiencies may complicate the care of persons with HIV.

    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Declines in dietary macronutrient intake in persons with HIV infection who develop depression
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Declines in dietary macronutrient intake in persons with HIV infection who develop depression
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Declines in dietary macronutrient intake in persons with HIV infection who develop depression
      Available formats
Corresponding author
*Corresponding author: Email
Hide All
1Wanke, CA, Silva, M, Knox, TA, Forrester, J, Spiegelman, D, Gorbach, SL. Weight loss and wasting remain common complications in individuals infected with human immunodeficiency virus in the era of highly active antiretroviral therapy. Clinical Infectious Diseases 2000; 31 (3): 803805.
2Tang, AM. Weight loss, wasting, and survival in HIV-positive patients: current strategies. The AIDS Reader 2003; 13 (12 Suppl.): S23S27.
3Tang, AM, Forrester, J, Spiegelman, D, Knox, TA, Tchetgen, E, Gorbach, SL. Weight loss and survival in HIV-positive patients in the era of highly active antiretroviral therapy. Journal of Acquired Immune Deficiency Syndromes 2002; 31 (2): 230236.
4Arnalich, F, Martinez, P, Hernanz, A, Gonzalez, J, Plaza, MA, Montiel, C, et al. . Altered concentrations of appetite regulators may contribute to the development and maintenance of HIV-associated wasting. AIDS 1997; 11 (9): 11291134.
5Tang, AM, Jacobson, DL, Spiegelman, D, Knox, TA, Wanke, C. Increasing risk of 5% or greater unintentional weight loss in a cohort of HIV-infected patients, 1995 to 2003. Journal of Acquired Immune Deficiency Syndromes 2005; 40 (1): 7076.
6Melchior, JC, Niyongabo, T, Henzel, D, Durack-Bown, I, Henri, SC, Boulier, A. Malnutrition and wasting, immunodepression, and chronic inflammation as independent predictors of survival in HIV-infected patients. Nutrition 1999; 15 (11–12): 865869.
7Shevitz, AH, Knox, TA, Spiegelman, D, Roubenoff, R, Gorbach, SL, Skolnik, PR. Elevated resting energy expenditure among HIV-seropositive persons receiving highly-active antiretroviral therapy. AIDS 1999; 13 (11): 13511357.
8Jacobson, DL, Bica, I, Knox, TA, Wanke, C, Tchetgen, E, Spiegelman, D, et al. . Difficulty swallowing and lack of receipt of highly active antiretroviral therapy predict acute weight loss in human immunodeficiency virus disease. Clinical Infectious Diseases 2003; 37 (10): 13491356.
9Carbonnel, F, Beaugerie, L, Abou, RA, D’Almagne, H, Rozenbaum, W, Le, QY, et al. . Macronutrient intake and malabsorption in HIV infection: a comparison with other malabsorptive states. Gut 1997; 41 (6): 805810.
10Cruess, DG, Evans, DL, Repetto, MJ, Gettes, D, Douglas, SD, Petitto, JM. Prevalence, diagnosis, and pharmacological treatment of mood disorders in HIV disease. Biological Psychiatry 2003; 54 (3): 307316.
11Christensen, L, Somers, S. Comparison of nutrient intake among depressed and nondepressed individuals. International Journal of Eating Disorders 1996; 20 (1): 105109.
12Edwards, R, Peet, M, Shay, J, Horrobin, D. Omega-3 polyunsaturated fatty acid levels in the diet and in red blood cell membranes of depressed patients. Journal of Affective Disorders 1998; 48 (2–3): 149155.
13Peet, M. International variations in the outcome of schizophrenia and the prevalence of depression in relation to national dietary practices: an ecological analysis. British Journal of Psychiatry 2004; 184: 404408.
14Morris, MS, Fava, M, Jacques, PF, Selhub, J, Rosenberg, IH. Depression and folate status in the US population. Psychotherapy and Psychosomatics 2003; 72 (2): 8087.
15Rosche, J, Uhlmann, C, Froscher, W. Low serum folate levels as a risk factor for depressive mood in patients with chronic epilepsy. Journal of Neuropsychiatry and Clinical Neurosciences 2003; 15 (1): 6466.
16Bottiglieri, T, Hyland, K, Laundy, M, Godfrey, P, Carney, MW, Toone, BK, et al. . Folate deficiency, biopterin and monoamine metabolism in depression. Psychological Medicine 1992; 22 (4): 871876.
17Lindenbaum, J, Healton, EB, Savage, DG, Brust, JC, Garrett, TJ, Podell, ER, et al. . Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis. New England Journal of Medicine 1988; 318 (26): 17201728.
18Burnam, MA, Wells, KB, Leake, B, Landsverk, J. Development of a brief screening instrument for detecting depressive disorders. Medical Care 1988; 26 (8): 775789.
19Stewart, AL, Ware, JE, eds. Measuring Function and Well-Being: The Medical Outcomes Study Approach. Durham, NC: Duke University Press, 1992.
20Radloff, LN. The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement 1977; 1: 385.
21Weissman, MM, Sholomskas, D, Pottenger, M, Prusoff, BA, Locke, BZ. Assessing depressive symptoms in five psychiatric populations: a validation study. American Journal of Epidemiology 1977; 106 (3): 203214.
22Myers, JK, Weissman, MM. Use of a self-report symptom scale to detect depression in a community sample. American Journal of Psychiatry 1980; 137 (9): 10811084.
23Weissman, MM, Pilowsky, DJ, Wickramaratne, PJ, Talati, A, Wisniewski, SR, Fava, M, et al. . Remissions in maternal depression and child psychopathology: a STAR*D-child report. JAMA: Journal of the American Medical Association 2006; 295 (12): 13891398.
24Robins, LN, Helzer, JE, Ratcliff, KS, Seyfried, W. Validity of the diagnostic interview schedule, version II: DSM-III diagnoses. Psychological Medicine 1982; 12 (4): 855870.
25Robins, LN, Helzer, JE, Croughan, J, Ratcliff, KS. National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity. Archives of General Psychiatry 1981; 38 (4): 381389.
26Sherman, AM. Social relations and depressive symptoms in older adults with knee osteoarthritis. Social Science & Medicine 2003; 56 (2): 247257.
27Ahluwalia, JS, Richter, K, Mayo, MS, Ahluwalia, HK, Choi, WS, Schmelzle, KH, et al. . African American smokers interested and eligible for a smoking cessation clinical trial: predictors of not returning for randomization. Annals of Epidemiology 2002; 12 (3): 206212.
28Hlatky, MA, Boothroyd, D, Vittinghoff, E, Sharp, P, Whooley, MA. Quality-of-life and depressive symptoms in postmenopausal women after receiving hormone therapy: results from the Heart and Estrogen/Progestin Replacement Study (HERS) trial. JAMA: Journal of the American Medical Association 2002; 287 (5): 591597.
29Katz, DA, McHorney, CA. The relationship between insomnia and health-related quality of life in patients with chronic illness. Journal of Family Practice 2002; 51 (3): 229235.
30Foy, CG, Wickley, KL, Adair, N, Lang, W, Miller, ME, Rejeski, WJ, et al. . The Reconditioning Exercise and Chronic Obstructive Pulmonary Disease Trial II (REACT II): rationale and study design for a clinical trial of physical activity among individuals with chronic obstructive pulmonary disease. Contemporary Clinical Trials 2006; 27 (2): 135146.
31Woods, NF, LaCroix, AZ, Gray, SL, Aragaki, A, Cochrane, BB, Brunner, RL, et al. . Frailty: emergence and consequences in women aged 65 and older in the Women’s Health Initiative Observational Study. Journal of the American Geriatrics Society 2005; 53 (8): 13211330.
32Sivarajan Froelicher, ES, Miller, NH, Christopherson, DJ, Martin, K, Parker, KM, Amonetti, M, et al. . High rates of sustained smoking cessation in women hospitalized with cardiovascular disease: the Women’s Initiative for Nonsmoking (WINS). Circulation 2004; 109 (5): 587593.
33Hays, RD, Spritzer, KL, McCaffrey, D, Cleary, PD, Collins, R, Sherbourne, C, et al. . The HIV Cost and Services Utilization Study (HCSUS) Measures of Health-Related Quality of Life.DRU-1997-AHCPR. Santa Monica, CA: RAND Corporation, 1998.
34Rothman, K, Greenland, S. Modern Epidemiology. Philadelphia, PA: Lippincott Williams & Wilkins, 1998.
35Robins, JM, Greenland, S. The role of model selection in causal inference from nonexperimental data. American Journal of Epidemiology 1986; 123 (3): 392402.
36Azizi, F, Esmaillzadeh, A, Mirmiran, P. Correlates of under- and over-reporting of energy intake in Tehranians: body mass index and lifestyle-related factors. Asia Pacific Journal of Clinical Nutrition 2005; 14 (1): 5459.
37Rennie, KL, Jebb, SA, Wright, A, Coward, WA. Secular trends in under-reporting in young people. British Journal of Nutrition 2005; 93 (2): 241247.
38Kim, J. The Correlates of Hunger and Reduced Dietary Intake in a Cohort of HIV-positive Adults of the Boston Area: A Cross Sectional Study with Analysis of Data Quality and Post-Recruitment Retention Rates. Boston, MA: Harvard School of Public Health, 2001.
39Ferrando, S, Evans, S, Goggin, K, Sewell, M, Fishman, B, Rabkin, J. Fatigue in HIV illness: relationship to depression, physical limitations, and disability. Psychosomatic Medicine 1998; 60 (6): 759764.
40Ickovics, JR, Hamburger, ME, Vlahov, D, Schoenbaum, EE, Schuman, P, Boland, RJ, et al. . Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women: longitudinal analysis from the HIV Epidemiology Research Study. JAMA: Journal of the American Medical Association 2001; 285 (11): 14661474.
41Page-Shafer, K, Delorenze, GN, Satariano, WA, JrWinkelstein, W. Comorbidity and survival in HIV-infected men in the San Francisco Men’s Health Survey. Annals of Epidemiology 1996; 6 (5): 420430.
42Mayne, TJ, Vittinghoff, E, Chesney, MA, Barrett, DC, Coates, TJ. Depressive affect and survival among gay and bisexual men infected with HIV. Archives of Internal Medicine 1996; 156 (19): 22332238.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed