{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T11:47:54Z","timestamp":1788868074046,"version":"build-2803163510"},"reference-count":31,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Women living with HIV (WLHIV) in low-income urban settings face multiple intersecting nutritional risks from food insecurity, poor dietary quality, and mental health problems. We evaluated the prevalence of household food insecurity and inadequate dietary diversity, examining their associations with depressive symptoms, antiretroviral therapy (ART)-related factors, and body mass index (BMI) among WLHIV attending routine ART clinics in Kinshasa, The Democratic Republic of Congo. This study addresses critical gaps in understanding the interplay between mental health and nutrition in the context of HIV care, with significant implications for improving health outcomes among vulnerable populations. Methods: In this clinic-based cross-sectional study (February\u2013April 2024), we enrolled 571 women on ART in Masina 2, Kinshasa. Household food insecurity was measured using the Household Food Insecurity Access Scale (HFIAS), dietary diversity was assessed using the Minimum Dietary Diversity for Women (MDD_W; inadequate \u2264 5 food groups in 24 h), and probable depression was assessed using the Hopkins Symptom Checklist-10 (HSCL-10), which is a validated screening tool. We obtained baseline BMIs from clinic records at ART induction, which we measured again upon survey completion. We used analysis of covariance (ANCOVA) to model follow-up BMI, adjusting for baseline values, age, ART duration, self-reported adherence, household food insecurity, dietary diversity, and probable depression. Sensitivity analyses included change-score and mixed-effects models. Results: The prevalence of any household food insecurity was high (75%; 95% CI:71.5\u201378.6), with 57.6% (95% CI:53.5\u201361.6) of the participants experiencing inadequate dietary diversity (MDD_W &lt; 5). Furthermore, forty-two per cent (95% CI:38.4\u201346.5) experienced depressive symptoms and sixty-eight percent (95% CI: 64.4\u201372.0) adhered to antiretroviral therapy (ART). The mean MDD_W was 4.3, with a low consumption rate of animal-source foods. Baseline BMI was associated with follow-up values (adjusted \u03b2unstandardized, 0.48 kg\/m2 per 1 kg\/m2 baseline, 95% CI 0.38\u20130.59; p &lt; 0.001). Probable depression was independently associated with a lower follow-up BMI (adjusted \u03b2unstandardized, \u22120.99 kg\/m2; 95% CI \u22121.72 to \u22120.26; p = 0.008). Time since ART initiation showed a slight positive association with BMI (adjusted \u03b2unstandardized, 0.10 kg\/m2 per year). Self-reported ART adherence, household food insecurity, and dietary diversity were not independently associated with follow-up BMI in fully adjusted models. The interaction between age and probable depression did not suggest heterogeneity between age groups (p = 0.503). Conclusions: In our cohort, food insecurity and poor dietary diversity were widespread but did not significantly correlate with BMI, while probable depression, a potentially modifiable factor, was independently associated with lower BMI after accounting for baseline nutritional status. These findings highlight the need for HIV care programs integrating mental health screening and services with nutrition-sensitive interventions to support recovery and long-term health among WLHIV.<\/jats:p>","DOI":"10.3390\/nu17203230","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T10:12:29Z","timestamp":1760523149000},"page":"3230","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Probable Depression Is Associated with Lower BMI Among Women on ART in Kinshasa, the Democratic Republic of Congo: A Cross-Sectional Study"],"prefix":"10.3390","volume":"17","author":[{"given":"Annie","family":"Kavira Viranga","sequence":"first","affiliation":[{"name":"Department of Nutrition, Kinshasa School of Public Health, University of Kinshasa, Kinshasa P.O. Box 11850, Democratic Republic of the Congo"},{"name":"Food Science, Nutrition and Dietetics Section, Higher Institute of Medical Techniques of Kinshasa, Kinshasa P.O. Box 774, Democratic Republic of the Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignace Balaw\u2019a","family":"Kalonji Kamuna","sequence":"additional","affiliation":[{"name":"Food Science, Nutrition and Dietetics Section, Higher Institute of Medical Techniques of Kinshasa, Kinshasa P.O. Box 774, Democratic Republic of the Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Mwanamoke Mbokoso","sequence":"additional","affiliation":[{"name":"Food Science, Nutrition and Dietetics Section, Higher Institute of Medical Techniques of Kinshasa, Kinshasa P.O. Box 774, Democratic Republic of the Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0524-9481","authenticated-orcid":false,"given":"Celestin Nzanzu","family":"Mudogo","sequence":"additional","affiliation":[{"name":"Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa P.O. Box 11850, Democratic Republic of the Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3828-6214","authenticated-orcid":false,"given":"Pierre","family":"Akilimali Zalagile","sequence":"additional","affiliation":[{"name":"Department of Nutrition, Kinshasa School of Public Health, University of Kinshasa, Kinshasa P.O. Box 11850, Democratic Republic of the Congo"},{"name":"Patrick Kayembe Research Center, Kinshasa School of Public Health, University of Kinshasa, Kinshasa P.O. Box 11850, Democratic Republic of the Congo"},{"name":"National Public Health Institute, Kinshasa P.O. Box 3243, Democratic Republic of the Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1729S","DOI":"10.3945\/ajcn.111.012070","article-title":"Conceptual framework for understanding the bidirectional links between food insecurity and HIV\/AIDS","volume":"94","author":"Weiser","year":"2011","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1097\/QAI.0b013e31802c2f51","article-title":"Psychiatric illness and virologic response in patients initiating highly active antiretroviral therapy","volume":"44","author":"Pence","year":"2007","journal-title":"J. Acquir. Immune Defic. Syndr."},{"key":"ref_3","unstructured":"WHO (2021). Global Health Sector Strategies on HIV, Hepatitis and Sexually Transmitted Infections, WHO."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e058704","DOI":"10.1136\/bmjopen-2021-058704","article-title":"Food insecurity and the risk of HIV acquisition: Findings from population-based surveys in six sub-Saharan African countries (2016\u20132017)","volume":"12","author":"Low","year":"2022","journal-title":"BMJ Open"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Issa, M.Y., Diagana, Y., Khalid, E.L.K., Coulibaly, S.M., Gueye, A., Dehah, R.M.H., and Vall, O.E.K.M. (2024). Dietary diversity and its determinants among women of reproductive age residing in the urban area of Nouakchott, Mauritania. BMC Public Health, 24.","DOI":"10.1186\/s12889-024-18211-8"},{"key":"ref_6","first-page":"8545934","article-title":"A Systematic Review and Meta-Analysis on Depression and Associated Factors among Adult HIV\/AIDS-Positive Patients Attending ART Clinics of Ethiopia: 2021","volume":"2021","author":"Zewudie","year":"2021","journal-title":"Depress. Res. Treat."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Musumari, P.M., Wouters, E., Kayembe, P.K., Kiumbu Nzita, M., Mbikayi, S.M., Suguimoto, S.P., Techasrivichien, T., Lukhele, B.W., El-Saaidi, C., and Piot, P. (2014). Food insecurity is associated with increased risk of non-adherence to antiretroviral therapy among HIV-infected adults in the Democratic Republic of Congo: A cross-sectional study. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0085327"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Coates, J., Swindale, A., and Bilinsky, P. (2007). Household Food Insecurity Access Scale (HFIAS) for Measurement of Food Access: Indicator Guide, Academy for Educational Development. Food and Nutrition Technical Assistance Project.","DOI":"10.1037\/e576842013-001"},{"key":"ref_9","first-page":"1","article-title":"Development of a dichotomous indicator for population-level assessment of dietary diversity in women of reproductive age","volume":"1","author":"Arimond","year":"2017","journal-title":"Curr. Dev. Nutr."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Okonji, E.F., Mukumbang, F.C., Orth, Z., Vickerman-Delport, S.A., and Van Wyk, B. (2020). Psychosocial support interventions for improved adherence and retention in ART care for young people living with HIV (10\u201324\u2009years): A scoping review. BMC Public Health, 20.","DOI":"10.1186\/s12889-020-09717-y"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Buju, R.T., Akilimali, P.Z., Kamangu, E.N., Mesia, G.K., Kayembe, J.M.N., and Situakibanza, H.N. (2022). Incidence and Predictors of Loss to Follow Up among Patients Living with HIV under Dolutegravir in Bunia, Democratic Republic of Congo: A Prospective Cohort Study. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19084631"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Rodr\u00edguez-Barrag\u00e1n, M., Fern\u00e1ndez-San-Mart\u00edn, M.I., Claver\u00eda, A., Le Reste, J.Y., Nabbe, P., Motrico, E., G\u00f3mez-G\u00f3mez, I., and Peguero-Rodr\u00edguez, E. (2023). Measuring depression in Primary Health Care in Spain: Psychometric properties and diagnostic accuracy of HSCL-5 and HSCL-10. Front. Med., 9.","DOI":"10.3389\/fmed.2022.1014340"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1093\/fampra\/cmq078","article-title":"Diagnosis of depressed young people in primary health care\u2014A validation of HSCL-10","volume":"28","author":"Haavet","year":"2011","journal-title":"Fam. Pract."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1111\/j.1469-7610.2009.02115.x","article-title":"One factor or two parallel processes? Comorbidity and development of adolescent anxiety and depressive disorder symptoms","volume":"50","author":"Iii","year":"2009","journal-title":"J. Child Psychol. Psychiatry"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2012","DOI":"10.1016\/j.socscimed.2012.02.033","article-title":"Food Insecurity, Depression and the Modifying Role of Social Support among People Living with HIV\/AIDS in Rural Uganda","volume":"74","author":"Tsai","year":"2012","journal-title":"Soc. Sci. Med."},{"key":"ref_16","first-page":"115","article-title":"Estimating wealth effects without expenditure data\u2013or tears: An application to educational enrollments in states of India","volume":"38","author":"Filmer","year":"2001","journal-title":"Demography"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Benzekri, N.A., Sambou, J., Diaw, B., Sall, H.I., Sall, F., Niang, A., Ba, S., Gu\u00e8ye, N.F.N., Diallo, M.B., and Hawes, S.E. (2015). High Prevalence of Severe Food Insecurity and Malnutrition among HIV-Infected Adults in Senegal, West Africa. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0141819"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Gebremichael, D.Y., Hadush, K.T., Kebede, E.M., and Zegeye, R.T. (2018). Food insecurity, nutritional status, and factors associated with malnutrition among people living with HIV\/AIDS in West Shewa Zone, Central Ethiopia. BioMed Res. Int., 2018.","DOI":"10.1155\/2018\/1913534"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Emerson, J.A., Caulfield, L.E., Kishimata, E.M., Nzanzu, J.-P., and Doocy, S. (2020). Mental health symptoms and their relations with dietary diversity and nutritional status among mothers of young children in eastern Democratic Republic of Congo. BMC Public Health, 20.","DOI":"10.1186\/s12889-019-8092-3"},{"key":"ref_20","unstructured":"FAO (2025, June 05). Minimum Dietary Diversity for Women: A Guide to Measurement. FAO and FANTA. Available online: https:\/\/www.fao.org\/3\/i5486e\/i5486e.pdf."},{"key":"ref_21","unstructured":"World Health Organization (2025, June 05). WHO Case Definitions of HIV for Surveillance and Revised Clinical Staging and Immunological Classification of HIV-Related Disease in Adults and Children. Available online: https:\/\/www.paho.org\/en\/documents\/who-case-definitions-hiv-surveillance-and-revised-clinical-staging-and-inmunological."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"ofad611","DOI":"10.1093\/ofid\/ofad611","article-title":"Changes in Body Mass Index Over Time in People with and Without HIV Infection","volume":"11","author":"Lam","year":"2024","journal-title":"Open Forum Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Tadesse, G., Rtbey, G., Tinsae, T., Andualem, F., Kelebie, M., Kibralew, G., Geremew, G.W., Abate, A.T., Wassie, Y.A., and Alemayehu, T.T. (2025). Depressive symptoms and its determinants among people living with HIV in Africa: Systematic review and meta-analysis. BMC Psychiatry, 25.","DOI":"10.1186\/s12888-025-06766-8"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Leddy, A.M., Zakaras, J.M., Shieh, J., Conroy, A.A., Ofotokun, I., Tien, P.C., and Weiser, S.D. (2021). Intersections of food insecurity, violence, poor mental health and substance use among US women living with and at risk for HIV: Evidence of a syndemic in need of attention. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0252338"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Markakis, K., Tsachouridou, O., Georgianou, E., Pilalas, D., Nanoudis, S., and Metallidis, S. (2024). Weight Gain in HIV Adults Receiving Antiretroviral Treatment: Current Knowledge and Future Perspectives. Life, 14.","DOI":"10.3390\/life14111367"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1007\/s10461-011-9942-x","article-title":"Adherence to highly active antiretroviral therapy (HAART): A meta-analysis","volume":"15","author":"Ortego","year":"2011","journal-title":"AIDS Behav."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1097\/01.aids.0000433238.93986.35","article-title":"Longitudinal assessment of associations between food insecurity, antiretroviral adherence and HIV treatment outcomes in rural Uganda","volume":"28","author":"Weiser","year":"2014","journal-title":"AIDS"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"The Lancet Hiv (2020). The syndemic threat of food insecurity and HIV. Lancet HIV, 7, e75.","DOI":"10.1016\/S2352-3018(20)30004-7"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/s12981-020-00291-2","article-title":"Food insecurity and the risk of depression in people living with HIV\/AIDS: A systematic review and meta-analysis","volume":"17","author":"Ayano","year":"2020","journal-title":"AIDS Res. Ther."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1093\/inthealth\/ihy016","article-title":"Dietary diversity and nutritional status among children in rural Burkina Faso","volume":"10","author":"Tapsoba","year":"2018","journal-title":"Int. Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e000836","DOI":"10.1136\/bmjph-2023-000836","article-title":"Social, economic and food insecurity among people living with HIV in Kenya during coinciding public health and environmental emergencies: A mixed-methods study","volume":"2","author":"Lyons","year":"2024","journal-title":"BMJ Public Health"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/20\/3230\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T10:22:46Z","timestamp":1760523766000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/20\/3230"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,15]]},"references-count":31,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["nu17203230"],"URL":"https:\/\/doi.org\/10.3390\/nu17203230","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,15]]}}}