Caloric and Protein Deficits and their association with Socio-Demographic Factors among Adults Living with HIV in Northern India

Abstract

Background: Adults living with HIV (ALHIV) are vulnerable to nutritional inadequacy due to increased metabolic demands and socio-economic constraints. However, Indian evidence quantifying calorie and protein intake relative to recommended dietary allowances (RDA) remains limited. This study assessed the adequacy of calorie and protein intake and examined their socio-demographic determinants among ALHIV. Materials and Methods: A cross-sectional study was conducted among 400 ALHIV aged 18–60 years attending an ART centre in Northern India (2024–2025), selected using simple random sampling. Dietary intake was assessed using a 24-hour recall method. Energy and protein intake were calculated and compared with ICMR–NIN 2020 RDA values; intake <100% RDA was considered inadequate. Associations were analysed using appropriate statistical tests, with p<0.05 considered significant. Results: A high prevalence of dietary inadequacy was observed: 94.7% of participants had inadequate calorie intake and 93.7% had inadequate protein intake. Severe deficits (<70% RDA) were present in 57.5% for calories and 64.8% for protein. Calorie inadequacy was significantly associated with educational status (p<0.001) and socio-economic class (p=0.011). In multivariable analysis, illiteracy independently predicted calorie inadequacy (AOR=4.27; 95% CI: 1.01–18.02; p=0.048). Protein inadequacy was significantly associated with socio-economic class (p=0.038). Conclusions: There is an alarmingly high burden of calorie and protein inadequacy among ALHIV in this setting. Educational disadvantage independently influences calorie intake, highlighting a critical gap in current HIV care. Routine dietary assessment and targeted nutritional counselling should be integrated into ART services.