Healthy Eating Index (HEI) in drug users living in three U.S. East Coast cities

Abstract

This cross‐sectional analysis seeks to characterize the dietary quality of current and former drug users (DUs). We computed HEI‐2005 scores, ranging from 0 (worst quality) to 100 (best quality), from 24 hour recalls collected on 282 HIV‐positive and 237 HIV‐negative DUs living in Baltimore, Boston, and Providence between 2005–2007. The mean HEI score in the population was 47±12. We examined quartiles of HEI to determine characteristics associated with better and worse diet quality. DU's with the best quality diet (HEI‐Q4) were more likely to be Hispanic, food secure, and live in Boston; while DU's with the worst diet quality (HEI‐Q1) were more likely to be currently using drugs and drinking alcohol at least once per day. In a multivariate logistic regression model, living in Boston (OR=3.5; 95%CI: 2.3, 5.5), being food secure (OR=1.6; 95% CI: 1.0, 2.5), and using drugs (OR=0.6; 95% CI: 0.4, 0.9) remained significantly associated with HEI‐Q4. Among HIV‐positive DUs, poorer quality diet was associated with lower CD4 counts (p<.001) and more HIV symptoms (p=.01). Diet quality was not associated with HIV status, gender, age, education, housing security, smoking, BMI, or depression. Examination of nutrition services available to DU's in the three cities could provide clues as to why diet quality was better in Boston. Among those with HIV, nutrition support should be targeted to those with more advanced disease.