(P17-049-23) Water Insecurity Is Associated With Adverse Changes in Fat Deposition During the Second Year of Life: Evidence From Western Kenya

Objectives: Household water insecurity (HWI), the inability to reliably access sufficient water for all domestic uses, is prevalent and negatively impacts food security, but the relationship between experiential HWI and growth has not been investigated. We therefore aimed to assess whether greater HWI is associated with suboptimal changes in child anthropometric measurements.

Methods: Pregnant women (n=371) were enrolled from seven clinics in western Kenya between 2014-15 and followed through two years postpartum (NCT02974972). For this secondary analysis, we used data from visits at which a 20-item HWI scale (range: 0-60; higher scores represent greater HWI), designed and validated for this population, was administered: at approximately 15, 18, and 21 months postpartum. Infant length, weight, head and arm circumference, and skinfolds were measured at all visits, and WHO z-scores were calculated. Multilevel mixed-effects models that accounted for clustering by clinic and repeated measures across visits were developed for each anthropometric outcome. Lagged HWI scores were interacted with lagged body composition. Models adjusted for season of interview, household wealth, primary drinking water source, maternal HIV status, and ethnicity (n=158).

Results: Most households experienced at least mild water insecurity, with a mean HWI score of 9.0 across visits. In multivariable models, HWI was not associated with changes in linear growth, weight, or head circumference but was negatively associated with changes in mid-upper arm circumference (MUAC) as well as triceps and subscapular skinfold thicknesses. Magnitudes of association varied by prior body composition. For instance, infants with a MUAC z-score of 2 and HWI score of 10 were expected to have a 0.71 lower MUAC z-score (95% CI: -0.90, -0.51) at the subsequent visit compared to those with a HWI score of zero; the expected magnitude of change for infants with an initial MUAC z-score of 1 was lower (predicted change: -0.40; 95% CI: -0.53, -0.27). Lagged HWI was also negatively associated with sum of skinfolds and arm fat area, but not arm muscle area.

Conclusions: HWI is negatively associated with infant fat deposition and should be further investigated as a risk factor for poor nutritional well-being.

Funding Sources: NIMH, NIDDK, NICHD, PepsiCo Global R+D