Browsing by Author "Harbron, Janetta"
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- ItemOpen AccessAdolescents’ Perspectives on the Drivers of Obesity Using a Group Model Building Approach: A South African Perspective(2022-02-14) Hendricks, Gaironeesa; Savona, Natalie; Aguiar, Anaely; Alaba, Olufunke; Booley, Sharmilah; Malczyk, Sonia; Nwosu, Emmanuel; Knai, Cecile; Rutter, Harry; Klepp, Knut-Inge; Harbron, JanettaOverweight and obesity increase the risk of a range of poor physiological and psychosocial health outcomes. Previous work with well-defined cohorts has explored the determinants of obesity and employed various methods and measures; however, less is known on the broader societal drivers, beyond individual-level influences, using a systems framework with adolescents. The aim of this study was to explore the drivers of obesity from adolescents’ perspectives using a systems approach through group model building in four South African schools. Group model building was used to generate 4 causal loop diagrams with 62 adolescents aged 16–18 years. These maps were merged into one final map, and the main themes were identified: (i) physical activity and social media use; (ii) physical activity, health-related morbidity, and socio-economic status; (iii) accessibility of unhealthy food and energy intake/body weight; (iv) psychological distress, body weight, and weight-related bullying; and (v) parental involvement and unhealthy food intake. Our study identified meaningful policy-relevant insights into the drivers of adolescent obesity, as described by the young people themselves in a South African context. This approach, both the process of construction and the final visualization, provides a basis for taking a novel approach to prevention and intervention recommendations for adolescent obesity.
- ItemOpen AccessAre women with history of pre-eclampsia starting a new pregnancy in good nutritional status in South Africa and Zimbabwe?(BioMed Central, 2018-06-15) Cormick, Gabriela; Betrán, Ana P; Harbron, Janetta; Dannemann Purnat, Tina; Parker, Catherine; Hall, David; Seuc, Armando H; Roberts, James M; Belizán, José M; Hofmeyr, G JBackground Maternal nutritional status before and during pregnancy is an important contributor to pregnancy outcomes and early child health. The aim of this study was to describe the preconceptional nutritional status and dietary intake during pregnancy in high-risk women from South Africa and Zimbabwe. Methods This is a prospective observational study, nested to the CAP trial. Anthropometric measurements before and during pregnancy and dietary intake using 24-h recall during pregnancy were assessed. The Intake Distribution Estimation software (PC-SIDE) was used to evaluate nutrient intake adequacy taking the Estimated Average Requirement (EAR) as a cut-off point. Results Three hundred twelve women who had pre-eclampsia in their last pregnancy and delivered in hospitals from South Africa and Zimbabwe were assessed. 73.7 and 60.2% women in South Africa and Zimbabwe, respectively started their pregnancy with BMI above normal (BMI ≥ 25) whereas the prevalence of underweight was virtually non-existent. The majority of women had inadequate intakes of micronutrients. Considering food and beverage intake only, none of the micronutrients measured achieved the estimated average requirement. Around 60% of pregnant women reported taking folic acid or iron supplements in South Africa, but almost none did so in Zimbabwe. Conclusion We found a high prevalence of overweight and obesity and high micronutrient intake inadequacy in pregnant women who had the previous pregnancy complicated with pre-eclampsia. The obesity figures and micronutrient inadequacy are issues of concern that need to be addressed. Pregnant women have regular contacts with the health system; these opportunities could be used to improve diet and nutrition. Trial registration PACTR201105000267371 . Registered 06 December 2010.
- ItemOpen AccessDietary adequacy, variety and diversity and associated factors (anthropometry and socio-economic status) in pregnant women attending the Bishop Lavis MOU in Cape Town(2015) De Bruyn, Celeste Marinda; Harbron, Janetta; Senekal, Marjanne; Odendaal, Hein JAim: The aim of this study was to determine the adequacy of the dietary intake of pregnant women attending Bishop Lavis MOU, in the Tygerberg area of Cape Town. Methods: One hundred and fifty-two women between 12 and 20 weeks' gestational age participating in the Main PASS study were recruited. They completed three interviewer-administered 24-hour dietary recall assessments on three different days, each approximately two weeks apart. Dietary reference values for adequate nutritional intake during pregnancy and the South African food based dietary guidelines and NARs and MAR were used to assess the nutritional adequacy. Anthropometric and socio-demographic information was also collected. Results: The results indicate that just over a quarter of the sample were classified as teenage pregnancies. The majority had between grades eight and ten, and had a monthly household income between R500 and R5000. With a mean energy intake of 10 168.4kJ, majority (79.5%) of the study sample did not meet the energy DRI. Close to half (42.8 %) of the study sample did not meet the DRI for protein intake. All participants met the carbohydrate EAR, and many exceeded the recommended fat intake. The intake of sugar and saturated fats exceeded recommendations with sugar contributing to almost half of the total energy from carbohydrates. The intakes of vitamin A, D and E, pantothenate, biotin, folate, calcium, iron, magnesium, potassium, and manganese fell below the recommendations. Sugar was the most commonly consumed food item, followed by potato, chicken, milk, and white bread. Apples were the most commonly consumed fruit. When compared to the FBDG, the study sample consumed double the recommended portions of starch, half the recommended daily fruit and vegetables, and half the recommended legumes. Conclusion: The high intake of refined carbohydrates, especially sugar, and the high intake of foods high in saturated fats needs to be addressed. Micronutrient intake is generally poor, especially with nutrients that are vital to proper growth and development of the foetus. Education on appropriate dietary changes, as well as suggestions to make implementation of such changes affordable would be invaluable, and may contribute towards decreasing the incidence of adverse pregnancy outcomes.
- ItemOpen AccessDietary intake, cost of foods and associated factors of women with gestational diabetes(2025) Gaffoor-Farooqui, Shabira; Harbron, JanettaBackground: Gestational Diabetes Mellitus (GDM) prevalence has increased globally over the last 20 years and according to the International Diabetes Federation (IDF), GDM prevalence in South Africa from 2011 to 2021 has increased by 11%. A study conducted in Johannesburg in 2018, highlighted that 9.1% (174/1906) of pregnant women developed GDM. Furthermore, an alarming 40% of women in South Africa with a history of GDM develop Type 2 Diabetes Mellitus (T2DM) within five years following their index pregnancy. Medical Nutrition Therapy (MNT) is essential in the treatment of GDM in combination with physical activity, lifestyle and behaviour change and a need exists for appropriate counselling and education. In low socioeconomic areas, implementing healthy diets is challenging, with affordability and availability being assumed as key barriers, necessitating and understanding food choice determinants. Developing viable solutions to these issues is essential for effective MNT, highlighting the need for further research to overcome these challenges. This Master's dissertation had two aims, with aim 1 investigating the dietary intake and associated factors of women with GDM and aim 2 to investigate determinants of cost and availability of foods (listed in the FFQ) and additional foods (not listed on FFQ) consumed by participants at baseline from the IINDIAGO study and compare to healthy and affordable alternatives where applicable. Methods: A cross-sectional descriptive study was conducted on n=205 women with GDM utilizing data from the IINDIAGO study. The IINDIAGO study is a convergent parallel mixed methods study with the main component being a pragmatic, 2-arm individually randomised controlled trial, which was carried out at five major referral centres and up to 26 well-baby clinics in the Western Cape and Gauteng provinces of South Africa. For the purpose of the current study only the baseline data in Cape Town were analysed. Dietary information was collected with the use of Food Frequency Questionnaires (FFQ) and interviewed-administered questionnaires were used to collect sociodemographic, socioeconomic, health behaviours, food security, psychosocial factors, past behaviour change attempts, perceived behavioural control and perceived barriers information. The costs of FFQ items at various supermarkets in Cape Town and availability of foods in areas participants resided was determined. A detailed cost evaluation was completed, and affordable healthy food alternatives were identified, culminating in the development of a diet plan based on the SEMDSA (2017) guidelines. Data were captured on REDCAP and subsequently transferred to Microsoft Excell 365 (Version 2309). The Statistical Package for Social Science (SPSS) was then used to analyse frequencies and means. Results: The findings revealed that participants' diets were energy-dense (ED) with a mean carbohydrate (CHO) intake of 417.6 ± 209.4g/d (70.4% of TE) and an alarmingly high intake of added sugars of 185.9 ± 191.5g/d (31.7% of TE). Table sugar, amongst the top 20 foods, contributed to the highest total energy intake (43.7%) as well as the top food item contributing to total CHO intake (61.3%). The top 40 commonly consumed food items revealed that sugar and some ED foods and snacks (crisps, fried chips, sausages, fried chicken, sausages, fruit juices) were significantly more expensive per portion per eaters in comparison to sugar sweetened beverages (SSB) and dairy fruit juice mixes. High fibre breakfast cereal (26.2%), brown bread (23.7%), fruit (11.3%), white bread (11%) and fried chips (7.6%) were the top contributors to fibre intake amongst participants. A significant portion of participants reported not consuming various types of porridge, such as 61.5% did not eat oats, 54.6% abstained from maize and a notable 95.6% abstained from consuming sorghum over the past month. Grains most consumed were white rice by 91.7% of participants followed by white pasta by 88.3%, while only 13.7% ate brown rice and 5.4% ate wholewheat pasta over the past month. The mean number of times fast food were consumed over a two-week period was 2.47 with 65.8% of participants consuming take-outs during preceding 2 weeks. The majority of participants added fats when preparing dishes such as rice, samp and barley (42.9%), yellow vegetables (52.7%), other vegetables (47.3%), pasta (64.9%) and baked potato (53.7%). The fats commonly used were soft tub margarine (60.5%), mixed oil or 'fish' oil (57.1%) and sunflower oil (30.2%). The five most commonly consumed foods by participants were fruit, potatoes, yellow vegetables, white rice and pasta. Less than a quarter (18.5%) experienced food security that led to either running out of money for food or the necessity to cut meal sizes or skip meals altogether, with less than 10% going to bed hungry due to affordability issues. The majority of women (81.4%) reported not experiencing food insecurity. A large proportion (60.9%) reported the cost of healthy food as a significant barrier to healthy eating. While the majority of participants were responsible for food preparation, about 40% perceived that they lacked sufficient knowledge in preparing healthy foods. Supermarkets in the areas where most participants resided stocked refined and ED foods (white bread, white pasta, deli-fried chicken, processed meats, hard brick margarine, fried ('slap') chips, doughnuts, potato chips, chocolates, sweets, cookies, crackers and soft drinks. Conversely, brown rice, barley, wholewheat pasta and certain low fat fresh produce (low fat and fat-free milk) were unavailable at some supermarkets. Seven basic healthy foods (wholewheat bread, brown rice, wholewheat pasta, soft tub margarine, grilled chicken, bran flakes, 2% low fat milk) collectively were 8.2% more expensive than their unhealthy counterparts. Utilizing the SEMDSA (2017) guidelines, a comparison of a healthy and unhealthy two-day diet plan revealed a minimal cost variation, with the healthy plan being 6.7% less expensive. The study further included a 7-day 8400 kJ (2000 Kcal) eating plan as a guideline. Regarding mental health, 48.5% of participants had no depression, while 40.1% were mildly to moderately depressed. Most (74.4%) reported receiving substantial social support and scored high (57.3%) for general life satisfaction (GLS). Less than a quarter received minimal social support, especially practical and financial support (14.9%) and 5.8% scored low for GLS. Only 27.8% of participants tried to exercise more to be healthier. Conclusion: Women of low socioeconomic status in Cape Town with GDM largely failed to meet the macronutrient guidelines established by the SEMDSA (2017) and international standards. Their diets were high in refined carbohydrates, sugars and ED foods with some foods such as chocolates, potato chips, fried chicken, processed meats, pies and desserts/puddings being often more expensive per portion per eaters than healthier alternatives. Fibre intake was suboptimal with inadequate vegetable diversity. Despite awareness of the dietary impact on GDM management, adherence to healthy eating was hindered by several barriers, including limited knowledge of nutritious foods, insufficient time for meal preparation and the high cost of healthier options. Although many participants reported food security, this status was likely aided by reliance on social grants by over half of them, raising concerns about sustainability, given the potential temporary nature of this support. For those experiencing food insecurity raises challenges, highlighting vulnerability among those at risk of insufficient support. Furthermore, the prevalence of unhealthy local food options presented additional challenges in making healthy dietary choices. Physical activity (PA) was also low, potentially due to time constraints, and/or insufficient guidance from health care professionals (HCP). While nearly half of participants had no depression, a significant portion experienced mild to moderate depression. Despite this, the majority reported receiving sufficient social support which could play a protective role in managing their mental and emotional well-being. The high levels of GLS for more than half of participants could suggest that many women still maintained a positive outlook on life, possibly aided by social support. The results also highlight gaps in support and proactive health behaviours as a minority received less social support, and a large proportion exercised less which indicates a need for greater focus in promoting health management behaviours, which are crucial for the management of GDM. Although basic healthy foods had minimal price difference in comparison to unhealthy foods and despite the efforts to calculate healthy diets at minimal costs, limited income and monthly costs can significantly burden low-income households, making adherence challenging without governmental assistance and cost-effective strategies. It is worthwhile to note that women with GDM do not necessarily eat drastically differently from non-pregnant or pregnant women of similar socioeconomic status in South Africa. However, their nutritional needs are more acute, and the persistence of poor dietary intake despite existing interventions, highlights a gap in program specificity. This study reinforces the need for targeted interventions and support strategies to assist these women achieve optimal nutrition and well-being and a need exists for further research for improved outcomes not just at baseline, but postpartum and in the prevention of T2DM.
- ItemOpen AccessA facility-based therapeutic group programme versus usual care for weight loss in obese patients attending a district hospital in the Cape Metropole(2014) Manning, Kathryn; Harbron, Janetta; Senekal, MarjanneThe primary aim of this research was to compare the impact of a six-week facility-based therapeutic group (FBTG) programme with that of usual care on weight loss and reduction in BMI in obese patients with one or more risk factors for the development of NCDs or existing NCDs, attending a district hospital in the Cape Metropole.
- ItemOpen AccessInvestigate the nutritional status, including body composition, of oncology patients attending an outpatient clinic at Groote Schuur hospital: a cross-sectional study(2024) Blacker, Megan; Harbron, Janetta; Nwosu, EmmanuelBackground There is an increase in cancer prevalence globally with an increase in cancer mortality in South Africa. Malnutrition, cancer cachexia and sarcopenia are conditions commonly experienced by people with cancer. Not only is there a deterioration of nutritional status, but these conditions are also known to have negative clinical and patient outcomes that include a decreased quality of life and functional status, increased hospital length of stay, increased treatment toxicity, reduced efficacy of anticancer treatments and an association with depression. Even though there is a greater understanding of the aetiology of cancer cachexia over recent decades, there has not been a global adoption of a definition and a framework for identification of cancer cachexia. Therefore, there is no standardisation of research to compare results related to prevalence and multimodal interventions which hampers implementation of awareness and identification of and treatment for cancer cachexia. The Global Leadership Initiative on Malnutrition (GLIM) identifies and classifies malnutrition across different health care settings. Recently suggested cancer guidelines identified cancer cachexia using amended GLIM diagnostic criteria. With sarcopenia identification, there have been American, Asian and European formulated guidelines with variation in the diagnostic criteria used. This makes it challenging for other countries not represented to create awareness and identification of sarcopenia in different healthcare settings. Gold standard methods in body composition, namely computer tomography (CT) and magnetic resonance imaging (MRI), and reference standard methods, namely dual energy X-ray absorptiometry (DEXA) have highlighted the common phenotypic component of reduced muscle mass in malnutrition, cancer cachexia and sarcopenia, with a plethora of reference populations used and cutoff points determined for different representations of muscle mass. This variety in research has added to the challenges of identifying reduced muscle mass, particularly in resource limited healthcare settings that do not have access to expensive CT, MRI and DEXA scans and relevant reference populations. Therefore, there is a need to identify alternative methods to identify reduced muscle mass earlier in the cancer journey that need to be cheap, accessible, easy to use within the South African health setting. These alternative methods will be helpful in the identification of malnutrition, sarcopenia and cancer cachexia. Aims The first aim was to investigate body composition, with particular focus on muscle mass, using DEXA as the reference standard in this sample of cancer patients, in relation to nutritional status indicators and alternative muscle mass markers. The second aim was to investigate malnutrition in cancer outpatients according to Global Leadership Initiative on Malnutrition (GLIM) using different approaches, including technical (DEXA) and clinical approaches to determine muscle mass. The third aim was to investigate sarcopenia in cancer outpatients according to the newest diagnostic guidelines from the European Working Group on Sarcopenia in Older People (EWGSOP) using muscle mass determined from DEXA (reference standard) and alternative muscle mass markers. The fourth aim was to investigate cancer cachexia using different diagnostic frameworks and the associations with nutritional status indicators in cancer outpatients. Method The study followed a quantitative, cross-sectional design where data were collected over 2 days and twenty-eight eligible cancer patients were recruited through consecutive sampling from colorectal, head and neck, ear, nose and throat oncology outpatient clinics at Groote Schuur Hospital (GSH). A two-phase questionnaire was developed for the purposes of this study where sociodemographic, clinical and cancer related data, biochemistry, physical activity, dietetics related data, a twenty-fourhour recall and semi-quantitative food frequency questionnaire information were collected. On the second data collection day, handgrip strength (HGS), nutrition risk screening-2002 (NRS-2002), patient generated subjective global assessment (PG-SGA), a second a twenty-four-hour recall, alternative muscle mass markers [mid upper arm circumference (MUAC), calf circumference (CC), corrected arm muscle area (cAMA), estimated appendicular skeletal muscle (est ASM), global physical examination (GPE)] and DEXA measurements were collected. Results There is a high prevalence of reduced muscle mass (82.1%) as determined by our reference standard, DEXA, expressed as ASM. From the six alternative muscle mass markers, calf circumference performed best across the different statistical tests in comparison to the reference standard, DEXA. Calf circumference demonstrated fair agreement related to Cohen's kappa, overall fair for sensitivity (73.9%) / specificity (80%) and a percentage agreement of 78.6%. Our results suggest that calf circumference may be used to screen cancer patients to determine those without RMM as the specificity was 80% i.e., only 20% of participants without RMM will be incorrectly categorised. None of our nutritional status indicators can be used as proxies for detecting reduced muscle mass. BMI, scored NRS-2002 and scored PG-SGA were statistically significant in participants identified with reduced muscle mass. Our study confirmed that malnutrition is prevalent in this cancer population ranging from 75.0% to 92.9% depending on the muscle mass assessment method and Global Leadership Initiative on Malnutrition (GLIM) approach used. Out of the six alternative muscle mass markers and not having muscle mass phenotype, calf circumference demonstrated good agreement related to Cohen's kappa, overall fair for sensitivity (73.9%) / specificity (80%) and a percentage agreement of 92.9% suggesting that it may be used as an alternative muscle mass phenotype in the GLIM diagnostic criterium for reduced muscle mass. We found a prevalence of sarcopenia from 7.4% to 18.5%, depending on the muscle mass method used Of the five alternative muscle mass markers, calf circumference agreed perfectly and had 100% sensitivity and specificity. We found that the diagnosis and classification of cancer cachexia varied depending on the diagnostic models used. We used two diagnostic models to identify pre-cachexia and found a range of 17.9% to 28.6%. We used four diagnostic models to identify cancer cachexia and found a range from 45.8% to 82.1%. None of the three diagnostic cancer cachexia frameworks performed well when compared to the most recent cancer cachexia framework adapted from GLIM. In addition, none of our nutritional status indicators performed well across all the different tests when compared to the recent cancer cachexia framework. Therefore, suggesting that our routine use of nutritional status indicators within practice, may not be sufficiently sensitive, specific and agree with our reference framework to diagnose cancer cachexia. Only handgrip strength and albumin are significantly different in the cancer cachexia group. In conclusion, despite our limitation regarding small sample size, calf circumference may be a possible alternative muscle mass marker to screen for reduced muscle mass, may be used as a proxy in the GLIM diagnostic criteria and for sarcopenia diagnosis. As cancer cachexia is recognized as a multifactorial and multi-organ syndrome, all diagnostic components may need to be present, therefore simplistic commonly used clinical and practical approaches may not be adequate to detect cancer cachexia early in the cancer patient's journey.
- ItemOpen AccessInvestigation of the underlying, modifiable and non-modifiable risk factors for gestational diabetes among women living in Cape Town(2023) Koech, Elzie; Harbron, JanettaGestational Diabetes Mellitus has adverse effects in pregnancy that affects both the mother and infant. These complications include preeclampsia, macrosomia, preterm birth and risk of developing type 2 diabetes later in life. Understanding the risk factors for GDM is important in order to come up with intervention programs. This study aimed to determine the underlying modifiable, non-modifiable and intermediate risk factors of GDM for women living in Cape Town South Africa. We also compared lifestyle factors between women after diagnosis of GDM and women without GDM. Methods: We conducted a case control study among women living in Cape Town. Cases were defined as women diagnosed with GDM recruited at Groote Schuur Hospital while controls were women without GDM recruited from Vanguard clinic. Questionnaires and medical record review were used to collect data. The association between GDM and both risk factors and lifestyle variables was analysed using multivariable logistic regressions, with GDM as a binary outcome variable. Results: A total of 167 cases and 199 controls were included in the study. The mean age of cases was 32.5 years (28.0-37.0) and the mean age of controls was 25 years (22.0-31.0). In adjusted analyses, the risk factors for GDM were; family history of diabetes mellitus (OR 3.10, 95% CI 1.45-6.61, p =003), (MUAC) (OR 1.17, 95% CI 1.04-1.31, p =0.008) and stillbirth (OR 11.61, 95% CI 1.04-129.90, p =0.047), and BMI (OR 1.11, 95% CI 1.05-1.17, p
- ItemOpen AccessLifestyle behaviours and beliefs of pregnant women with gestational diabetes: a longitudinal follow-up study(2019) Krige, Stephanie Marie; Harbron, Janetta; Booley, SharmilahWomen with gestational diabetes mellitus (GDM) have increased risk of adverse pregnancy outcomes such as delivering Large-for-gestational-age babies, preeclampsia or birth trauma, as well as increased risk of developing type 2 diabetes (T2DM) later in life. Lifestyle management through a healthy diet and physical activity both during and after a GDM pregnancy is the first line treatment option in GDM management and for delaying the onset of T2DM. The research for this Master thesis had two main aims: firstly, to investigate the dietary intake and beliefs related to dietary intake of pregnant women with GDM in Cape Town, and whether they adhere to established dietary recommendations and secondly, to investigate the change in dietary intake, physical activity and associated factors as well as beliefs related to these lifestyle behaviours in women with GDM from pregnancy to a postpartum follow-up assessment. Methods: For the first aim a cross-sectional study was conducted on 239 pregnant women with GDM in Cape Town and for the second aim, 98 women were followed-up 3 to 15 months postpartum. Assessments included: a quantified Food Frequency Questionnaire (qFFQ), General Practice Physical Activity Questionnaire (GPPAQ) and beliefs relating to specific dietary components were assessed using the Theory of Planned Behaviour (TPB). Results: At baseline, the majority of the sample had inadequate intakes of vitamin D (87.4%), folate (96.5%) and iron (91.3%), and the dietary intake of these women was not optimal and fell short in meeting several nutritional guidelines for pregnant women with hyperglycaemia. At follow-up, the dietary changes made during pregnancy were not maintained postpartum. Fruit and vegetable intake (F&V) fell short of the recommended 400g intake at both baseline and follow-up. The intake of carbohydrates, added sugar, table sugar, sugar sweetened beverages (SSBs), pulses and energy-dense foods increased significantly from pregnancy to postpartum. In conclusion, women with prior GDM fail to maintain the dietary changes made during pregnancy. These women being at risk for the development of T2DM would benefit from interventions supporting behaviour change towards a healthier lifestyle in pregnancy and continued in the postpartum period.
- ItemOpen AccessNutritional and health status of HIV+ adults stable on HAART attending a healthcare facility in Cape Town, South Africa(2022) Oyetunji, Iyanuoluwa Oyedeji; Harbron, Janetta; Duncan, AlastairBackground: PLWH have twice the chances of developing cardiovascular disease (CVD) when compared to the uninfected population. This and other NCDs are important cause of non-AIDS related mortality among PLWH, and its prevalence may increase as PLWH continue to age. Factors that may have association with the increased risk of NCDS among PLWH have been identified including the use of HAART, systemic inflammation, male gender, aging, diet, and sedentary lifestyle. The relationship between higher diet quality and a lower risk of NCDs has been reported among PLWH. Furthermore, dietary interventions have reduced the risk of NCDs among PLWH. However, studies assessing dietary intake among PLWH in South Africa are not recent and were conducted among ART-naïve participants. This dissertation contains a scoping review of literature that sought to identify the diet quality and food insecurity indices that have been used among PLWH and how these constructs are associated with the risk of developing CVD. The primary study component assessed the nutritional and health status of adults living with HIV stable on HAART attending the Heideveld CHC in Cape Town. We also investigated the association that may exist between these factors, especially diet quality, and the risks of NCDs. Methods: For this thesis, a scoping review and primary study was conducted. For the scoping review, the frameworks of Arksey and O'Malley, the Joanna Briggs Institute's (JBI) manual for conducting scoping reviews, and the Preferred Reporting Items for Systematic review and Meta Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines were used for the scoping review. The protocol was registered on OSF registries and published in BMJ Open. Extracted data were presented in tables, followed by a descriptive summary of findings. A search strategy was developed, and a preliminary MEDLINE (via PubMed) search was conducted followed by a final search on PubMed, EbscoHost, Scopus, Web of Science, and COCHRANE library databases. The findings from the scoping review were also used to refine the protocol of the cross-sectional study. The primary study was descriptive and cross-sectional including 247 adults receiving HAART from the Heideveld CHC. Eligible participants were HIV positive, on HAART for at least 1 year, aged 18 years or older, and able to communicate in English language, isiXhosa, or Afrikaans. Ethical approvals were obtained from the UCT ethics committee and the Department of Health. Data were collected using an interviewer-administered questionnaire and the patients' folder. Data were collected on socio-demographic variables, HIV infection-related information, anthropometry, biochemical, and clinical measures, as well as weight perception, satisfaction, and management goals. Other measures included dietary intake and habits, food security, physical activity, self-esteem, smoking, and alcohol intake. Data were captured using Microsoft Excel (version 2180) and analyzed using RStudio Version 1.2.5033. Appropriate statistical methods were used to summarize and describe the results. Results: A total of 31 studies were included in the scoping review after the recommended multilevel screening against the inclusion criteria. Three studies assessing food security status showed that food insecurity was high in PLWH. Six studies assessing dietary adequacy using a predefined diet quality index showed that PLWH had moderate adherence to the Healthy Eating Index (HEI) and Mediterranean Diet Score (MDS) guidelines. However, adherence to the recommendation of individual food items or nutrients was low. Other studies presented intakes of individual nutrients or food components. Two African studies were included with none using a diet quality index. The two most reported CVD risks were obesity and hypertension. The association between diet and risk of CVD reported was complex; while some studies found significant associations, some did not. In the primary study, the majority (69.9%) were females with a median age of 46 years. The median duration of infection was 12 years, the median ART duration was 10 years, and 94.7% had a suppressed viral load. One-third of the participants had comorbidities, hypertension was the most prevalent comorbidity reported, followed by dyslipidemia and diabetes. Other comorbidities reported were CVD, renal problems, and cancer. The prevalence of obesity was 40.7% while 27.6% were overweight. Based on predefined criteria, 50.0% of the participants had high blood pressure. Food insecurity was reported by 89.0% of the participants. The median intake of fruits and vegetables was 0.9 and 1.6 servings/day respectively. Habitual consumption of SSB and processed meat on average of 1.0 servings/day was reported. Mean (SD) DASH and Alternate Healthy Eating Index (aHEI) scores were 21.6 (5.1) and 41.9 (9.8) respectively. While 80.0% did not try to gain weight in the previous year, 51.0% gained weight. However, 58.0% were happy with their present weight. There were significant differences between the three BMI categories for gender (p< 0.001), level of education (p< 0.001), ever being pregnant (p=0.046), creatinine (p=0.002), systolic BP (p=0.010), relative hand grip strength (p< 0.001), PA (p<0.001), and being a smoker (p< 0.001). There was a significant difference between those who were hypertensive and those who were not for age (p< 0.001), level of education (p=0.019), and ever being pregnant (p=0.008). There was no significant association between aHEI score and BMI, as well as DASH score and hypertension. Conclusions: Findings from the scoping review suggest that the majority of PLWH are affected by food insecurity and achieve only moderate adherence to recommendations for diet quality. Few studies have used diet quality indices to assess dietary adequacy among PLWH, and the association of diet with risks of CVD is complex and needs further research. In our primary study, the prevalence of obesity and hypertension was high among the participants, and hypertension was the most prevalent comorbidity reported. The participants were mostly middle-aged females, they were on long-term ART and most of them had an undetectable viral load. The dietary habits and consumption of participants did not conform to recommendations. Obesity was more likely among females, those who had completed high school education, women who had been previously pregnant, those who were sedentary, and less likely among those who were previous and current smokers. Hypertension had a significant positive association with age. Diet quality was not significantly different among PLWH with or without comorbidities. The findings of this study emphasize the need to incorporate holistic nutrition education into HIV care at the PHC level. More nutrition-focused research is needed among PLWH in South Africa.
- ItemOpen AccessRisk factors for obesity development in Caucasian and Zulu women : personal and parental weight history, weight management practices, eating behaviour and taste sensitivity : a case-control study(2011) Herrmann, Fiona; Senekal, Marjanne; Harbron, JanettaObesity is a significant health problem in South Africa and the need for intervention in this regard has been emphasized. Existing information indicates that modifiable risk factors such as diet and physical activity may be contributing to this problem. However, little other information on many of the other potential risk factors for obesity development is available. The primary aim of this study therefore was to investigate the associations between weight status, personal and parental weight history, weight management practices (including body weight and shape satisfaction), eating behaviour and 6-n-propylthiouracil (PROP) taste sensitivity in Zulu and Caucasian women using a case control design. The secondary aim was to compare Zulu and Caucasian cases as well as Zulu and Caucasian controls for key variables.
- ItemOpen AccessThe effect of calcium intake on body weight in pregnant women from South Africa, Zimbabwe and Argentina participating in the Calcium and Pre-eclampsia trial(2019) Cormick, Gabriela; Harbron, Janetta; Belizán, José M; Betrán, Ana PilarIntroduction: The prevalence of overweight and obesity is increasing worldwide. It has been estimated that every kilogram of weight gain during adulthood represents a 3% to 6% risk increased of cardiovascular disease. There are some studies showing an inverse relationship between calcium intake and body weight. Overweight and obese women are advised to lose weight before conception, however the evidence on how to achieve this is scarce. No studies have investigated the effect of calcium supplementation on weight management before conception or during pregnancy. Aims and objectives: The overarching purpose of this project was to provide information and enrich the body of evidence of the effect of calcium intake on body weight. The first aim was to evaluate the effect of calcium intake on body weight of fertile or pregnant women; secondly to investigate the pre-pregnancy weight status, weight gain during pregnancy and adequacy of dietary intake of pregnant women participating in the Calcium and Pre-eclampsia (CAP) trial. The third aim was to perform a systematic review of studies evaluating the effect of calcium intake on body weight. I was part of the core research team throughout the CAP trial duration and also lead the nutritional component. The trial sample size included 540 pregnant women recruited between 2012 and 2017 in South Africa, Zimbabwe and Argentina. Women were randomized pre-pregnancy to receive 500 mg of elemental calcium or placebo until 20 weeks´ gestation, whereafter they received 1500 mg. Weight was measured pre-pregnancy and at 8, 20 and 32 weeks’ gestation. Diet was assessed at 20 weeks´ gestation. Ethical approval was obtained from appropriate national and institutional ethical review bodies as applicable for each study site. Results: There was a high proportion of women who started their pregnancy overweight or obese (73.7% in South Africa and 60.2% in Zimbabwe). Most women had an inadequate intake of micronutrients at 20 weeks pregnancy. For the most basic micronutrients like iron, calcium, folate and zinc, the percentage of women with intakes below requirements was above 90%. Although there was no effect of calcium supplementation on body weight in the sample of the CAP trial, the calcium group had a no statistically significant smaller increase in body weight during pregnancy especially in those who were obese at the start of the trial. The systematic review shows a small but statistical effect of calcium supplementation in body weight (Mean Difference (MD) -0.33 kg, 95% CI -0.57 to -0.09); (p=0.007); 819 participants; 15 studies) and in BMI (MD -0.17, 95% CI -0.21 to -0.13); p < 0.00001; 695 participants; 10 studies). Conclusion: We found a high prevalence of obesity found together with the micronutrient inadequacy which show a very poor nutritional status of women who have the possibility of getting pregnant again. This needs to be addressed so that maternal and perinatal outcomes are improved. There is a need to implement nutritional counselling preconceptionally to these women before they fall pregnant. The results of this thesis show a no statistically significant smaller increase in body weight in women supplemented with calcium, opening a promising area of research for weight management including the study of the mechanisms involved. Before making clinical recommendations further studies are needed with higher sample size to have the power to detect clinically significant effects.