OpenUCT :: Browsing by Author "Senekal, Marjanne"

Browsing by Author "Senekal, Marjanne"

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Open Access
Application and interpretation of multiple statistical tests to evaluate validity of dietary intake assessment methods
(Biomed Central Ltd, 2015) Lombard, Martani; Steyn, Nelia; Charlton, Karen; Senekal, Marjanne
BACKGROUND:Several statistical tests are currently applied to evaluate validity of dietary intake assessment methods. However, they provide information on different facets of validity. There is also no consensus on types and combinations of tests that should be applied to reflect acceptable validity for intakes. We aimed to 1) conduct a review to identify the tests and interpretation criteria used where dietary assessment methods was validated against a reference method and 2) illustrate the value of and challenges that arise in interpretation of outcomes of multiple statistical tests in assessment of validity using a test data set. METHODS: An in-depth literature review was undertaken to identify the range of statistical tests used in the validation of quantitative food frequency questionnaires (QFFQs). Four databases were accessed to search for statistical methods and interpretation criteria used in papers focusing on relative validity. The identified tests and interpretation criteria were applied to a data set obtained using a QFFQ and four repeated 24-hour recalls from 47 adults (18-65 years) residing in rural Eastern Cape, South Africa. RESULTS: 102 studies were screened and 60 were included. Six statistical tests were identified; five with one set of interpretation criteria and one with two sets of criteria, resulting in seven possible validity interpretation outcomes. Twenty-one different combinations of these tests were identified, with the majority including three or less tests. Coefficient of correlation was the most commonly used (as a single test or in combination with one or more tests). Results of our application and interpretation of multiple statistical tests to assess validity of energy, macronutrients and selected micronutrients estimates illustrate that for most of the nutrients considered, some outcomes support validity, while others do not. CONCLUSIONS: One to three statistical tests may not be sufficient to provide comprehensive insights into various facets of validity. Results of our application and interpretation of multiple statistical tests support the value of such an approach in gaining comprehensive insights in different facets of validity. These insights should be considered in the formulation of conclusions regarding validity to answer a particular dietary intake related research question.
Open Access
Application and interpretation of multiple statistical tests to evaluate validity of dietary intake assessment methods
(BioMed Central, 2015-04-22) Lombard, Martani J; Steyn, Nelia P; Charlton, Karen E; Senekal, Marjanne
Background: Several statistical tests are currently applied to evaluate validity of dietary intake assessment methods. However, they provide information on different facets of validity. There is also no consensus on types and combinations of tests that should be applied to reflect acceptable validity for intakes. We aimed to 1) conduct a review to identify the tests and interpretation criteria used where dietary assessment methods was validated against a reference method and 2) illustrate the value of and challenges that arise in interpretation of outcomes of multiple statistical tests in assessment of validity using a test data set. Methods: An in-depth literature review was undertaken to identify the range of statistical tests used in the validation of quantitative food frequency questionnaires (QFFQs). Four databases were accessed to search for statistical methods and interpretation criteria used in papers focusing on relative validity. The identified tests and interpretation criteria were applied to a data set obtained using a QFFQ and four repeated 24-hour recalls from 47 adults (18–65 years) residing in rural Eastern Cape, South Africa. Results: 102 studies were screened and 60 were included. Six statistical tests were identified; five with one set of interpretation criteria and one with two sets of criteria, resulting in seven possible validity interpretation outcomes. Twenty-one different combinations of these tests were identified, with the majority including three or less tests. Coefficient of correlation was the most commonly used (as a single test or in combination with one or more tests). Results of our application and interpretation of multiple statistical tests to assess validity of energy, macronutrients and selected micronutrients estimates illustrate that for most of the nutrients considered, some outcomes support validity, while others do not. Conclusions: One to three statistical tests may not be sufficient to provide comprehensive insights into various facets of validity. Results of our application and interpretation of multiple statistical tests support the value of such an approach in gaining comprehensive insights in different facets of validity. These insights should be considered in the formulation of conclusions regarding validity to answer a particular dietary intake related research question.
Open Access
Development and validation of a quantitative choline food frequency questionnaire for use with drinking and non-drinking pregnant women in Cape Town, South Africa
(BioMed Central, 2018-11-22) Carter, R Colin; Jacobson, Sandra W; Booley, Sharmilah; Najaar, Baheya; Dodge, Neil C; Bechard, Lori J; Meintjes, Ernesta M; Molteno, Christopher D; Duggan, Christopher P; Jacobson, Joseph L; Senekal, Marjanne
Background Although animal and human studies have demonstrated interactions between dietary choline and fetal alcohol spectrum disorders, dietary choline deficiency in pregnancy is common in the US and worldwide. We sought to develop and validate a quantitative food frequency questionnaire (QFFQ) to estimate usual daily choline intake in pregnant mothers. Methods A panel of nutrition experts developed a Choline-QFFQ food item list, including sources with high choline content and the most commonly consumed choline-containing foods in the target population. A data base for choline content of each item was compiled. For reliability and validity testing in a prospective longitudinal cohort, 123 heavy drinking Cape Coloured pregnant women and 83 abstaining/light-drinking controls were recruited at their first antenatal clinic visit. At 3 prenatal study visits, each gravida was interviewed about alcohol, smoking, and drug use, and administered a 24-hour recall interview and the Choline-QFFQ. Results Across all visits and assessments, > 78% of heavy drinkers and controls reported choline intake below the Dietary Reference Intakes adequate intake level (450 mg/day). Women reported a decrease in choline intake over time on the QFFQ. Reliability of the QFFQ across visits was good-to-acceptable for 2 of 4 group-level tests and 4 of 5 individual-level tests for both drinkers and controls. When compared with 24-hr recall data, validity of the QFFQ was good-to-acceptable for 3 of 4 individual-level tests and 3 of 5 group-level tests. For controls, validity was good-to-acceptable for all 4 individual-level tests and all 5 group-level tests. Conclusions To our knowledge, this is the first quantitative choline food frequency screening questionnaire to be developed and validated for use with both heavy and non-drinking pregnant women and the first to be used in the Cape Coloured community in South Africa. Given the high prevalence of inadequate choline intake and the growing evidence that maternal choline supplementation can mitigate some of the adverse effects of prenatal alcohol exposure, this tool may be useful for both research and future clinical outreach programs.
Open Access
Dietary 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 J
Aim: 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.
Open Access
A 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, Marjanne
The 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.
Open Access
The Food Environment of Primary School Learners in a Low-to-Middle-Income Area in Cape Town, South Africa
(2021-06-15) O’Halloran, Siobhan A.; Eksteen, Gabriel; Polayya, Nadene; Ropertz, Megan; Senekal, Marjanne
Rapid changes in food environments, where less nutritious foods have become cheaper and more accessible, have led to the double burden of malnutrition (DBM). The role food environments have played in shaping the DBM has attained global interest. There is a paucity of food environment research in low-to-middle-income countries. We conducted a case study of the food environments of school aged learners. A primary school in Cape Town was recruited. A multi-method design was used: a home food and eating behaviours questionnaire completed by 102 household respondents and four questions completed by 152 learners; learner participatory photography; a semi-structured school principal interview; a tuckshop inventory; observation of three-day tuckshop purchases. Foods that were commonly present in households: refined carbohydrates, fats/oils, chicken, processed meats, vegetables, fruit, legumes, snacks/drinks. Two thirds of households had rules about unhealthy drinks/snacks, ate supper together and in front of the TV, ate a home cooked meal five–seven times/week and ate breakfast together under two times/week. Vegetables were eaten under two times/week in 45% of households. A majority of learners (84%) took a lunchbox to school. Twenty-five learners photographed their food environment and 15 participated in semi-structured interviews. Six themes emerged: where to buy; what is available in the home; meal composition; family dynamics; peer engagement; food preparation. Items bought at informal food outlets included snacks, drinks and grocery staples. The principal interview revealed the establishment of a healthy school food environment, including a vegetable garden, although unhealthy snacks were sold at the tuckshop. Key dimensions of the food environment that require further investigation in disadvantaged urban and informal settlement areas include the home availability of unhealthy foods, eating behaviours in households and healthfulness of foods sold by informal food outlets.
Open Access
Formative assessment of primary school educators in independent schools in Gauteng to advise the need for an intervention for the prevention of non-communicable diseases
(2021) Drummond, Linda Anne; Steyn, Nelia; Senekal, Marjanne
Background: Non-communicable diseases (NCDs) are a significant contributor to premature mortality in South Africa. The risks for NCDs among educators in higher socio-economic areas of South Africa have not been studied. The aim of this research was to conduct a formative assessment of grade 4 to 7 educators in independent (non-public) schools in Gauteng to advise the need for an intervention for the prevention of NCDs targeted at these educators. Methods: A cross-sectional, descriptive study design was used to assess the educators' dietary risks for NCDs, their weight status and association with select individual and social factors, and the educators' modifiable and intermediate risk factors for NCDs. A self-administered estimated three-day food record was used to assess dietary and alcohol intake. A self-administered questionnaire was used to collect individual (age, gender, socio-economic status (SES), education level, personal weight and weight loss history, weight status of parents, nutrition knowledge, psychological well-being, body image discordance and satisfaction with body areas) and social factors (influence of significant others on body image) that affect weight status. This questionnaire was also used to assess other modifiable NCD risks (tobacco smoking, physical inactivity) in addition to dietary and alcohol intake, and psychological well-being mentioned. Intermediate NCD risk factors were assessed by taking anthropometric measurements and obtaining non-fasting finger prick blood samples to assess blood glucose, total cholesterol, and triglyceride levels. Results: Eighty-one educators participated and 91% were female. They had a high SES and education level. The median (IQR) age of the educators was 42.0 (35.0; 50.0) years. Sixty-four educators submitted completed food records. The percentage of educators that exceeded the World Health Organisation recommendations for particular dietary parameters were as follows: saturated fat: 91%, trans-fats: 31%, free sugars: 27% and sodium: 28%. Almost three quarters of educators (72%) consumed a lower carbohydrate diet (<45%E) and 94% consumed inadequate amounts of dietary fibre. Thirty percent of educators exceeded the recommended intake for alcohol. The percentage of educators that did not meet the Dietary Reference Intakes for certain micronutrients were as follows: potassium: 100%, vitamin D: 97%, folate: 92%, calcium: 70%, vitamin E: 73%, magnesium: 66%, and vitamin C: 50%. None of the educators had a Dietary Diversity Score (DDS) <4 (mean ± SD DDS: 6.1 ± 1.2) and their diets were varied (mean ± SD Food Variety Score: 13.4 ± 4.5). The ten most frequently consumed items were coffee, brown bread, chicken, full fat cheese, full cream milk, salad, beef, sugar, chocolate, and high fibre breakfast cereals in descending order. As a result, 11 of the 13 measured dietary risk factors outlined by the Global 2017 Diet Collaborators (2019) were present among the educators. The median (IQR) BMI of the total group was 23.9 (21.6; 29.2)kg/m2 . Twenty-seven percent of educators were overweight, 14% obese and 75% had a distorted view of their body size. Overweight/obese educators were significantly more likely to see themselves as smaller than they were (p< .001) and also to have higher levels of dissatisfaction with their bodies in general (p< 0.001), and all the body areas assessed. Female educators wanted to weigh median (IQR) 5 (2; 12)kg less than their actual weight. Sixty-five percent of educators had attempted weight loss in the past two years. Forty-six percent of the educators were psychologically stressed. Nutrition knowledge scores were as follows: poor: 8%, fair: 55% and good: 37%. Significant protectors against being overweight/obese were being younger than 30 years (OR=0.18; 95% CI: 0.04-0.88; p=0.034), not having a distorted body image (OR=0.09; 95% CI: 0.03-0.32; p< 0.001) and being satisfied with their waist (OR=0.29; 95% CI: 0.01-0.85; p=0.025), hips (OR=0.21; 95% CI: 0.07- 0.65; p=0.007) and legs (OR=0.29; 95% CI: 0.10-0.83; p=0.02). All studied NCD risk factors were present in the total group. More prominent risks in those <30 years were a diet high in SSBs, excess sedentary behaviour, elevated triglycerides and smoking, and in those ≥30 years were a diet high in total fat, having a high waist circumference, having elevated cholesterol levels, being overweight/obese and having low PA levels. Nine percent of the educators smoked cigarettes and 32% of educators exceeded alcohol recommendations. The top nine risks were dietary factors including low intake of vegetables, legumes, milk, calcium, fruit, nuts/seeds, fibre, polyunsaturated fat and high intake of red meat. Seventeen percent of educators had insufficient PA levels and 39% spent >4 hours sitting/day. In addition to the levels of psychological distress and overweight/obesity already mentioned, 43% had waist circumferences indicating risk. Eleven percent of educators had a high blood pressure (≥140/≥90 mm Hg), 37% a raised glucose level (≥5.6-< 11.0 mmol/L), 43% a raised total cholesterol level (≥5.0 mmol/L) and 72% a high triglyceride level (≥2.0 mmol/L). Conclusions: Considering the limitations indicated for this study, it can be concluded that the educators teaching at independent schools in Gauteng had a high dietary risk for NCDs, despite consuming a diverse and varied diet. The prevalence of overweight and obesity among the female educators requires intervention. Individual and social factors, that could be used to tailor interventions aimed at preventing or controlling overweight and obesity among this group, were identified. This study provides insights into the modifiable and intermediate risk factors for NCDs among educators teaching at independent schools and indicates the need for effective interventions aimed at reducing their risk for NCDs.
Open Access
Genotype-based personalised nutrition for obesity prevention and treatment: are we there yet?
(MedPharm Publications, 2012) Senekal, Marjanne
Interactions between genotype and dietary intake include genetic moderation of the effect of dietary intake on disease development (nutrigenetics). Research on nutrigenetics has focused mainly on single-nucleotide polymorphisms (SNPs) and supports the notion that interactions between genes, diet, other lifestyle factors, disease, and time (life cycle span), contribute to the risk of most polygenic nutritionrelated diseases. Typically, genotype-based personalised nutrition involves genotyping for a number of susceptibility SNPs associated with the prevention, or management, of a particular disease. Dietary advice is then personalised to the individual's genotype to ensure optimal prevention or treatment outcomes. To ensure evidence-based practice, research design and methodology, applied in the investigation of relevant associations, and confirmation of causality, should be appropriate and rigorous. The process of identifying SNPs associated with disease patterns is ongoing. Of note is that the combined effect on body mass index of the SNPs at the currently confirmed 32 loci is a modest 1.45%, bearing in mind that the estimated heritability of obesity is 40-70%. Conclusions formulated by various researchers on the translation of nutrigenetics research into personalised nutrition, including obesity prevention and management, indicate that scientists hold the opinion that more research is necessary before evidence-based practice in this area can be guaranteed.
Open Access
Growth and weight status in treatment-naive 12-16 year old adolescents with Alcohol Use Disorders in Cape Town, South Africa
(BioMed Central Ltd, 2011) Naude, Celeste; Senekal, Marjanne; Laubscher, Ria; Carey, Paul; Fein, George
BACKGROUND: Heavy alcohol consumption during adolescence has many known harmful health and social consequences and is strongly associated with numerous health risk behaviours. The consequences of heavy alcohol use during adolescence on nutritional status, specifically growth and weight status are largely unknown at this time. METHODS: Substance use, anthropometric indices of growth and weight, dietary energy intake and physical activity in heavy drinking adolescents (meeting DSM-IV criteria for alcohol use disorders) and matched light/non-drinking control adolescents were assessed. RESULTS: Lifetime alcohol dose, measured in standard drinks of alcohol, was orders of magnitude higher in adolescents with alcohol use disorders (AUDs) compared to controls. The AUDs group was selected to represent relatively 'pure' AUDs, with minimal other drug use and no psychiatric diagnoses. The growth and weight status of adolescents with AUDs were generally comparable to that of controls, and is in line with the growth and weight status of the South African adolescent population. A greater proportion of overweight/obese females was found in both groups, with this percentage tending to be greater, although not significantly so, in the AUDs group. Adolescent females with AUDs had increased odds of being overweight/obese compared to controls, after adjustment for smoking, physical activity and energy intake. CONCLUSION: Anthropometric indices of growth and weight status of participants in the Control and AUD groups were generally comparable. Female adolescents with AUDs may have an increased risk of being overweight/obese compared to adolescent females without AUDs. The presence of an AUD in our adolescent sample was associated with higher energy intake. Longitudinal studies are needed to elucidate the effects of heavy alcohol use on energy balance, growth and weight status in adolescents as they age. Nonetheless, the current study contributes to our understanding of the impacts of heavy alcohol consumption on important aspects of adolescent development.
Open Access
Has Food Security and Nutritional Status Improved in Children 1–<10 Years in Two Provinces of South Africa between 1999 (National Food Consumption Survey) and 2018 (Provincial Dietary Intake Study (PDIS))
(Multidisciplinary Digital Publishing Institute, 2022-01-18) Steyn, Nelia P.; Nel, Johanna H.; Drummond, Linda; Malczyk, Sonia; Senekal, Marjanne
The 1999 National Food Consumption Survey in South Africa showed that food insecurity (hunger) was prevalent in households with children aged one to <10 years. A repeat of the survey in two provinces: Gauteng (GTG) and the Western Cape (WC) was undertaken in 2018. Results showed that in all domains (living areas) in GTG, food shortage prevalence decreased between 1999 and 2018, from 55.0% to 29.6% in urban informal areas, from 34.1% to 19.4% in urban formal areas and from 42.1% to 15.6% in rural areas. While the prevalence of food shortage in urban formal areas in the WC remained similar in 2018, prevalence decreased from 81.8% to 35.7% in urban informal areas and from 38.3% to 20.6% in rural areas. Energy and macronutrient intakes improved significantly in GTG between 1999 and 2018 but not in the WC; intakes were significantly higher in the WC at both time points. The only significant change in stunting, wasting, overweight and obesity prevalence was that 7–<10-year-olds in GTG were significantly more likely to be wasted (BAZ < 2SD) in 2018 than in 1999 (20.2% versus 6.9% respectively). In the WC, 1–3-year-olds were significantly more likely to be obese in 2018 than in 1999 (8.1% versus 1.7% respectively) and 7–<10-year-olds were less likely to be stunted (14.5% versus 4.9% respectively). There were significant negative correlations between the hunger score and dietary variables in both provinces in 1999. In GTG in 2018, only the correlation with fat intake remained while there were still several significant correlations in WC in 2018. Changes in top 12 energy contributors reflect a shift to high or moderate energy foods low in nutrients from 1999 to 2018. Nutrient dense (high micronutrients, low energy/g) foods (e.g., fruit) fell off the list in 2018. Logistic regression analyses reflect the importance for food security of having a parent as head of the household and/or caregiver, and parents having grade 12 or higher education and being employed. We conclude that food security nutritional status indicators improved amongst 1–<10-year-old children especially in GTG between 1999 and 2018. However, the shift to poorer food choices and increase in wasting in older children and overweight in younger children are of concern.
Open Access
Health status of primary school educators in low socio-economic areas in South Africa
(BioMed Central, 2015-02-25) Senekal, Marjanne; Seme, Zibuyile; de Villiers, Anniza; Steyn, Nelia P
Background: Non-communicable Diseases (NCDs) are major health concerns in South Africa. According to the life cycle approach NCD prevention strategies should target children. Educators are important external factors influencing behaviour of learners. The objective of this study was to assess the prevalence of selective NCD risk factors in educators of primary school learners. Methods: A cross-sectional design was used to assess the body mass index (BMI) and waist circumference (WC), blood glucose (BG), cholesterol (BC), blood pressure (BP), perceived health and weight, and parental NCD history of 517 educators in the Western Cape of South Africa. Results: The sample included 40% males and 60% females; 64% urban and 36% rural, 87% were mixed ancestry, 11% white and 2% black. Mean age for the total group was 52 ± 10.1 years, BMI 30 ± 1.2 kg/m2 (31% overweight, 47% obese), diastolic BP 84 ± 10.0 mmHg, systolic BP 134 ± 18.7 mmHg (46% high BP), BG 4.6 ± 2.3 mmol/L (2% high BG), BC 4.4 ± 0.9 (30.4% high BC) and WC 98 ± 14.1 cm for males (38% high WC) and 95 ± 15.3 for females (67% high WC). BMI was higher (p = 0.001) and systolic (p = 0.001) and diastolic (p = 0.005) BP lower in females. Rural educators were more obese (p = 0.001). BMI (p = 0.001) and systolic BP (p = 0.001) were lower in younger educators. Correct awareness of personal health was 65% for BP, 79.2% for BC and 53.3% for BG. Thirty-eight percent overweight/obese females and 33% males perceived their weight as normal. Conclusion: The findings of this study demonstrated a number of characteristics of educators in the two study areas that may influence their risk for developing NCDs and their potential as role models for learners. These included high levels of obesity, high blood pressure, high waist circumference, high cholesterol levels, and high levels of blood glucose. Furthermore, many educators had a wrong perception of their actual body size and a lack of awareness about personal health.
Open Access
Illustration of the Importance of Adjustment for within- and between-Person Variability in Dietary Intake Surveys for Assessment of Population Risk of Micronutrient Deficiency/Excess Using an Example Data Set
(Multidisciplinary Digital Publishing Institute, 2022-01-11) Nel, Johanna H.; Steyn, Nelia P.; Senekal, Marjanne
Nutrition intervention decisions should be evidence based. Single 24-h recalls are often used for measuring dietary intake in large dietary studies. However, this method does not consider the day-to-day variation in populations’ diets. We illustrate the importance of adjustment of single 24-h recall data to remove within-person variation using the National Cancer Institute method to calculate usual intake when estimating risk of deficiency/excess. We used an example data set comprising a single 24-h recall in a total sample of 1326 1–<10-year-old children, and two additional recalls in a sub-sample of 11%, for these purposes. Results show that risk of deficiency was materially overestimated by the single unadjusted 24-h recall for vitamins B12, A, D, C and E, while risk of excess was overestimated for vitamin A and zinc, when compared to risks derived from usual intake. Food sources rich in particular micronutrients seemed to result in overestimation of deficiency risk when intra-individual variance is not removed. Our example illustrates that the application of the NCI method in dietary surveys would contribute to the formulation of more appropriate conclusions on risk of deficiency/excess in populations to advise public health nutrition initiatives when compared to those derived from a single unadjusted 24-h recall.
Open Access
Investigation of beliefs relating to weight gain prevention behaviours and weight related constructs in first year female students at three South African Universities
(2020) Lasker, Gabrielle Lana; Senekal, Marjanne
Introduction International as well as South African research indicates that first year female students at tertiary institutions may be specifically prone to weight gain and that these students should be targeted for weight management interventions. To contribute to this field of research a self-help weight management manual was developed for South African first year female students and tested in a controlled trial. The manual was found to result significant lower weight gain in the intervention group. The research group followed on and posited that development of further elements to combine with the self-help manual should consider beliefs students hold regarding weight gain prevention behaviours and weight related constructs. This research aimed to investigate the beliefs of first year female students from three universities in the Western Cape, South Africa regarding weight gain prevention behaviours and weight related constructs. The first objective was to elicit salient beliefs held by first year female students regarding weight gain prevention behaviours (dietary patterns, physical activity alcohol intake and sleep time) and weight related constructs (eating behaviour, body shape dissatisfaction, stress, selfesteem and depression/anxiety) using a qualitative research design (Phase 1). The second objective was to identify weight gain prevention belief patterns of first year female students, to investigate the association thereof with actual weight gain prevention behaviours and weight related constructs and identify significant predictors of the belief patterns using a quantitative cross-sectional research design (Phase 2). Methods and results The target population for both Phases was English speaking 18-20-year old first year female students who were registered for the first time for a qualification at University of Cape Town (UCT), Stellenbosch University (SU) or the University of the Western Cape (UWC) in South Africa. Students who were pregnant, breastfeeding, elite athletes, following dietary restrictions for a medical condition, or had a disease that may influence their weight, were not eligible for participation. For Phase 1 total of 28 in-depth interviews were conducted with participants with representation of living situation (university residence or private accommodation, those living at home were excluded) and race (black African, mixed ancestry or white) ensured in recruitment. Eighteen of the interviews were fully coded until data saturation was apparent. The additional 10 interviews were coded for new information only. Data analysis was conducted using the audio coding option on Nvivo Version 12. Core belief themes that emerged reflect awareness of recommendations of behaviours of weight gain prevention, awareness of benefits of performance of these behaviours, awareness of consequences of not meeting the requirements as well as non-concern relating to not performing the behaviours. Further beliefs focused mainly on barriers to and facilitators these behaviours. Phase 2 comprised completion of a questionnaire that covered socio-demographics, self-reported weight and height, dietary (including alcohol intake), physical activity, sleep time, body shape satisfaction, eating behaviour, self-esteem, presence of depression/anxiety symptoms and belief statements (derived from Phase 1) by a convenience sample of 168 first year female students from the same three universities to identify weight gain prevention (WGP) belief patterns, associated factors and predictors thereof. Four weight gain belief patterns (WGP Belief Patterns) were extracted using principal component analysis: WGP Belief Pattern 1: Barriers to weight management; WGP Belief Pattern 2: Facilitators for healthy eating and exercise; WGP Belief Pattern 3: Barriers to exercise; WGP Belief Pattern 4: Social barriers to healthy eating. Numerous associations between these belief patterns and dietary patterns including snacking after dinner, problematic eating behaviours (including a higher emotional eating, cognitive restraint and uncontrolled eating), body shape dissatisfaction, attempts to prevent weight gain during the study year, a higher or lower BMI, perception of overweight/obesity as a child/adolescent, higher stress and lower self- esteem were evident. Regression analysis identified identified snacking after dinner, emotional eating, body shape dissatisfaction and attempts to prevent weight gain during the study year as predictors of a higher score, whereas a higher BMI and perception to have been thin as an adolescent as predictors of a lower score on WGB Belief Pattern 1; for WGP Belief Pattern 2: a higher BMI and a higher score for Dietary Pattern 2 (fruits, vegetables and legumes) were identified as predictors of a higher score, and a higher MET-minutes and a higher score for Dietary Pattern 1 (sugary foods/drinks, slap chips, take-outs) as predictors of a lower score; for WGP Belief Pattern 3: a higher BMI and uncontrolled eating were identified as being predictors of a higher score, and a higher self-esteem and weight gain prevention attempts in the study year as predictors of a lower score; and a higher level of body shape dissatisfaction and a higher level of cognitive restraint were identified as being predictors of a higher score, and a higher BMI, perception of being thin as a child, lower stress and a higher self-esteem as predictors of a lower score on WGP belief pattern 4. Overarching conclusions Results and conclusions of the in depth interviews conducted to assess the beliefs of first year female students from three universities in the Western Cape, South Africa, regarding weight gain prevention behaviours and weight related constructs show that a multicultural sample of students held numerous beliefs regarding potential barriers and facilitators to weight gain prevention. Results of the quantitative assessment of these beliefs in a cross-sectional survey conducted amongst the same target group resulted in the extraction of three barrier WGP Belief Patterns, including barriers to weight management per se (feeling stressed/anxious or sad/depressed, mindless eating, being awake at night, experiencing lack of health food options at university, preparing one's own meals, feeling fat, having people around you who do not eat healthy and the difficulty of not overeating were barriers to weight management), barriers to exercise (feeling sad/depressed, feeling stressed/anxious, having poor body shape satisfaction and feeling fat were barriers to exercise) and social barriers to healthy eating (socialising, judgement from peers when making healthy food choices and drinking alcohol were barriers to weight management). Specific predictors of these patterns, namely snacking patterns, cognitive restraint, uncontrolled eating, emotional eating, problematic eating behaviours, body shape dissatisfaction, overweight/obesity as a child/adolescent, higher stress levels and lower self-esteem have typically been reported to be associated with challenges to healthy weight management. A concern is that students who participated in the cross sectional survey were characterized by many of these predictors. Predictors of the single facilitator WGP Belief Pattern (facilitators of healthy eating and exercise: complying with a healthy diet plan, finding enjoyment in healthy eating, preparing vegetables in a tasty way, finding affordable ways to eat healthy, making time in the day for exercise, knowing how to prepare one's own meals, planning meals and snacks ahead and exercising) that was extracted from the quantitative data reflect factors that have typically been reported to be associated with improved weight management (healthy eating and higher physical activity levels), as well as factors that have typically been reported to be associated with weight management challenges (unhealthy eating and a higher BMI). Overarching recommendations Although the associations between the four weight gain prevention belief patterns and weight status of first year female students were not investigated in this study, factors found to be associated with and predictors of the three barrier patterns point to potential risk for the experience of weight gain prevention challenges by first year female students. Although this notion should ideally be confirmed in further research, addressing the focus of the beliefs included in the barrier belief patterns, as well as the characteristics of the students that have been reported to be associated with weight management challenges in the literature in weight gain prevention interventions for first year female students at tertiary institutions is recommended.
Open Access
Investigation of weight management-related focus areas in middle-class overweight/obese Black (Zulu) women to advise healthy weight loss intervention development
(2015) Kassier, Susanna Maria; Senekal, Marjanne; de Villiers, Anniza
The South African Demographic and Health Survey (1998 and 2003) revealed that urban black women had the highest prevalence of overweight/obesity and central obesity across all population and gender groups. This trend was confirmed by the South African National Health and Nutrition Examination Survey (SANHANES-1) who reported a substantial increase in the prevalence of obesity among black South African women. Hence, the high prevalence of overweight/obesity and central obesity among urban black South African women needs to be addressed through targeted weight loss/management interventions, as obesity and central obesity are risk factors for the development of a number of non-communicable diseases (NCDs). However, from the international literature, it is evident that overweight/obese black women are less likely to embark on a weight loss intervention, while those who seek treatment, are unlikely to complete the intervention, as weight loss interventions targeting as well as including black women have reported attrition rates ranging from 0to 79%. In addition, at this point in time, no common attrition tendencies have been documented for large clinic-based weight loss interventions targeting African-American women in the United States of America. As there is a serious paucity of published information on weight loss interventions targeting overweight/obesity in urban black South African women, the aim of this research was to investigate weight management-related focus areas in overweight/obese black (Zulu) women residing in an urban area in South Africa. This information is essential to advise the development of healthy weight loss interventions and appropriate messaging to promote weight loss and maintenance in black South African women. In order to achieve the this aim, the following research questions were formulated: (i) What is the weight management related profile of overweight/obese treatment-seeking black women; (ii) What is the outcome of a culturally sensitive healthy weight loss intervention in terms of weight loss, compliance (attendance of intervention sessions, lifestyle changes) and attrition: and (iii) Which factors may explain the outcomes of the culturally sensitive healthy weight loss intervention? To guide the investigation of these research questions the researcher first set out to identify weight management-related focus areas for overweight/obese black women from the literature. Ten succinct focus areas emerged and include the following: 1) treatment seeking behaviour; 2) weight loss success; 3) compliance to and attrition from weight loss programmes; 4) cultural influences on body shape and size perception and satisfaction; 5) cultural influences on food choices and eating patterns6) cultural influences on physical activity; 7) environmental factors and social support; 8)appropriateness of the weight loss programme for the target population; 9) dietary restraint, disinhibition, perceived hunger and bingeing and 10) psychological well-being (depression).
Open Access
Low carbohydrate versus isoenergetic balanced diets for reducing weight and cardiovascular risk: a systematic review and meta-analysis
(Public Library of Science, 2014) Naude, Celeste E; Schoonees, Anel; Senekal, Marjanne; Young, Taryn; Garner, Paul; Volmink, Jimmy
BACKGROUND: Some popular weight loss diets restricting carbohydrates (CHO) claim to be more effective, and have additional health benefits in preventing cardiovascular disease compared to balanced weight loss diets. Methods and FINDINGS: We compared the effects of low CHO and isoenergetic balanced weight loss diets in overweight and obese adults assessed in randomised controlled trials (minimum follow-up of 12 weeks), and summarised the effects on weight, as well as cardiovascular and diabetes risk. Dietary criteria were derived from existing macronutrient recommendations. We searched Medline, EMBASE and CENTRAL (19 March 2014). Analysis was stratified by outcomes at 3-6 months and 1-2 years, and participants with diabetes were analysed separately. We evaluated dietary adherence and used GRADE to assess the quality of evidence. We calculated mean differences (MD) and performed random-effects meta-analysis. Nineteen trials were included (n = 3209); 3 had adequate allocation concealment. In non-diabetic participants, our analysis showed little or no difference in mean weight loss in the two groups at 3-6 months (MD 0.74 kg, 95%CI −1.49 to 0.01 kg; I 2 = 53%; n = 1745, 14 trials; moderate quality evidence) and 1-2 years (MD 0.48 kg, 95%CI −1.44 kg to 0.49 kg; I 2 = 12%; n = 1025; 7 trials, moderate quality evidence). Furthermore, little or no difference was detected at 3-6 months and 1-2 years for blood pressure, LDL, HDL and total cholesterol, triglycerides and fasting blood glucose (>914 participants). In diabetic participants, findings showed a similar pattern. CONCLUSIONS: Trials show weight loss in the short-term irrespective of whether the diet is low CHO or balanced. There is probably little or no difference in weight loss and changes in cardiovascular risk factors up to two years of follow-up when overweight and obese adults, with or without type 2 diabetes, are randomised to low CHO diets and isoenergetic balanced weight loss diets.
Open Access
Mean ± Standard Deviation Intake Values for 1–<10-Year-Old South African Children for Application in the Assessment of the Inflammatory Potential of Their Diets Using the DII® Method: Developmental Research
(Multidisciplinary Digital Publishing Institute, 2021-12-21) Malczyk, Sonia; Steyn, Nelia P.; Nel, Johanna H.; Eksteen, Gabriel; Drummond, Linda; Oldewage-Theron, Wilna; Faber, Mieke; van Stuijvenberg, Martha E; Senekal, Marjanne
This study aimed to develop a set of mean ± standard deviation (SD) intake values for South African (SA) children for 36 of the 45 food parameters included in the original Dietary Inflammatory Index (DII^®) tool. The SA food composition database contains 30 of the 45 food parameters included in the original DII^®, and a supplementary database was developed for six of the food parameters not included in the SA database. The SA child mean ± SD intake of macronutrients, micronutrients and select flavonoids was calculated by age in years, using eight data sets from dietary surveys conducted in SA in the last three decades. A total sample of 5412 children was included in the calculation of the mean ± SD. The current study sample was determined to be representative of 1–<10-year-old children in SA, and the plausibility of the mean intake values was confirmed by being in line with age-appropriate recommendations. Furthermore, an increase in energy, macronutrient, and most micronutrient intakes with increase in age was evident. The generated mean ± SD values for SA children can be used for calculation of the inflammatory potential of the dietary intake of SA children in the age range of 1–<10-year-old children.
Open Access
Risk 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, Janetta
Obesity 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.
Open Access
The inflammatory potential of the diet of 1-9-year-old children living in two urbanized and economically active provinces in South Africa
(2021) Malczyk, Sonia; Senekal, Marjanne; Eksteen, Gabriel
The challenge of preventing and treating noncommunicable diseases (NCDs) has become a global issue of paramount importance. Climbing obesity rates among children could become a major contributor to the burden of NCDs. While there are numerous factors that contribute to the development of obesity and NCDs, an abundance of research suggests that “sustained inflammation is the common denominator of all chronic disease” (Noland, 2017). Low-grade inflammation is characterized by raised concentrations of inflammatory biomarkers without any overt symptoms (Bonaccio et al., 2017). To date, many studies have demonstrated that unhealthy eating patterns contribute to the development and/or maintenance of low-grade inflammation with particular eating patterns having been categorized as either pro-inflammatory or anti-inflammatory; however, information on the inflammatory potential of the diet of children is sparse, specifically in South Africa. To assess the overall inflammatory potential of an individual's diet, researchers first attempted to provide a tool to classify the inflammatory potential of diets in 2009, with the development of the Dietary Inflammatory Index (DII) tool (Cavicchia et al., 2009). This tool has since been revised and adapted. Key values used in the calculation of the DII include the inflammatory score for each of the 45 parameters in the tool, the mean±SD intake of the population (adults in this case) of each parameter and the mean±SD intake of the actual study sample (Shivappa et al., 2014); however, there is no version of the DII that is suitable for use in children in the South African setting. The aims of this research are: 1) to adapt the DII for application in South African children (the South African Child Dietary Inflammatory Index: the SACDII) (sub-study 1) 2) to apply the SACDII in the investigation of the inflammatory potential of the diet of 1–9-year-old children in two urbanized and economically active provinces in South Africa and the association thereof with sociodemographic, anthropometric, and dietary diversity variables (sub-study 2) SUB-STUDY 1: Adaptation of the DII for use in South African Children Aim: To adapt the DII for application in South Africa by generating a mean±SD intake value for the food parameters on the adult DII (Shivappa et al., 2014) for South African children. Objectives: To identify quantified dietary surveys that involved 1 – 10-year-old South African children published over the last three decades; to obtain the raw data sets (food codes and grams consumed for each food parameter) of identified surveys from the principal investigators (PIs); to generate a nutrient/food data base that includes values for the majority of the 45 food parameters included in the DII (Shivappa et al., 2014); and to combine all raw data obtained and reanalyse the combined data to derive the mean±SD intake of each food parameter using the generated data base.
Open Access
Theory and evidence-based development and feasibility testing of a weight loss intervention (Health4LIFE) for overweight and obese primary school educators employed at public schools in low-income settings, Western Cape Province, South Africa
(2022) Hoosen, Fatima; Senekal, Marjanne
Background: Bearing in mind the prevalence of overweight/obesity found among educators (teachers) and their role modelling function, it is imperative that appropriate weight loss interventions are developed and implemented to control obesity in this target population, while ensuring that they model a healthy body size and lifestyle behaviours in their teaching environment. The United Kingdom (UK) Medical Research Council (MRC) state that best intervention development practice involves a systematic approach where best published research evidence and most suitable theories are combined, referred to as the ‘theory and evidence-based approach'. Intervention development should inherently consider behaviour change theories to assist researchers in deciding which theoretical constructs to target to achieve behaviour change. The MRC guidance recommends that following the development of an intervention, the next step should focus on feasibility testing to advise full-scale evaluation and implementation in real world settings. A feasibility study allows an intervention to be refined by either making incremental or simultaneous adaptations throughout the feasibility study, as well as during all phases of the development of the intervention. Aim: The aims of this research were to 1) conduct a theory and evidenced-based process to develop a weight loss intervention for overweight and obese primary school educators employed at public schools in low-income settings in the Western Cape Province, South Africa and 2) to test the feasibility of the developed intervention in a mixed methods study design. Intervention development Methods: This research firstly involved identification of an appropriate intervention development framework and then behaviour change theories for integration in the framework. The Behaviour Change Wheel (BCW) integrated with the Theory of Planned Behaviour (TPB) to gain insight in educator beliefs regarding dietary and physical activity behaviours and the Health Belief Model (HBM) to address the concept of health awareness (first step to behaviour change) were selected. The Step approach to Message Design and Testing (SatMDT) tool was chosen to underpin intervention message development. The systematic process approach applied in the development of the weight loss intervention in this research included five overarching stages, namely 1) identifying the target behaviours for weight loss, 2) understanding the behaviour, 3) identifying the intervention options, 4) identifying the content and implementation options, and 5) testing and refinement of the intervention materials. Key considerations that emerged in various steps that determined decisions regarding delivery format, are as follows: target population specific factors, setting, affordability, access to electronic devices and internet, limited or no professional contact and preference regarding weight loss intervention delivery mode. Outcome: Step by step application of the BCW framework combined with the TPB, the HBM and the SatMDT resulted in the development of the self-help Health4LIFE weight loss intervention consisting of three elements: 1) a wellness day, 2) a hard copy self-help manual and 3) 80 text messages sent over a 16-week period. The discussion of this section of the thesis focuses on critiquing the use of a theorybased approach (BCW combined with the TPB, HBM and SatMDT) in intervention development. Feasibility testing/assessment Methods: Feasibility outcomes that were identified for the purposes of this research included reach, applicability, acceptability, implementation integrity (primary outcomes), and signals of effect in terms of belief patterns (diet and physical activity beliefs), stage of change for dietary and physical activity behaviours, lifestyle behaviours (diet and physical activity) and weight (secondary outcomes). A cluster sampling method was used to randomly select public schools within the Metro North District in the Western Cape Province. These schools were contacted and educators were invited to participate in the wellness day and the subsequent intervention. Random sampling of schools was repeated until the target of 20 schools was achieved. Ten of these schools were then randomly assigned to the control and 10 to the intervention group. Three sub-studies were conducted to assess the feasibility outcomes. Sub-study 1 involved testing the intervention in a pilot randomised controlled trial. The intervention group received the Health4LIFE weight loss intervention, and the control group received a hard copy of the Department of Health's ‘Choose a Healthy Lifestyle' booklet. Analysis to assess within group change and differences between groups for within group change over the 16- week period were done by protocol, thus using data for completers only. Sub-study 2 investigated the perceptions of educators who participated in the intervention arm and sub-study 3 the perceptions of principals of participating schools regarding reach, acceptability, applicability and implementation integrity. Results: Recruitment (n= 137) and drop-out (n=52) statistics indicated that reach was acceptable, with the exception of male educators who were underrepresented, and black African educators and educators who had attempted weight loss before who were more likely to drop-out. Barriers that may compromise school participation include interruption of teaching time, prior commitments by schools/educators, an already full school program and need to obtain permission from the Department of Basic Education (DoBE) for deviations from the normal school day. Qualitative inputs from principals and educators supported acceptability and applicability of the intervention They were positive about the wellness day, approved of implementation in the school setting, found the hard copy manual useful, enjoyable and easy to understand, and considered the text messages to be helpful and motivational for the day. It was evident that aspects that may need refinement include self monitoring activities, low frequency of contact with interventionists and arrangement of visits to the school. The planned implementation procedure (wellness day, engagement with most sections in the manual and sending of text messages) went as intended, reflecting good implementation integrity, with the exception of the drop-out of three entire schools due to scheduling challenges. Clear signals of effect were evident. The Health4LIFE intervention resulted in favourable shifts in belief patterns regarding dietary intake and physical activity; favourable shifts in stage of change for “increase fruit intake” and “decrease sugar intake”, significant changes in some lifestyle behaviours (increased intake of low fat food items, increased intake of vegetables, decreased intake of sugary food items, decreased frequency of adding fat and sugar to food, increase in physical activity and decreased time spent being sedentary) and a trend towards weight loss in the intervention group. The only significant changes in the control group related to dietary intake (increased intake of vegetables and increased intake of low-fat foods). Overarching conclusions and recommendations: Although the time and effort required to follow a systematic process using the BCW cannot be denied, at the end of this process a very clear understanding of the determinants of a specific behaviour and the mechanisms of action required to affect behaviour change is achieved. These insights are imperative for identification of the most appropriate intervention delivery mode and development of the intervention content. This research provides a comprehensive and systematic guide to using the BCW in a theory and evidence-based process for the development of a self-help weight loss intervention. Results reflecting reach, acceptability, applicability, implementation integrity and potential effectiveness of the Health4LIFE intervention support feasibility of the intervention. Material signals of effect in terms of shifts in belief patterns and stage of change, as well as improvements in lifestyle behaviours were evident. It is plausible that these shifts and changes could collectively result in weight loss, as a trend towards weight loss were found. These signals of effect warrant further evaluation of the intervention in a full-scale study and/or consideration for implementation by the DoBE. Based on the feasibility outcomes it is recommended that the following minor refinements of the Health4LIFE intervention receive attention before next steps are taken: recruitment of male educators, drop-out of black African educators and those who have attempted weight loss before, lack of DoBE policies to address educator health and wellbeing, educator suggestions to improve the intervention manual and poor completion of self-monitoring activities. Major intervention refinements that emerged from the feasibility testing for consideration include more frequent in-person contact between educators and interventionists, extending intervention duration, and making use of eHealth options for contact sessions and self-monitoring. However, the feasibility of major refinements would require additional investigation, further extending the already lengthy intervention development process. Bearing this in mind, implementation of the Health4Life intervention in public schools in low-income settings in its current format, but with minor changes to the hard copy manual as recommended by educators, should be considered.
Open Access
Weight-loss strategies of South African female university students and comparison of weight management-related characteristics between dieters and non-dieters
(BioMed Central, 2016-09-01) Senekal, Marjanne; Lasker, Gabrielle L; van Velden, Lindsay; Laubscher, Ria; Temple, Norman J
Background: Female university students are at risk for weight gain and use of inappropriate weight-loss strategies. By gaining a greater understanding of the weight-loss strategies used by and weight management related characteristics of these students, effective weight management interventions for this vulnerable group can be developed. Methods: Two hundred and fifty female students from South Africa universities, aged 18–25 years, participated in this cross-sectional study; 162 attempted weight loss during the year preceding the study (dieters) and 88 were non-dieters. Weight and height were measured and BMI (kg/m2 ) computed. A self-administered questionnaire was used to record all other variables. Weight loss strategies were described for dieters and compared between BMI groups within the dieters group. Weight management related characteristics were compared between dieters and non-dieters. Statistical tests included Pearson Chi-square test, independent samples t-test or Mann-Whitney U test (depending on distribution of the data). Predictors for a higher BMI and being overweight/obese (BMI ≥25 kg/m2 ) were identified using regression models. Results: Healthy weight-loss strategies included increased exercise and fruit/vegetable intake and decreased intake of sugar and fat containing items; unhealthy methods included eating little food and skipping meals; and extreme weight loss strategies included laxatives and vomiting. The most commonly used weight-loss product was Herbex. Dieters were characterized by a higher BMI, overestimation of their weight (especially normal weight students), dissatisfaction with weight and select body parts, higher intake of breakfast and healthy foods, lower intake of unhealthy foods, higher levels of vigorous physical activity, higher use of select informal weight-loss information sources and experiencing more pressure to lose weight from mothers, siblings and friends. Predictors of higher BMI and/or increased risk for BMI ≥25 included weight-loss attempt during the past year, race, dissatisfaction with waist, perception of currently being “chubby,” and higher frequencies of intake of a snack and fatty foods. Conclusion: Attempting weight-loss is common among female students and predicts BMI. Healthy (mainly), unhealthy and extreme weight loss methods are used. Dieters are characterized by a less realistic body image, lower body satisfaction, higher pressure to lose weight, use of informal weight-management information and a healthier life-style.