OpenUCT :: Browsing by Department "Division of Human Nutrition"

Browsing by Department "Division of Human Nutrition"

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Open Access
Added sugar, macro-and micronutrient intakes and anthropometry of children in a developing world context
(Public Library of Science, 2015) Maunder, Eleni M W; Nel, Johanna H; Steyn, Nelia P; Kruger, H Salome; Labadarios, Demetre
Objective The objective of this study was to determine the relationship between added sugar and dietary diversity, micronutrient intakes and anthropometric status in a nationally representative study of children, 1-8.9 years of age in South Africa. METHODS: Secondary analysis of a national survey of children (weighted n = 2,200; non weighted n = 2818) was undertaken. Validated 24-hour recalls of children were collected from mothers/caregivers and stratified into quartiles of percentage energy from added sugar (% EAS). A dietary diversity score (DDS) using 9 food groups, a food variety score (FVS) of individual food items, and a mean adequacy ratio (MAR) based on 11 micronutrients were calculated. The prevalence of stunting and overweight/obesity was also determined. RESULTS: Added sugar intake varied from 7.5-10.3% of energy intake for rural and urban areas, respectively. Mean added sugar intake ranged from 1.0% of energy intake in Quartile 1 (1-3 years) (Q1) to 19.3% in Q4 (4-8 years). Main sources of added sugar were white sugar (60.1%), cool drinks (squash type) (10.4%) and carbonated cool drinks (6.0%). Added sugar intake, correlated positively with most micronutrient intakes, DDS, FVS, and MAR. Significant negative partial correlations, adjusted for energy intake, were found between added sugar intake and intakes of protein, fibre, thiamin, pantothenic acid, biotin, vitamin E, calcium (1-3 years), phosphorus, iron (4-8 years), magnesium and zinc. The prevalence of overweight/obesity was higher in children aged 4-8 years in Q4 of %EAS than in other quartiles [mean (95%CI) % prevalence overweight 23.0 (16.2-29.8)% in Q4 compared to 13.0 (8.7-17.3)% in Q1, p = 0.0063]. CONCLUSION: Although DDS, FVS, MAR and micronutrient intakes were positively correlated with added sugar intakes, overall negative associations between micronutrients and added sugar intakes, adjusted for dietary energy, indicate micronutrient dilution. Overweight/obesity was increased with higher added sugar intakes in the 4-8 year old children.
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
Are 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 J
Background 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.
Open Access
An assessment of the ffectiveness [i.e. effectiveness] of growth monitoring and promotion practices within the Lusaka urban district of Zambia
(2004) Kawana, Beatrice Mazinza; Hendricks, Michael; Charlton, Karen
Open Access
Development and validation of a dietary assessment tool to determine dietary intake of people living in oesophageal cancer risk areas in the rural Eastern Cape of South Africa
(2011) Lombard, Martani Johanni; Steyn, N P
Rural areas in the Eastern Cape (EC) Province of South Africa have a high incidence of oesophageal cancer (OC). Amongst the known risk factors associated with the cancer is fumonisin exposure (a mycotoxin growing on maize), poor dietary habits and nutrient deficiencies. Little is known about the current dietary habits and nutrient intake of these people, and therefore maize consumption and fumonisins exposure.
Open Access
Did HealthKick, a randomised controlled trial primary school nutrition intervention improve dietary quality of children in low-income settings in South Africa?
(2015-09-23) Steyn, Nelia P; de Villiers, Anniza; Gwebushe, Nomonde; Draper, Catherine E; Hill, Jillian; de Waal, Marina; Dalais, Lucinda; Abrahams, Zulfa; Lombard, Carl; Lambert, Estelle V
Background: Numerous studies in schools in the Western Cape Province, South Africa have shown that children have an unhealthy diet with poor diversity and which is high in sugar and fat. HealthKick (HK) was a three-year randomised controlled trial aimed at promoting healthy eating habits. Methods: Sixteen schools were selected from two low-income school districts and randomly allocated to intervention (n = 8) or control school (n = 8) status. The HK intervention comprised numerous activities to improve the school nutrition environment such as making healthier food choices available and providing nutrition education support. Dietary intake was measured by using a 24-h recall in 2009 in 500 grade 4 learners at intervention schools and 498 at control schools, and repeated in 2010 and 2011. A dietary diversity score (DDS) was calculated from nine food groups and frequency of snack food consumption was determined. A school level analysis was performed. Results: The mean baseline (2009) DDS was low in both arms 4.55 (SD = 1.29) and 4.54 (1.22) in the intervention and control arms respectively, and 49 % of learners in HK intervention schools had a DDS ≤4 (=low diversity). A small increase in DDS was observed in both arms by 2011: mean score 4.91 (1.17) and 4.83 (1.29) in the intervention and control arms respectively. The estimated DSS intervention effect over the two years was not significant [0 .04 (95 % CI: −0.37 to 0.46)]. Food groups least consumed were eggs, fruit and vegetables. The most commonly eaten snacking items in 2009 were table sugar in beverages and/or cereals (80.5 %); followed by potato crisps (53.1 %); non-carbonated beverages (42.9 %); sweets (26.7 %) and sugar-sweetened carbonated beverages (16 %). Unhealthy snack consumption in terms of frequency of snack items consumed did not improve significantly in intervention or control schools. Discussion: The results of the HK intervention were disappointing in terms of improvement in DDS and a decrease in unhealthy snacking. We attribute this to the finding that the intervention model used by the researchers may not have been the ideal one to use in a setting where many children came from low-income homes and educators have to deal with daily problems associated with poverty.Conclusions: The HK intervention did not significantly improve quality of diet of children.
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
Disaccharide intolerance and protein-calorie malnutrition.
(1971) Bowie, Malcolm David
Open Access
Effects of agricultural biodiversity and seasonal rain on dietary adequacy and household food security in rural areas of Kenya
(2015-04-25) M’Kaibi, Florence K; Steyn, Nelia P; Ochola, Sophie; Du Plessis, Lisanne
Abstract Background Kenya has a high prevalence of underweight and stunting in children. It is believed that both agricultural biodiversity and seasonal rainfall influences household food security and dietary intake. In the present study we aimed to study the effects of agricultural biodiversity and seasonal rains on dietary adequacy and household food security of preschool Kenyan children, and to identify significant relationships between these variables. Methods Two cross-sectional studies were undertaken in resource-poor households in rural Kenya approximately 6 months apart. Interviews were done with mothers/caregivers to collect data from randomly selected households (N = 525). A repeated 24-hour recall was used to calculate dietary intake in each phase while household food security was measured using the Household Food Insecurity Access Scale (HFIAS). A nutrient adequacy ratio (NAR) was calculated for each nutrient as the percent of the nutrient meeting the recommended nutrient intake (RNI) for that nutrient. A mean adequacy ratio (MAR) was calculated as the mean of the NARs. Agricultural biodiversity was calculated for each household by counting the number of different crops and animals eaten either from domestic sources or from the wild. Results Dietary intake was low with the majority of households not meeting the RNIs for many nutrients. However intake of energy (p < 0.001), protein (p < 0.01), iron (p < 0.01), zinc (p < 0.05), calcium (p < 0.05), and folate (p < 0.01) improved significantly from the dry to the rainy season. Household food security also increased significantly (p < 0.001) from the dry (13.1 SD 6.91) to the rainy season (10.9 SD 7.42). Agricultural biodiversity was low with a total of 26 items; 23 domesticated and 3 from the natural habitat. Agricultural biodiversity was positively and significantly related to all NARs (Spearman, p < 0.05) and MAR (Spearman, p < 0.001) indicating a significant positive relationship between agricultural biodiversity of the household with dietary adequacy of the child’s diet. Conclusion Important significant relationships were found in this study: between agricultural biodiversity and dietary adequacy; between agricultural biodiversity and household food security and between dietary adequacy and household food security. Furthermore, the effect of seasonality on household food security and nutrient intake was illustrated.
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
Factors influencing adherence to dietary guidelines: a qualitative study on the experiences of patients with type 2 diabetes attending a clinic in Cape Town
(Medical and Pharmaceutical Publications, 2014) Ebrahim, Z; De Villiers, A; Ahmed, T
Objective: The purpose of this study was to explore the experiences of patients with type 2 diabetes mellitus attending the Groote Schuur Hospital Diabetes Clinic in relation to contextual factors that promote or impede adherence to nutrition care guidelines. Subjects and setting: Eight diabetic patients (four males and four females) attending the Groote Schuur Hospital Diabetes Clinic who were between 40-70 years old. Outcome measures: Qualitative analysis of factors influencing adherence to dietary guidelines. Method: An explorative study, using a qualitative approach with eight semi-structured interviews, was used. Patients were interviewed at the diabetes outpatient clinic in Cape Town. Semi-structured interviews were recorded and transcribed, and thereafter analysed using ATLAS/ti®. Results: Various themes as to what influences adherence to dietary guidelines emerged. An ecological analysis is offered to understand the different levels of influence on participants’ dietary behaviour. The main identified factors at individual level were motivation, individual knowledge, perceptions of moderation, self- responsibility, taste concept or cravings, and temptations. At small group (family and friends) level, family relations with the patients were identified as the main support system used to manage the diabetes. At the organisational or health systems level, long waiting times and the theme of seeing different doctors emerged as problematic factors, but overall, patients were satisfied with the clinic service. At community and policy level, culture and the cost of food were identified as key influential factors with regard to adherence to nutrition care guidelines. Conclusion: This study shows the usefulness of adopting an ecological model in identifying factors that influenced adherence to dietary guidelines by patients with type 2 diabetes. Some factors acted as enablers and others as barriers. These had an impact on patient adherence to nutrition care guidelines. These factors should be considered by diabetes educators, including dietitians and nurses and doctors, when planning treatment modalities for patients with type 2 diabetes mellitus.
Open Access
Fat Mass and Obesity-Associated (FTO) Gene Polymorphisms Are Associated with Physical Activity, Food Intake, Eating Behaviors, Psychological Health, and Modeled Change in Body Mass Index in Overweight/Obese Caucasian Adults
(2014) Harbron, Janetta; van der Merwe, Lize; Zaahl, Monique; Kotze, Maritha; Senekal, Marjanne
The fat mass and obesity-associated (FTO) gene is currently recognized as the most robust predictor of polygenic obesity. We investigated associations between the FTO rs1421085 and rs17817449 polymorphisms and the FTO rs1421085–rs17817449 haplotype and dietary intake, eating behavior, physical activity, and psychological health, as well as the effect of these associations on BMI. N = 133 treatment seeking overweight/obese Caucasian adults participated in this study. Genotyping was performed from whole blood samples. Weight and height was measured and a non-quantified food frequency questionnaire was completed to assess food group intake. Validated questionnaires were completed to assess physical activity (Baecke questionnaire), psychological health (General Health questionnaire, Rosenburg self-esteem scale and Beck Depression Inventory), and eating behavior (Three Factor Eating questionnaire). The risk alleles of the FTO polymorphisms were associated with poorer eating behaviors (higher hunger, internal locus for hunger, and emotional disinhibition scores), a higher intake of high fat foods and refined starches and more depressive symptoms. The modeled results indicate that interactions between the FTO polymorphisms or haplotypes and eating behavior, psychological health, and physical activity levels may be associated with BMI. The clinical significance of these results for implementation as part of weight management interventions needs further investigation.
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
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
Implementation of the HealthKick intervention in primary schools in low-income settings in the Western Cape Province, South Africa: a process evaluation
(2015-08-22) de Villiers, Anniza; Steyn, Nelia P; Draper, Catherine E; Hill, Jillian; Dalais, Lucinda; Fourie, Jean; Lombard, Carl; Barkhuizen, Gerhard; Lambert, Estelle V
Abstract Background The HealthKick intervention, introduced at eight primary schools in low-income settings in the Western Cape Province, South Africa, aimed to promote healthy lifestyles among learners, their families and school staff. Eight schools from similar settings without any active intervention served as controls. Methods The Action Planning Process (APP) guided school staff through a process that enabled them to assess areas for action; identify specific priorities; and set their own goals regarding nutrition and physical activity at their schools. Educators were introduced to the APP and trained to undertake this at their schools by holding workshops. Four action areas were covered, which included the school nutrition environment; physical activity and sport environment; staff health; and chronic disease and diabetes awareness. Intervention schools also received a toolkit comprising an educator’s manual containing planning guides, printed resource materials and a container with physical activity equipment. To facilitate the APP, a champion was identified at each school to drive the APP and liaise with the project team. Over the three-years a record was kept of activities planned and those accomplished. At the end of the intervention, focus group discussions were held with school staff at each school to capture perceptions about the APP and intervention activities. Results Overall uptake of events offered by the research team was 65.6 % in 2009, 75 % in 2010 and 62.5 % in 2011. Over the three-year intervention, the school food and nutrition environment action area scored the highest, with 55.5 % of planned actions being undertaken. In the chronic disease and diabetes awareness area 54.2 % actions were completed, while in the school physical activity and sport environment and staff health activity areas 25.9 and 20 % were completed respectively. According to educators, the low level of implementation of APP activities was because of a lack of parental involvement, time and available resources, poor physical environment at schools and socio-economic considerations. Conclusions The implementation of the HealthKick intervention was not as successful as anticipated. Actions required for future interventions include increased parental involvement, greater support from the Department of Basic Education and assurance of sufficient motivation and ‘buy-in’ from schools.
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 diarrhoea in critically ill patients receiving enteral nutrition
(1989) Rund, Joy E J
The incidence and causes of diarrhoea among critically ill patients receiving enteral tube feeding were investigated. Sixty acutely ill surgical or medical intensive care patients who had had a minimum of 48 hrs bowel rest were entered into the study. They were randomly assigned to receive one of two lactose free liquid formula diets - "Ensure", a commercially available feed containing 825 kCal/L and 34 g/L of protein with an osmolality of 441mOsm/1 or "Casilan Oil", a home-made feed containing 840 kCal /L and 45g/L of protein with an osmolality of 383 mOsm/1. The feeds were administered by constant nasogastric infusion. Patients received 1000ml at a rate of 40ml per hour for the first day and up to 2000ml at 80 ml per hour for the remainder of the study period. Investigations included documentation of medical history, medications administered and clinical details for each patient. Serum albumin was measured and the nutritional status of each patient was assessed using anthropometric measurements. Feeds were tested for bacterial contamination on the three days following the start of feeding and small intestinal bacterial overgrowth was assessed by the 1 g-¹⁴C Xylose breath test of Toskes and King. Twelve of the sixty patients had to be withdrawn from the trial within 24 hours of the start of enteral feeding for medical reasons. The remaining forty eight patients completed at least three days on enteral feeding and thereby became eligible for analysis. In 10/48 patients (21%) diarrhoea was present before enteral feeding began. Four of these 1 O patients continued to pass loose stools when enteral feeding was started while the remaining 6 settled. Diarrhoea developed in a further 10 patients (21%) after enteral feeding began. The overall incidence of diarrhoea in the group of critically ill patients studied was therefore 42% (20/48). However, of the fourteen patients who experienced diarrhoea during enteral feeding four had diarrhoea before feeding began. Therefore, the true incidence of diarrhoea related to enteral feeding was only 10/38 (26%). Furthermore, in 7 of these 10 patients, another possible cause of diarrhoea was present. There was no significant association between diarrhoea and nutritional status, hypoalbuminaemia, sepsis, length of bowel rest, sucralfate and antibiotic therapy other than amikacin. Twenty one patients received Ensure and 27 received Casilan Oil. Despite the differences in the composition of the feeds, the incidence of diarrhoea was similar on the Ensure and the Casilan Oil. No particular factor pertaining to the composition of the feeds was associated with diarrhoea. Significant contamination of feeds was universal but there was no constant relationship between bacterial counts, or types, and the occurrence of diarrhoea. Certain other factors were found to be significantly associated with diarrhoea. Abdominal injury was positively associated with the occurrence of diarrhoea (p<0.05). Diarrhoea could have been attributed to the underlying disease state in 7 of the patients. All three patients who were receiving lactulose as treatment for liver failure developed diarrhoea. While no association was noted between diarrhoea and antibiotic therapy in general, treatment with the antibiotic, amikacin, correlated significantly, albeit marginally, with the occurrence of diarrhoea (p<0.05). Twenty six patients were tested for small intestinal bacterial overgrowth. Only one patient, with an elevated excretion of ¹⁴CO₂, indicative of small intestinal bacterial overgrowth, developed diarrhoea. There was, however, a positive association between diarrhoea and decreased excretion of ¹⁴CO₂. It would appear that the bacterial flora was suppressed in patients with diarrhoea. Amikacin therapy was also associated with decreased excretion of ¹⁴CO₂. This may suggest that amikacin could have altered the bowel flora with resultant development of diarrhoea. While abdominal injury and disease were associated with the development of diarrhoea and amikacin was a possible factor associated with diarrhoea, the results of the present study indicate that enteral tube feeding with either the commercial feed, Ensure or the home-made feed, Casilan Oil was not a cause of diarrhoea in the majority of critically ill patients assessed. Furthermore, in most patients who commenced the trial with diarrhoea, improvement was noted on enteral feeding.
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).