Browsing by Subject "Dietetics"

Now showing 1 - 6 of 6
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    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.
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    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.
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    Investigate the nutritional status, including body composition, of oncology patients attending an outpatient clinic at Groote Schuur hospital: a cross-sectional study
    (2024) Blacker, Megan; Harbron, Janetta; Nwosu, Emmanuel
    Background There is an increase in cancer prevalence globally with an increase in cancer mortality in South Africa. Malnutrition, cancer cachexia and sarcopenia are conditions commonly experienced by people with cancer. Not only is there a deterioration of nutritional status, but these conditions are also known to have negative clinical and patient outcomes that include a decreased quality of life and functional status, increased hospital length of stay, increased treatment toxicity, reduced efficacy of anticancer treatments and an association with depression. Even though there is a greater understanding of the aetiology of cancer cachexia over recent decades, there has not been a global adoption of a definition and a framework for identification of cancer cachexia. Therefore, there is no standardisation of research to compare results related to prevalence and multimodal interventions which hampers implementation of awareness and identification of and treatment for cancer cachexia. The Global Leadership Initiative on Malnutrition (GLIM) identifies and classifies malnutrition across different health care settings. Recently suggested cancer guidelines identified cancer cachexia using amended GLIM diagnostic criteria. With sarcopenia identification, there have been American, Asian and European formulated guidelines with variation in the diagnostic criteria used. This makes it challenging for other countries not represented to create awareness and identification of sarcopenia in different healthcare settings. Gold standard methods in body composition, namely computer tomography (CT) and magnetic resonance imaging (MRI), and reference standard methods, namely dual energy X-ray absorptiometry (DEXA) have highlighted the common phenotypic component of reduced muscle mass in malnutrition, cancer cachexia and sarcopenia, with a plethora of reference populations used and cutoff points determined for different representations of muscle mass. This variety in research has added to the challenges of identifying reduced muscle mass, particularly in resource limited healthcare settings that do not have access to expensive CT, MRI and DEXA scans and relevant reference populations. Therefore, there is a need to identify alternative methods to identify reduced muscle mass earlier in the cancer journey that need to be cheap, accessible, easy to use within the South African health setting. These alternative methods will be helpful in the identification of malnutrition, sarcopenia and cancer cachexia. Aims The first aim was to investigate body composition, with particular focus on muscle mass, using DEXA as the reference standard in this sample of cancer patients, in relation to nutritional status indicators and alternative muscle mass markers. The second aim was to investigate malnutrition in cancer outpatients according to Global Leadership Initiative on Malnutrition (GLIM) using different approaches, including technical (DEXA) and clinical approaches to determine muscle mass. The third aim was to investigate sarcopenia in cancer outpatients according to the newest diagnostic guidelines from the European Working Group on Sarcopenia in Older People (EWGSOP) using muscle mass determined from DEXA (reference standard) and alternative muscle mass markers. The fourth aim was to investigate cancer cachexia using different diagnostic frameworks and the associations with nutritional status indicators in cancer outpatients. Method The study followed a quantitative, cross-sectional design where data were collected over 2 days and twenty-eight eligible cancer patients were recruited through consecutive sampling from colorectal, head and neck, ear, nose and throat oncology outpatient clinics at Groote Schuur Hospital (GSH). A two-phase questionnaire was developed for the purposes of this study where sociodemographic, clinical and cancer related data, biochemistry, physical activity, dietetics related data, a twenty-fourhour recall and semi-quantitative food frequency questionnaire information were collected. On the second data collection day, handgrip strength (HGS), nutrition risk screening-2002 (NRS-2002), patient generated subjective global assessment (PG-SGA), a second a twenty-four-hour recall, alternative muscle mass markers [mid upper arm circumference (MUAC), calf circumference (CC), corrected arm muscle area (cAMA), estimated appendicular skeletal muscle (est ASM), global physical examination (GPE)] and DEXA measurements were collected. Results There is a high prevalence of reduced muscle mass (82.1%) as determined by our reference standard, DEXA, expressed as ASM. From the six alternative muscle mass markers, calf circumference performed best across the different statistical tests in comparison to the reference standard, DEXA. Calf circumference demonstrated fair agreement related to Cohen's kappa, overall fair for sensitivity (73.9%) / specificity (80%) and a percentage agreement of 78.6%. Our results suggest that calf circumference may be used to screen cancer patients to determine those without RMM as the specificity was 80% i.e., only 20% of participants without RMM will be incorrectly categorised. None of our nutritional status indicators can be used as proxies for detecting reduced muscle mass. BMI, scored NRS-2002 and scored PG-SGA were statistically significant in participants identified with reduced muscle mass. Our study confirmed that malnutrition is prevalent in this cancer population ranging from 75.0% to 92.9% depending on the muscle mass assessment method and Global Leadership Initiative on Malnutrition (GLIM) approach used. Out of the six alternative muscle mass markers and not having muscle mass phenotype, calf circumference demonstrated good agreement related to Cohen's kappa, overall fair for sensitivity (73.9%) / specificity (80%) and a percentage agreement of 92.9% suggesting that it may be used as an alternative muscle mass phenotype in the GLIM diagnostic criterium for reduced muscle mass. We found a prevalence of sarcopenia from 7.4% to 18.5%, depending on the muscle mass method used Of the five alternative muscle mass markers, calf circumference agreed perfectly and had 100% sensitivity and specificity. We found that the diagnosis and classification of cancer cachexia varied depending on the diagnostic models used. We used two diagnostic models to identify pre-cachexia and found a range of 17.9% to 28.6%. We used four diagnostic models to identify cancer cachexia and found a range from 45.8% to 82.1%. None of the three diagnostic cancer cachexia frameworks performed well when compared to the most recent cancer cachexia framework adapted from GLIM. In addition, none of our nutritional status indicators performed well across all the different tests when compared to the recent cancer cachexia framework. Therefore, suggesting that our routine use of nutritional status indicators within practice, may not be sufficiently sensitive, specific and agree with our reference framework to diagnose cancer cachexia. Only handgrip strength and albumin are significantly different in the cancer cachexia group. In conclusion, despite our limitation regarding small sample size, calf circumference may be a possible alternative muscle mass marker to screen for reduced muscle mass, may be used as a proxy in the GLIM diagnostic criteria and for sarcopenia diagnosis. As cancer cachexia is recognized as a multifactorial and multi-organ syndrome, all diagnostic components may need to be present, therefore simplistic commonly used clinical and practical approaches may not be adequate to detect cancer cachexia early in the cancer patient's journey.
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    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.
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    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.