Browsing by Subject "nutrition"

Now showing 1 - 9 of 9
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    The effect of early versus late enteral feeding on the hypermetabolic response of the paediatric burned patient
    (2001) Venter, Marcha; Rode, Heinz
    Background: Red Cross Children's Hospital treats an average of 2 000 children per annum with thermal injuries. Five hundred of these are new injuries and 60 patients have a total body surface area burn (TBSAB) that exceeds 20%. There is substantial evidence in adult burn literature that suggests that early enteral feeding (EEF) compared to initial starvation has a profound impact on the hormonal response, metabolic rate and gastrointestinal maintenance post thermal injury. However, research addressing these issues in the burned child (birth to 13 years old), are limited. Aim: To compare EEF, to delayed or late enteral feeding (LEF), and to evaluate whether the practice is beneficial in paediatric burned patients. Criteria: The criteria for the patients were (a) a burn less than 24 hours old and a TBSAB more than or equal to 20%, (b) an age of less than 13 years and (c) admission to the Red Cross Children's Hospital Burns Unit. Objectives: The objectives were to compare the effect of EEF and LEF on (1) the concentrations of insulin, insulin-like growth factor-1 (IGF1), glucagon, cortisol and growth hormone (GH), (2) the estimated energy expenditure (EEE) and calculated energy expenditure, (3) the respiratory quotient (RQ), (4) the intestinal permeability and (5) the clinical outcome. Methods: The children were assigned to either the EEF or LEF group. Nine patients in each study group completed the study successfully, with similar median ages (4.5 yr.), body weights (14 kg) and TBSAB (30%). The EEF group was enterally fed via a nasojejunal feeding tube within a median time of 10.75 hours post burn, whereas the LEF group fasted for a median of 54 hours, after which enteral feeds were introduced. This study is unique in that enteral feeds were used as part of the resuscitation regime in the EEF group. The EEF group received their full resuscitation volumes from the enteral feed at a median time of 16 hours from initiation. Venous blood samples were taken daily between 7h00 and 8h00, before breakfast, for the hormone measurements. The REE and RQ were measured by indirect calorimetry and compared to the recommended dietary allowances (RDA), Galveston and Solomon's equations, which estimate energy requirements. Small bowel permeability was measured by the sugar-absorption-test (SAT), and expressed as lactulose:rhamnose ratios.
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    Evaluation of a school-based nutrition and physical activity programme for Grade 4 learners in the Western Cape province
    (South African Academy of Family Practice, 2013) Jacobs, K L; Mash, B; Draper, C E; Forbes, J; Lambert, E V
    Objective: This study aimed to evaluate the effectiveness of the Making the Difference programme (MTDP), an education-and activity-based intervention for Grade 4 learners at primary schools in the Western Cape. Design: This was a cross-sectional, post-intervention survey of an existing programme, using control schools as a comparator. Setting and subjects: The study involved Western Cape primary schools in the 2009 school year. Schools were randomly sampled from two regions. Four intervention (active in the MTDP) and five control (non-participating) schools (n = 325 learners) were selected. Outcome measures: The following outcome measures were assessed using an administered questionnaire to learners: learners' knowledge of, attitudes towards, and behaviour in relation to nutrition and physical activity. Results: A small but significant improvement (eating vegetables and taking lunch boxes to school) was demonstrated with regard to self-reported behaviour in relation to nutrition in the intervention group. However, this behaviour was not explained by differences in barriers to healthy eating, self-efficacy or knowledge, which were not different between the groups, or by perceived social support, which was actually significantly increased in the control group. Groups displayed no differences in physical activity or sedentary behaviour. However, the results showed a significant difference between the groups in terms of a reduction in perceived barriers to physical activity and increased physical activity self-efficacy in the active group. Conclusion: While the MTDP only had a modest effect on the self-reported nutrition and physical activity behaviour of the learners, results regarding lower perceived barriers to physical activity and increased physical activity self-efficacy were promising.
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    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.
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    Healthy lifestyle interventions in general practice Part 10: Lifestyle and arthritic conditions - Osteoarthritis
    (South African Academy of Family Physicians, 2010) Schwellnus, M P; Patel, D N; Nossel, C; Dreyer, M; Whitesman, S; Derman, E W
    Chronic musculoskeletal disease is one of the most common causes of disability worldwide with considerable economic impact in health care. Osteoarthritis (OA) is the most common chronic musculoskeletal disease affecting a large proportion of the population with an increasing predicted prevalence in the next two decades. Regular physical exercise, nutritional intervention, psychological support and other lifestyle interventions are very important components of the nonpharmacological management of patients with OA. The main rationale to include regular exercise as part of a lifestyle intervention programme for OA is to improve muscle strength and proprioception, and to promote the other general health benefits of participating in regular physical activity. Nutritional intervention should focus on weight reduction while basic nutrients that are required for healthy joints should be provided. Glucosamine and chondroitin supplemention is commonly used and may reduce pain, improve function and reduce or arrest disease progression. Psychological intervention has a particular role in assisting with pain management.
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    Healthy lifestyle interventions in general practice Part 13: Lifestyle and osteoporosis
    (South African Academy of Family Physicians, 2011) Schwellnus, M P; Patel, D N; Nossel, C; Dreyer, M; Whitesman, S; Micklesfield, L; Derman, E W
    Osteoporosis is defined as a systemic skeletal disease that is characterised by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fractures. Therefore, the diagnosis of osteoporosis is based on measurement of bone mineral density (BMD) using central (axial) dual energy X-ray absorptiometry (DXA), and clinical evidence of a fragility fracture (history or radiological evidence). Osteoporosis is a major public health problem, affecting about 30% of postmenopausal women of Caucasian origin, and 70% of those aged 80 years. The risk factors for osteoporosis include lifestyle factors, genetic/ethnic factors, specific diseases causing secondary osteoporosis, ageing factors, qualitative factors, and drugs that are toxic to bone. In addition, there are specific additional risk factors for falls that need to be considered. It is well established that lifestyle factors, including physical activity, nutritional intervention, psychosocial intervention, smoking cessation and other lifestyle factor interventions are key elements in the prevention and management of osteoporosis. Guidelines for these lifestyle interventions in the prevention and management of osteoporosis are reviewed.
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    Healthy lifestyle interventions in general practice: Part 14: Lifestyle and obesity
    (South African Academy of Family Physicians, 2011) Derman, E W; Whitesman, S; Dreyer, M; Patel, D N; Nossel, C J; Lambert, E V; Schwellnus, M P
    Obesity is defined as an excessive amount of body fat or adiposity. It can be measured using the body mass index (BMI), and according to established criteria for adult men and women, overweight is defined as a BMI between 25-30 kg/m2, and obesity as a BMI > 30 kg/m2. Obesity is clinically associated with many serious co-morbidities, and is widely recognised as one of the leading health threats in most countries around the world. Weight loss is recommended for patients with a BMI > 25 kg/m2. The goals of weight loss therapy are to reduce obesity-related co-morbidities and decrease the risk of future obesity-related medical complications. The management of obesity is multifactorial, and involves the use of combined lifestyle interventions, including regular physical activity and dietary and psychosocial intervention. Practical clinical advice regarding interventions in these important areas is provided in this article.
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    Nutritional, immune, micronutrient and health status of HIV-infected children in care centres in Manguang
    (2009) Steenkamp, L; Dannhauser, A; Walsh, D; Joubert, G; Veldman, F J; Van der Walt, E; Cox, C; Hendricks, M K; Dippenaar, H
    Aim: To assess the nutritional, immune, micronutrient and health status of antiretroviral-naïve HIV-infected children. Method: A cross-sectional descriptive study was undertaken between September 2004 and March 2006 amongst HIV-infected children of which none received antiretroviral therapy, in care centres in Mangaung, Free State. Results: The study included 37 clinically stable and food-secure HIV-infected children. Their median age was 5.4 years (range 1.2–10.2 years). Fifteen children (41%) were underweight, 30 (81%) were stunted and one (3%) was wasted. The most commonly observed clinical features were lymphadenopathy (84%), skin rashes (51%), hepatomegaly (32%) and pallor (41%). Eight per cent of children had features of TB, while 19% had a lower respiratory tract infection. The median viral load of the group (n = 35) was 117 000 copies/ml, the median CD4+ cell count was 477 cells/mm3 and the median CD4 percentage was 22.5%. A significant negative correlation could be demonstrated between viral load and nutritional indicators. Children had deficient serum levels relative to normal reference values for glutathione (91% of children), albumin (78%), vitamin A (63%), vitamin D (44%), zinc (38%) and vitamin E (13%). Sixty per cent of the children were anaemic and 30% were iron deficient. Conclusion: A high prevalence of acute and chronic malnutrition and micronutrient deficiencies occurred among HIV-infected children residing in care centres. The study highlights the need to investigate early initiation of antiretroviral therapy and nutrition interventions, including aggressive supplementation, in order to improve the prognosis of these children.
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    A practical approach to the nutritional management of chronic kidney disease patients in Cape Town, South Africa
    (BioMed Central, 2016-07-08) Ameh, Oluwatoyin I; Cilliers, Lynette; Okpechi, Ikechi G
    Background: The multi-racial and multi-ethnic population of South Africa has significant variation in their nutritional habits with many black South Africans undergoing a nutritional transition to Western type diets. In this review, we describe our practical approaches to the dietary and nutritional management of chronic kidney disease (CKD) patients in Cape Town, South Africa. Discussion: Due to poverty and socio-economic constraints, significant challenges still exist with regard to achieving the nutritional needs and adequate dietary counselling of many CKD patients (pre-dialysis and dialysis) in South Africa. Inadequate workforce to meet the educational and counselling needs of patients, inability of many patients to effectively come to terms with changing body and metabolic needs due to ongoing kidney disease, issues of adherence to fluid and food restrictions as well as adherence to medications and in some cases the inability to obtain adequate daily food supplies make up some of these challenges. A multi-disciplinary approach (dietitians, nurses and nephrologists) of regularly reminding and educating patients on dietary (especially low protein diets) and nutritional needs is practiced. The South African Renal exchange list consisting of groups of food items with the same nutritional content has been developed as a practical tool to be used by dietitians to convert individualized nutritional prescriptions into meal plan to meet the nutritional needs of patients in South Africa. The list is currently utilized in counselling CKD patients and provides varied options for food items within the same group (exchangeable) as well as offering ease for the description of suitable meal portions (sizes) to our patients. Summary: Regular and continuous education of CKD patients by a multi-disciplinary team in South Africa enables our patients to meet their nutritional goals and retard CKD progression. The South African renal exchange list has proved to be a very useful tool in meeting this need.
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    The association between nutrition and physical activity knowledge and weight status of primary school educators
    (2014) Dalais, Lucinda; Abrahams, Zulfa; Steyn, Nelia P; de Villiers, Anniza; Fourie, Jean M; Hill, Jillian; Lambert, Estelle V; Draper, Catherine E
    The purpose of this study was to investigate primary school educators' health status, knowledge, perceptions and behaviour regarding nutrition and physical activity.Thus, nutrition and physical activity knowledge, attitudes, behaviour and risk factors for the development of non-communicable diseases of 155 educators were assessed in a cross-sectional survey. Height, weight, waist circumference, blood pressure and random glucose levels were measured. Twenty percent of the sample had normal weight (body mass index (BMI, kg/m2) < 25), 27.7% were overweight (BMI> 25 to < 30) and 52.3% were obese (BMI < 30). Most of the participants were younger than 45 years (54.2%), females 78.1%, resided in urban areas (50.3%), with high blood pressure (> 140/90 mmHg: 50.3%), and were inactive (48.7%) with a high waist circumference (> 82 cm: 57.4%). Educators' nutrition and physical activity knowledge was poor. Sixty-nine percent of educators incorrectly believed that eating starchy foods causes weight gain and only 15% knew that one should eat five or more fruit and/or vegetables per day. Aspects of poor nutritional knowledge, misconceptions regarding actual body weight status, and challenges in changing health behaviours, emerged as issues which need to be addressed among educators. Educators' high risk for developing chronic non-communicable diseases (NCDs) may impact on educator absenteeism and subsequently on school functioning. The aspects of poor nutrition and physical activity knowledge along with educators' high risk for NCD development may be particularly significant not merely in relation to their personal health but also the learners they teach.