The inflammatory potential of the diet of 1-9-year-old children living in two urbanized and economically active provinces in South Africa

Master Thesis


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The challenge of preventing and treating noncommunicable diseases (NCDs) has become a global issue of paramount importance. Climbing obesity rates among children could become a major contributor to the burden of NCDs. While there are numerous factors that contribute to the development of obesity and NCDs, an abundance of research suggests that “sustained inflammation is the common denominator of all chronic disease” (Noland, 2017). Low-grade inflammation is characterized by raised concentrations of inflammatory biomarkers without any overt symptoms (Bonaccio et al., 2017). To date, many studies have demonstrated that unhealthy eating patterns contribute to the development and/or maintenance of low-grade inflammation with particular eating patterns having been categorized as either pro-inflammatory or anti-inflammatory; however, information on the inflammatory potential of the diet of children is sparse, specifically in South Africa. To assess the overall inflammatory potential of an individual's diet, researchers first attempted to provide a tool to classify the inflammatory potential of diets in 2009, with the development of the Dietary Inflammatory Index (DII) tool (Cavicchia et al., 2009). This tool has since been revised and adapted. Key values used in the calculation of the DII include the inflammatory score for each of the 45 parameters in the tool, the mean±SD intake of the population (adults in this case) of each parameter and the mean±SD intake of the actual study sample (Shivappa et al., 2014); however, there is no version of the DII that is suitable for use in children in the South African setting. The aims of this research are: 1) to adapt the DII for application in South African children (the South African Child Dietary Inflammatory Index: the SACDII) (sub-study 1) 2) to apply the SACDII in the investigation of the inflammatory potential of the diet of 1–9-year-old children in two urbanized and economically active provinces in South Africa and the association thereof with sociodemographic, anthropometric, and dietary diversity variables (sub-study 2) SUB-STUDY 1: Adaptation of the DII for use in South African Children Aim: To adapt the DII for application in South Africa by generating a mean±SD intake value for the food parameters on the adult DII (Shivappa et al., 2014) for South African children. Objectives: To identify quantified dietary surveys that involved 1 – 10-year-old South African children published over the last three decades; to obtain the raw data sets (food codes and grams consumed for each food parameter) of identified surveys from the principal investigators (PIs); to generate a nutrient/food data base that includes values for the majority of the 45 food parameters included in the DII (Shivappa et al., 2014); and to combine all raw data obtained and reanalyse the combined data to derive the mean±SD intake of each food parameter using the generated data base.