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- Volume 18, Issue 2, 2005
South African Journal of Clinical Nutrition - Volume 18, Issue 2, 2005
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Volume 18, Issue 2, 2005
Source: South African Journal of Clinical Nutrition 18, pp 44 –46 (2005)More Less
Dietitians who work in South Africa need to ensure that they are employed under acceptable business models in order to avoid prosecution by the HPCSA. Acceptable business models are: working in solo practice as a registered dietitian working in partnership or association with another health professional(s) who is/are also registered with the HPCSA working in an incorporated practice according to HPCSA regulations (see below).
Author M.R. DavidsSource: South African Journal of Clinical Nutrition 18, pp 47 –49 (2005)More Less
The epidemic of chronic kidney disease Chronic kidney disease (CKD) is increasingly being acknowledged as a worldwide public health problem which leads to progressive renal failure, cardiovascular disease and premature death. The Third National Health and Nutrition Examination Surveys (NHANES III) in the USA found that an estimated 20 million Americans have CKD. It is among the leading causes of death in the industrialised world, and the 9th most important cause of death in the USA.
Source: South African Journal of Clinical Nutrition 18, pp 51 –57 (2005)More Less
Objective. The objective of this developmental study was the development of renal exchange lists for the South African population with renal failure.
Subjects and design. A questionnaire was circulated to South African renal dietitians to establish the format and composition of the proposed exchange lists. Foodfinder 3 was used for assessment of nutrient composition of foods, and the NRIND Food Quantities Manual was used for assessment of portion sizes. Results from the Food Consumption Study were used to identify food items frequently consumed by the South African population, and dietitians with knowledge of the eating habits of Moslem, Indian, white, black and coloured groups were consulted regarding the inclusion of cultural foods. Portion sizes were determined by protein content of foods. The preliminary exchange lists were circulated for comment and tested for a period of 1 year.
Results. Many new food items were added during revision of the exchange lists. Portion sizes were adapted to be more realistic, and in some cases additional sub-groups were added. Foodfinder 3 and renal exchange list values for all food items included in the exchange lists were then compared, and this showed highly significant correlations for all nutrients concerned. There was no significant difference between mean nutrient values for the two methods, with the exception of protein, the content of which was consistently and significantly underestimated by a mean of 0.1 g per food item. This underestimation is not considered to be of clinical importance.
Conclusion. In this study renal exchange lists were developed for use in South African persons with renal failure. Despite the small but significant underestimation of protein content, the lists appear to be of sufficient precision for use in clinical practice.
Source: South African Journal of Clinical Nutrition 18, pp 60 –66 (2005)More Less
Objective. The objective of this descriptive study was to assess the practices of South African dietitians regarding the dietary treatment of patients with chronic renal failure.
Subjects and design. A questionnaire was mailed to 600 randomly selected dietitians registered with the Health Professions Council of South Africa. Practices were compared to international standards for pre-dialysis, haemodialysis (HD) and peritoneal dialysis (PD) patients.
Results. A 26% response rate was obtained, with only 28% of these dietitians indicating that they counsel renal patients. The majority of dietitians met the international dietary recommendations, but a substantial number deviated from them. This was especially evident in PD patients, where the deviation ranged from 20% (4 dietitians) in the case of energy and phosphate, to 55% (11 dietitians) in the case of calcium. Parameters used for the assessment of nutritional status included body mass index (45% of dietitians), serum albumin (44%), clinical examinations (43%), bioelectrical impedance (37%) and diet history (36%). Methods used to monitor dietary compliance included biochemistry, dietary history, anthropometric measurements and clinical investigation. The most frequently used approaches in the management of protein-energy malnutrition included supplemental drinks (86%) and dietary enrichment at household level (76%).
Conclusion. Although the majority of dietitians met international standards for most nutrients, there was some variation and uncertainty. Ongoing education will enable South African dietitians to treat renal patients competently and with confidence.
Source: South African Journal of Clinical Nutrition 18, pp 70 –75 (2005)More Less
Background. Despite the recommendation of the World Health Organization (WHO) of exclusive breastfeeding for the first 4 - 6 months of life, several South African studies on infant feeding practices have shown that the introduction of feeds other than breastmilk before 4 months is a common practice. The timing of initiation of complementary feeding within the first 4 months is, however, difficult to determine.
Objective. To determine feeding practices of mothers of infants 8 weeks of age or younger, attending the postnatal clinic at Ga-Rankuwa Hospital.
Methods. A cross-sectional study of mothers attending the postnatal clinic at Ga-Rankuwa Hospital using a standardised interview schedule.
Results. A total of 150 mothers were interviewed. All infants in the sample were younger than 9 weeks of age. The mean age of the sample was 37.4 (5.2 weeks) ± 12.1 days. Although 99% of infants were breastfed, exclusive breastfeeding was practised by only 4.6% of the sample. Water was given to 88%, infant formula to 43% and complementary feeds to 37%. Forty-six per cent of mothers said that the reason for giving water to their babies was to prevent constipation. Infant formula was added because mothers believed that their breastmilk was insufficient for their infants' needs. Of the complemented infants, 91% had received complementary feeds before 7 weeks of age. Thin maize meal porridge providing less than 1 kJ/ml and negligible protein was the most commonly given first food.
Conclusion. Breastfeeding was almost universal, exclusive breastfeeding was the exception. Mixed feeding was common, with the introduction of complementary feeds occurring within the first 2 months of life, well before the WHO recommendations.
Served versus actual nutrient intake of hospitalised patients with tuberculosis as compared with energy and nutrient requirementsSource: South African Journal of Clinical Nutrition 18, pp 78 –93 (2005)More Less
Objectives. To assess whether actual nutrient intake of hospitalised patients with tuberculosis differed from that served by the hospital and from that required according to current recommendations.
Design. Descriptive, cross-sectional study.
Setting. Brooklyn Chest Hospital in Brooklyn, Cape Town, Western Cape, South Africa.
Subjects. Thirty patients with pulmonary tuberculosis from Brooklyn Chest Hospital, 23 male, 7 female, were enrolled in the study.
Outcome measures. Assessment included dietary intake in order to calculate energy and nutrient intake, and height and weight at the beginning of the study in order to calculate body mass index (BMI).
Results. Patients were receiving and consuming sufficient macronutrients (with the exception of protein in all patients) and sufficient micronutrients (with the exceptions of calcium, iodine, folate and vitamin E in all patients, beta-carotene, vitamin C and vitamin D in male patients, and selenium and pantothenate in female patients). Actual intake consumed in the hospital did not differ from that served by the hospital in the case of male patients, with the exception of iodine; for female patients, however, owing to significant plate wastage, consumed intake was less than that served by the hospital (with the exceptions of vitamin C and vitamin K). A total of 52% of the male patients and 71% of the female patients were normally nourished, according to their BMI. The remainder were mildly to severely malnourished on the basis of their BMI.
Conclusions. According to current recommendations, the patients institutionalised at Brooklyn Chest Hospital for tuberculosis were receiving inadequate protein and a number of micronutrients (calcium, iodine, folate and vitamin E in all patients, beta-carotene, vitamin C and vitamin D in male patients, and selenium and pantothenate in female patients). Intervention programmes should therefore be introduced as an adjunct to antituberculosis therapy in order to rectify inadequate nutrient intake and to target malnourished patients.
Author Alexander A. KalimbiraSource: South African Journal of Clinical Nutrition 18 (2005)More Less
Extracted from text ... SAJCN 96 September 2005, Vol. 18, No. 2 CORRESPONDENCE The difficulty of assessing night blindness in Malawi: Language barriers To the Editor: For a long time vitamin A deficiency (VAD) has been recognised as a public health problem in Malawi, primarily on the basis of localised studies.1 However, a national micronutrient survey conducted in 20012 showed that the prevalence of VAD (serum retinol < 20 mg/dl3) was 59.2% in preschool children and 57.4% in non-pregnant women of reproductive age, clearly indicating a very serious public health problem.4 During this survey, 2 night blindness (XN) was also assessed with 7.7% ..
Author N-G. AspSource: South African Journal of Clinical Nutrition 18, pp 98 –101 (2005)More Less
Author Supranee ChangbumrungSource: South African Journal of Clinical Nutrition 18, pp 105 –106 (2005)More Less
WHO global strategy on diet, physical activity and health : how can Codex Alimentarius take action to support its implementation?Source: South African Journal of Clinical Nutrition 18, pp 107 –109 (2005)More Less
A profound shift in the balance of the major causes of death and disease, described as the epidemiological transition, has already occurred in developed countries and is underway in many developing countries. Globally, the burden of chronic non-communicable diseases (NCDs) has increased rapidly. In 2001, NCDs accounted for almost 60% of the 56 million deaths annually and 47% of the global burden of disease.
Source: South African Journal of Clinical Nutrition 18, pp 112 –114 (2005)More Less
Using biodiversity for food, dietary diversity, better nutrition and health A significant proportion of the diverse foods available in our environment have been progressively neglected in spite of modern and 'improved' agricultural practices, thereby narrowing the base of global food security. This has resulted over the years in food supply crises, hunger and malnutrition.
Author D. LabadariosSource: South African Journal of Clinical Nutrition 18, pp 119 –121 (2005)More Less
The prevalence of malnutrition and stunting, among children in particular, is a reasonably accurate reflection of the prevailing socioeconomic status in a given environment. Malnutrition is also known to adversely impact on body function, disease predisposition, morbidity and mortality, and health care costs. It is therefore not surprising that nutritional status is one of the key Millennium Development Goals.
Source: South African Journal of Clinical Nutrition 18, pp 124 –128 (2005)More Less
The purpose of the New Nutrition Science project is to enlarge the context of the discipline and to give it a new conceptual framework, so that nutrition science, with its application in food and nutrition policy, can work most effectively in the 21st century. The project is work in progress.
Source: South African Journal of Clinical Nutrition 18, pp 130 –135 (2005)More Less
The new nutrition science is meant to work. Its conceptual framework is designed to derive from present and foreseeable realities, and in particular the fundamental driving forces of well-being and disease. As a biological, social and environmental science it is concerned to protect and improve personal, population and planetary health, all together.
Author I.A. MacdonaldSource: South African Journal of Clinical Nutrition 18, pp 136 –138 (2005)More Less
Epidemiological evidence linking flavonoid consumption and cardiovascular disease has accumulated over the past 15 years. Most of the studies have considered flavanols in tea and red wine as the main dietary sources, and have shown reduced prevalence of cardiovascular disease in those with a high flavanol intake.
Author A.J. McMichaelSource: South African Journal of Clinical Nutrition 18, pp 140 –148 (2005)More Less
Nutrition science draws on human, animal and tissue studies. Nutritional epidemiology faces four basic methodological difficulties: (i) the diet is a complex exposure; (ii) dietary intake is difficult to estimate; (iii) the biological impact of diet is often age / stage-dependent (affecting choice of study design and duration); and (iv) reductionist assumptions are often inappropriate - whole diets may be more important than specific nutrients in determining health risk. Beyond these research challenges lies a penumbra of other questions. For example: What health risks result from intensified methods of food production? What are the global and local environmental consequences, and resultant health risks, of the escalating demand for food (driven by population size and changing consumer preference)?
Arising from the above are questions about the range and quality of evidence that is appropriate within the broad field of 'nutrition science'. Those issues include consideration of:
1. The health consequences of integrated whole-diets (Mediterranean, 'PolyMeal', low GI diet, etc.) versus seeking classic, atomistic, evidence of risks / benefits from specific nutrients or foods.
2. Life-course dietary data versus short-term controlled-trial dietary interventions. The former provide low-quality but high-relevance data; the latter provide high-quality but often low-relevance (short duration, age / stage-specific) data.
3. Palaeo-anthropological and historical data on the types of diet that have prevailed during long, formative, periods of human biological evolution - e.g. palaeolithic diet v. modern industrial diet. What profile of nutrient intake are we humans best equipped to consume?
4. Evidence of collateral human health risks from modern modes of food production, distribution and availability. For example:
- extravagant use of antibiotics in commercial high-volume livestock production, resulting in antibiotic-resistant bacteria
- chemical contamination of factory-farmed foods: pesticides, heavy metals, hormones
- intensified methods of livestock production, leading to health risks such as human variant Creutzfeldt-Jacob disease (due to 'mad cow' disease, or bovine spongiform encephalopathy), Nipah virus disease and avian influenza
- diversion of grain as livestock feed, versus availability as food for Third-World populations: a source of food deprivation, malnutrition and its health consequences
- contribution of forest clearance and livestock production to greenhouse gas emissions, climate change and its adverse health impacts (now and, more so, in the future)
- adverse health impacts of loss of small-farmer livelihoods as food-producing conglomerates and supermarket chains consolidate 'production units'. (This applies in both high- and low-income countries.)
Author Ruth K. Oniang'oSource: South African Journal of Clinical Nutrition 18, pp 150 –154 (2005)More Less
in agriculture and food security in Africa Food insecurity, hunger and malnutrition are widespread and increasing in sub-Saharan Africa. Almost one-half of the sub-Saharan African population is food-insecure, and about one-third of the preschool children are malnourished. More than 4 million preschool children die every year, mostly from nutrition-related illness.
Author N. PiaseuSource: South African Journal of Clinical Nutrition 18, pp 156 –162 (2005)More Less
Modernisation has resulted in a growing urban population as people migrate from rural areas in search of education and work. With these transitions, the gap between the rich and the poor has increased. A number of poor people struggle with job insecurity and with low incomes due to low skill and education.