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- Volume 24, Issue 4, 2011
South African Journal of Clinical Nutrition - Volume 24, Issue 4, 2011
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Volume 24, Issue 4, 2011
Author Demetre LabadariosSource: South African Journal of Clinical Nutrition 24 (2011)More Less
The year's end is remarkable, for two relevant and notable landmarks in nutrition. The first event is the National Breastfeeding Consultative Meeting, held on 22-23 August, in the presence of the Minister of Health, Deputy Minister of Health, and other top officials in the health and nutrition terrain. In the meeting, the Tshwane declaration of support for breastfeeding in South Africa was launched, and is published in full in this issue of the SAJCN.
Author Anne TillSource: South African Journal of Clinical Nutrition 24, pp 169 –170 (2011)More Less
For many years, the Association for Dietetics in South Africa has used the slogan: "If it's about nutrition, ask your dietitian". However, do the public and our colleagues consider us to be the first point of reference when it comes to nutrition information? Certainly, private practising dietitians form the largest segment of the dietetic profession. In number terms, at least, they should collectively contribute the most to building the image of, and progressing, the dietetics profession.
Source: South African Journal of Clinical Nutrition 24, pp 174 –177 (2011)More Less
The global obesity epidemic continues to gain momentum, and South Africa is one of those countries with an extremely high prevalence of obesity. The reported association between obstructive sleep apnoea (OSA) and obesity has resulted in a parallel increase in the incidence of OSA. Obesity and OSA interact by inducing systemic inflammation, metabolic aberrations and endocrine abnormalities, all of which predispose patients to atherosclerosis and cardiovascular disease. OSA is associated with a pro-inflammatory state, and increased serum C-reactive protein concentrations. Cardiovascular complications of OSA include myocardial infarction, stroke, congestive heart failure, hypertension and cardiac arrhythmias. The complications of OSA and obesity result in reduced quality of life, significant morbidity, and increased mortality, for untreated patients. OSA causes symptoms such as snoring, apnoea, excessive daytime sleepiness, and morning headaches, but 80-90% of patients are never diagnosed, or treated for their condition. Recognition of these symptoms, and referral of patients for a polysomnogram (home- or laboratory-based), expedites the diagnosis and therapy of OSA. While continuous positive airway pressure (CPAP) remains the mainstay of therapy, dietary measures are important, and should be implemented. Loss of weight can lead to significant reductions in the apnoea-hypopnoea index (AHI) of patients with OSA, and obese patients with OSA should aim for a 10% reduction in body weight.
Iron status and cardiovascular disease risk in black South African women : the PURE study : original researchSource: South African Journal of Clinical Nutrition 24, pp 179 –185 (2011)More Less
Objective : To examine the associations between measures of iron status and cardiovascular disease (CVD) risk factors in South African women.
Method : In a cross-sectional study, demographic information and health history were obtained during individual interviews using validated questionnaires in the North West Province, South Africa. Anthropometric indices, iron indices, blood pressure, blood glucose and lipid profiles were measured using standard procedures in 1 262 apparently healthy black South African women aged 35 years or older. Iron status was assessed using serum concentrations of ferritin, transferrin receptor (TfR) and TfR:ferritin ratio.
Results : Associations between iron status parameters and CVD risk factors were generally weak (r < 0.3, p < 0.01) and were not retained when adjustment was made for age, body mass index, smoking, alcohol consumption and C-reactive protein in the analysis. Waist circumference (WC) and waist:hip ratio (WHR) were higher in the fourth quartile of serum ferritin than in the third quartile, and also in the third quartile compared to the second quartile (P < 0.05). Based on WC and WHR respectively, 31% and 52% of the women had excess abdominal obesity. The mean (95% confidence interval) serum TfR concentration was high, at 9.09 µg/ml (8.77, 9.44), indicating risk of iron deficiency. The mean (95% confidence interval) concentrations of lipids [total cholesterol 4.78 mmol/l (4.64, 4.93), high-density lipoprotein cholesterol 1.45 mmol/l (1.39, 1.52), low-density lipoprotein cholesterol 1.65 mmol/l (1.53, 1.78), triglyceride 1.12 mmol/l (1.07, 1.18)] were within reference ranges.
Conclusion : No significant association was found between iron status parameters and established CVD risk factors. However, excessive abdominal adiposity indicated by high WC and WHR contributes significantly to increased serum ferritin concentration in this population.
Source: South African Journal of Clinical Nutrition 24, pp 186 –191 (2011)More Less
Objectives : To assess the acceptance of popular maize food products (phutu, thin porridge and samp), prepared with yellow, provitamin A-biofortified maize varieties, in 212 subjects between the ages of three and 55 years, from rural KwaZulu-Natal.
Design : A cross-sectional study.
Method : Preschool, primary school and secondary school subjects were randomly selected from two primary schools and one secondary school, respectively, while adult subjects constituted a convenience sample. Pre- and primary school children completed a paired preference test. Secondary school and adult subjects completed a five-point facial hedonic and a preference ranking test. Focus group discussions were conducted using adult subjects.
Results : Preschool children preferred yellow maize to white maize food products: phutu (81% vs. 19%; p-value < 0.001), thin porridge (75% vs. 25%; p-value < 0.001) and samp (73% vs. 27%; p-value < 0.001). There was no statistically significant difference in preference for white and yellow maize by primary school children. Secondary school and adult subjects preferred white maize to yellow maize. Focus group discussions confirmed the preference for white maize by the adults.
Conclusion : The study findings suggest that yellow, provitamin A-biofortified maize has the potential to succeed as a new strategy of dealing with the serious problem of vitamin A deficiency, especially among children of preschool age. However, in older groups, this strategy is unlikely to be successful, unless other strategies are implemented, including intensive nutrition education programmes on the nutritional benefits of the maize, targeting the market price at which yellow maize is sold, increasing its availability in local grocery stores, and improving its sensory properties through breeding.
South African private practising clinical dietitians' perceptions of the relevance of service-specific healthcare marketing principles and communication elements : original researchSource: South African Journal of Clinical Nutrition 24, pp 192 –198 (2011)More Less
Background : South African dietitians are confronted with the challenge of effectively marketing themselves as a sound source of information on nutrition to both the public and other health professionals. The marketing initiative should focus on the promotion of both the profession itself and individual practices. The aim was to assess the perception of South African private practising clinical dietitians of the relevance of service-specific healthcare marketing principles and communication elements (within the ambit of Act 53 of 1974). The design was a descriptive cross-sectional survey in the quantitative domain. Convenience sampling was used (n = 79).
Method : Data were collected by means of an electronic questionnaire. The response rate was low (16.8%), and the results could not be generalised.
Results : The dietitians seemed more focused on the science of nutrition, than on marketing their profession and individual practices. There was an overall awareness of the need for marketing in the dietetic private sector, but the importance and implementation thereof did not receive the amount of attention that it justifies. A number of service-specific healthcare marketing principles received "slightly relevant" or "not relevant" ratings.
Conclusion : For the dietetic profession to reach its full potential in South Africa, and for dietetic private practices to be successful on all levels, dietitians need to focus more of their time and energy on business-related aspects such as marketing. By integrating the theory from the literature with the findings from the study, a profession-specific marketing flow diagram and recommendations could be proposed.
Source: South African Journal of Clinical Nutrition 24, pp 199 –201 (2011)More Less
Background : South Africa is experiencing a dramatic increase in obesity in both urban and rural areas. It is important to understand access to food better and how this influences food choice in rural environments. This study aimed to explore the nature and availability of fast foods in rural South Africa.
Method : Convenience sampling was used to procure fast food samples. The study was conducted in rural northeast South Africa in four villages, part of the South African Medical Research Council and University of the Witwatersrand-Agincourt Health and Socio-Demographic Surveillance System (HSDSS). The outcome measures were assessment of the availability of fast foods and their macronutrient composition.
Results : This study highlights the availability of fast foods through informal community vendors. Of note is the limited variety of foods sold by informal vendors, of which a striking two thirds were either vetkoek or fried chips, which on average yielded 943-5 552 kJ and 11-64 g fat. Additionally, we found that rural vendors sold a local fast food item, the kota.
Conclusion : Given that rural South Africa is undergoing rapid health, social, and nutrition transitions, this study signals the need for more comprehensive research to improve our understanding of the contributory role of fast food and its connection with both livelihoods and the burgeoning obesity epidemic in poorer rural areas. It is through better research and greater understanding that we can work with communities and local government to improve access to more nutrient-rich foods that are less energy dense.
Household market participation and stunting in preschool children in Lilongwe, Malawi : scientific letterSource: South African Journal of Clinical Nutrition 24, pp 202 –204 (2011)More Less
Background : Stunting among Malawian preschool children continues to be a concern.
Method : A cross-sectional survey of 251 semi-urban households, who participated in a community-supported preschool programme, was conducted.
Results : Of the 433 participating two- to five-year-old children, 34.4% had stunting. Children from families who grow tobacco were less likely than other children to have stunting (27.0% vs. 37.3%, p-value = 0.04). In contrast, children from families who grow a local type of cowpea (khobwe) had a higher rate of stunting than other children (46.8% vs. 32.9%, p-value = 0.01).
Conclusion : The study suggests that the increased income associated with household participation in the growing of globally marketable cash crops, as compared to the growing of local crops, may lead to increased nutritional benefits for children.
Source: South African Journal of Clinical Nutrition 24, pp 205 –206 (2011)More Less
Tropical diabetic hand syndrome describes an acute symptom complex found in patients with diabetes in the tropics, usually following minor trauma to the hand. Two different patients, both previously diagnosed with diabetes, suddenly developed an abscess of the hand that progressively worsened, and became an ulcer that was difficult, to manage at the referring private hospitals. The hands and lives of both patients were saved. The frequency of these cases appears to be increasing. Aggressive glycaemic control is a vital control measure for upper limb sepsis. Education remains the most important preventive tool in underdeveloped countries, and should remain an integral part of prevention.
Author A. PrinsSource: South African Journal of Clinical Nutrition 24, pp 209 –211 (2011)More Less
When should we change our practises? An unplanned theme emerged in the first session - the time to change is now! Prof. P Wischmeyer, University of Colorado,USA, presented ample evidence that glutamine is an indispensable nutrient that needs to be supplementated in the critically ill patient. The evidence presented indicated that glutamine supplementation improved beneficially influenced such clinical parameters as length of stay (LOS), infection rate and mortality. One of the mechanisms by which glutamine mediates its beneficial effects is its effect on heat shock proteins.
Source: South African Journal of Clinical Nutrition 24 (2011)More Less