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- Volume 25, Issue 3, 2012
South African Journal of Clinical Nutrition - Volume 25, Issue 3, 2012
Volumes & issues
Volume 25, Issue 3, 2012
Author Demetre LabadariosSource: South African Journal of Clinical Nutrition 25 (2012)More Less
In a child lies the future of any nation. The good news in the recently released report "The Child Development Index 2012 : Progress, challenges and inequality" is particularly welcome. "The story in numbers (as given in the report indicate) : 127 countries improved their scores on the Child Development Index in the period of 2005-10; 9,000 fewer children under-five died per day on average in the period of 2005-10 than in 1995-99, 50 million more children were in primary school in the period of 2005-10 than in 1995-99; 36 million fewer children were underweight in 2005-10 than 1995-99; But ... more children suffered from acute malnutrition in 2005-10than in the first half of the 2000s." The Child mortality index is based on i) under-five mortality ii) primary school aged children not in school and iii) prevalence of being underweight.
Source: South African Journal of Clinical Nutrition 25, pp 90 –92 (2012)More Less
There has been considerable debate on the impact of sugar in our daily diet. While the relationship between sugar and dental caries has long been known, the relationship of sugar to other disease conditions has only recently come to light. There is strong evidence to show that sugar-sweetened beverages increase the risk of the development of obesity and type 2 diabetes.
Source: South African Journal of Clinical Nutrition 25, pp 94 –111 (2012)More Less
Clinical nutrition has evolved from providing nutrients to meet the patient's needs to nutrition therapy that additionally aims to provide specific nutrients, or combinations thereof, which can reduce infection and improve outcomes in critically ill patients. The value of immunonutrition in the management of critically ill, preoperative and postoperative patients is now acknowledged by many healthcare practitioners. Amid the demonstration of clinical and economic benefit in defined conditions, South African practitioners should aim to translate current knowledge to best practice in order to optimise nutrition therapy and ultimately clinical outcome in critically ill patients. For the future, a paradigm shift to pharmaconutrition has been suggested. This practice dissociates the administration of key single nutrients, in the form of requirement based parenteral or enteral nutrition, from the delivery of pharmaconutrients in the full effective pharmacological dose, as evaluated in large, well-designed trials, in order to achieve therapeutic effects. This has been evaluated in large, well designed trials. The purpose of this review is not to provide an exhaustive overview of the available literature on immunonutrition, but rather to highlight key and recent significant studies, with a focus on energy and protein, glutamine, arginine, omega-3 fatty acids and micronutrients, and relate them to the South African context. Finally, the bigger picture should always be borne in mind, within the settings of the complexity of the acute phase response and the heterogeneity of the critical care population. As the evidence base evolves, the definition of optimal nutrition therapy should include all relevant components in the right mix, at the right time, to the right patients, to ensure optimal clinical benefit and outcome.
Source: South African Journal of Clinical Nutrition 25, pp 112 –119 (2012)More Less
Objectives: The aim of this study was to determine the overall level of job satisfaction among South African registered dietitians and possible relationships between the influencing factors.
Design: The design was a cross-sectional descriptive study.
Setting and subjects: A national survey was carried out among all dietitians registered with the Health Professions Council of South Africa,excluding community service dietitians.
Outcome measures: A two-part, self-administered, adapted job satisfaction survey questionnaire was used. Demographic data were collected. The questionnaire covered nine themes pertaining to job satisfaction: salary, promotion, knowledge and skills, professional colleagues, being a member of the multidisciplinary team, communication, the work environment, rewards of the job and nature of the work.
Results: A final response rate of 22.5% (n = 340) was obtained. South African registered dietitians were only slightly satisfied (65.7%) with their current employment. There was no significant difference (p-value = 0.291) pertaining to overall job satisfaction between those working and living overseas and those working and living in South Africa. Primarily, lower levels of satisfaction were observed to be due to poor salaries, lack of promotion opportunities and a poor perception of professional image. Significant positive correlations were found between age (p-value = 0.036), professional experience (p-value = 0.035), area of expertise (p-value = 0.001), hours of work (p-value = 0.021) and location of work (p-value = 0.00001).
Conclusion: Although overall job satisfaction scores indicated that South African registered dietitians are only slightly satisfied with their employment, registered dietitians reported that they love the nature of the work and what they do, tending towards confirmation of career satisfaction. Recommendations include re-evaluation of registered dietitian salary scales, career pathing with promotion opportunities,boosting the professional image and expanding the teaching of nondietetic skills to dietetic undergraduates.
Measuring micronutrient intakes at different levels of sugar consumption in a population in transition : the Transition and Health during Urbanisation in South Africa (THUSA) study : original researchSource: South African Journal of Clinical Nutrition 25, pp 122 –130 (2012)More Less
Objective: The objective was to investigate the absolute micronutrient intake and the possibility of micronutrient dilution of added sugar in the diets of an African population in nutritional transition.
Design: A cross-sectional, comparative, population-based design was used. Respondents who consumed sugar were divided into four quartiles of percentage of added sugar intake.
Setting: The setting was 37 randomly selected rural and urban areas of the North West province.
Subjects: The subjects were 1 742 adult volunteers (739 men and 1 003 women), aged between 15-65 years. After exclusion of low-energy reporters, the sample comprised 1 045 subjects (472 men and 573 women).
Outcome measures: The outcomes measures were the macronutrient and micronutrient intakes of subjects in different quartiles of added sugar intake and body mass index (BMI).
Results: The average intake of added sugar was 10.01% of total energy (67.12 g) in men and 11.2% total energy (67.10 g) in women. Respondents who consumed the most added sugar had significantly lower mean intakes of alcohol, but higher intakes of energy, macronutrients and most micronutrients. The diets of those in the highest sugar intake group contained significantly less thiamine, riboflavin, niacin, vitamin B12, pantothenic acid, biotin, magnesium, phosphorus and zinc per 4.18 MJ. At every level of added sugar consumption, the mean intakes of fibre (men only), folate, ascorbic acid and calcium (men and women) did not meet the dietary reference intakes [estimated average requirements (EAR)] and pantothenic acid and biotin (women only) did not meet the adequate intake. There were no significant differences in mean BMI across the quartiles of added sugar intakes in men, but the mean BMI of women who consumed the most added sugar was significantly higher than that of those who consumed less sugar. Respondents who consumed the most added sugar had significantly higher intakes of fruit (men only), bread and soft drinks, and lower intakes of maize meal and alcohol (men and women).
Conclusion: Absolute intakes of most micronutrients were significantly higher in consumers with a high sugar intake [Quartile (Q) 4] compared with the lowest consumers of sugar (Q1). The lowest percentages of participants whose micronutrient intakes fell below the EAR were in Q4 and Q3. However, expression of micronutrient intake per 4.18 kJ (micronutrient dilution) revealed significantly less of most micronutrients per 4.18 MJ for men and women who consumed the most added sugar, compared with those who consumed the least.
Weight gain, physical activity and dietary changes during the seven months of first - year university life in Malawi : original researchAuthor Alexander A. KalimbiraSource: South African Journal of Clinical Nutrition 25, pp 132 –139 (2012)More Less
Objective: The objective of the study was to assess weight gain, physical activity and dietary changes during the first year of university life in Malawi.
Setting: The setting was Bunda College of Agriculture, University of Malawi.
Subjects: The subjects were first-year students (n = 47) enrolled for the 2008/2009 academic year.
Method: A prospective cohort study was carried out, with repeated measures (November 2008 and June 2009). It included residential and nonresidential students. Data were collected using self-administered structured questionnaires. Weight, height and mid-upper-arm circumference were measured.
Results: There was a significant difference in mean weight gain between female (7.1 ± 3.2 kg, n = 26) and male students (9.6 ± 3.5 kg, n = 21) (p-value = 0.013). Overall, within the first year of university life, the students gained 8.5 ± 3.6 kg (p-value < 0.001), and a modest but significant height of 0.2 cm (p-value = 0.04). Body mass index (kg/m2) increased from 20.7 ± 3.2 to 23.9 ± 3.2 (p-value < 0.001). At the baseline, in general, the students lived sedentary lives, with 6.6 hours spent resting, 2.1 hours engaged in light activities, and 0.9 hours engaged in heavy activities. No significant changes were observed at the end of the study. Daily consumption of wheat products, meat and meat products, sugar, milk and milk products and margarine increased, while that of other foods such as fish, and fruits and vegetables declined.
Conclusion:Unprecedented freshman weight gain was observed in this study. Transition to university life in Malawi might be the beginning of poor dietary and lifestyle changes. If not restrained, these could elevate the risk of lifestyle diseases in people who have attained tertiary education and who are important to national development.
Source: South African Journal of Clinical Nutrition 25, pp 142 –148 (2012)More Less
Objective: To quantify the effect of common illnesses on energy intake in rural Kenyan children.
Design, setting and subjects: Toddlers in rural Kenya (n = 110) were studied longitudinally from 18-30 months of age in the mid-1980s.
Outcome measures: Morbidity data were collected weekly using an illness questionnaire and physical inspection. Food intake was quantitatively assessed on two successive days each month. Food intake on days of illness was compared to food intake on days of wellness and during convalescence.
Results: Significant decreases in mean daily energy intake were seen between days of wellness vs. days of severe illness. Above usual intake was observed during convalescence. Girls showed a greater reduction in intake during illness compared to boys. Food intake reductions were greatest in children with gastrointestinal (diarrhoea) and lower respiratory tract infections, measles and other febrile illnesses. In the case of severe illness, a compensatory increase in intake during week one of the convalescence period was observed, being greater in girls (376 kcal vs. 71 kcal extra per day for boys).
Conclusion: Food intake is decreased during common acute illnesses in children and increased above their usual intake during convalescence. Food should not be withheld from sick children and feeding should be actively encouraged during illness, particularly during convalescence with the return of appetite. These data, although somewhat dated, are still applicable to toddlers in rural Africa where malnutrition and feeding practices have changed very little.
Source: South African Journal of Clinical Nutrition 25 (2012)More Less
Cape Branch The Cape Branch of the Nutrition Society of South Africa hosted a half-day mini-symposium entitled "Ethics in nutrition - Current issues" on Thursday 17 May, 2012 at the Nutritional Intervention Research Unit of the Medical Research Council, Cape Town.
Northern Branch A joint symposium was held by the ADSA North-West and NSSA Northern branches. The very relevant topic "North West province making strides in breastmilk banking" was discussed on 25 July 2012, at the North-West University.
Source: South African Journal of Clinical Nutrition 25 (2012)More Less
Only a small number of truly exceptional international leaders have emanated from Africa. One of these is the South African Nobel Prizewinner, Nelson Mandela. In reality, Africa is poorly led and most African countries still carry the burden of neo-patrimonial leaders who cling to their own knowledge, ideas, judgments and leadership positions, while rarely accepting advice from followers. Africa is known to have well-intended reforms, but without the necessary galvanising action. While improved leadership in Africa might not be the only answer to addressing nutritional problems, it would definitely be a first step in the right direction.