South African Journal of Clinical Nutrition - Volume 26, Issue 2, January 2013

The triad of diarrhoea, pneumonia and stunting is the most deadly combination, especially early in a child's life, and if a child survives it in the short term, he or she remains prone to its effects later in adult life. Globally, it is estimated that in children under the age of five years, pneumonia and diarrhoea are responsible for 29% of child deaths, amounting to 2-million children, 90% of which occur in sub-Saharan Africa and South Asia.

The recurring issue of misleading and questionable advertising of nutritional supplements is one that should concern us, as professionals, whose code of practice and professional behaviour hinges on the need to provide the right information to our customers, whether they are hospital patients, the clients of dieticians in private practice, the public sector, or members of the public to whom we provide products on a commercial basis designed to improve their health and well-being. Our task is inherently simplified in situations in which we have formal legal provision to assist us to provide clear guidelines that pertain to the dissemination of correct information. However, in cases where regulation is either non-existent, insufficient, ambiguous or poorly enforced, our task is far more difficult, since in such cases it is far easier for unscrupulous commercial interests to impact upon the gullibility and lack of scientific information that the average consumer possesses. In particular, the perennial, understandable but naïve quest of consumers to find the proverbial "magic bullet" supplement, which does not exist, is even more difficult to manage. In these situations, we need to use our own judgement to a far greater extent. Of course, this entails strengthening our own scientific knowledge base of the topics concerned.

Omega-3 (n-3) fatty acids are essential to maintain satisfactory human health and need to be consumed in the diet. Western diets are often deficient in n-3 fatty acids because of an insufficient intake of cold water oily fish. The main n-3 fatty acids in fatty fish are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). To date, no formally accepted dietary reference intakes for EPA and DHA exist, while international intake recommendations differ widely. Supplementation is an easy and convenient way of increasing dietary n-3 fatty acid intake, but very little information is available to health professionals when advising consumers on choosing a supplement to suit their lifestyle. Reliable nutrition information on product labels is vital since misleading information may lead to erroneous dosages with concomitant adverse effects. Since no formal regulatory structure for dietary supplements currently exists in South Africa, consumers depend on self-regulation within the industry for assurance of product quality, consistency, potency and purity of n-3 fatty acid supplements. Therefore, the aim of this article is to equip health professionals with proper knowledge with special reference to the bioavailability of fish oil supplements, reliability of labelling information, dietary intake recommendations, potential adverse effects and some general advice when purchasing n-3 fatty acid supplements.

Objective: Nutritional supplements are inadequately regulated in South Africa. These types of products are increasingly advertised and the advertisements frequently contain health claims. Because advertisements play a considerable role in informing potential consumers, it is crucial that information about supplements in advertisements is accurate. A survey was carried out to determine the extent to which health claims are made in nutritional supplement advertisements and to describe the appropriateness of the research cited within the advertisements in support of the health claims.

---

Design: The design was a descriptive survey.

---

Method: The five women's magazines with the highest circulation figures in South Africa in July 2010 were identified by the Audit Bureau of Circulations of South Africa as Cosmopolitan, Finesse, Move!, Rooi Rose and Sarie. Issues of these magazines were obtained during the period from September 2010 to August 2011. Pre-specified eligibility criteria were used to identify suitable advertisements and to determine the percentage of nutritional supplements about which health claims were made. The percentage of these supplements for which research was cited in support of the claims was also determined, and the level and appropriateness of the cited research, described.

---

Results: In total, 486 eligible advertisements were identified which referred to 158 nutritional supplements. Of these, 137 (86.7%) made health claims and 9 of the 137 (6.6%) cited research to support their claims. The cited research was judged to be largely inappropriate based on study design and/or the characteristics of the study.

---

Conclusion: South Africans should be wary of advertisements that make claims about the health benefits and safety of nutritional supplements. Regulation of the advertising of nutritional supplements is urgently needed.

Objectives: To explore the female athlete triad components in university track and field athletes, as well as calculate estimated energy availability.

---

Design: Cross-sectional descriptive study design.

---

Setting and subjects: Sixteen volunteer, white, female track and field athletes were recruited from North-West University.

---

Outcome measures: Athletes completed a demographic, health and sport questionnaire; pathogenic body weight control questionnaire; menstrual history questionnaire; four 24-hour dietary recalls and one three-day diet and exercise record form. Body composition and bone mineral density (BMD) were assessed with dual energy X-ray absorptiometry. The bulimia, drive for thinness and body dissatisfaction subscales of the Eating Disorder Inventory, and the cognitive dietary restraint subscale of the Three-Factor Eating Questionnaire, was used to measure disordered eating behaviour. Estimated energy availability was calculated using a three-day dietary and exercise record form completed by the athlete on three heavy training days.

---

Results: In the total group, 25% had menstrual pattern changes, 62.5% disordered eating behaviour, 73.3% (11/15) low estimated energy availability, and 12.5% reported stress fractures during the past two years. The average estimated energy availability was 18.5 (14.1-40.9) kcal/kg fat-free mass/day. Diet or fat-burning pills were the most popular pathogenic weight-control measures used by 37.5% athletes. Athletes with menstrual pattern changes had lower spine [1.043 (0.975-1.059) vs. 1.166 (1.090-1.234) g/cm², p-value = 0.043] and femoral neck [0.905 ± 0.045 vs. 1.025 ± 0.027 g/cm², p-value = 0.042) BMD. Altogether, 87.5% athletes presented with various components of [sentence incomplete in article].

---

Conclusion: More than two thirds of this group of student track and field athletes had low estimated energy availability and more than three quarters were classified with various combinations of the components of the female athlete triad.

---

Objective: To assess the Infant and Young Child Feeding (IYCF) policy implementation among healthcare workers working at the Nelson Mandela Bay District (NMBD) public healthcare facilities.

---

Design: Descriptive survey using quantitative closed structured questionnaires.

---

Setting: Nursing professionals (n = 32) rendering maternal and child health services in 19 permanent NMBD clinics were included in a convenience sample in October 2011.

---

Method: The closed, structured questionnaire was developed based on statements contained within the 2007 IYCF policy and administered by one interviewer. Ethics approval was obtained and respondents had to provide informed written consent. Data were analysed by means of descriptive and differential statistics.

---

Results: Sixty-three per cent of nursing professionals were older than 40 years of age and more than half had already completed the Integrated Management of Childhood Illness (IMCI) and 20-hour IYCF training course. Respondents achieved a high mean score of 8.07 on knowledge of infant feeding in the context of human immunodeficiency virus (HIV). However, no association could be demonstrated between knowledge scores and previous training. Despite high scores on perceptions of the importance of IYCF counselling, 56% of the participants reported that they had never seen the IYCF policy before.

---

Conclusion: Relevant training in IYCF in the context of HIV, the availability of IYCF policy guidelines and monitoring of counselling and training of health professionals and volunteers, are some of the challenges that need to be addressed to improve implementation of IYCF policy in the NMBD district.

Background: Childhood malnutrition in developing countries contributes to developmental delays, as well as increased morbidity and mortality. The effectiveness of feeding programmes as a strategy to improve childhood malnutrition has been questioned.

---

Objective: A systematic review was undertaken to examine the effectiveness of preschool feeding programmes in fostering the growth of children in developing countries.

---

Design: A systematic literature search was undertaken to identify published studies that related to the objective. Studies had to be randomised intervention studies that reported on the growth outcomes of children from birth to six years of age in order to be included.

---

Setting: An initial literature search yielded 59 studies, of which 44 were excluded based on initial screening. Five more were omitted based on detailed data extraction. Ten studies met the inclusion criteria. The results of these studies were compared and narratively described in the context of the objective.

---

Results: The studies showed a great level of heterogeneity with regard to sample characteristics, intervention and reporting of results. In the context of recovery from malnutrition, most studies reported there to be a positive effect from feeding programmes. In studies that reported on weight gain, those that employed a supervised intake of food supplements resulted in higher rates of weight gain. Micronutrient fortification was described as having a positive influence on the rate of linear growth in studies that reported on linear growth. Intensive nutrition education aimed at mothers and caregivers is a sustainable way in which to change child feeding behaviour and may contribute to the effectiveness of nutrition intervention.

---

Conclusion: The limitations of the study included the following: there was a low number (59) of identified studies in the initial search because of the use of limited search terms, assessment of risk of bias was carried out by only one reviewer using a self-designed grading system, there were high levels of heterogeneity, and less than half of the individual studies were rated to be of a high quality. In view of these limitations, no firm conclusion can be drawn. Additional research, aimed at determining the impact of supplementary feeding programmes in supporting the growth of disadvantaged children, is encouraged.

Objective: Non-prescription, weight-loss products are advertised as quick-solution alternatives to long-term lifestyle changes.

---

Design: Cross-sectional descriptive.

---

Setting: Free State province.

---

Subjects: Fifty-six dieticians registered to the Free State branch of the Association of Dietetics in South Africa, excluding lecturers and students, and 88 pharmacists working in the Bloemfontein area.

---

Outcome measures: Structured telephonic interviews were conducted with 25 dieticians and 46 pharmacists to ascertain whether or not they had heard of the individual ingredients listed in non-prescription, weight-loss products and if they knew if each of these ingredients were scientifically proven to induce weight loss.

---

Results: Most dieticians and pharmacists reported that they had heard of green tea extract (92% and 89%), chromium picolinate (76% and 59%), apple cider vinegar (100% and 96%), lemon juice (100% and 87%) and alcohol (100% and 91%), respectively, being ingredients in weight-loss products. More dieticians and pharmacists reported that, to their knowledge, green tea extract (52% vs. 26%), chromium picolinate (52% vs. 15%), apple cider vinegar (64% vs. 33%), lemon juice (80% vs. 64%) and alcohol (76% vs. 61%), were not scientifically proven to be effective in attaining weight loss. Both groups included a percentage who were not familiar with the ingredients, or who thought that these ingredients had been demonstrated to be effective, despite no conclusive evidence existing in the literature.

---

Conclusion: Healthcare professionals need to actively educate themselves about non-prescription weight-loss products in order to guide the public and reduce consumer confusion.

Arrangements started for the next biennial congress of the Nutrition Society of South Africa and ADSA.

Social media and communications guideline

---

Ethics CPD article for all ADSA members

---

Professional indemnity cover

---