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- Volume 27, Issue 4, 2014
South African Journal of Clinical Nutrition - Volume 27, Issue 4, 2014
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Volume 27, Issue 4, 2014
Source: South African Journal of Clinical Nutrition 27 (2014)More Less
With great sadness the SAJCN's Editorial Management Board and the Councils of its parent Societies, Association for Dietetics in South Africa (ADSA), the Nutrition Society of South Africa (NSSA) and the South African Society for Parenteral and Enteral Nutrition (SASPEN), wishes to inform its members of the premature passing on the 11th November of Dr Douw Greeff, the CEO of our publishing company, Medpharm Publications, which Douw established as a landmark entity in the medical publishing domain over the past 25 years.
Eating disorders in South African schools : a public health crisis that needs immediate intervention : guest editorialAuthor Zandile MchizaSource: South African Journal of Clinical Nutrition 27, pp 185 –186 (2014)More Less
This South African Journal of Clinical Nutrition issue opens another window of opportunity for targeted interventions to be urgently implemented that will encourage a positive body image in young South African women of diverse ethnicities. South Africa is a unique multicultural society which comprises various cultural and religious groups. These groups contend with body image dissatisfaction due to the influences of Western culture that stretch far beyond the communities that are traditionally considered to be "Western".
Nutritional management of acute kidney injury in the critically ill : a focus on enteral feeding : review articleAuthor J. DownsSource: South African Journal of Clinical Nutrition 27, pp 187 –193 (2014)More Less
Optimal nutritional management of critically ill patients who present with acute kidney injury (AKI) is paramount. The management of this patient population is probably more complicated than that of chronic care haemodialysis (HD) patients as AKI patients have significant protein catabolism, insulin resistance (abnormal carbohydrate metabolism) and an altered fat metabolism, and AKI patients on continuous renal replacement therapy (RRT) are at greater risk of protein and micronutrient losses. The primary goals of nutritional management of AKI patients are to attenuate protein (muscle) catabolism, and to replace micronutrient losses, specifically folic acid, thiamine and selenium, while being mindful of the potentially harmful effects of excessive vitamin C and vitamin A in retinol form. Hence, it is prudent, if standard enteral feeds are used, that the latter are considered, especially if the patient is on RRT. The majority of intensive care units (ICUs) in South Africa do not have scale beds or Bluetooth bed scales to accurately measure body weight, which is required to accurately determine fluid and nitrogen balance. Nitrogen balance is required for the calculation of the appropriate prescription of protein. Hence, critically ill AKI patients on RRT are at possible risk of the provision of either insufficient or excessive protein. Insufficient protein intake in catabolic AKI patients is associated with an increased mortality risk. A good understanding of the classification of patients with AKI, the types of RRT used in the management of these patients, the specialised macronutrient and micronutrient requirements, and appropriate fluid management is required for the appropriate dietary management of critically ill AKI patients. The aim of this review is to address all of these. To achieve optimal nutritional management of AKI patients in the ICU, especially those on RRT in South Africa, it is critically important that the lack of ICU scale beds and ready-to-hang specialised dialysis enteral feeds is addressed.
Under- and overnutrition and evidence of metabolic disease risk in rural black South African children and adolescents : original researchSource: South African Journal of Clinical Nutrition 27, pp 194 –200 (2014)More Less
Objectives : The objective was to determine the prevalence of under- and overnutrition, as well as evidence of metabolic disease risk in rural black South African children and adolescents.
Design : A cross-sectional study was conducted.
Setting : The setting was the Agincourt Health and Socio-demographic Surveillance System site, Mpumalanga province.
Subjects : Six hundred children were randomly selected, of whom 588 were included in the analytical sample (mean age of 11.5 years, range of 7-15 years).
Outcome measures : Outcome measures were anthropometric and blood pressure assessments, Tanner pubertal staging, as well as the determination of fasting serum lipid and glucose concentrations.
Results : Using age and sex-specific World Health Organization 2007 growth references, the prevalence of stunting was determined to be 6.2% in the boys, and 2.7% in the girls, while 4.1% of the boys and 4.4% of the girls were underweight. Combined overweight and obesity prevalence was higher in the girls (13.5%) than in the boys (2.7%). Girls had significantly a higher body mass index and hip circumference than the boys in the early, mid and late pubertal stages. Pre-hypertension prevalence, using either systolic or diastolic blood pressure for sex, age and height, was 15% and 10% in the girls and boys, respectively. Furthermore, impaired fasting glucose (FG) (FG ≥ 5.6 mmol/l) was detected in 5% of the children. High-density lipoprotein cholesterol concentrations less than 1 mmol/l were observed in 0.7% of the boys and in 12% of the girls, which is indicative of cardiometabolic risk.
Conclusion : Stunting levels were higher in the boys than in the girls in mid to late childhood in a rural setting in South Africa, while the girls had a higher prevalence of overweight and obesity than the boys. Pre-hypertension prevalence in the boys and girls was high. Other metabolic risk factors, i.e. impaired FG and lipids, were also seen in this population and were associated with adiposity. The study highlights the critical need for targeted health promotion interventions to optimise child health as part of a noncommunicable disease preventative strategy.
Adolescent food frequency and socio-economic status in a private urban and peri-urban school in Hilton, KwaZulu-Natal : original researchSource: South African Journal of Clinical Nutrition 27, pp 201 –207 (2014)More Less
Objective : The objective of the study was to make a comparative analysis of the dietary preferences of adolescents attending an urban versus a peri-urban school in KwaZulu-Natal, in order to investigate the association between socio-economic status and food frequency.
Design : The design was a cross-sectional descriptive survey.
Setting : The setting was an urban and peri-urban high school in Hilton, KwaZulu-Natal.
Subjects : One hundred and eleven grade 9-11 learners from a peri-urban school, and 98 grade 9-11 learners from an urban school, volunteered to participate.
Outcome measures : A non-quantified food frequency questionnaire was used to assess food frequency. A socio-demographic questionnaire developed for the purpose of this study was utilised to collect information on parental education, employment status and household or accommodation data. A Household Food Insecurity Access Scale questionnaire was used to determine the household food insecurity of the learners.
Results : The findings indicated that there was a higher preference for globalised foods (high in fat and sugar), particularly fast food, by learners from the peri-urban school (p-value < 0.01). These learners were also more likely to consume locally available, high-fat snacks (p-value < 0.01). Grade 10 urban school learners consumed more red meat and processed meats than their peri-urban school counterparts (p-value < 0.01). Negative correlations were observed between parental education and employment status (particularly of the mothers) and fast food consumption in adolescents (p-value < 0.01).
Conclusion : A high frequency of globalised or energy-dense food intake was associated with low socio-economic status. Although healthy eating habits were generally poor in urban and peri-urban adolescents, food sources varied, possibly owing to cost and availability. The importance of a diverse diet and the inclusion of a wider range of affordable, nutrient-rich foods should be promoted in the school setting, and also to parents, particularly those of a lower socio-economic status.
Abnormal eating attitudes and weight-loss behaviour of adolescent girls attending a "traditional" Jewish high school in Johannesburg, South Africa : original researchSource: South African Journal of Clinical Nutrition 27, pp 208 –216 (2014)More Less
Objectives : This study aimed to determine the prevalence of abnormal eating attitudes and weight-loss behaviour in female Jewish adolescents. Teachers' awareness of these factors and their attitudes towards a school programme to address these were also investigated.
Design : A cross-sectional study was conducted.
Subjects and setting : Female learners in grades 8-11 (n = 220), attending a "traditional" Jewish high school in Johannesburg were included. Teachers (n = 38) at the relevant school were also recruited.
Outcome measures : A questionnaire consisting of the 26-item version of the Eating Attitudes Test (EAT-26) and a modified section of the USA Youth Risk Behavior Survey was completed by learners. Teachers completed a questionnaire designed by the researchers.
Results : Twenty per cent of the learners (n = 43) achieved EAT-26 scores ≥ 20, suggestive of a possible eating disorder, while 30.2% (n = 65) required clinical evaluation for a potential eating disorder. Thirty-three per cent (n = 72) of the adolescent girls considered themselves to be overweight, while 64% (n = 139) were trying to lose weight at the time of the study. 19.1% (n = 42) had engaged in one or more extreme methods of weight loss in the past 12 months. Most teachers (81.6%, n = 29) underestimated the proportion of adolescent girls requiring clinical evaluation and 71.1% (n = 27) underestimated the extent of current weight-loss attempts. Almost all of the teachers (97.3%, n = 37) recognised the need to address disordered eating attitudes. However, only 34.2% of the teachers (n = 13) viewed the school as the appropriate place in which to do this, and were also prepared to participate in the programme and sacrifice class time.
Conclusion : To date, no published South African literature documents the presence of abnormal eating attitudes in Jewish adolescent females in South Africa. The prevalence fell within the upper end of rates reported in studies on adolescent girls in South Africa and abroad. Teachers who participated in this study were not fully aware of the extent to which eating-related issues affected female learners. A qualitative exploration thereof could yield valuable insights.
Acceptance of a complementary food prepared with yellow, provitamin A-biofortified maize by black caregivers in rural KwaZulu-Natal : original researchSource: South African Journal of Clinical Nutrition 27, pp 217 –221 (2014)More Less
Objectives : The objective was to assess the sensory acceptability and consumer perceptions of soft porridge made with yellow, provitamin A-biofortified maize by black African female infant caregivers from rural KwaZulu-Natal.
Design : This was a cross-sectional study.
Setting : The study was conducted at Edendale Hospital, located in the uMgungundlovu District, KwaZulu-Natal province. The hospital serves a high proportion of people from rural areas in this district.
Subjects : Sixty black African female infant caregivers participated in the study.
Outcome measures : The sensory acceptability of soft porridge made from two varieties of provitamin-A biofortified maize and one variety of white maize were evaluated by black African female infant caregivers (n = 60) using a five-point facial hedonic scale. Some of the subjects (n = 21) participated in focus group discussions to assess consumer perceptions.
Results : There was no significant difference in the sensory acceptability of the biofortified maize porridge and the white maize porridge, irrespective of caregiver age (p-value > 0.05). The caregivers expressed a willingness to give their infants porridge made with provitamin A-biofortified maize if it was more affordable, readily available and beneficial to health.
Conclusion : The biofortified maize soft porridge was found to be as acceptable as the white maize soft porridge to black African female infant caregivers from rural KwaZulu-Natal. Provitamin A-biofortified maize has the potential to be used as a complementary food item that would contribute to the alleviation of vitamin A deficiency.
Nutritional quality of a ready-to-use food, and its acceptability to healthy and HIV-infected children receiving antiretroviral treatment : original researchSource: South African Journal of Clinical Nutrition 27, pp 222 –227 (2014)More Less
Objectives : The objectives of this study were to determine the nutritional quality of a ready-to-use food (RUF), and its acceptability to children who were "healthy" and to those who were human-immunodeficiency virus (HIV)-infected and receiving antiretroviral therapy (ART).
Design : This was a cross-sectional survey that assessed the consumer acceptability of the RUF by the children.
Setting and subjects : One hundred and eighty-eight children were selected from six schools, a day care and a hospital in Pietermaritzburg. Of these children, 123 were "healthy", and 65 HIV-infected and receiving ART.
Outcome measures : The outcome measure of the study was the nutritional quality of the RUF in terms of its nutrient levels relative to appropriate nutritional standards, and its acceptability rating by the children.
Results : The RUF had appreciable levels of energy (2 624 kJ/100 g) and protein (15.7 g/100 g).The nutritional composition met the World Health Organization/World Food Programme/the United Nations Standing Committee on Nutrition/The United Nations Children's Fund recommendations for an RUF regarding energy, protein and essential amino acid levels. Sensory evaluation indicated that the RUF was acceptable to both children who were healthy and to those who were HIV-infected. Generally, more than 75% of the participants in both groups rated the product overall as "good". More than 65% of the children liked the taste, smell and mouth feel.
Conclusion : The RUF that was used in this study is a good source of energy and quality protein, and is acceptable to children. Further micronutrient analysis would determine the additional role of the RUF in alleviating micronutrient deficiencies, including vitamin A, zinc and iron. Since the RUF is acceptable to children who were healthy and to those who were HIV-infected on ART, it can be used to address protein-energy malnutrition in these target groups.
Source: South African Journal of Clinical Nutrition 27 (2014)More Less
As part of its growth and development programme, SASPEN is now a block member of the European Society for Clinical Nutrition and Metabolism (ESPEN), and has a seat on the ESPEN Board. Arina Prins, our President, attended a board meeting in Geneva prior to the ESPEN 2014 Congress in September. The collaboration with ESPEN brings considerable opportunities to block members, such as research grants, and access to the ESPEN journals and LLL courses.
Nutritional management of a complicated surgical patient by means of fistuloclysis : SASPEN case studyAuthor A. Du ToitSource: South African Journal of Clinical Nutrition 27, pp 230 –236 (2014)More Less
A fistula is defined as an abnormal communication between two organs, an organ and the skin, or an organ and a wound. Up to 70% of patients with fistulae present with malnutrition. Enteral nutrition (EN) has considerable advantages over parenteral nutrition (PN) support, including improved gut barrier function, a reduction in infectious morbidity and improved immune function. EN support remains the preferred route of nutrition support in patients with fistulae, unless it causes a significant increase in fistula output, abdominal pain or exacerbates diarrhoea. Fistuloclysis, i.e. enteral feeding via an intestinal fistula, is an effective means of providing nutritional support to these patients and can replace the need for PN support.