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- Volume 28, Issue 2, 2015
South African Journal of Clinical Nutrition - Volume 28, Issue 2, 2015
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Volume 28, Issue 2, 2015
Author Demetre LabadariosSource: South African Journal of Clinical Nutrition 28 (2015)More Less
The Editorial Board of the SAJCN is very excited to update their readers of the technological progress in the publishing world as well as informing our readers on the exciting developments ahead: "There is no doubt that there are considerably more challenges to a scholarly journal published in 2015 than simply preparing a paper copy that is timeously posted to its readership. We say this with great respect because not so long ago all our efforts were consolidated to achieve only that. However, printing a journal took much longer, and the publishing process was entirely streamlined in accordance with printing deadlines."
Author Renee BlaauwSource: South African Journal of Clinical Nutrition 28, pp 60 –61 (2015)More Less
Critical illness, sepsis, surgery, multi-organ failure and haemodynamic instability are conditions that are associated with feeding inadequacies and nutritional challenges. Conversely, meeting nutritional requirements and providing optimal nutrition are associated with an improved outcome. Since these facts have been reported repeatedly, why then are we still faced with study results on suboptimal feeding?
Complications relating to enteral and parenteral nutrition in trauma patients : a retrospective study at a level one trauma centre in South Africa : original researchSource: South African Journal of Clinical Nutrition 28, pp 62 –68 (2015)More Less
Objectives: The aim of the study was to compare the incidence of complications in patients receiving enteral and parenteral nutrition (PN), and review how the early initiation of enteral feeding and early achievement of caloric goal would affect the incidence of complications.
Design: The design was a retrospective audit of an ethics-approved prospective trauma registry and electronic medical record.
Setting: The setting was a level one trauma centre intensive care unit.
Subjects: One thousand and two consecutively treated patients were selected from 1 096 in the database.
Outcome measures: Demographic data, nutrition, route of administration, time of initiation and complications in the form of sepsis, pneumonia and feed intolerance, were determined.
Results: Patients receiving total PN (TPN) during their length of stay had a hazard ratio of 9.11 for the development of sepsis, compared to patients who were solely fed via the enteral route (p-value <0.001). The patients who reached their nutritional goal late showed a hazard ratio of 2.67 for the development of sepsis, compared to patients who reached the goal early (p-value < 0.001). Patients with late initiation of feeding also had a greater risk of developing sepsis, with a hazard ratio of 2.41, compared to patients with early initiation (p-value < 0.001). Patients achieving the nutritional goal late had a 17.9% increased risk of developing pneumonia (p-value < 0.001).
Conclusion: This study confirms previous findings that the use of TPN is a strong predictor of the development of sepsis, compared to enteral nutrition. Causality linkage should be made with caution owing to the study design.
Early enteral nutrition compared to outcome in critically ill trauma patients at a level one trauma centre : original researchSource: South African Journal of Clinical Nutrition 28, pp 70 –76 (2015)More Less
Objectives: The benefit of an early enteral nutrition start in critical ill patients is widely accepted. However, limited published data focus on trauma patients. This study aimed to investigate the effect of early enteral nutrition initiation on length of stay and mortality in an intensive care unit (ICU), as well as explore if enteral nutrition initiation could serve as a prognostic marker in trauma patients.
Design: This was a retrospective audit of a prospective ethics-approved database (University of KwaZulu-Natal Biomedical Research Ethics Committee No BE207-09) which compared enteral nutrition to outcome.
Setting: The setting was a level 1 trauma ICU in Durban, South Africa.
Subjects: The subjects were critically ill trauma patients.
Outcome measures: Demographic data, enteral nutrition timing, feed tolerance, and the outcome of early versus late initiation of enteral feeding were the outcome measures.
Results: Nine hundred and fifty-two patients were included. Eight hundred and ninety-eight received enteral nutrition and were divided into three subgroups (tertiles T1-T3) according to their Injury Severity Score (ISS). The statistical analysis demonstrated that an early enteral nutrition start had a significant positive effect on both length of stay (13.7 vs. 16.4 days, p-value 0.00315) and mortality (9.5 % vs. 20.7 % p-value 0.0062). A multiple logistic regression model was developed, using multiple variables, to test the factors that affected the outcome. There was a significant effect on length of stay with an early enteral nutrition start in patients with a low to medium ISS (T1), and a highly significant effect on mortality in patients with a low to medium, and high, ISS (T1 and T2). Early initiation of enteral nutrition is strongly favoured in regression analyses.
Conclusion: Patients in the trauma ICU benefit from an early enteral nutrition. The model used featuring the three independent variables, i.e. the day on which enteral nutrition is commenced, age and ISS, may serve as a prognostic marker with regard to length of stay and mortality in the ICU.
Source: South African Journal of Clinical Nutrition 28, pp 77 –80 (2015)More Less
Morals refer to a belief-derived system according to which a certain group governs its behaviour, whereas ethics is a broader term whereby belief-system-based behaviour is replaced by a generic code of behaviour, often founded in an international code. In South Africa, the Health Professions Council of South Africa (HPCSA) is a statutory body which was established in terms of the Health Professions Act (No 56 of 1974) to regulate the behaviour of practitioners, and which is committed to serving and protecting the public and providing guidance to registered healthcare practitioners. This study analyses the case content of all guilty verdicts relating to professional standard breaches and ethics misconduct against HPCSA-registered dietitians in the period 2007-2013. One core finding of the study was that a guilty verdict of unethical behaviour against dietitians in South Africa occurs very rarely. Even though dietitians may not be prone to unethical behaviour, it is strongly recommended that thorough, in-depth training in ethics, including bioethics and professional integrity, forms an integral and compulsory part of all undergraduate and postgraduate dietetic programmes.
The intake and quality of breakfast consumption in adolescents attending public secondary schools in the North West province, South Africa : original researchSource: South African Journal of Clinical Nutrition 28, pp 81 –88 (2015)More Less
Objectives: The objectives of the study were to determine the proportion and quality of breakfast intake in adolescents, and to determine the effect of breakfast intake and quality on overall diet quality.
Design: A cross-sectional quantitative study design was used.
Setting: The setting was seven public secondary schools in Potchefstroom and the surrounding areas in North West province.
Subjects: The subjects were randomly selected adolescents in grades 9-11 (n = 244).
Outcome measures: A self-administered demographic questionnaire was completed by the adolescents. Single 24-hour recall, using the four-stage multiple-pass method, was conducted to obtain information on breakfast and dietary intake for the day. Breakfast quality was measured by applying a breakfast quality score. The Diet Quality Index Revised was used to assess the quality of the overall diet. Spearman's rank correlation coefficient was employed to assess an association between the continuous variables. The chi-square or Fisher's exact test was utilised to assess an association between the categorical variables.
Results: The proportion of breakfast intake and skipping was 81% and 19%, respectively. The mean breakfast quality score was moderate (3.1). No significant difference was shown in the diet quality score for the breakfast eaters and skippers. The breakfast quality score was marginally associated with calcium intake (p-value < 0.0001, r = 0.418), phosphorous intake (p-value < 0.0001, r = 0.378) and total diversity score (p-value < 0.0001, r = 0.369).
Conclusion: The proportion of breakfast skipping, moderate quality of the breakfast consumed and trend of improved nutrient intake with improved breakfast quality highlights the need for breakfast education and intervention as part of the Integrated School Health Policy.
Source: South African Journal of Clinical Nutrition 28, pp 89 –91 (2015)More Less
Dietetics is a constantly evolving scientific field, and challenges for the dietitian are not restricted to private practice, but rather span across all sectors of the profession, and are an opportunity for personal and professional growth. The need for evidence-based care and sound scientific information in the context of the vast entity of the Internet and social media are indeed daunting in terms of both challenges and opportunities. Developing the appropriate marketing and business skills can be beneficial during the journey of lifelong learning and in the process of becoming a health professional who is known for excellent service delivery and professionalism.
Author R. BlaauwSource: South African Journal of Clinical Nutrition 28, pp 92 –96 (2015)More Less
The following case study was discussed at the SASPEN Workshop held during the Nutrition Congress 2014. It is a reflection of the general opinion of the audience, followed by a rationale of the latest literature on the topic. Herewith follows a summarised discussion of the case.
Source: South African Journal of Clinical Nutrition 28 (2015)More Less
The 9th World Congress on Developmental Origins of Health and Disease (DOHAD) will be held at the Cape Town International Convention Centre, Cape Town, from 8-11 November 2015. The congress brings together scientists, clinical researchers, obstetricians, paediatricians, public health professionals and policy leaders from around the world. Experts will address the many challenges which currently impact upon the health of mothers, babies in the womb, infants, children and adolescents, as well as explore solutions, interventions and policies to optimise health across the life of people.
Source: South African Journal of Clinical Nutrition 28 (2015)More Less
Building on the success of the road show, "Back to Basics", conducted in 2014, SASPEN took the training to the Free State in May 2015. This was the final "Back to Basics" road show to be hosted by SASPEN. We have managed to reach five of the nine provinces with this road show and the SASPEN committee would like to thank you for giving us the opportunity to visit you and participate in uplifting the dietetic profession in your province!