Safety of Micronutrients

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Hospital malnutrition in children : what are the challenges?

CITATION: Blaauw, R. 2018. Hospital malnutrition in children : what are the challenges?. South African Journal of Clinical Nutrition, 31(1):4-5.The original publication is available at http://www.sajcn.co.zaNo abstract availablehttp://www.sajcn.co.za/index.php/SAJCN/article/view/1329Publisher's versio

Diagnosis of hospital malnutrition in the adult population

CITATION: Blaauw, R. 2017. Diagnosis of hospital malnutrition in the adult population. South African Journal of Clinical Nutrition, 32(1):8-10It is well known that malnutrition is associated with increased morbidity (increased complications1-3 and longer length of ICU and hospital stay1-4) as well as increased mortality.1-6 Early identification and appropriate management of malnutrition on the other hand is associated with improved outcomes.7 Nutritional status screening and assessment therefore should be performed on all patients on admission to hospital.8,9 Those identified as malnourished or at-risk of developing malnutrition should be referred for specialised nutrition support in an attempt to correctly manage and improve nutritional status.EditorialPublishers’ Versio

Body fat distribution as a risk factor for osteoporosis

Objective: The aim of this study was to compare the body fat distribution of patients with osteoporosis (GP) with that of an appropriately matched non-GP control group. Design: Case control study. Setting: Department of Endocrinology and Metabolism, Tygerberg Hospital. Participants: A total of 56 patients with histologicatly proven idiopathic GP, of whom 39 were women (mean age 61 ± 11 years) and 17 men (49 ± 15 years), were compared with 125 age- and sex-matched non-OP (confirmed by dual energy X-ray absorptiometry) subjects, 98 women (60 ± 11 years) and 27 men (51 ± 16 years). Outcome measures: Anthropometric data, including weight, height, skinfold measurements, mid-upper arm, waist and hip circumferences, as well as elbow breadth. Results: The men and women with OP were significantly shorter (P = 0.04 and P = 0.03 respectively) and of lower body mass (P = 0.04 and P = 0.02 respectively) than the control subjects, although their mean body mass indices were comparable. The OP population had significantly lower skinfold, elbow breadth and ann circumference values, although the majority of subjects in both groups fell within the 15 - 85th percentiles. Despite their lower body mass, both the OP women (P = 0.009) and men (P =0.002) had significantly higher waist/hip ratios than corresponding controls. Conclusion: Whatever the underlying pathogenesis, this new finding suggests that, should these results be confirmed by larger studies, OP can be added to the list of diseases associated with a waist fat distribution.S Afr Med J 1996; 86: 1081-108

The impact of existing diabetes self-management education interventions on knowledge, attitudes and practices in public health care institutions in Harare, Zimbabwe

CITATION: Nkomani, S., Ruskaniko, S. & Blaauw, R. 2019. The impact of existing diabetes self-management education interventions on knowledge, attitudes and practices in public health care institutions in Harare, Zimbabwe. South African Journal of Clinical Nutrition, 34(1):27-33, doi:10.1080/16070658.2019.1641272The original publication is available at https://www.tandfonline.com/toc/ojcn20/currentIntroduction: Diabetes self-management education (DSME) and medical nutrition therapy (MNT), provided by diabetes educators and registered dietitians respectively, considerably improve glycaemic control. However, it is unknown what interventions exist in many African countries and the impact thereof. Aim: To determine the impact of existing DSME interventions on knowledge, attitudes and practices (KAP) of adults with type 2 diabetes attending public health care facilities in Harare, Zimbabwe. Methods: A cross-sectional, researcher-administered survey was designed to assess DSME KAP at eight outpatient diabetes clinics that provide diabetes services. Participants were conveniently sampled. Associations between mean scores for knowledge, attitudes and practices were compared between characteristics of DSME interventions. Results: A total of 154 participants were recruited and divided evenly between two tertiary (n = 77) and six primary outpatient clinics (n = 77). The mean age was 61.8 years (SD ± 12.7), mean years since diagnosis with diabetes was 8.1 years (SD ± 8.3) and the majority were females (66.9%, n = 103). Most participants (90.3%, n = 139) reported receiving some DSME. Participants most frequently cited a tertiary clinic as the place where DSME was received. Fewer had consulted a dietitian (49.0%, n = 76) or diabetes educator (52.0%, n = 80). Higher levels of diabetes knowledge were observed for tertiary clinic attendees (p = 0.00), consultation with a dietitian (p < 0.01) and diabetes educator (p = 0.00). Only those who had consulted a dietitian reported better adherence to dietary guidelines (p = 0.00) and physical activity (p = 0.02) self-care behaviours. Conclusion: Dietitian-led interventions significantly improved both knowledge and practices, highlighting a need to scale up dietetic intervention, particularly in primary clinics where limited interventions occur.https://www.tandfonline.com/doi/full/10.1080/16070658.2019.1641272Publisher’s versio

Obesity and other nutrition related abnormalities in pre-dialysis chronic kidney disease (CKD) participants

CITATION: Ebrahim, Z., Moosa, M. R. & Blaauw, R. 2019. Obesity and other nutrition related abnormalities in pre-dialysis chronic kidney disease (CKD) participants. Nutrients, 12(12):3608, doi:10.3390/nu12123608.The original publication is available at http://www.mdpi.comPublication of this article was funded by the Stellenbosch University Open Access FundChronic kidney disease (CKD) is increasing in sub-Saharan Africa. Undernutrition has been prevalent amongst end stage CKD patients, with limited data on the prevalence of obesity. The aim of this study was to assess the nutritional status of CKD patients using various methods sensitive to over and under-nutrition. Stage 3 to 5 CKD patients (glomerular filtration rate (GFR) < 60 mL/min/1.73 m2) attending a pre-dialysis clinic in Cape Town, were enrolled. Exclusion criteria included infectious and autoimmune conditions. Sociodemographic, clinical and biochemical data were collected, and anthropometric measurements were performed. Dietary intake was measured with a quantified food frequency questionnaire (FFQ). Statistical Package for the Social Sciences (SPSS) version 26 was used for statistical analysis. Seventy participants, with mean age of 41.8 ± 11.8 years, 52.9% females and 47.1% males were enrolled. Participants enrolled mainly had stage 5 kidney failure. Thirty percent were overweight (21) and 25 (36%) were obese, 22 (60%) of females were overweight and obese, while 13 (39.4%) of males were predominantly normal weight. Abdominal obesity was found in 42 (60%) of participants, mainly in females. Undernutrition prevalence was low at 3%. Dietary assessment showed a high sugar and protein intake. There was a high prevalence of overweight, obesity and abdominal obesity in CKD stage 35 patients, with unhealthy dietary intake and other nutritional abnormalities.https://www.mdpi.com/2072-6643/12/12/3608Publisher's versio

Omega-3 Fatty Acid and Iron Supplementation Alone, but Not in Combination, Lower Inflammation and Anemia of Infection in Mycobacterium tuberculosis-Infected Mice

Progressive inflammation and anemia are common in tuberculosis (TB) and linked to poor clinical outcomes. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have inflammation-resolving properties, whereas iron supplementation in TB may have limited efficacy and enhance bacterial growth. We investigated effects of iron and EPA/DHA supplementation, alone and in combination, on inflammation, anemia, iron status markers and clinical outcomes in Mycobacterium tuberculosis-infected C3HeB/FeJ mice. One week post-infection, mice received the AIN-93 diet without (control) or with supplemental iron (Fe), EPA/DHA, or Fe+EPA/DHA for 3 weeks. Mice supplemented with Fe or EPA/DHA had lower soluble transferrin receptor, ferritin and hepcidin than controls, but these effects were attenuated in Fe+EPA/DHA mice. EPA/DHA increased inflammation-resolving lipid mediators and lowered lung IL-1α, IFN-γ, plasma IL-1β, and TNF-α. Fe lowered lung IL-1α, IL-1β, plasma IL-1β, TNF-α, and IL-6. However, the cytokine-lowering effects in the lungs were attenuated with Fe+EPA/DHA. Mice supplemented with EPA/DHA had lower lung bacterial loads than controls, but this effect was attenuated in Fe+EPA/DHA mice. Thus, individually, post-infection EPA/DHA and iron supplementation lowered systemic and lung inflammation and mitigated anemia of infection in TB, but not when combined. EPA/DHA also enhanced bactericidal effects and could support inflammation resolution and management of anemia

PSR J1024-0719:A Millisecond Pulsar in an Unusual Long-Period Orbit

PSR J1024-0719 is a millisecond pulsar that was long thought to be isolated. However, puzzling results concerning its velocity, distance, and low rotational period derivative have led to a reexamination of its properties. We present updated radio timing observations along with new and archival optical data which show that PSR J1024-0719 is most likely in a long-period (2-20 kyr) binary system with a low-mass (approximate to 0.4 M-circle dot), low-metallicity (Z approximate to -0.9 dex) main-sequence star. Such a system can explain most of the anomalous properties of this pulsar. We suggest that this system formed through a dynamical exchange in a globular cluster that ejected it into a halo orbit, which is consistent with the low observed metallicity for the stellar companion. Further astrometric and radio timing observations such as measurement of the third period derivative could strongly constrain the range of orbital parameters

The use of specialised enteral formulae for patients with diabetes mellitus

Short surveyThe majority of enteral nutrition products for diabetes mellitus have a carbohydrate content of 30-45% and fat between 40-49%, mainly monounsaturated fat, with a mix of soluble and insoluble fibre (total of 14-24 g/l). Does this have short- and long-term benefits and which component(s) is/are crucial for the outcome or is it the combination that counts? Both manipulations of DM specific enteral formulae, i.e. addition of fibre and altered carbohydrate to fat percentage seem to be effective for short-term glucose control, but do not show convincing evidence regarding lipid management. In terms of gastro-intestinal function, there seems to be adequate evidence that fibre plays an important role for the management of diarrhoea and constipation. The implications of high fat intake on the longer-term, especially in patients suffering from gastroparesis, are less clear

Prospektiewe risikofaktor-analise in pasiente met bewese osteoperose

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