Eat clean and safe food: a food-based dietary guideline for the elderly in South Africa

As the population of elderly individuals in South Africa (SA) grows, there is a need to promote the continued health of these persons as they progress through the life cycle. Food Based Dietary Guidelines (FBDGs) for the SA elderly were developed to address this need. These thirteen guidelines for the elderly collectively offer a basis of health practices that the elderly can follow to ensure that they are taking the right steps toward maintaining their health. While the guideline ‘Eat clean and safe food’ is not included in the current SA FBDGs, this recommendation is of particular importance to the elderly, who face a much higher risk of foodborne illness than most of the general population due to a number of factors. Reduced immunity and other physiological changes are a result of ageing, malnutrition, diseases and and/or medication side effects. All these factors play a role in the elderly’s risk of foodborne illness. Increased susceptibility to certain pathogens also causes higher rates of foodborne illness infection. Lastly, elderly people’s food safety knowledge and pre-established beliefs and practices regarding food handling and preparation can be influential in their sensitivity to foodborne disease. These risk factors, coupled with the heavy burden of foodborne illness and existing gaps in food safety policy, practices and education in SA, substantiate the need for a dietary guideline to address the importance of clean and safe food consumption among the elderly in SA

An introduction to the Food-Based Dietary Guidelines for the Elderly in South Africa

Food-based dietary guidelines (FBDGs) are not a new concept and are being used in many countries to promote healthy eating and the prevention of diet-related chronic diseases. The Food and Agriculture Organization (FAO) recommended FBDGs as an approach to prevent malnutrition and promote healthy dietary behaviours in populations, taking into consideration local conditions, traditional dietary practices and socioeconomic and cultural factors whilst at the same time using evidence-based scientific principles. South Africa (SA) currently has two sets of guidelines, namely the paediatric food-based dietary guidelines and the South African FBDGs for the population aged seven years and older. The recognition that elderly malnutrition remains a major public health concern in SA led to the formulation of a specific set of guidelines for this vulnerable population group based on existing nutrition-related health issues, local dietary habits and barriers to food intake experienced by those aged 60 and above. This introductory paper on the development of the elderly food-based dietary guidelines (EFBDGs) will be followed by six technical papers motivating why these guidelines are suited to address nutrition-related issues among the elderly in SA

Be active: a food-based dietary guideline for elderly South Africans

The goal of this paper is to support the ‘Be active!’ food-based dietary guideline (FBDG) for South Africans of seven years and older by means of a technical guideline regarding physical activity (PA) specifically for the elderly. Optimal nutrition and physical activity (PA) are essential to ensure healthy ageing. PA is an integral part of a healthy lifestyle; however; the rate of low PA in the elderly (59.7%) is high in South Africa (SA). Regular PA reduces the risks of chronic diseases, such as diabetes, high blood pressure, heart diseases and cancers. Therefore, this review study aims to gather available information concerning PA and suitable methods to promote PA among the elderly in SA. Lack of environmental support for PA, trainers, PA-educated caregivers, poor knowledge about the recommended level of PA and its benefits, lack of motivation by healthcare providers, poor health and nutritional status, and lack of opportunity for social engagement prevent the elderly from participating in PA. Elderly individuals without any physical challenges should participate in at least 150 minutes of moderate-intensity aerobic PA in a week, or at least 75 minutes per week of vigorous-intensity aerobic PA or an equivalent combination of both types of aerobic PA. It is better to start PA slowly and increase the duration and frequency gradually. Even those who have some disease limitations should try to change their status from ‘inactive or no activity’ to ‘some level of activity’ to enjoy the health benefits of PA. More research and programmes focusing on promotion of PA need to be implemented in order to improve PA among the elderly in SA

‘Drink clean, safe water and/or other fluids through-out the day even if you do not feel thirsty’: a food-based dietary guideline for the elderly in South Africa

This review summarises information from available literature to support the dietary guideline ‘Drink Clean, Safe Water and/or Other Fluids Through-Out the Day Even if You Do Not Feel Thirsty’ set for the elderly of South Africa (SA). Water is essential for life and is necessary for important functions of the body like maintenance of tissue structure, blood volume regulation, temperature regulation and excretion of metabolites through kidneys. Though water is necessary for all, the elderly are especially at risk of dehydration due to altered hormonal activity and body functions that reduce their sensitivity to thirst (water intake) and urination (water excretion). Total body water is also reduced in the elderly, so they are unable to buffer the effects of water loss in the body. Therefore, water intake should be monitored properly in the elderly so that they can lead a happy and healthy life and reduce the economic burden due to hospitalisation caused by water imbalance or dehydration, which is common in the elderly. Two litres of water per day is generally considered adequate, but there is no consensus regarding the exact requirement for water as need varies due to climate and physical activity levels. The importance of water to maintain bodily functions and the risk of dehydration substantiate the need for a dietary guideline to address the importance of clean and safe water/fluid consumption regularly throughout the day among the elderly in SA

If you drink alcohol, drink sensibly: a food-based dietary guideline for the elderly in South Africa

The use and misuse of alcohol has become a public health problem among the South African (SA) elderly population, among whom risky drinking is a common practice. Previous publications encouraging alcohol use have referred to two supposedly beneficial effects of alcohol, categorised as: (1) cardioprotective and haemostatic; and (2) promoting a positive balance in iron status. However, more recent evidence has weakened these assertions for all age groups as the disadvantages of alcohol use far outweigh these benefits. Some of these disadvantages can cause severe medical and physical harm to the elderly. Attempts to curb risky drinking among the SA elderly must be adopted through screening by clinicians during consultations, use of various screening and diagnostic tools available for addressing alcohol use and abuse, and exploiting the channels of alcohol exposure for appropriate interventions. Elderly populations are vulnerable to alcohol misuse irrespective of their consumption patterns or levels of use because of their ageing condition and the interaction of alcohol with medication. Therefore, there is a need to sensitise the SA elderly population on the risk posed by alcohol use, misuse or abuse, hence the FBDG ‘If you drink alcohol, drink sensibly’

Food and beverages undermining elderly health: three food-based dietary guidelines to avoid or delay chronic diseases of lifestyle among the elderly in South Africa

Dietary patterns among South African older adults indicate a moderate intake of total fat and salt, as well as a high sugar intake. Total fat, saturated fat, sugar and salt intakes are associated with non-communicable diseases (NCDs) and mortality. Processed and ultra-processed foods are common in elderly households and contain high levels of fat, sugar and salt and are associated with frailty. This paper aims to review the available scientific evidence on the effect on health status of dietary sugar, fat and salt consumption among the elderly. This information will be used to confirm the need for dietary sugar, fat and salt food-based dietary guidelines for the elderly South African population

Comparison of three school feeding strategies for primary school children in an informal settlement in Gauteng, South Africa

The aim of this study was to compare the impact of three school feeding strategies on the nutritional status of primary school children aged six to 13 in an informal settlement in Gauteng. The methods included dietary surveys and anthropometric and biochemical measurements of a sample of 160 primary school children allocated to three different school feeding intervention groups. One group (n=60) received a whole wheat pilchard and spinach vetkoek, a second received food according to the Government Primary School Nutrition Programme (PSNP)(n=60), and a third (n=40) received fruit. The children were given these items every day for seven months, except during school holidays and weekends. The baseline anthropometric measurements indicated that 13.6%, 20.9% and 10.8% of the children in the vetkoek, PSNP and fruit groups respectively were underweight (lesser than 5th percentile for weight-for-age) and 17.3%, 23.6% and 5.2% were stunted (lesser than 5th percentile for height-for-age). The post-intervention results indicated that the children in all three groups had improved significantly in weight and height, and in dietary intakes of zinc and iron. The results of this study indicated that all three feeding strategies contributed to an improved nutritional status. Providing fruit as a school feeding strategy may be the most affordable and easy to implement. More research is recommended to measure the impact of these strategies on a long- term basis. Opsomming Die doel van die studie was om die impak van drie skoolvoedingstrategieë op die voedingstatus van ses tot dertien jaar oue laerskoolkinders in 'n informele nedersetting in Gauteng te bepaal. Die metodes het die volgende ingesluit: dieetopnames, antropometriese en biochemiese metings in 'n steekproef van 160 laerskoolkinders, wat ewekansig in drie skoolvoedingintervensiegroepe verdeel is. Die groepe het bestaan uit 'n volkoring sardyn-en-spinasie-vetkoek groep (n=60), die Government Primary School Nutrition Programme (PSNP) groep (n=60), en 'n vrugtegroep (n=40) wat hierdie items elke dag vir sewe maande, behalwe vir skoolvakansies en naweke, ontvang het. Die antropometriese metings voor die intervensie het bevind dat 13.6%, 20.9% en 10.8% van die kinders ondergewig (kleiner as 5de persentiel vir gewig-vir-ouderdom) was in die vetkoek-, PSNP- en vrugtegroep, respektiewelik, en 17.3%, 23.6% en 5.2% se groei is belemmer (kleiner as 5de persentiel vir lengte-vir-ouderdom). Die na-intervensieresultate het aangedui dat die kinders in al drie die groepe se gewig, lengte, sowel as sink en ysterinname betekenisvol verbeter het. Die resultate van hierdie studie het aangetoon dat al drie die voedingstrategieë bygedra het tot ’n verbeterde voedingstatus. Die voorsiening van vrugte as ’n skoolvoedingstrategie is egter bekostigbaar en maklik om te implementeer. Meer navorsing om die impak op die langtermyn te toets, word aanbeveel

Food and beverages promoting elderly health: six food-based dietary guidelines to plan good mixed meals for elderly South Africans

Studies have shown that the elderly are at a higher risk of developing malnutrition due to physiological and pathological changes. Several studies have confirmed that older South Africans have insufficient dietary diversity, resulting in nutritional deficiencies. Furthermore, poor and uninformed dietary choices are associated with the development of several diseases and increased mortality. Following the Elderly Food Based Dietary Guidelines (EFBDGs) related to promoting elderly health could ensure that the elderly have an adequate intake of nutritious foods. This paper provides an overview of six FBDGs relating to promoting health and is based on the South African Food Based Dietary Guidelines

Nutritional adequacy of menus offered to children of 2 - 5 years in registered childcare facilities in Inanda, KwaZulu-Natal Province, South Africa

Background. The number of children that spend a large part of the day at child care facilities has risen worldwide. The parent relies on care givers in child care facilities (CCFs) to provide children with balanced meals. Studies in various parts of South Africa that analysed CCFs menus have found that the menus do not satisfy the daily requirements of energy and micronutrients for children. With increased numbers of children attending CCFs and increased obesity prevalence in children in SA and in KwaZulu Natal information with regards to food presented at the facilities was of interest not only to compare the energy and micronutrient intake but to also to consider the dietary diversity offered to the children on a daily basis. Objective. The objective of this study was to analyse menus offered to children in CCFs in Inanda, KwaZulu-Natal for nutritional adequacy and to calculate the contribution the meals make to the Dietary Reference Intakes for children in the two to five year age category. Methods. Permission from the Department of Social Development in Durban (DSD) was obtained to approach the CCFs to participate in the study. Ten CCFs in the Inanda area were randomly selected from the DSD list of 45 registered CCFs. The researcher gathered menus, recipes and serving sizes from each of the 10 CCFs. Food Finder Version 3 Software (Medical Research Council SA), adjusted to include fortified wheat and bread products, was used to analyse the recipes. Results. The CCFs in Inanda served breakfast and lunch to the children on a daily basis. The top 20 list of foods offered cereal-based staples of rice and maize meal more frequently than meat, dairy products and fruit and vegetables. All the CCFs did not meet 60 percent of daily requirements for energy, fibre and calcium for children in this age group. Conclusion. Menus offered to children of age two to five years in registered CCFs in Inanda are nutritionally inadequate

Child and youth care workers: Profile, nutrition knowledge and food safety and hygiene practices

Background: Facilities concerned with children ‘in need of care’ should not only be considered as a last resort for a child’s care, but also as an intervention that requires more than addressing a child’s basic physical needs. The nutritional needs of children are particularly important to consider as they are a fundamental part of the care provided. Objectives: The purpose of this descriptive quantitative study was to investigate the profile, nutrition knowledge, food safety and hygiene practices of child and youth care workers (CCWs) in residential care settings in order to guide the development of a food preparation and nutrition manual. Method: The residential care settings included in this study were three that were selected randomly in Durban. CCWs (N = 40) employed permanently or part-time were included. Convenience purposive sampling of the CCWs was undertaken. A structured self-administered questionnaire, developed and tested for this purpose, was used to gather information on the profile, nutrition knowledge, food safety and hygiene practices. The data were analysed for descriptive statistics (means and frequencies). Results: The majority of CCWs were women aged 18−34 years. Very few had completed a relevant tertiary qualification. The results indicated that the respondents’ knowledge was fair on general nutrition guidelines, but there were areas of concern. Specifically, knowledge on recommended fruit and vegetable intake, correct serving sizes and importance of a variety in the diet were lacking. Some knowledge about food safety and hygiene practices was demonstrated, but not in totality. Conclusion: The overall findings supported the development of a comprehensive food preparation and nutrition manual for child residential care facilities.   Agtergrond: Fasiliteite gemoeid met kinders ‘in die behoefte van sorg’ nie net beskou moet word as ’n laaste uitweg vir ’n kind se sorg nie, maar ook as ’n intervensie wat meer as net die basiese en fisiese behoeftes van kinders aanspreek. Die voedingsbehoeftes van kinders is veral belangrik om te oorweeg as ’n fundamentele element van versorging. Doelwit: Die doel van hierdie beskrywende kwantitatiewe studie was om die profiel, voeding kennis en voedsel- veiligheid en higiëne van kinder-en jeugsorgwerkers te ondersoek in residensiële sorg instellings met die doel om ’n voedsel voorbereiding en voedings handleiding te ontwikkel. Metode: Die residensiële sorg instellings het bestaan uit drie ewekansig gekiesde kinderhuise in Durban. Die studie het bestaan uit kinder-en jeugsorgwerkers (N = 40) in permanente of deeltydse poste. ’n Doelgerigte steekproef van die kinder-en jeugsorgwerkers is onderneem. ’n Gestruktureerde self-geadministreerde vraelys, ontwikkel en getoets vir hierdie doel, is gebruik om inligting oor die profiel, voeding kennis, voedselveiligheid en higiëniese praktyke van die kinder- en jeugsorgwerkers in te samel. Die data is ontleed vir beskrywende statistieke. Resultate: Die meerderheid van die kinder- en jeugsorgwerkers was vroulik, tussen die ouderdomme van 18−34 jaar. Min het ‘n toepaslike tersiêre kwalifikasie gehad. Dit blyk uit die resultate dat die respondente se algemene voeding riglyne was aanvaarbaar. Die resultate het gedui op ’n gebrek aan kennis oor die aanbevole vrugte en groente inname, korrekte porsiegroottes en die belangrikheid van ’n verskeidenheid in die dieet. Die respondente het tot ’n mindere mate kennis oor voedselveiligheid en higiëne gehad. Gevolgtrekking: Die algemene bevindinge ondersteun die ontwikkeling van ’n omvattende voedsel voorbereiding en voedings handleiding vir kinder residensiële sorg instellings