Obesity and HIV: a compounding problem

Objectives: A cross-sectional study was undertaken at Lancers Road Clinic, Durban, South Africa to determine body composition, haemoglobin, serum albumin and serum high sensitivity C-reactive protein (hs-CRP) levels in asymptomatic ART-naive HIV positive adults. Methods: All eligible adults attending the clinic were sampled. Body composition was assessed using deuterium dilution. Descriptive statistics, Wilcoxon rank-sum test, chi-square test, Fisher’s exact test and Spearman’s rank correlation coefficient were used for data analysis. Results: A total of 84 participants (CD4 count: 542.5 ± 145 cell/mm3) enrolled. The mean body mass index (BMI) was 29.5 (± 6.4) kg/m2 and the mean fat mass percentage was 44.9 (± 18.7). The prevalence of overweight (26.2%, 22/84) and obesity (46.4%, 39/84) was high. Mean haemoglobin (Hb) levels were 12.0 ± 1.6 g/dl. Mild, moderate and severe anaemia was present in 21.4% (18/84), 20.2% (17/84) and 1.2% (1/84) of patients, respectively. Mean albumin levels (36.2 ± 3.8 g/l) were on the borderline low range of normal with mildly depleted albumin levels being present in a third (32.1%, 27/84) of patients. The mean hs-CRP levels (5.5 ± 7.2 mg/l) were high. Conclusion: In this cohort of patients, wasting was not associated with HIV as the prevalence of overweight/obesity was high and followed the population trend in SA. This seemingly well, asymptomatic population of people living with HIV was at an increased risk of morbidity, progression and death due to the compounding factors of overweight/obesity, hypoalbuminemia, raised hs-CRP levels and anaemia

The prevalence and degree of dehydration in rural South African forestry workers.

Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2008.South African forestry workers are predisposed to dehydration due to the heavy physical activity they perform in impermeable regulation safety clothing in hot and often humid environments where the availability of a variety of suitable fluids at reasonable temperatures is limited. As dehydration reduces both physical and mental capacity the potential consequences include decreased productivity and an increased risk for injury. The aim of this cross sectional observational study was to determine the prevalence and severity of dehydration in rural forestry workers in both winter (minimum and maximum daily temperatures 3-22°C) and autumn (minimum and maximum daily temperatures 14-27°C). The convenience sample included 103 workers in autumn (Nelspruit, n=64 males, n=39 females, mean age 37.32 years, mean BMI 22.3 kg/m2) and 79 in winter (Richmond, n=68 males, n=11 females, mean age 25.85 years, mean BMI 22.2 kg/m2). The sample included chainsaw operators, chainsaw operator assistants, debarkers and stackers. The risk of heat illness was moderate in Nelspruit (average daily temperature 21.1°C 67% rh) and low in Richmond (average daily temperature 17.0°C 39% rh). The prevalence of dehydration was determined by urine specific gravity (USG) measurements. Percent loss of body weight in the course of the shift was used to determine the severity of dehydration. In Nelspruit 43% (n=43) and in Richmond 47% (n=37) of the forestry workers arrived at work dehydrated (USG>1.020 g/ml). Pre break this had increased to 49% (n=49) in Nelspruit and 55% (n=33) in Richmond. By the end of shift the number of dehydrated forestry workers had significantly increased to 64% (n=64, p≤0.001) in Nelspruit and 63% (n=42, p=0.043) in Richmond. A minimum of 21% (n=2) in Nelspruit and 23% (n=15) in Richmond of the forestry workers had lost more than 2% of their body weight which could significantly decrease work capacity and work output as well as mental and cognitive ability. Dehydration was not related to season (winter/autumn), gender or job category. In Nelspruit 23% (n=23) and in Richmond 13% (n=10) arrived at work overhydrated (USG<1.013 g/ml). Pre break this had decreased to 14% (n=14) in Nelspruit and 10% (n=6) in Richmond. By the end of shift 4% (n=4) in Nelspruit and 2% (n=1) in Richmond had remained overhydrated and without correcting for fluid and food intake, 5% (n=5) had gained over 2% of their body weight in Nelspruit while none had gained weight in Richmond. Overhydration was not related to season (winter/autumn), gender or job category. Physical symptoms at the end of shift included tiredness (24%), toothache (13%) and headaches (10%) although these did not correlate to end of shift USG readings (p=0.221). The fluid requirements for male workers (n=8) who did not eat or drink across the shift was 439 ml per hour. The contractors were unaware of how much fluid should be supplied to workers and how much fluid they actually supplied. The only fluid provided by the contractors was water at the ambient air temperature which was the main source of fluid for the majority. Some forestry workers brought a limited variety of other fluids including amahewu, tea and cold drinks to work. At least 40% of the work force investigated, started their shift already compromised to work to capacity (USG>1.020 g/ml). The prevalence of dehydration had increased by the break emphasizing the need to begin drinking early on in the shift. The majority of forestry workers were dehydrated at the end of the shift. A significant proportion was dehydrated to the extent (>2%) that both work capacity and mental ability would be significantly compromised. A select group of forestry workers were drinking excessive amounts of fluid and were therefore susceptible to potentially fatal dilutional hyponatremia especially as water was the primary source of fluid. Dehydration in both autumn and winter was identified as being a significant but preventable risk. As a consequence of overhydration, a small group of forestry workers may be susceptible to dilutional hyponatremia. Fluid intake guidelines for males of 450 ml per hour appeared to be safe and were within the recommendations of the American College of Sports Medicine. Fluid guidelines for females need investigation.Accompanying DVD REFERENCE ONLY - NOT FOR LOAN. Housed at life Sciences Library Issue Desk - 08XTVC01, Appendix A, Forestry video

The nutrient quality and labelling of ready-to-eat snack foods with health and/or nutrition claims

Background: Nutrition claims on food labels are used to attract attention to products. Inaccurate claims on ready-to-eat (RTE) snack food products may mislead consumers into consuming a higher volume of a seemingly ‘healthy’ product.Objectives: A study was undertaken to determine the following surrounding the packaging of RTE snack food products: (i) compliance of health and or nutrient claims; (ii) average nutrient content per snack category; (iii) accuracy of the total energy content; (iv) eligibility to make claims once the R429 legislation is implemented.Outcome measures: Nutrient content per 100 g and serving size was analysed. Claims related to nutrient content were audited.Design: An analysis was undertaken of the labels of 93 South African-produced RTE snack food products from 10 categories, displaying health and or nutrition claims.Results: Ninety-one products displayed nutrient content claims. Twenty-three (25.3%) nutrient content claims were noncompliant with the R146 legislation. Twenty-one (22.6%) displayed negative claims, three (14.3%) were ineligible. Eighteen products (19.4%) displayed endorsement claims, four (4.4%) were eligible. Sixty-four products (68.8%) displayed a higher total energy content when applying the conversion factors to the displayed macronutrient values. Only 22 (23.7%) products would be eligible to make health and/or nutrition claims once the R429 legislation is promulgated.Conclusion: A higher proportion of eligible claims were found. More than 70% of food manufacturers will need to make changes to the nutrient content or labels once the R429 legislation is implemented. A two-pronged approach of manufacturer compliance and consumer education may improve food choices and reduce the incidence of obesity and NCDs

A randomised double blind placebo controlled trial to determine the effect of soluble dietary fibre (inulin-type fructans) on disease progression and body composition of HIV positive ARV naive adults attending a wellness clinic in KZN South Africa.

Ph. D. University of KwaZulu-Natal, Pietermaritzburg 2015.Abstract available in PDF file

Obesity and HIV: a compounding problem

Objectives: A cross-sectional study was undertaken at Lancers Road Clinic, Durban, South Africa to determine body composition, haemoglobin, serum albumin and serum high sensitivity C-reactive protein (hs-CRP) levels in asymptomatic ART-naive HIV positive adults. Methods: All eligible adults attending the clinic were sampled. Body composition was assessed using deuterium dilution. Descriptive statistics, Wilcoxon rank-sum test, chi-square test, Fisher’s exact test and Spearman’s rank correlation coefficient were used for data analysis. Results: A total of 84 participants (CD4 count: 542.5 ± 145 cell/mm3) enrolled. The mean body mass index (BMI) was 29.5 (± 6.4) kg/m2 and the mean fat mass percentage was 44.9 (± 18.7). The prevalence of overweight (26.2%, 22/84) and obesity (46.4%, 39/84) was high. Mean haemoglobin (Hb) levels were 12.0 ± 1.6 g/dl. Mild, moderate and severe anaemia was present in 21.4% (18/84), 20.2% (17/84) and 1.2% (1/84) of patients, respectively. Mean albumin levels (36.2 ± 3.8 g/l) were on the borderline low range of normal with mildly depleted albumin levels being present in a third (32.1%, 27/84) of patients. The mean hs-CRP levels (5.5 ± 7.2 mg/l) were high. Conclusion: In this cohort of patients, wasting was not associated with HIV as the prevalence of overweight/obesity was high and followed the population trend in SA. This seemingly well, asymptomatic population of people living with HIV was at an increased risk of morbidity, progression and death due to the compounding factors of overweight/obesity, hypoalbuminemia, raised hs-CRP levels and anaemia

The nutrient quality and labelling of ready-to-eat snack foods with health and/or nutrition claims

Background: Nutrition claims on food labels are used to attract attention to products. Inaccurate claims on ready-to-eat (RTE) snack food products may mislead consumers into consuming a higher volume of a seemingly ‘healthy’ product. Objectives: A study was undertaken to determine the following surrounding the packaging of RTE snack food products: (i) compliance of health and or nutrient claims; (ii) average nutrient content per snack category; (iii) accuracy of the total energy content; (iv) eligibility to make claims once the R429 legislation is implemented. Outcome measures: Nutrient content per 100 g and serving size was analysed. Claims related to nutrient content were audited. Design: An analysis was undertaken of the labels of 93 South African-produced RTE snack food products from 10 categories, displaying health and or nutrition claims. Results: Ninety-one products displayed nutrient content claims. Twenty-three (25.3%) nutrient content claims were non-compliant with the R146 legislation. Twenty-one (22.6%) displayed negative claims, three (14.3%) were ineligible. Eighteen products (19.4%) displayed endorsement claims, four (4.4%) were eligible. Sixty-four products (68.8%) displayed a higher total energy content when applying the conversion factors to the displayed macronutrient values. Only 22 (23.7%) products would be eligible to make health and/or nutrition claims once the R429 legislation is promulgated. Conclusion: A higher proportion of eligible claims were found. More than 70% of food manufacturers will need to make changes to the nutrient content or labels once the R429 legislation is implemented. A two-pronged approach of manufacturer compliance and consumer education may improve food choices and reduce the incidence of obesity and NCDs

Determining percentage body fat of male South African jockey apprentices irrespective of hydration status

Objective: The aim was to determine the most appropriate field techniques to measure %BF when both euhydrated and dehydrated. Design: A cross-sectional descriptive study was undertaken. Setting: South Africa. Subjects: 17 male apprentice jockeys (mean age 18.8 ± 1.7 years). Outcome measures: Agreement of %BF results determined using predictive equations based on skinfold thickness measurements and bioelectric impedance analysis (BIA) with that of the reference method, euhydrated deuterium dilution (eDD). Results: The mean %BF according to eDD was 9.5 ± 2.8%. The skinfold equations by Slaughter et al. (1988) for ages 8–18 years in either hydration state, Durnin and Womersley using either Siri or Brožek et al. for ages 17–19 years when dehydrated only, and the Van Loan et al. BIA equation when euhydrated only were the most acceptable methods. Conclusion: Regardless of hydration status, the skinfold equation by Slaughter et al. is recommended for jockey apprentices 18 years and younger. For those > 19 years, the hydration state must be confirmed prior to measurement. If euhydrated, the Van Loan et al. BIA equation is recommended and if dehydrated the Durnin and Womersley using either Siri or Brožek et al. is recommended