Dietary intake and metabolic control of children aged six to ten with type 1 diabetes mellitus in KwaZulu-Natal

Objectives: The objective of this study was to assess the dietary intake and metabolic control of children with type 1 diabetes.Design: A cross-sectional observational study was carried out.Subjects: A total of 30 subjects whose ages ranged from six to ten years were included in the study.Setting: The study was conducted at the Paediatric Diabetic Clinics at Grey’s Hospital, Pietermaritzburg and Inkosi Albert Luthuli Central Hospital (IALCH), Durban, in KwaZulu-Natal.Outcome measures: Dietary intake was assessed using a three-day dietary record. Metabolic control was assessed using glycosylated haemoglobin (HbA1c).Results: The mean percentage contributions of macronutrients to total energy as determined by the three-day dietary records were as follows: carbohydrate – 52%; added sucrose – 2%; protein – 16%; fat – 32%. The mean intakes were similar to the recommendations of the International Society for Pediatric and Adolescent Diabetes (ISPAD) Consensus Guidelines (2002). Micronutrient intake was generally adequate. The mean latest glycosylated haemoglobin (HbA1c) for the sample as at the time of the study was 9.7%. Five of the thirty subjects had HbA1c values that were within the recommended levels for children with type 1 diabetes.Conclusions: The macronutrient intake in this sample was found to be similar to the ISPAD Consensus Guidelines (2002) while micronutrientintake was adequate in most cases. Overall the sample had poor  metabolic control

Are South African women willing and able to apply the new Food-Based Dietary Guidelines? Lessons for nutrition educators

Background Consumer testing was a prime consideration in developing specific South African food-based dietary guidelines (FBDGs) which were nationally adopted in 2003. Objectives This study aimed to determine the consumer's ability to apply the FBDGs appropriately, in terms of identifying foods/drinks according to the FBDG food categories; perceived importance of and barriers to applying each FBDG; and planning a typical day's meals to reflect the FBDGs. Design A cross-sectional study of 333 women from different cultural and socio-economic backgrounds. Setting: KwaZulu-Natal, South Africa. Methods Data collection comprised focus-group discussions (n = 103) and structured individual interviews (n = 230). Results The identification of foods/drinks according to the FBDG food categories reflected a high level of comprehension by participants of these food categories. Participants from all study samples endorsed the importance of applying the FBDGs, predominantly for health reasons. Participants cited barriers to the application of the FBDGs as affordability, availability, household taste preferences, routine food-purchasing habits, time constraints, traditional/ habitual food-preparation methods, and persistent attitudes. Only three FBDGs were mentioned as difficult to apply, namely, “fruits/ vegetables”, “foods from animals” and “legumes”. Meal plans did reflect the FBDGs, illustrating the flexibility of their use across cultural and socio-economic differences. Conclusions Consumer testing of the FBDGs was mainly positive. The study has highlighted areas of confusion regarding certain concepts, terminology and misconceptions, and has identified barriers to application. These concerns can be addressed through the reformulation and retesting of certain dietary guidelines, and the provision of explanatory consumer information and health-worker training materials. SAJCN Vol. 21 (2) 2008: pp. 17-2

The current and potential contribution of home-grown vegetables to diets in South Africa#

In this paper the current and potential utilisation of crops (bought and home produce) in diets in South Africa is reviewed. Available data shows that at all levels, national, household and individual, the amounts of fruits and vegetables available and consumed are about half the WHO (2003) recommendations of at least 400g per day. To counteract this, the South African Food Based Dietary Guidelines promote fruit and vegetable consumption. The 1999 National Food Consumption Survey (NFCS), showed that in South Africa, nationally, 17% of the sample produced crops only, 9% produced crops and livestock and 8% produced livestock only. Median intakes of nutrients such asenergy, vitamin A and calcium for children in rural households with crop and livestock production, although raised, were still below requirements. However, evaluation of an intervention which combined production of vitamin A rich crops in home gardens with nutrition education and growth monitoring, showed vitamin A intakes increased above required levels. Another possible approach is the promotion of the consumption of indigenous vegetables, which are rich sources of several micronutrients. The 1999 NFCS data showed that ten percent of the children in rural areas consumed wild leaves/spinach. In conclusion, the traditions of crop production and indigenous vegetable consumption can be built on, by the combined efforts of agriculturalists and nutritionists. The increased utilisation of indigenous crops in the South African diet would contribute to combating both under-nutrition and over-nutrition

The role and training of human nutritionists in health promotion units in the United Kingdom

The UK Department of Health white paper, The Health of the Nation (1992) set national targets for nutrient intake and the reduction of nutrition-related diseases. One means for achieving these targets is by the work of nutritionists in Health Promotion Units in the UK. The purpose of this study was to determine the role, employment and perceived adequacy of the training of nutritionists. Methods: A survey of these units was undertaken in September-December 1994, by postal questionnaire. Fifty questionnaires were returned (response rate 25%). Fifty four percent of the respondents (n=27) employed at least one nutritionist. Manpower forecasts for the demand for nutritionists were split between remaining the same (54%) and increasing (44%). Most nutritionists (70-100%) were involved in dissemination of nutrition knowledge, in training other health professionals and food providers, consultancy, evaluation and the development of nutrition strategies. Fewer were involved in research (52%), nutritional assessment (56%), lobbying and advocacy (44%) and training students (36%). Most units (92%) preferred to employ nutritionists with relevant work experience. The current training of nutritionists was generally felt to be satisfactory. the study of Nutrition, Community Nutrition, Nutrition Education, Health Promotion, Nutrition Policy and Planning and the development of written and oral communication, interpersonal skills, organisational skills and prioritisation were perceived to be very important. The low response rate makes generalisations difficult. These preliminary findings suggest that academic institutions educating nutritionists should encourage work placements in health promotion units, and place particular emphasis on the dissemination of nutritional knowledge, evaluation and the development of Nutrition Strategies, and the underpinning academic knowledge and skills

Impact of the special training of community health workers on breastfeeding counselling and support in KwaZulu-Natal

Objectives. To evaluate the impact of special training of community health workers (CHWs) on breastfeeding counselling and support. Design. A cross-sectional, observational study. Setting. The study was conducted in the area serviced by the Thukela District Child Survival Project, Bergville, KwaZulu-Natal. Subjects. Mother-infant pairs (N = 95) visited by specially trained CHWs formed the intervention group and were compared with a control group of mother-infant pairs (N = 64) visited by normally trained CHWs. Both groups of CHWs had been trained in the integrated management of childhood illnesses (IMCI). Outcome measures. To test for significant differences between the intervention and control groups in exclusive breastfeeding (EBF), feeding of colostrum, withholding of prelacteals, infant growth and diarrhoeal disease rates. Results. EBF rates of 71.6% and 59.4% were found in the intervention and control groups respectively (p = 0.1). Both study groups showed higher rates of EBF compared with other areas in KwaZulu-Natal. The prevalence of feeding colostrum was 88.4% in the intervention and 92.2% in the control groups (p = 0.4). The prevalence of withholding prelacteals was 77% in the intervention and 86% in the control groups (p = 0.1). At the time of the interview, infants in both groups showed consistent growth (weight-for-age z-scores: intervention = 0.13, control = 0.18; p = 0.7). Diarrhoea prevalence did not differ significantly between study groups and varied from 7.5% (in the 7 days before interview, p = 0.1) to 16% (in the previous 3 months for infants ≥3 months, p = 0.5). Conclusion. The special training did not have the anticipated impact on measured parameters. Training CHWs in IMCI was as effective as special training. If generally applied, the former may increase rates of EBF, improve infant growth and reduce the risk of diarrhoeal illness in South Africa. South African Journal of Clinical Nutrition Vol. 19(1) 2006: 29-3