Nutritional management of chronic renal failure by dietitians - the South African experience

Objective: The objective of this descriptive study was to assess the practices of South African dietitians regarding the dietary treatment of patients with chronic renal failure.Subjects and design: A questionnaire was mailed to 600 randomly selected dietitians registered with the Health Professions Council of South Africa. Practices were compared to international standards for pre-dialysis, haemodialysis (HD) and peritoneal dialysis (PD) patients.Results: A 26% response rate was obtained, with only 28% of these dietitians indicating that they counsel renal patients. The majority of dietitians met the international dietary recommendations, but a substantial number deviated from them. This was especially evident in PD patients, where the deviation ranged from 20% (4 dietitians) in the case of energy and phosphate, to 55% (11 dietitians) in the case of calcium. Parameters used for the assessment of nutritional status included body mass index (45% of dietitians), serum albumin (44%), clinical examinations (43%), bioelectrical impedance (37%) and diet history (36%). Methods used to monitor dietary compliance included biochemistry, dietary history, anthropometric measurements and clinical investigation. The most frequently used approaches in the management of protein-energy malnutrition included supplemental drinks (86%) and dietary enrichment at household level (76%).Conclusion: Although the majority of dietitians met international standards for most nutrients, there was some variation and uncertainty. Ongoing education will enable South African dietitians to treat renal patients competently and with confidence.South African Journal of Clinical Nutrition Vol. 18(2) 2005: 60-6

Nutritional status of renal transplant patients

Objective. To assess the effect of renal transplantation on the nutritional status of patients.Design. Prospective descriptive study.Setting. Renal Transplant Clinic at Tygerberg Hospital, Western Cape.Subjects. Fifty-eight renal transplant patients from Tygerberg Hospital were enrolled in the study. The sample was divided into two groups of 29 patients each: group 1, less than 28 months post-transplant; and group 2, more than 28 months post-transplant.Outcome measures. Nutritional status assessment comprised biochemical evaluation, a dietary history, anthropometric measurements and a clinical examination.Results. Serum vitamin B6 levels were below normal in 56% of patients from group 1 and 59% from group 2. Vitamin B6 intake, however, was insufficient in only 14% of patients from group 1and10% from group 2. Serum vitamin C levels were below normal in 7% of patients from group 1 and 24% from group 2, while vitamin C intake was insufficient in 21%and14% of patients from groups 1 and 2 respectively. Serum magnesium levels were below normal in 55% of patients from group 1, and in 28% from group 2. Serum albumin and cholesterol levels increased significantly during the post-transplant period in the total sample (P = 0.0001). There was also a significant increase in body mass index (P = 0.0001) during the post-transplant period.Conclusions. Several nutritional abnormalities were observed, which primarily reflect the side-effects of immunosuppressive therapy. The causes, consequences and treatment of the vitamin B6 and vitamin C deficiencies in renal transplant recipients need further investigation

Development of the South African renal exchange lists

Objective: The objective of this developmental study was the development of renal exchange lists for the South African population with renal failure.Subjects and design: A questionnaire was circulated to South African renal dietitians to establish the format and composition of the proposed exchange lists. Foodfinder 3 was used for assessment of nutrient composition of foods, and the NRIND Food Quantities Manual was used for assessment of portion sizes. Results from the Food Consumption Study were used to identify food items frequently consumed by the South African population, and dietitians with knowledge of the eating habits of Moslem, Indian, white, black and coloured groups were consulted regarding the inclusion of cultural foods. Portion sizes were determined by protein content of foods. The preliminary exchange lists were circulated for comment and tested for a period of 1 year.Results: Many new food items were added during revision of the exchange lists. Portion sizes were adapted to be more realistic, and in some cases additional sub-groups were added. Foodfinder 3 and renal exchange list values for all food items included in the exchange lists were then compared, and this showed highly significant correlations for all nutrients concerned. There was no significant difference between mean nutrient values for the two methods, with the exception of protein, the content of which was consistently and significantly underestimated by a mean of 0.1 g per food item. This underestimation is not considered to be of clinical importance.Conclusion: In this study renal exchange lists were developed for use in South African persons with renal failure. Despite the small but significant underestimation of protein content, the lists appear to be of sufficient precision for use in clinical practice.South African Journal of Clinical Nutrition Vol. 18(2) 2005: 51-5

Nutrition and Kidney Transplantation. Editorial

GesondheidswetenskappeMenslike VoedingPlease help us populate SUNScholar with the post print version of this article. It can be e-mailed to: [email protected]

Protein and energy requirements in patients with acute renal failure on continuous renal replacement therapy. Editorial.

GesondheidswetenskappeMenslike VoedingPlease help us populate SUNScholar with the post print version of this article. It can be e-mailed to: [email protected]

Anaemia in South Africa: the past, the present and the future (Editorial)

Please help populate SUNScholar with the full text of SU research output. Also - should you need this item urgently, please send us the details and we will try to get hold of the full text as quick possible. E-mail to [email protected]. Thank you.Journal Articles (subsidised)Geneeskunde en GesondheidswetenskappeMenslike Voedin

Development of a preliminary regression equation for estimating the weight of Black South African paraplegic males using anthropometric measurements, Tshwane, South Africa

Objective: To develop a regression equation to estimate the weight of black male paraplegic South African subjects. Design: Cross-sectional study. Setting: Outpatient paraplegic clinic of Kalafong Hospital, Tshwane, South Africa. Subjects: Subjects (n = 43) were selected from a population of black paraplegic males attending the clinic. Outcome measures: The following measurements were obtained in triplicate from the consenting subjects: weight, waist, calf, chest and neck circumference, mid upper-arm circumference (MUAC), supine length, upper-arm length and wrist circumference. The age of the subject, time elapsed since injury, level of injury and level of spasticity were recorded. Results: Body weight correlated significantly with waist, calf, chest and neck circumference and MUAC with respective Pearson correlation coefficient values (R) of 0.85 or higher and significant levels (p-values) of p < 0.0001. A regression equation to estimate weight was chosen on the basis of strength and practicality and included the following variables: circumferences of the calf, chest, and neck as well as the supine length. The regression equation was significant (p < 0.0001). Conclusion: A regression equation was developed which could be used, when further validated, to estimate the weight of black South African paraplegic males. SAJCN Vol. 21 (3) 2008: pp. 127-13

An assessment of the implementation of the National Therapeutic Programme for pregnant women within the City of Cape Town district

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Nutrition in Liver Disease

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Assessing Nutrition Intervention Programmes that addressed Malnutrition among young children in South Africa between 1994 - 2010

Geneeskunde en GesondheidswetenskappeMenslike VoedingPlease help us populate SUNScholar with the post print version of this article. It can be e-mailed to: [email protected]