A comparative analysis of the nutrition status, nutrition knowledge and food frequency of adolescents attending an urban versus a peri-urban school in Hilton, KwaZulu-Natal.

Ph. D. University of KwaZulu-Natal, Pietermaritzburg 2014.Adolescence is an important stage in human development. Optimum nutrition is crucial during this period, as additional nutrient requirements are needed to promote growth and maturation. With the nutrition transition in low-to-middle-income countries (LMICs), adolescents are increasingly exposed to energy-dense, nutrient poor foods; however it is not entirely clear the impact of socioeconomic status, in particular household food insecurity, on the consumption frequency of these foods. The impact nutrition knowledge may have on the dietary choices adolescents make is also unclear. Poor food choices among adolescents can contribute towards overweight/obesity and stunting, leading to the susceptibility to both communicable and non-communicable diseases (NCDs) in adulthood. The objective of this study was to determine the prevalence of overweight/obesity and stunting among South African adolescents from different socioeconomic backgrounds, in relation to their nutrition knowledge, household food insecurity status, and frequency of food consumption. The study consisted of a cross-sectional descriptive survey conducted among learners from a high-income, private urban school and a low-income, government peri-urban school in Hilton, KwaZulu-Natal. A total of 98 grade nine to eleven learners from the urban school and 111 grade nine to eleven learners from the peri-urban school volunteered to participate (N= 209). Nutritional status was determined by anthropometric measurements that included weight, height and MUAC. Subsequently BMI was calculated. Nutrition knowledge and food frequency were determined via non-quantified nutrition knowledge and food frequency questionnaires. A socio-demographic questionnaire (SDQ) was used to collect information on parental level of education and employment status. Household food security was determined using the Household Food Insecurity Access Scale (HFIAS). A higher prevalence of overweight and obesity was observed among urban learners compared to their peri-urban counterparts, however only for the boys as peri-urban girls had a notable prevalence of overweight and obesity compared to urban girls. Stunting was present among peri-urban learners but virtually absent in their urban counterparts, which was indicative of a double-burden of overweight/obesity and stunting within the peri-urban group. Peri-urban learners had parents with lower education and employment levels compared to urban learners. Adolescents with mothers that were educated up to tertiary level were associated with a higher nutrition knowledge scores (NKS). Urban learners had a higher mean NKS than peri-urban learners; however it did not necessarily reflect healthier food choices, as urban learners had a high consumption frequency of fatty red and processed meat, white bread and fizzy drinks. Peri-urban learners reported a higher preference for deep-fried, high-fat snacks such as vetkoeks and samosas; which may be related to the high levels of household food insecurity that was noted. Among grade ten peri-urban learners, 50% reported having no food to eat of any kind in the household, with 5% reporting that it occurred often. Poor dietary habits among adolescents in general were observed in this study; although food sources varied between urban and peri-urban learners possibly due to differences in cost and availability of food items. A lower SES was an underlying factor for the consumption of energy-dense foods among peri-urban learners; while a higher SES was associated with the consumption of more expensive fatty foods among urban learners. Thus, the risk of malnutrition (overweight/obesity and stunting) and subsequent disease susceptibility is present in both groups as a result

Food supplementation among HIV-infected adults in Sub-Saharan Africa: Impact on treatment adherence and weight gain

This is the author's manuscript of an article published in the Proceedings of the Nutrition Society.Sub-Saharan Africa has the highest proportion of undernourished people in the world, along with the highest number of people living with HIV and AIDS. Thus, as a result of high levels of food insecurity many HIV patients are also undernourished. The synergism between HIV and undernutrition leads to poor treatment adherence and high mortality rates. Undernutrition has a debilitating effect on the immune system due to key nutrient deficiencies and the overproduction of reactive species (oxidative stress), which causes rapid HIV progression and the onset of AIDS. Therapeutic food supplementation used in the treatment of severe acute malnutrition is being applied to HIV palliative care; however, little biochemical data exist to highlight its impact on oxidative stress and immune recovery

Sugar sweetened beverage consumption in the early years and implications for type 2 diabetes: A sub-Saharan Africa context

This article has been accepted for publication and will appear in a revised form, subsequent to peer review and/or editorial input by Cambridge University Press, in Proceedings of the Nutrition Society published by Cambridge University Press. Copyright Nutrition Society / Cambridge University Press.This review aims to explore trends of early consumption of sugar-sweetened beverages (SSBs) in Sub-Saharan Africa (SSA), within the context of growing child and adolescent obesity and escalating type-2 diabetes prevalence. We explore efforts to mitigate these, drawing on examples from Africa and elsewhere. SSBs including carbonated drinks and fruit juices, play a contributory role in the development of obesity and associated non-communicable diseases. SSA is an attractive market for beverage companies owing to its rapid economic growth, growing middle class and youthful populations. SSBs already contribute significantly to total sugar and energy consumption in SSA where a plethora of marketing techniques targeted at younger people are utilised to ensure brand recognition and influence purchasing and brand loyalty. Coupled with a general lack of nutrition knowledge or engagement with preventative health, this can lead to frequent consumption of sugary drinks at a young age. Many high and some middle income countries public health efforts address increasing prevalence of obesity and type-2 diabetes by focussing on strategies to encourage reduction in sugar consumption via health policy and public education campaigns. However, similar efforts are not as developed or forthcoming in low-income countries. Health care systems across SSA are ill-prepared to cope with epidemic proportions of non-communicable diseases, particularly when contextualized with the ongoing battle with infectious diseases. We conclude that greater efforts by governments and the nutrition community to educate the public on the health effects of increased and excessive consumption of SSBs are necessary to help address this issue

Exploring the health status of older persons in Sub Saharan Africa

Sub-Saharan Africa has traditionally had a low life expectancy due to the onslaught of the HIV epidemic, high levels of chronic diseases, injuries, conflict and undernutrition. Therefore, research into public health concerns of older persons has largely been overlooked. With a growing population, the roll-out of antiretroviral treatment, and the effects of globalisation; Sub-Saharan Africa is experiencing an increase in the number of people over 50 years of age as well as an increase in the prevalence of non-communicable diseases. The aim of this review is to highlight available research on the health status of older persons in Sub-Saharan Africa, and to identify the current gaps that warrant further investigation. A literature search was conducted across multiple databases to identify studies in Sub-Saharan Africa on older persons (aged 50 years and older) related to health indicators including nutritional status, non-communicable diseases and HIV burden. Whilst it was concluded that older persons are at an increased risk of poor health, it was also determined that significant gaps exist in this particular area of research; namely nutrient deficiency prevalence. Resources should be directed towards identifying the health concerns of older persons and developing appropriate interventions

The effects of Sutherlandia frutescens and Fumonisin B1 on Jurkat cells.

Thesis (M.Med.Sc.)-University of KwaZulu-Natal, 2011.The medicinal plant Sutherlandia frutescens (SF) is commonly consumed in South Africa, and is traditionally applied to a range of ailments. Yet its popularity stems from the use of SF as a cancer treatment. This plant contains a range of active compounds including L-canavanine (L-CAV), D-pinitol and gamma (γ)-aminobutyric acid, all of which contribute to the therapeutic properties of SF. It is also endorsed by the South African Ministry of Health as a supplementary treatment for HIV/AIDS. Maize is the staple crop of South Africa, and can be frequently contaminated by the mycotoxin fumonisin B1 (FB1). The mycotoxin is linked to an extensive list of livestock diseases. Although little is known about its role in human disease, FB1 has been epidemiologically linked to oesophageal cancer in South Africa. Both SF and FB1 have been shown to promote apoptosis, and the effect(s) of consuming both in combination is currently unknown. The principle aim of this study was to determine whether SF and FB1 had either synergistic or antagonising effects in combination, by investigating immune cell toxicity Jurkat cells. Apoptotic parameters such as caspase activation, mitochondrial depolarisation, phosphatidylserine (PS) externalisation and ATP quantification were analysed. Levels of caspase activation were highest in cells treated with SF only (caspase-3: 86.79 RLU, no significance compared to other treatments; caspase-8: 40.1 RLU, significance compared to other treatments [p<0.05]; caspase-9: 11.07 RLU, significance compared to FB1 and control treatments [p<0.05]). ATP levels were significantly highest in SF-treated cells compared to other treatments (8.17 RLU, [p<0.05]). Mitochondrial depolarisation was also highest in SF-treated Jurkat cells at 18.5% depolarisation with no significance compared to other treatments, however PS externalisation were significantly lower in SF-treated cells compared with other treatments (3.69% [p<0.05]). Oxidative stress parameters were also investigated, including thiobutyric acid reactive species (TBARS), Glutathione (GSH) and Reactive Nitrogen Species (RNS) assays. TBARS levels were significantly higher in FB1 treated cells (OD 1.95, [p<0.05]) compared to SF and control. Glutathione and RNS levels were also lowest in FB1-treated cells. The data suggests that SF induces apoptosis, characteristic of its nature as an anti-cancer treatment, and FB1 induces oxidative stress, which is characteristic of its carcinogenic properties. Based on this preliminary study, it appears that FB1 and SF both synergises and antagonises the other in combination, yet further investigation is needed into its effects in vivo

Association between dietary diversity, health and nutritional status of older persons in rural Zambia

Objective: The purpose of the study was to assess the association between dietary diversity, health and nutritional status of older persons aged 50 years and above in Milenge district of Luapula province, Zambia. Design: A cross-sectional, descriptive study was conducted. Subjects and setting: The study was conducted among 135 older persons (≥ 50 years) comprising 67 men and 68 women who were randomly selected from three communities in Milenge district, Luapula province. Outcome measures: Anthropometric measurements (weight and height) were used to determine the prevalence of malnutrition among the respondents by calculating the body mass index (BMI). Food consumption was assessed using a non-quantified food frequency questionnaire and dietary diversity scores were used to determine the adequacy of food intake, while a health questionnaire was used to determine self-perceived health status of the respondents. Results: Based on the WHO BMI classification, 30.4% of older persons were underweight, whilst 8.1% were overweight. There was a significant difference in mean BMI between male and female older persons (p < 0.01). More men had severe underweight, whilst more women were found to be overweight and obese. The mean dietary diversity score (DDS) was 3.6 ± 1.1. Dietary assessment showed that 64.4% of the respondents had dietary diversity scores that were below the mean value, while 35.6% had scores above the mean value. The Spearman rho correlation test revealed a positive correlation (r = 0.184, p = 0.028) between BMI categories and dietary diversity scores. The majority (74%) of respondents reported having at least one health condition including high blood pressure (42.6%), coronary heart disease (8.9%), malaria (24.4%), tuberculosis (35.6%) and pneumonia (24.4%), while only 26% perceived themselves to be healthy. Conclusion: The study revealed a high prevalence of undernutrition and low dietary diversity among older persons. A positive association was found between nutritional status and dietary diversity. Although the majority of the respondents reported having health conditions, there was no relationship between nutrition-related health conditions and dietary diversity

Dietary diversity and nutritional status of children aged 6–59 months from rural fishing and non-fishing communities in Zambia

Low-quality complementary foods combined with inappropriate feeding practices put children under the age of five in developing countries at high risk for undernutrition. This study explored dietary diversity, fish consumption patterns and nutritional status of children in Luapula, a rural province in Zambia, where households rely on capture fisheries for their livelihoods. In the cross-sectional study, households with children aged 6–59 months were enrolled in the study. A semi-structured questionnaire was utilised to collect socioeconomic characteristics, dietary intake and anthropometric data. Descriptive statistics and bivariate associations were conducted. 23% of children aged 6–23 months met the minimum dietary diversity. About 49% and 41% of the children were fed on fresh small pelagic fish and large dried fish once to twice a week, respectively. Imbilya (Serranochromis mellandi), Chisense (Poecilothrissa moeruensis), and amatuku (Tilapia sparrmanii) were the most preferred fish species due to their availability and affordability. Only 3.5% of children consumed porridge to which fish powder had been added. There was a significant difference in the height for age z scores of children in the two communities (χ2= 12.404; p = 0.002, d.f = 2). Low dietary diversity was observed across the fishing and non-fishing communities and less than half of the children consumed fish despite proximity of the study sites to one of the largest water bodies in Zambia. Better nutrition outcomes were observed among children in capture fisheries dependent households. Nutrition education in growth monitoring and promotion centres should address the issue of adequacy of diets with regard to frequency and diversity

The effects of germination and roasting on nutraceutical and antioxidant properties of Jirani variety of millet

The objective of this study was to determine the effects of processing variables (germination time, roasting temperature and time) on the phytonutrients and antioxidants activity of millet. The germination time employed in this study ranged from 24 - 72 h, roasting temperature ranged from 112.5 -120.0°C and the roasting time ranged from 15-21 min based on an earlier preliminary study. All samples exhibited antioxidant properties and these properties were dose dependent. Positive correlations were obtained between the antioxidant activity of the samples and the content of the phytochemicals. Both germination and roasting time had an effect on the total antioxidant capacity of the germinated millet product. There was an interactive effect between the germination time and roasting time on the total antioxidant capacity and DPPH scavenging property. A negative interactive effect of germination time and roasting temperature as well as roasting temperature and roasting time on the total antioxidant capacity and DPPH values were observed. The germinated and roasted millet products showed the total antioxidant capacity of 39.30 - 66.01 mg/100g, DPPH value of 68.26 - 79.65 μg/ml and reducing power values of 0.353 - 0.441 μg/ml. The results demonstrated that germinated and roasted millet could be useful as an ingredient for functional food. The optimum conditions for processing millet into a functional food ingredient are germination time of 68.97 h, roasting temperature of 114.79°C and roasting time of 15.00 min, resulting at roasted millet product that possess 54.644 mg/100g of total antioxidant capacity, 72.152 μg/ml of DPPH value and 0.376μg/ml of reducing power values