Public health programmes, packages and processes

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Fast-food consumption among 17-year-olds in the Birth to Twenty cohort

Objectives: Assessment of fast-food consumption in urban black adolescents.Design: The current research was a descriptive cross-sectional study.Setting: Subjects attending the Birth to Twenty (Bt20) research facility at the Chris Hani Baragwanath Hospital in Soweto, Johannesburg between September 2007 and May 2008 were enrolled.Subjects: 655 black subjects (51.1% females) were consecutively selected to participate from the larger cohort of Bt20.Outcome measures: Fast-food item consumption and frequency of  fast-food outlet visits were assessed by interviewer-administered questionnaire.Results: Over a 7-day assessment period, participants consumed 5 026 fast-food items, with the most popular food item being an item known colloquially as a ‘quarter’. There were no gender differences in terms of preferences. Mean fast-food intake was 8.1 (4.6) items and 7.2 (4.7) items per week for males and females respectively (ρ = 0.01). A typical ‘quarter’ consists of a quarter-loaf of white bread, chips, a slice of cheese and any number of delicatessen meats and sauces. A macronutrient comparison between a ‘quarter’ and three commercially available fast-food meals was undertaken, with the ‘quarter’ providing the most energy (5 970 kJ) and being the least expensive (mean cost = R9.16).Conclusion: The average estimated daily energy requirement for a 17-year-old is approximately 10 000 kJ, thus the ‘quarter’ may make a significant contribution to daily energy intake. Further research assessing the role of fast-foods in the provision of total energy and nutrient intakes in adolescents is require

Pregnancy- and lactation-associated osteoporosis

Pregnancy-and lactation-associated osteoporosis is a rare syndrome of spontaneous fractures occurring in late pregnancy or lactation. Early diagnosis and management is essential, because of the severity of the morbidityassociated with these fractures. Prior to therapy, other reversible causes of osteoporosis should be excluded through adequate investigation. Treatment includes cessation of breastfeeding, the provision of adequate pain relief,and the use of specific osteoporosis drugs, preferably those with short-term bone retention. Although there is no persuasive evidence that calcium and vitamin D requirements increase during pregnancy or lactation comparedto the non-pregnant woman of childbearing age, it is advisable to ensure that women are vitamin D replete during pregnancy and lactation

Socio-economic predictors of stunting in preschool children – a population-based study from Johannesburg and Soweto

Background. Stunting continues to be a child public health concern in many African countries, including South Africa. This study uses data from the Birth to Twenty study, held in Johannesburg, to investigate a range of household-level socioeconomic and social support predictors of stunting in children aged less than 30 months.Design. Logistical regression models were constructed using aconceptual framework to investigate the association between early life measures of socio-economic status and stunting

Under- and overnutrition and evidence of metabolic disease risk in rural black South African children and adolescents

Objectives: The objective was to determine the prevalence of under- and overnutrition, as well as evidence of metabolic disease risk in rural black South African children and adolescents.Design: A cross-sectional study was conducted.Setting: The setting was the Agincourt Health and Socio-demographic Surveillance System site, Mpumalanga province.Subjects: Six hundred children were randomly selected, of whom 588 were included in the analytical sample (mean age of 11.5 years, range of 7-15 years).Outcome measures: Outcome measures were anthropometric and blood pressure assessments, Tanner pubertal staging, as well as the determination of fasting serum lipid and glucose concentrations.Results: Using age and sex-specific World Health Organization 2007  growth references, the prevalence of stunting was determined to be 6.2% in the boys, and 2.7% in the girls, while 4.1% of the boys and 4.4% of the girls were underweight. Combined overweight and obesity prevalence was higher in the girls (13.5%) than in the boys (2.7%). Girls had significantly a higher body mass index and hip circumference than the boys in the early, mid and late pubertal stages. Pre-hypertension prevalence, using either systolic or diastolic blood pressure for sex, age and height, was 15% and 10% in the girls and boys, respectively. Furthermore, impaired fasting glucose (FG) (FG . 5.6 mmol/l) was detected in 5% of the children.  High-density lipoprotein cholesterol concentrations less than 1 mmol/l were observed in 0.7% of the boys and in 12% of the girls, which is indicative of cardiometabolic risk.Conclusion: Stunting levels were higher in the boys than in the girls in mid to late childhood in a rural setting in South Africa, while the girls had a higher prevalence of overweight and obesity than the boys.  Pre-hypertension prevalence in the boys and girls was high. Other  metabolic risk factors, i.e. impaired FG and lipids, were also seen in this population and were associated with adiposity. The study highlights the critical need for targeted health promotion interventions to optimise child health as part of a noncommunicable disease preventative strategy

Paediatric hypertension in South Africa: An underestimated problem calling for action.

Hypertension is a major global health problem and the most prominent risk factor for cardiovascular diseases, which disproportionately affect low- and middle-income countries (LMICs). According to a recent report from the Word Health Organization/Strategic Advisory Group of Experts (WHO-SAGE) group, almost half of the South African (SA) adult population is living with hypertension. Although the condition occurs less frequently in children than in adults, evidence now supports the concept that adult essential hypertension has its roots in childhood. A systematic review reports that the prevalence of hypertension in SA children ranges from 7.5% to 22.3%. One in five children aged 5 years is hypertensive (≥95th percentile for age, height and sex), and 60% of children with elevated blood pressure (BP) (>90th percentile for age, height and sex) maintain that status into early adulthood. In addition, there are distinct BP trajectories set early in childhood that are mainly driven by patterns of early life growth and socioeconomic environment. We seek to raise awareness of paediatric hypertension, its risk factors and its consequences, and highlight the importance of action, which can inform early detection and intervention strategies in the context of an increasing burden of cardiovascular disease in SA

Even transient rapid infancy weight gain is associated with higher BMI in young adults and earlier menarche.

BACKGROUND: Early postnatal rapid 'catch-up' weight gain has been consistently associated with subsequent higher obesity risk and earlier pubertal development. In many low- and middle-income countries, infancy catch-up weight gain is transient and often followed by growth faltering. We explored the hypothesis that even transient catch-up weight gain during infancy is associated with later obesity risk and earlier puberty. METHODS: A total of 2352 (1151 male, 1201 female) black South African children in the birth to twenty prospective birth cohort study (Johannesburg-Soweto) underwent serial measurements of body size and composition from birth to 18 years of age. At the age of 18 years, whole-body fat mass and fat-free mass were determined using dual-energy X-ray absorptiometry. Pubertal development was assessed by the research team between ages 9 and 10 years, and it was recorded annually from the age of 11 years using a validated self-assessment protocol. RESULTS: Catch-up weight gain from birth to the age of 1 year, despite being followed by growth faltering between ages 1 and 2 years, was associated with greater mid-upper arm circumference (P=0.04) and skinfold thickness (P=0.048) at 8 years of age, and with higher weight (P<0.001) and body mass index (P=0.001) at 18 years of age after adjustment for sex, age, smoking during pregnancy, birth order, gestational age, formula-milk feeding and household socio-economic status. Infancy catch-up weight gain was also associated with younger age at menarche in girls (P<0.001). This association persisted after adjustment for smoking during pregnancy, birth order, gestational age, formula-milk feeding and household socio-economic status (P=0.005). CONCLUSION: Transient catch-up weight gain from birth to the age of 1 year among children born in a low-income area of South Africa was associated with earlier menarche and greater adiposity in early adulthood. This observation suggests that modifiable determinants of rapid infancy weight gain may be targeted in order to prevent later obesity and consequences of earlier puberty in girls.We are grateful to all study participants, their families and research assistants. Birth to twenty has been supported by The Wellcome Trust, Human Sciences Research Council, Medical Research Council, University of the Witwatersrand, the South African-Netherlands Programme on Alternative Development and the Anglo American Chairman’s Fund.This is the author accepted manuscript. The final version is available via NPG at http://www.nature.com/ijo/journal/vaop/ncurrent/full/ijo201525a.html