Genotype-based personalised nutrition for obesity prevention and treatment: are we there yet?

Interactions between genotype and dietary intake include genetic moderation of the effect of dietary intake on disease development (nutrigenetics). Research on nutrigenetics has focused mainly on single-nucleotide polymorphisms (SNPs) and supports the notion that interactions between genes, diet, other lifestyle factors, disease, and time (life cycle span), contribute to the risk of most polygenic nutritionrelated diseases. Typically, genotype-based personalised nutrition involves genotyping for a number of susceptibility SNPs associated with the prevention, or management, of a particular disease. Dietary advice is then personalised to the individual’s genotype to ensure optimal prevention or treatment outcomes. To ensure evidence-based practice, research design and methodology, applied in the investigation of relevant associations, and confirmation of causality, should be appropriate and rigorous. The process of identifying SNPs associated with disease patterns is ongoing. Of note is that the combined effect on body mass index of the SNPs at the currently confirmed 32 loci is a modest 1.45%, bearing in mind that the estimated heritability of obesity is 40-70%. Conclusions formulated by various researchers on the translation of nutrigenetics research into personalised nutrition, including obesity prevention and management, indicate that scientists hold the opinion that more research is necessary before evidence-based practice in this area can be guaranteed.Keywords: nutrigenetics, obesity, genotype, personalised nutrition, weight managemen

Avian Influenza: What the family practitioner should know

Human immunity to influenza A virus depends on the specific subtype. Mortality after exposure to subtypes commonly causing human infection is low (approximately 0.1%). Other subtypes are specifically adapted to cause disease in birds. These subtypes are known as ‘avian influenza'. Under certain circumstances avian influenza can also be transmitted to humans, causing a severe infection known as highly pathogenic avian influenza (HPAI), with a mortality currently exceeding 50%.For full text, click here:SA Fam Pract 2006;48(3):56-5

Market and product assessment of probiotic/prebioticcontaining functional foods and supplements manufactured in South Africa

Objectives. Probiotic and prebiotic products manufactured in South Africa  were identified and health and content claims stated on the labels were  evaluated according to available scientific evidence, the proposed South  African regulations in the Foodstuffs, Cosmetics and Disinfectants Act (Act  No. 54 of 1972, www.doh.gov.za), and microbial assessment.Results. The range of products identified included probioticand/ or prebiotic-containing supplements (capsules), food items fortified with  probiotics and/ or prebiotics, and fermented food containing probiotics, e.g. dairy products. Most of the health-related claims on the labels of the identified products do not comply with proposed South African regulations. However, results also indicate that the proposed South African regulations should be reconsidered to include an additional 5 claims, for which  scientifically sound evidence is available. The claims regarding probiotic strains, viable cell numbers, prebiotic type and concentration stated on the labels of the products are mostly in line with the proposed South African  regulations. The actual viable cell content of 3 out of 5 probiotic  supplements readily available on the South African market did not comply  with the content claim stated on the label. However, this problem did not seem to affect the inhibitory activity of the pro biotic strains against  indicator strains isolated from faeces of patients diagnosed with AIDS. To validate this finding in vivo assessments should be implemented before  considering the need to include a wider range of prescribed viable cell numbers in the proposed South African regulations.Conclusions. The proposed South African regulations regarding probiotic-  and prebiotic-containing products should be revised based on the results of  this research, and the manufacturers of these products should be held responsible for providing the consumer with scientifically sound and legally  correct information

Weight and health status of black female students

Objective. To examine black female students for the occurrence of risk factors associated with chronic diseas~s of lifestyle, namely obesity, hypertension, nicotine usage, dyslipidaemia and compromised mental health (depression).Design. A cross-sectional analytical study design was used. All participants were examined within a period of 3 months during 1994. Weight, height, and hip and waist measurements were taken. Body mass index (BMI), waist-hip ratio (WHR) and waist circumference (WC) were calculated for each subject. Two systolic and diastolic blood pressure readings were taken for each participant. Questionnaires were used to determine specific risk factors related to lifestyle. The Beck Depression Inventory (BDI) was used to measure psychological well-being. Fasting blood samples were collected and analysed for serum lipids and iron status.Setting. The University of the North in the Northern Province of South Africa.Subjects. A complete data set of sociodemographic information, anthropometric measurements and blood pressure readings, as well as a psychological health test and a medical questionnaire, were obtained from 231 of the 431 first-year female students who attended the university orientation programme. Only students with a complete data set were included in the sample.Results. Eighteen per cent of students were overweight (BMI 25 - 29.9), 6.5% were obese (BMI ≥ 30), and 26.8% were underweight. Mean blood pressure, BMI, WHR and WC increased significantly with age and were highest among the  ≥ 24-year-olds. Only 1.6% of students had elevated blood pressure, 1.0% smoked and 4.4% took snuff. BMI, WC and WHR were positively correlated with blood pressure and age. Few students had dyslipidaemia (3.8% cholesterol> 5.2 mmol/l). However 14.5% were anaemic (Hb < 11.5 g/dl) and 24.6% had microcytosis « 80 fl). Nearly one-fifth of students (17.7%) were classified as being moderately to severely depressed. Conclusions. Black female students younger than 24 years exhibited few risk factors associated with chronic diseases of lifestyle. However in older women (;<,24 years) there were significant increases in BMI, WHR, WC and blood pressure. A large number of students of all ages exhibited moderate to severe depression and anaemia was prevalent

A systematic review of doctoral graduate attributes: Domains and definitions

Doctoral graduate attributes are the qualities, skills, and competencies that graduates possess, having completed their doctorate degree. Graduate attributes, in general, lack conceptual clarity, making the investigation into and quality assurance processes attached to doctoral outcomes challenging. As many graduate attributes are “unseen” or implicit, the full range of attributes that doctoral graduate actually possess needs to be synthesized, so that they may be recognized and utilized by educational stakeholders. The aim of this study was to establish and describe what attributes graduates from doctoral degrees possess. A systematic review of peer-reviewed, primary literature published between January 2016 and June 2021 was conducted, identifying 1668 articles. PRISMA reporting was followed, and after screening and full text critical appraisal, 35 articles remained for summation through thematic synthesis. The doctoral graduate attribute domains identified included knowledge, research skills, communication skills, organizational skills, interpersonal skills, reputation, scholarship, higher order thinking skills, personal resourcefulness, and active citizenship. Many of the domains were conceptualized as transferable or interdisciplinary, highlighting the relevance of the attributes doctoral graduates possess. The review findings align with existing frameworks yet extend those that tend to focus on generic “seen” attributes, and include a range of “unseen”, intrinsic qualities as outcomes of the doctoral degree. The review contributes to the conceptual development of doctoral graduate attributes, by synthesizing actual outcomes, as opposed mto prospective attributes or attributes-in-process. Doctoral graduate attributes should be conceptualized to integrate both generic attributes alongside intrinsic qualities that are important for employability. Increased awareness as to the scope of doctoral graduate attributes among stakeholders, such as doctoral supervisors, students, graduates and employers, may facilitate improved educational outcomes and employability. Future research into the contextual relevance of the domains identified and how they are developed may be beneficial. Future research could involve the development of context-relevant scales to empirically measure doctoral graduate attributes among alumni populations, as a quality assurance outcome indicator. Such findings could inform program reform, improving the relevance of doctoral education and the employability of doctoral graduate

Obesity in South Africa: Challenges for government and health professionals

OBJECTIVES: To review data on the prevalence, causes and health consequences of obesity in South Africa and propose interventions to prevent and treat obesity and related outcomes. METHODS: Data from existing literature were reviewed with an emphasis on changing eating and activity patterns, cultural factors, perceptions and beliefs, urbanisation and globalisation. Results of studies on the health consequences of obesity in South Africans are also reviewed. RESULTS: Shifts in dietary intakes and activity patterns to higher fat intakes and lower physical activity are contributing to a higher prevalence of obesity. Few overweight black women view themselves as overweight, and some associate thinness with HIV/AIDS. Glucose and lipid toxicity, associated with insulin resistance, play roles in the pathogenesis of the co-morbid diseases of obesity. Elevated free fatty acids in the black population predispose obese black patients to type 2 diabetes. CONCLUSION & RECOMMENDATIONS: Obesity prevention and treatment should be based on education, behaviour change, political support, intersectoral collaboration and community participation, local actions, wide inclusion of the population, adequately resourced programmes, infiltration of existing initiatives, evidence-based planning, and proper monitoring and evaluation. Interventions should have the following components: reasonable weight goals, healthful eating, physical activity and behavioural change. Genes and mutations affecting susceptibility to the development of co-morbidities of obesity and vulnerable periods of life for the development of obesity should be prioritised. Prevention should be managed in community services, identification of high-risk patients in primary healthcare services and treatment of co-morbid diseases in hospital services

Guideline: Appropriate use of tigecycline

INTRODUCTION: Tigecycline, the first of a new class of antibiotics, the glycylcyclines, was licensed in South Africa for the parenteral treatment of adult patients with complicated intraabdominal infections (cIAIs) and complicated skin and softtissue infections (cSSTIs). METHODS: A multidisciplinary meeting representative of the Association of Surgeons of South Africa, the Critical Care Society of Southern Africa, the Federation of Infectious Diseases Societies of Southern Africa, the South African Thoracic Society and the Trauma Society of South Africa was held to draw up a national guideline for the appropriate use of tigecycline. Background information reviewed included randomised controlled trials, other relevant publications and local antibiotic susceptibility patterns. The initial document was drafted at the meeting. Subsequent drafts were circulated to members of the working group for modification. OUTPUT: The guideline addresses several important aspects of the new agent, summarising key clinical data and highlighting important considerations with the use of the drug. The recommendations in this guideline are based on currently available scientific evidence together with the consensus opinion of the authors. CONCLUSION: This statement was written out of concern regarding the widespread misuse of antibiotics. Its primary intention is to facilitate heterogeneous use of antibiotics as a component of antibiotic stewardship and to highlight the appropriate use of tigecycline in particular.Sponsored through an unrestricted educational grant from Wyeth