Cardiovascular disease and nutrition: The use of food-based dietary guidelines for prevention in Africa

There is no doubt that morbidity and mortality from cardiovascular disease (CVD) are increasing in many African countries. Research and implementation of public health nutrition programmes in the developed world have shown that CVD can be prevented by dietary interventions. The objectives of this paper are to (i) review the relationships between diet and CVD; (ii) review the possible contribution of the nutrition transition, which is associated with economic development and “modernisation” to CVD in Africa; (iii) identify barriers and challenges plus assessing the opportunities available to steer the nutrition transition into a more positive direction; and (iv) show how ideal nutrient intakes can be translated into appropriate food based dietary guidelines (FBDGs) and how to apply these for prevention and management of CVDs. This should result in appropriate recommendations for diets that will be country-specific, affordable, culturally acceptable and based on available, traditional and indigenous foods. It is concluded that all health professionals should be sensitised, informed, trained and/or educated to apply FBDGs in a way that will motivate the public or patients to follow healthier diets for primary, secondary and tertiary prevention and treatment of CVD

Dietary cholesterol - the role of eggs in the prudent diet

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Nutrient adequacy

Not sure whether PDF can be uploadedKey Messages "Nutrient adequacy, a result of consumption of sufficient amounts of all essential nutrients and energy to meet individual requirements, is a prerequisite for normal growth, development and health. " Two thirds or more of hospital patients suffer from malnutrition at initial presentation.  "A variety of standardized methodological tools to assess, restore and maintain nutritional status are available. " "A holistic approach is advised, including processes of screening for malnutrition, assessing nutritional status, diagnosing specific deficiencies, and designing and implementing an appropriate medical nutrition therapy plan. " Health professionals should be aware of and use available methodological and interpretive tools to assist them in this important task.

Evidence-based nutrition

The evidence-based approach has recently been implemented to translate the vast body of literature available into effective action aimed at addressing the pressing nutritional problems that affect populations.In this paper, the first in a series on the topic, the meaning of evidence-based nutrition (EBN) is clarified and the broad outlines of how to review and interpret both individual papers and reviews of a collection of papers is discussed.The objectives of the EBN approach and the steps to follow in the process are outlined. A useful checklist for the critical appraisal of research papers is given and criteria for reviewing reviews of all relevant available information are discussed. The benefits of the EBN approach are highlighted

Evidence-based nutrition - review of epidemiological studies

Results from epidemiological studies are often used to explore the relationships between nutrition and health. The objective of this paper is to provide guidelines for evaluating the quality and strength of evidence from different types of epidemiological studies (including ecological, cross-sectional, case-control, cohort and experimental studies) for conclusions about the relationship between nutrition and health.The discussion include advantages and disadvantages of these different types of studies, exposures, outcomes, the role of chance, bias and confounding factors, recruitment and sampling procedures and criteria, study size and power, measurement error (random and systematic), time effects, observer and participant effects, compliance, as well as analysis and interpretation of results. A checklist for reviewing epidemiological studies is given as guide to assess the quality of the data and the suitability of the study results for specific conclusions

Integrated nutrition science: from theory to practice in South Africa

Objective: To describe an integrated, holistic conceptual framework and research paradigm for a better understanding of the nutrition transition in middle- and low-income countries.Motivation: Current inability effectively to prevent the increasing burden related to changes in food consumption patterns and other health behaviours of populations in transition motivates a new approach for nutrition research and practice. In this proposed approach, broader and integrated dimensions of science and practice may be applied for a better understanding of this complex phenomenon.Result: Examples from our own studies are given and quoted to illustrate how results from transdisciplinary studies were used to design an integrated, holistic programme to improve quality of life of people infected with HIV.Conclusion: Based on these experiences it is argued that the more holistic and integrated approach should and could lead to more effective and sustainable interventions to prevent the adverse health consequences of the nutrition transition. At the same time such an approach will contribute to efforts to conserve the environment and also human, living and natural resources

Fortification of maize meal improved the nutritional status of 1-3-year-old African children

Objective: To evaluate the effectiveness of a vitamin-fortified maize meal to improve the nutritional status of 1–3-year-old malnourished African children.Design: A randomised parallel intervention study was used in which 21 experimental children and their families received maize meal fortified with vitamin A, thiamine, riboflavin and pyridoxine, while 23 control children and their families received unfortified maize meal. The maize meal was provided for 12 months to replace the maize meal habitually consumed by these households.Methods: Sixty undernourished African children with height-for-age or weight-for-age below the 5th percentile of the National Center for Health Statistics' criteria and aged 1–3 years were randomly assigned to an experimental or control group. Baseline measurements included demographic, socio-economic and dietary data, as well as height, weight, haemoglobin, haematocrit, serum retinol and retinol-binding protein (RBP). Anthropometric, blood and serum variables were measured again after 12 months of intervention. Complete baseline measurements were available for 44 children and end data for only 36. Changes in these variables from baseline to end within and between groups were assessed for significance with paired t-tests, t-tests and analysis of variances using the SPSS program, controlling for expected weight gain in this age group over 12 months. Relationships between changes in variables were examined by calculating correlation coefficients.Results: The children in the experimental group had a significantly (P0.05) higher increase in body weight than control children (4.6 kg vs. 2.0 kg) and both groups had significant (P0.05) but similar increases in height. The children in the experimental group showed non-significant increases in haemoglobin and serum retinol, while the control children had a significant (P=0.007) decrease in RBP. The change in serum retinol showed a significant correlation with baseline retinol (P=0.014), RBP (P=0.007) and weight (P=0.029), as well as with changes in haemoglobin (P=0.029).Conclusion: Despite a small sample size, this study showed positive effects of a vitamin-fortified maize meal on weight gain and some variables of vitamin A status in 1–3-year-old African children. The study confirmed the relationship between vitamin A and iron status. The results suggest that fortification of maize meal would be an effective strategy to address micronutrient deficiencies in small children in South Africa

Evidence-based nutrition - using a meta-analysis to review the literature

One of the purposes of this series on evidence-based nutrition1,2 is to elucidate how students and researchers in nutrition, practitioners, health care providers and policy makers can apply basic principles and standardised methods to synthesise and make sense of large, often unmanageable amounts of information. This is necessary in order to draw conclusions from empirical studies and make decisions which will be evidence-based and not unduly influenced by bias and chance effects. The purpose of this paper in the series is to show how a meta-analysis can be used to do this by statistically combining results from independent but related studies into a composite measure of effect.A meta-analysis is a statistical technique used to combine the results of studies addressing the same question into a one number summary.3, 4 The meta-analysis method can be applied in the social-behavioural and biomedical sciences5 and is therefore particularly suitable for nutrition data. The term meta-analysis should not be confused with a systematic review. Egger and Smith4 suggest that the term meta-analysis should be used ‘to describe the statistical integration of separate studies whereas systematic review is most appropriate for denoting any review of a body of data that uses clearly defined methods and criteria’. According to this definition a meta-analysis can, if appropriate, be part of a systematic review. It is always appropriate and desirable to systematically review a body of data, but it may at times be inappropriate to pool results from separate studies.4 Because a systematic review is a structured, systematic qualitative and quantitative integration of comparable results of several independent studies, it can provide a firm basis for planning and policy recommendations.6 A meta-analysis has been described as ‘a quantitative approach to research reviews’,7 ‘aggregating data’,8 ‘the epidemiology of results’5 and ‘the application of statistical procedures to collections of empirical findings’.3 A meta-analysis uses specific statistical methods to combine, summarise and integrate comparable results from different studies. The unit of observation is therefore the study. A major purpose of pooling results in a meta-analysis is to increase statistical power and precision of estimates in smaller studies.3-9 There are excellent sources available3-10 with detailed, step-by-step guidelines, recommendations and numerous examples of how to do a meta-analysis. In this paper the advantages and limitations of a meta-analysis and the process of conducting one will be outlined briefly to motivate nutritionists when and how to use it in their interpretation of the literature, in drawing conclusions from studies with conflicting results, and in policy formulation

Have milk, maas or yoghurt every day: a food–based dietary guideline for South Africa

A national working group recently reached consensus that a guideline message for milk consumption should form part of the set of revised food-based dietary guidelines (FBDGs) for South Africa. The message was formulated as: “Have milk, maas or yoghurt every day”. This paper provides scientific support for this FBDG, based on the nutrition and health profile of South Africans; addresses concerns about possible detrimental effects of milk consumption, such as lactose intolerance, saturated fat and trans-fat content, milk allergies and dental caries in children; and identifies barriers to increased consumption. The guideline refers to milk, maas and yoghurt, and not all dairy products. This is based on the nutrient contribution of these products to a healthy diet. Milk (and some dairy products) has a low sodium-to-potassium ratio, as well as bioactive peptides, which may protect against the development of noncommunicable diseases. There is some evidence that the calcium in milk and dairy plays an important role in the regulation of body weight and bone mineral content in children. Available data show that milk and calcium intake in South Africans is low. Identified barriers include perceptions about lactose intolerance, taste, price, lack of knowledge on the nutritive value of milk and milk products, and possibly cultural taboos. As a result, increasing the consumption of milk, maas and yoghurt of South Africans will require active, multifaceted and multilevel promotio