The interaction between the microbiome, diet and health

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Adherence of patients with type 2 diabetes mellitus with the SEMDSA lifestyle guidelines

Background: Type 2 diabetes mellitus (T2DM) is considered to be the fastest growing chronic disease in the world and thus multi-sectoral, population-based strategies and approaches are needed to address the modifiable risk factors involved in the development and treatment of T2DM. Evidence-based nutrition principles and recommendations are summarised by the Society for Endocrinology, Metabolism and Diabetes in South Africa (SEMDSA) into guidelines for the management of T2DM. This study aimed to determine the adherence of patients with T2DM with the SEMDSA lifestyle guidelines.Methods: A cross-sectional study was conducted in a private practice (n = 50), during which an interviewer-assisted questionnaire related to socio-demographics, diet and lifestyle was completed with each participant. Participants were also weighed and measured.Results: 88% of participants were overweight (22%) or obese (66%). Diets consumed were generally high in total energy (TE) (median: 13 272 kJ), low in carbohydrates (CHO) (56% of participants consumed < 45% of CHO from TE), high in saturated fat (92% consumed ≥ 7% from TE) and high in sodium (74% of participants consumed ≥ 2 300 mg sodium daily). Exercise was not commonplace; 84% of participants did not meet the guideline for aerobic exercise and 92% did not meet the guideline for resistance training.Conclusion: The adherence of participants to the SEMDSA guidelines was poor, thus increasing the risk of long-term complications and poor glycaemic control.Keywords: diet, lifestyle, private practice, SEMDSA guidelines, Type 2 diabete

Knowledge, perceptions and practices of HIV-infected mothers regarding HIV and infant feeding

Objectives: The objective of this study was to determine the knowledge, perceptions and practices of HIV-infected mothers regarding human immunodeficiency virus (HIV) and infant feeding. Design: A cross-sectional study design was applied. Setting: The study was undertaken at a regional hospital in Bloemfontein. Subjects: A total of 100 mother–infant pairs that were still in hospital after the delivery of the baby were included. All mothers were HIV-infected. Outcome measures: Sociodemographic information, medical history, and knowledge, perceptions and practices related to infant feeding in the context of HIV were noted. Results: The median age of mothers was 31 years, and most mothers reported anti-retroviral therapy (ART) use (93.0%). The median CD4 cell count was 383 cells/mm3, and median haemoglobin level was 11.4 g/dl. Most mothers planned to breastfeed their infant(s) (70.0%). A large percentage of the mothers reported that they did not know or were not aware of the fact that HIV can be transmitted to an infant via breastfeeding (43.0%). Only half of the mothers had been shown how to either breastfeed or formula feed by healthcare staff (depending on their choice). Conclusion: The knowledge, perceptions and practices related to infant feeding were inadequate in mothers included in this study. Providing scientifically based, unbiased information is fundamental during counselling on infant feeding to ensure the success of prevention of mother-to-child transmission (PMTCT) programmes. If women feel confident in their acquired knowledge, they are more likely to be self-empowered and make informed decisions related to infant feeding

Nutritional status and food intake of women residing in rural and urban areas of Lesotho

Objective: The socio-demography, anthropometry and food intake of women residing in rural and urban areas of Lesotho were determined. Design: Cross-sectional survey. Setting: Basotho women from four randomly selected villages in Maseru and Berea, which includes both urban and rural areas. Subjects: A total of 452 women were included in the study. Outcome measures: Socio-demographic information was collected using a structured questionnaire completed in an interview with each participant. Standard methods were used to determine anthropometric measurements, while usual food intake was determined using a short unquantified food frequency questionnaire. Results: A large percentage of participants were unemployed with a significantly higher percentage in urban compared with rural areas (65.5 vs. 49.2%; CI 6.8%; 25.4%). A higher percentage of urban than rural participants had a BMI ≥ 30 kg/m2 (53.5 vs. 44.4%, respectively) and waist circumference ≥ 88 cm (62.7 vs. 54.1%, respectively). For both rural and urban participants, stiff maizemeal porridge was commonly consumed with all meals, often with moroho (cooked green leafy vegetables). Although a variety of vegetables (onions, cabbage, pumpkin, tomatoes, turnips and potatoes) were frequently eaten by most participants, quantities of intake were not determined. Protein sources consumed almost every day by more than 50% of all participants were dried beans. Chicken, eggs and full cream milk were consumed significantly more frequently by urban participants. Significantly more urban participants had access to a variety of fruits and vegetables, and they were also more likely to consume foods such as polony, Russians (sausage containing pork and beef), sausage, sweetened drinks, mayonnaise and margarine more frequently than rural participants. Conclusions: A nutrition transition associated with the frequent intake of processed, sugary and high-fat foods was identified in urban participants. These unhealthy dietary practices may lead to an increased risk of obesity and poor health outcomes. The development of culturally acceptable and relevant interventions is thus recommended

Household food security and HIV status in rural and urban communities in the Free State province, South Africa

Higher socioeconomic status impacts profoundly on quality of life. Life-event stressors, such as loss of employment, marital separation/divorce, death of a spouse and food insecurity, have been found to accelerate disease progression among people with human immunodeficiency virus (HIV). The objective of this study was to determine significant independent sociodemographic and food security factors associated with HIV status in people from rural and urban communities in the Assuring Health for All study, which was undertaken in rural Trompsburg, Philippolis and Springfontein and urban Mangaung, in the Free State Province of South Africa. Sociodemographic and food security factors associated with HIV status were determined in 886 households. Logistic regression with forward selection (p < 0.05) was used to select significant independent factors associated with HIV status. Variables with a p-value of < 0.15 were considered for inclusion in the model. Adults 25–64 years of age were eligible to participate. Of the 567 rural participants, 97 (17.1%) were HIV-infected, and 172 (40.6%) of the 424 urban participants. A relatively high percentage of respondents had never attended school, while very few participants in all areas had a tertiary education. The unemployment rate of HIV-infected adults was higher than that of HIV-uninfected adults. A high percentage of respondents in all areas reported running out of money to buy food, with this tendency occurring significantly more among urban HIV-infected than HIV-uninfected respondents. In all areas, a high percentage of HIV-infected respondents relied on a limited number of foods to feed their children, with significantly more HIV-infected urban respondents compared to their uninfected counterparts reporting this. Most participants in all areas had to cut the size of meals, or ate less because there was not enough food in the house or not enough money to buy food. During periods of food shortage, more than 50% of respondents in all areas asked family, relatives or neighbours for assistance with money and/or food, which occurred at a higher percentage of HIV-infected rural participants compared to HIV-uninfected rural participants. More than half of all participants reported feeling sad, blue or depressed for two weeks or more in a row. HIV infection was negatively associated with being married (odds ratio 0.20 in rural areas and 0.54 in urban areas), while church membership decreased the likelihood of HIV (odds ratio 0.22 in rural areas and 0.46 in urban areas). Indicators of higher socioeconomic status (having a microwave oven and access to vegetables from local farmers or shops) decreased the likelihood of HIV in rural areas (odds ratios 0.15 and 0.43, respectively). Indicators of lower socioeconomic status such as spending less money on food in the rural sample (odds ratio 3.29) and experiencing periods of food shortages in the urban sample (odds ratio 2.14), increased the likelihood of being HIV-infected. Interventions aimed at poverty alleviation and strengthening values can contribute to addressing HIV infection in South Africa.Keywords: HIV, poverty, food securit

Diabetes-related knowledge, attitude and practices (KAP) of adult patients with type 2 diabetes mellitus in the Free State province, South Africa

Introduction: Type 2 diabetes mellitus (T2DM) is a global health problem with high morbidity and mortality in patients who are mostly still economically active. The growing incidence and health implications for those affected make T2DM a major public health issue. Objectives: To compile a demographic, anthropometric and knowledge, attitude and practices (KAP) profile of adult patients with T2DM in the public health sector of the Free State province, South Africa. Design: A descriptive observational study was conducted. Setting: A total of 255 participants attending public health facilities in the Free State were interviewed. Outcome Measures: Questionnaires were completed in an interview to determine demographics and KAP. Anthropometric measurements were obtained by standard techniques. Results: The majority of the participants (n = 222; 87.1%) were black women from urban areas, who were overweight and obese. The median age at diagnosis was 48 years (range 15–80 years), and 25 participants (9.8%) lacked formal schooling. In 212 participants (83.1%), a waist circumference above cut-off points was observed. Only half of the participants knew the normal range for blood glucose. Approximately 80% felt that they would be a different person if they did not have diabetes. Although 96.1% of participants were knowledgeable about the benefits of physical exercise, only 31.0% reported exercising on a daily basis. A statistically significant association was found between knowledge and attitudes, indicating that better knowledge about diabetes could be associated with a more positive attitude towards diabetes. Conclusion: Poor knowledge, a negative attitude and poor practices related to diabetes were observed in a very high percentage of participants, which may contribute to morbidity and mortality. The fact that knowledge was associated with attitude indicates that interventions aimed at improving knowledge could benefit patients in more than one way. Interventions to equip patients to successfully manage their condition are urgently required

Reported health, lifestyle and clinical manifestations associated with HIV status in people from rural and urban communities in the Free State Province, South Africa

Background: HIV infection impacts heavily on the infected individual’s overall health status.Aim: To determine significant health, lifestyle (smoking and alcohol use) and independent clinical manifestations associated with HIV status in rural and urban communities.Methods: Adults aged between 25 and 64 years completed a questionnaire in a structured interview with each participant. Blood specimens were analysed in an accredited laboratory using standard techniques and controls. Anthropometric measurements were determined using standardised methods.Results: Of the 567 rural participants, 97 (17.1%) were HIV-infected, and 172 (40.6%) of the 424 urban participants. More than half of HIV-infected rural participants used alcohol and more than 40% smoked. Median body mass index (BMI) of HIV-infected participants was lower than that of uninfected participants. Significantly more HIV-infected participants reported experiencing cough (rural), skin rash (urban), diarrhoea (rural and urban), vomiting (rural), loss of appetite (urban) and involuntary weight loss (rural). Significantly more HIV-uninfected participants reported diabetes mellitus (urban) and high blood pressure (rural and urban). In rural areas, HIV infection was positively associated with losing weight involuntarily (odds ratio 1.86), ever being diagnosed with tuberculosis (TB) (odds ratio 2.50) and being on TB treatment (odds ratio 3.29). In the urban sample, HIV infection was positively associated with having diarrhoea (odds ratio 2.04) and ever being diagnosed with TB (odds ratio 2.49).Conclusion: Involuntary weight loss and diarrhoea were most likely to predict the presence of HIV. In addition, present or past diagnosis of TB increased the odds of being HIV-infected. Information related to diarrhoea, weight loss and TB is easy to obtain from patients and should prompt healthcare workers to screen for HIV

Malnutrition in the elderly residing in long-term care facilities: a cross sectional survey using the Mini Nutritional Assessment (MNA®) screening tool

Objectives: The objective of this study was to determine and compare the nutritional status of the elderly in two long-term care facilities - one situated in a higher socio-economic area and one in a lower socio-economic area.Design: A cross-sectional study was undertaken.Setting: The study setting comprised two urban areas of Bloemfontein, Free State province, South Africa.Subjects: Sixty-two elderly residing in a long-term care facility from both the higher and lower socio-economic areas agreed to participate and met inclusion criteria (N = 124).Outcome measures: The nutritional status of participants was assessed using the Mini Nutritional Assessment (MNA®) questionnaire. Indicators of nutritional status that were assessed as part of the validated MNA® included anthropometry, a global assessment, dietary assessment and subjective assessment. A total score of 24 or more points was interpreted as being wellnourished.Results: Malnutrition was identified in 3.2% of participants from the long-term care facility situated in the higher socio-economic area and 11.3% from the lower socio-economic area. A significantly higher percentage of participants from the lower socioeconomic area were found to be at risk of malnutrition than those from the higher socio-economic area (74.2% vs. 37.1%) [95% CI 19.8%; 51.4%]. Participants from the higher socio-economic area consumed significantly more fluid and protein rich foods than their counterparts.Conclusion: Elderly participants from the lower socio-economic area were more likely to have a poor nutritional status and be at risk of malnutrition. The findings highlight the need to focus on screening for malnutrition in order to promote health and prevent the possible development of nutrition-related co-morbidities in the elderly.Keywords: care facility, elderly, malnutrition, mini nutritional Assessment, nutrition screening, South Afric

Agreement between measured height, and height predicted from ulna length, in adult patients in Bloemfontein, South Africa

Objective: To assess the agreement between measured height, and height predicted from ulna length using the Malnutrition Universal Screening Tool (MUST) equations, in adult patients admitted to government hospitals in Bloemfontein, South Africa.Design: Descriptive cross-sectional survey.Setting: Medical, surgical, pulmonary, orthopaedic, cardiovascular and general wards at Pelonomi, Universitas and National Hospitals in Bloemfontein.Subjects: All patients between 19 and 60 years, admitted during a two-week period in March 2015, who gave written informed consent, and were able to stand upright and unassisted, were included.Outcome measures: Standing height (via stadiometer; referred to as reference height), weight and ulna length were measured. Predicted height and body mass index (BMI) were calculated from ulna length using MUST equations, and compared with reference height and BMI by 95% confidence intervals (CI) and Bland–Altman analysis.Results: The sample comprised n = 200 participants (48% female; median age: 42 years: 32–51 years). The median height estimated from ulna length (170.2 cm; range: 154.2–213.0 cm) was statistically significantly (95% CI [7.1; 7.7]) longer than the median reference height (163.9 cm; range: 145.1–188.4 cm). The Bland–Altman analysis indicated that the 95% limits of agreement between the two methods ranged from –19.8 to 5.7 cm. Median BMI based on estimated height (20.1 kg/m2) was significantly (95% CI [–1.9; –1.6]) lower than median BMI calculated from reference height (21.8 kg/m2).Conclusion: Height predicted from ulna length with the MUST equations overestimated height in this population. This may be related to high prevalence of stunting in the South African population. The discrepancy may have clinical implications particularly for critically ill patients.Strong message: Estimations of height based on upper body long-bone measurements may not be reliable in populations with a high prevalence of stunting.Keywords: standing height, predicted height, ulna length, MUST equations, stuntin

The relationship between obesity, leptin, adiponectin and the components of metabolic syndrome in urban African women, Free State, South Africa

Objectives: Obesity prevalence is increasing worldwide. In South Africa, older and urbanised African women have significantly higher rates of obesity. Limited information is available on the relationship between anthropometric parameters, adipokines and metabolic health status of African women. This study investigated the relationship between obesity, adipokines and the components of metabolic syndrome in urban African women.Methods: This study included 135 urban African women that were 26–63 years of age, identified with metabolic syndrome in the urban leg of the Assuring Health for All in the Free State (AHA-FS) study. To establish anthropometric status, the following measures were taken: body weight, height and waist circumference. Blood was drawn to determine leptin, adiponectin levels and metabolic status.Results: Adiponectin levels in obese women were significantly decreased compared to normal weight women. Leptin levels and leptin:adiponectin ratios (L:A) were increased in the obese group compared to the overweight and normal weight groups. Leptin and L:A showed strong positive correlations with body mass index and waist circumference. Adiponectin levels decreased as the number of components of metabolic syndrome increased. The L:A ratio was significantly lower in women with elevated triglycerides and significantly higher in women with elevated blood glucose levels. Adiponectin levels were significantly lower in women with elevated blood glucose.Conclusion: This study confirms the inverse relationship between adiponectin and leptin with increased body adiposity. Results indicate that waist circumference, fasting blood glucose and triglyceride levels are the metabolic syndrome components most closely associated with altered adiponectin and leptin levels and L:A in urban African women with metabolic syndrome.Keywords: adipokines, adiponectin, components of metabolic syndrome, leptin, L:A ratio, obesit