Development and comparative validation of a dietary fat screener for grade six children

Background Risk factors for chronic non-communicable diseases have been shown to track from childhood into adulthood. Cost-effective intervention starts with valid screening. The aim of this research was development and comparative validation of a dietary fat screener in grade six learners. Methods A pictorial, quantitative food frequency questionnaire type, scored dietary fat screener (test method), consisting of ten food categories associated with high fat intakes, was developed and subjected to developmental evaluations in the target group. Subsequently the test method was administered to learners of an urban middle-class school (Pretoria, South Africa). Test-retest reproducibility was checked in a random sub-sample. Two reference methods were used for comparison: Parental completion of the screener and a three-day food record by the children. Reliability testing of the test method involved measuring internal consistency and test-retest reproducibility. Credibility of energy intakes in the food record was checked. Mean cholesterol intake and percentage fat and saturated fat energy were determined. Comparative validation was based on correlations, mean differences and the Bland Altman method for continuous variables. Percentage agreement, kappa statistics and the McNemar tests were determined for categorical data, as were sensitivity, specificity and predictive values. Receiver operating characteristic curves were plotted. Results Sample: Out of 108 children, 39 (100%) were re-tested, 93 (86%) provided usable food records and 78 (72%) parents responded. Mean age was 148±4.4 months. Reliability: The test method was internally consistent. Test-retest reproducibility of portion size and frequency of intake estimates depended on the food category. No systematic error between administrations was noted as mean category and final score differences between the two administrations did not differ significantly from zero. A significant (r=0.36, P=0.02) correlation existed between administrations, but boys were characterised by random error and a lack of reproducibility (r=0.26, P=0.29), whilst for girls reproducibility could be established (r=0.58, P=0.01). Comparison to screener by parents: Children and parents did not agree in respect of reported portion size and frequency of intake. Parents had lower values for all scores. Correlation between children’s and parents’ final scores was 0.23 (P=0.04) (boys: r=0.13, P=0.46; girls: r=0.33, P=0.04), but the mean difference in final scores differed significantly from zero (P=0.0001). Classification was identical in 74% of cases, but when corrected for chance this agreement was also poor. Comparison to food record: The food record appeared to be a plausible reflection of energy intakes during the recording period. For girls a significant (P<0.05) correlation between test method final score versus cholesterol intake and energy from total and saturated fat was found. The sensitivity of the test method was very high (over 90%). Chance corrected agreement between test method classification and measures of fat intake from the food record was poor. Changing the cut-off of the test method final score could not achieve high sensitivity and high specificity simultaneously. Conclusion The dietary fat screener cannot yet be used as sole indicator of high fat intake in grade six learners. Until the discriminatory abilities have been improved, its value lies in creating awareness of high fat intakes and providing a food-based starting point for anticipatory guidance.Thesis (PhD (Human Nutrition))--University of Pretoria, 2006.Human Nutritionunrestricte

Nutrition screening : science behind simplicity

Nutrition screening triggers entry into the nutrition care process.1 Screening has informally been described as simple, quick or low-intensity proxy for more complex procedures. More formal definitions for the nutrition setting have been proposed, describing nutrition screening as a process of identifying patients, clients, or groups who may be at risk of malnutrition or may already be malnourished to determine if a detailed nutrition assessment is indicated.2 Nutrition screening can rely on anthropometric, dietary, clinical and/ or biochemical parameters, can be “general” in nature or focus on a particular aspect of nutritional status, intended for a specific target group and/or context. One of the most important characteristics of a screening tool is its costeffectiveness, i.e. whether it is able to adequately achieve its aim with the least resources. To determine whether the intended aim is achieved, the screening tool’s findings are typically compared to those of a comprehensive nutrition assessment, a technique called comparative or relative validation.http://www.sajcn.co.za/index.php/SAJCNam2017Human Nutritio

Weight and height : the foundation of anthropometry and body composition

Nutrition screening and assessment initiate the nutrition care process of individuals and groups and are also core in nutrition monitoring and evaluation. Anthropometry is an objective nutritional assessment method, and, in the case of infants and children, growth monitoring is also a sensitive indicator of health status. Most quantitative nutrition research studies involving nutritional status include a description of the subjects’ weight and height. Among the advantages associated with weight and height are the universal use, ease of taking the measurements as well as availability and low cost of the necessary equipment. On the other hand, two publications in this issue argue that in different South African settings height measurement poses challenges, thereby justifying an analysis of the accuracy of available height estimation equations from segment lengths. In both cases the authors raise doubts about the performance of the equations tested.http://www.sajcn.co.za/index.php/SAJCNam2017Human Nutritio

Human milk fortification strategies for improved in-hospital growth of preterm infants

Human milk is the preferred feed for preterm infants, yet it may need to be fortified for optimal growth and development. Standard fortification of human milk seldom meets the recommended intake of protein, leading to inadequate post-natal growth. This article aims to critically review different human milk fortification strategies with a focus on in-hospital growth of premature infants in resource-limited settings. Super, adjustable and target fortification are compared to standard fortification. Different growth outcome parameters limit comparability of findings, but super fortification and adjustable fortification present opportunities to explore. More uniform growth outcome assessment is recommended. Practical implementation and costeffectiveness in the local setting need to be investigated.http://www.sajcn.co.za/index.php/SAJCNam2017Human Nutritio

Dairy intake-related intentions, attitudes, subjective norms and perceived behavioural control of South African nutrition professionals

BACKGROUND : Intake of dairy-related nutrients of South Africans is low. Nutrition professionals may influence dietary behaviour. Their own disposition related to dairy is unknown, yet important in promoting the “have milk, maas or yoghurt every day” guideline. Aim: Guided by the Theory of Planned Behaviour (TPB), this study aimed to describe determinants of target behaviour of consumption of 2–3 servings of dairy daily among nutrition professionals. METHODS : An electronic survey (Qualtrics Online Survey Software) of conveniently sampled Association for Dietetics in South Africa (ADSA) and Nutrition Society of South Africa (NSSA) members determined their dairy-related behaviour, intentions, attitudes, subjective norms and perceived behavioural control regarding dairy in general, and of milk, maas, yoghurt and cheese. RESULTS : Three hundred and six (306) responses (aged 36.4 ± 10.5 years) were received. A third of nutrition professionals reported that their daily dairy intake was 2–3 servings 4–6 times per week, yet over 40% met the target once per week or less often. Intake differed across products. Intention to consume the target was high (5.2 ± 0.12; scale 1–7). Attitudinal evaluations revealed highest belief scores related to nutritional quality and bone health. Associations with cancer development, diabetes and the environment were believed to be least likely. Professional training and scientific evidence emerged as the strongest subjective norms. Nutrition professionals perceived themselves to be in control of the target behaviour, yet their clients significantly less so (p < 0.0001). CONCLUSION : Nutrition professionals’ attitudes, subjective norms and behavioural control can aid responsive empowerment to support dairy-related nutrition education of South Africans.This study was funded by the Consumer Education Project (CEP) of Milk SA, but conducted and published independently.The Consumer Education Project (CEP) of Milk SAhttp://www.sajcn.co.za/index.php/SAJCNam2017Human Nutritio

The development and usability of a web-based mobile application as a dairy intake screener for South African adults

Paper-based dietary assessment tools such as food frequency questionnaires (FFQ) and especially dietary screeners are making way for versions that use technology. Amidst low intakes of dairy and dairy-related nutrients in South Africa, and to increase public awareness thereof, we aimed to develop and evaluate the usability of an application (app) to screen for dairy intake in higher income South African adults. In a consultative process, a dairy intake screener (‘Dairy Diary’) was developed as an eight-item quantitative FFQ with four types of commonly consumed local dairy products: milk, maas (fermented milk), yoghurt, and cheese. For each dairy product, usual frequency of consumption and portion size per eating occasion were scored resulting in three risk classes: <1 serving daily; 1≤2 servings daily; ≥2 servings daily. Digitalisation included product- and portion-specific graphics with linkage to risk class-relevant preliminary dairy-related guidance as part of a web-based mobile app. For the evaluation of the usability, the 26-item end-user version of the Mobile Application Rating Scale (uMARS) was used in an online cross-sectional survey (Qualtrics; April 2020). Items were scored on a 5-point Likert-type scale, resulting in three final app scores. From a conveniently recruited sample of 1102, 703 (64%; 81% female; mean age 29.8 ± 11.0 years) were retained for analysis. uMARS-informed descriptive statistics summarise the findings. The uMARS app mean objective quality score (3.9 ± 0.85), app subjective quality score (3.5 ± 0.77), app-specific score (3.6 ± 0.94), and additional question on e-portion (4.3 ± 0.78) met the minimum acceptability score of ≥3.0. For the subscales, the mean score for aesthetics was the highest (4.4 ± 0.82), followed by information (4.3 ± 0.90) and functionality (4.0 ± 1.33). Engagement scored lowest (3.0 ± 1.55). The ‘Dairy Diary’ is a user-friendly screener for dairy intake.The development of the “Dairy Diary” was supported by the CEP of Milk SA and study is partially funded by Nestle Nutrition Institute of Africa (NNIA).https://www.cambridge.org/core/journals/journal-of-dairy-researchhj2023Human Nutritio

Reliability and validity of a modified MEDFICTS dietary fat screener in South African schoolchildren are determined by use and outcome measures

BACKGROUND In South Africa, noncommunicable diseases and obesity are increasing and also affect children. No validated assessment tools for fat intake are available. Objective To determine testeretest reliability and relative validity of a pictorial modified meats, eggs, dairy, fried foods, fats in baked goods, convenience foods, table fats, and snacks (MEDFICTS) dietary fat screener. DESIGN We determined testeretest reliability and diagnostic accuracy with the modified MEDFICTS as the index test and a 3-day weighed food record and parental completion of the screener as primary and secondary reference methods, respectively. Participants/setting Grade-six learners (aged 12 years, 4 months) in an urban, middleclass school (n¼93) and their parents (n¼72). OUTCOME MEASURES Portion size, frequency of intake, final score, and classification of fat intake of the modified MEDFICTS, and percent energy from fat, saturated fatty acids, and cholesterol of the food record. Statistical analyses For categorical data agreement was based on kappa statistics, McNemar’s test for symmetry, and diagnostic performance parameters. Continuous data were analyzed with correlations, mean differences, the Bland-Altman method, and receiver operating characteristics. RESULTS The classification of fat intake by the modified MEDFICTSwas testeretest reliable. Final scores of the group did not differ between administrations (P¼0.86). The correlation of final scores between administrations was significant for girls only (r¼0.58; P¼0.01). Reliability of portion size and frequency of intake scores depended on the food category. For girls the screener final scorewas significantly (P<0.5) correlated to total, saturated fat, and cholesterol intakes (butnot topercentenergy fromfat andsaturatedfattyacids intakes).The sensitivity of the modified MEDFICTS was very high (>90%), but chance corrected agreement between the classifications was poor. Parents did not agree with their children. CONCLUSIONS Testeretest reliability and relative validity of a modified MEDFICTS dietary fat screener in South African schoolchildren depended on the use and outcome measures applied.http://ac.els-cdn.comhb201

High protein content in breast milk from South African mothers of preterm infants

AIM : Macronutrient and energy content of human milk are largely assumed for fortification practices. The aim was to explore macronutrient and energy content of transition and mature human milk from South African mothers of preterm infants with a birth weight <1800 g. Secondary objectives compared day to night milk; and explored associations with selected innate factors. METHODS : In this single-centre, observational study macronutrient and energy content of day, night and mixed samples of transition (first 14 days of life) and mature (from Day 15 of life) human milk were analysed with mid-infrared spectroscopy. RESULTS : In total, 116 samples (38 days; 37 night; 41 mixed) from 47 mothers were retained for statistical analysis. Mean true protein, carbohydrate, fat and energy content of mixed samples per 100 mL were 1.5 ± 0.4 g, 7.2 ± 0.7 g, 3.5 ± 0.9 g and 69.4 ± 9.9 kcal, respectively. Mixed transition milk (n = 9) had 1.9 ± 0.3 g protein and 67.4 ± 9.6 kcal and mixed mature milk (n = 32) 1.4 ± 0.4 g protein and 70.0 ± 10.1 kcal, per 100 mL.The protein content of transition (p = 0.004) and mature (p = 0.004) milk were significantly higher than published data. Transition milk: 1.5 g protein, 65 kcal; mature milk: 1.2 g protein, 72 kcal per 100 mL. Night samples had less fat (p = 0.014) and energy (p = 0.033) than day samples. With increasing day of life protein content declined (p = 0.003). CONCLUSION : The protein content of human milk from South African mothers of preterm babies differs from published data and has implications for human milk fortification practises.https://wileyonlinelibrary.com/journal/apaHuman Nutritio

The meaning of food for obese men : a qualitative study

Vetsugtigheid is wêreldwyd ‘n wesenlike probleem en Suid-Afrika is geen uitsondering nie Wanneer mans van die verskillende Suid-Afrikaanse bevolkingsgroepe in oënskou ge-neem word, toon wit mans die hoogste voor-koms van vetsugtigheid. Intervensie strategieë vir vetsugtigheid het nog nie bevredigende resultate gelewer nie en een van die redes mag wees dat die strategeë nie die sosiale konteks, emosionele faktore en ‘n persoon se verhouding met voedsel in berekening bring nie. Alhoewel baie navorsing oor die oorsake van vetsug-tigheid en die verwante gevolge daarvan gedoen is, is daar min navorsing beskikbaar oor hoe hierdie gedrag ontstaan en hoe dit kan verander. Voedselkeuse is ‘n dinamiese proses wat ingebed is in sosiale verhoudinge en kort- en langtermyn gevolge vir ‘n persoon se ge-sondheid inhou. Komplekse menslike gedrag moet op mikrovlak bestudeer word vir beter begrip van die vetsugtigheidsprobleem. Die invloed van sosiale- en gesinsnetwerke op die ontwikkeling van vetsugtigheid moet ook in ag geneem word. Die navorsingstrategie vir hierdie studie is ‘n kwalitatiewe en fenemologiese benadering. ‘n Lewensverloop- en simboliese interaksionis-tiese perspektief is as geskik beskou vir ’n studie waar ontwikkelingsfases ter sprake kom en die ontwikkeling van voedsel- en gewigs-lewensbane in interaksie met ander geskied. Die steekproef is saamgestel uit veertien mans met ‘n BMI groter as 30kg/m². Drie in-diepte onderhoude is met elk van die deelnemers gevoer: ‘n aanvanklike ontmoeting, ‘n in-diepte ongestruktureerde onderhoud en ‘n opvolg-onderhoud. Verbatim transkripsies van die on-derhoude sowel as bekrywings van die onderhoudsituasies is gebruik vir die bespreking en interpretasie van die resultate. Die rekenaar-program ATLAS.ti is vir data-analise gebruik met inagneming van die breë navorsingsvrae wat die studie gerig het. Die doel van hierdie artikel is om die rol van voedsel gedurende die lewensverloop van die vetsugtige man kwalitatief te bestudeer, met die primêre doel om die betekenis wat hy aan voedsel koppel en die rol wat hierdie beteke-nisse in sy eetgewoontes speel, beter te ver-staan. Die bevindinge van hierdie studie toon dat voedsel addisionele betekenis en waarde vir die deelnemers gehad het. Met betrekking tot hul ervaring met voedsel het 2 hooftemas uit die data na vore gekom naamlik: “vir die liefde van voedsel” en “spesiale betekenis van voedsel”. Die vetsugtige man se eetgewoontes en die betekenis wat voedsel vir hom het, is deur betekenisvolle ander soos sy gesinslede gedu-rende kinderjare en adolessensie, sy vrou en kollegas gedurende vroeë volwasse jare asook vriende wat ‘n betekenisvolle rol gespeel gedurende die volwasse stadium, beïnvloed. Die deelnemers eet vir die plesier wat voedsel aan hul verskaf en die betekenis wat voedsel vir hul het. Voedselvoorbereiding het gepaard-gegaan met vreugdevolle afwagting. Veskeie faktore soos die huwelik, vriende en hul beroep beϊnvloed hul voedsellewensbane. Voedsel is nie net ter wille van die sensoriese plesier geёet nie; dit het ook sosiale betekenis gehad en is beskou as ‘n simbool van liefde, versorging en vertroosting. Gedurende vroeё volwassenheid is dit as ‘n simbool van korporatiewe aanvaar-ding deur kollegas gesien. Voedsel is ook gebruik om vriende te beϊndruk en om soos ‘n “man” te eet. Kognitiewe beoordeling is elke keer gebruik in situasies waar die deelnemer ‘n besluit in terme van sy eetgedrag moes neem. Voedsel kan nie van die simboliese betekenis wat daaraan geheg word, geskei word nie. Die vetsugtige man se voedsellewensbaan beϊn-vloed sy gewigslewensbaan wat gevolglik ‘n negatiewe invloed op sy belewenis van die self het.http://reference.sabinet.co.za/sa_epublication/famecsam201

Strategies men use to cope with stress caused by severe obesity : a qualitative study

This qualitative study sought to explore and describe the coping strategies obese men use, as well as the lived experience of being obese. A phenomenological approach, symbolic interactionism and life course perspectives were used as theoretical points of departure. Experiences of being obese were described through three individual, in-depth, unstructured interviews. Emotion-focused coping strategies like blaming, denial and reappraisal, as well as avoidance were used while problem-focused coping strategies consisted of physical activity, weight loss diets and wearing appropriate clothes. Cognitive appraisals gave rise to certain emotions and feelings that their self and well-being were at risk and need to be dealt with. Along the life course they developed a specific coping trajectory. Identification of coping strategies and better awareness of the lived experience of obese men may enhance the knowledge of professionals, family members as well as parents who need to support them. It also provided tools to help vulnerable obese people deal with the consequences of stigma associated with it.http://http://www.krepublishers.com/02-Journals/JP/JP-00-0-000-000-2010-Web/JP-00-0-000-000-2009-1-Cover.htmam2016Consumer Scienc