The inflammatory potential of the diet of 1-9-year-old children living in two urbanized and economically active provinces in South Africa

The challenge of preventing and treating noncommunicable diseases (NCDs) has become a global issue of paramount importance. Climbing obesity rates among children could become a major contributor to the burden of NCDs. While there are numerous factors that contribute to the development of obesity and NCDs, an abundance of research suggests that “sustained inflammation is the common denominator of all chronic disease” (Noland, 2017). Low-grade inflammation is characterized by raised concentrations of inflammatory biomarkers without any overt symptoms (Bonaccio et al., 2017). To date, many studies have demonstrated that unhealthy eating patterns contribute to the development and/or maintenance of low-grade inflammation with particular eating patterns having been categorized as either pro-inflammatory or anti-inflammatory; however, information on the inflammatory potential of the diet of children is sparse, specifically in South Africa. To assess the overall inflammatory potential of an individual's diet, researchers first attempted to provide a tool to classify the inflammatory potential of diets in 2009, with the development of the Dietary Inflammatory Index (DII) tool (Cavicchia et al., 2009). This tool has since been revised and adapted. Key values used in the calculation of the DII include the inflammatory score for each of the 45 parameters in the tool, the mean±SD intake of the population (adults in this case) of each parameter and the mean±SD intake of the actual study sample (Shivappa et al., 2014); however, there is no version of the DII that is suitable for use in children in the South African setting. The aims of this research are: 1) to adapt the DII for application in South African children (the South African Child Dietary Inflammatory Index: the SACDII) (sub-study 1) 2) to apply the SACDII in the investigation of the inflammatory potential of the diet of 1–9-year-old children in two urbanized and economically active provinces in South Africa and the association thereof with sociodemographic, anthropometric, and dietary diversity variables (sub-study 2) SUB-STUDY 1: Adaptation of the DII for use in South African Children Aim: To adapt the DII for application in South Africa by generating a mean±SD intake value for the food parameters on the adult DII (Shivappa et al., 2014) for South African children. Objectives: To identify quantified dietary surveys that involved 1 – 10-year-old South African children published over the last three decades; to obtain the raw data sets (food codes and grams consumed for each food parameter) of identified surveys from the principal investigators (PIs); to generate a nutrient/food data base that includes values for the majority of the 45 food parameters included in the DII (Shivappa et al., 2014); and to combine all raw data obtained and reanalyse the combined data to derive the mean±SD intake of each food parameter using the generated data base

Has Food Security and Nutritional Status Improved in Children 1–<10 Years in Two Provinces of South Africa between 1999 (National Food Consumption Survey) and 2018 (Provincial Dietary Intake Study (PDIS))

The 1999 National Food Consumption Survey in South Africa showed that food insecurity (hunger) was prevalent in households with children aged one to &lt;10 years. A repeat of the survey in two provinces: Gauteng (GTG) and the Western Cape (WC) was undertaken in 2018. Results showed that in all domains (living areas) in GTG, food shortage prevalence decreased between 1999 and 2018, from 55.0% to 29.6% in urban informal areas, from 34.1% to 19.4% in urban formal areas and from 42.1% to 15.6% in rural areas. While the prevalence of food shortage in urban formal areas in the WC remained similar in 2018, prevalence decreased from 81.8% to 35.7% in urban informal areas and from 38.3% to 20.6% in rural areas. Energy and macronutrient intakes improved significantly in GTG between 1999 and 2018 but not in the WC; intakes were significantly higher in the WC at both time points. The only significant change in stunting, wasting, overweight and obesity prevalence was that 7&ndash;&lt;10-year-olds in GTG were significantly more likely to be wasted (BAZ &lt; 2SD) in 2018 than in 1999 (20.2% versus 6.9% respectively). In the WC, 1&ndash;3-year-olds were significantly more likely to be obese in 2018 than in 1999 (8.1% versus 1.7% respectively) and 7&ndash;&lt;10-year-olds were less likely to be stunted (14.5% versus 4.9% respectively). There were significant negative correlations between the hunger score and dietary variables in both provinces in 1999. In GTG in 2018, only the correlation with fat intake remained while there were still several significant correlations in WC in 2018. Changes in top 12 energy contributors reflect a shift to high or moderate energy foods low in nutrients from 1999 to 2018. Nutrient dense (high micronutrients, low energy/g) foods (e.g., fruit) fell off the list in 2018. Logistic regression analyses reflect the importance for food security of having a parent as head of the household and/or caregiver, and parents having grade 12 or higher education and being employed. We conclude that food security nutritional status indicators improved amongst 1&ndash;&lt;10-year-old children especially in GTG between 1999 and 2018. However, the shift to poorer food choices and increase in wasting in older children and overweight in younger children are of concern

Provincial dietary intake study (PDIS) : micronutrient intakes of children in a representative/random sample of 1- to <10-year-old children in two economically active and urbanized provinces in South Africa

CITATION: Senekal M, et al. 2020. Provincial Dietary Intake Study (PDIS): Micronutrient Intakes of Children in a Representative/Random Sample of 1- to <10-Year-Old Children in Two Economically Active and Urbanized Provinces in South Africa. International Journal of Environmental Research and Public Health, 17(16). doi:10.3390/ijerph17165924The original publication is available at https://www.mdpi.com/journal/ijerphIn 1999, the National Food Consumption Survey found serious risk of dietary deficiency for a number of micronutrients in 1- to 9-year-old children in South Africa. To address these shortfalls, fortification with vitamin A, thiamine, riboflavin, niacin, vitamin B6, folic acid, iron and zinc of maize meal and bread flour was made mandatory in 2003. The aim of this study was to examine micronutrient intakes of 1- to <10-year-old children after nearly 20 years of fortification in two of the most urbanized and economically active provinces, Gauteng (GTG) and the Western Cape (WC). A multistage stratified cluster random sampling design and methodology was used. Households were visited by fieldworkers who interviewed caregivers and obtained dietary intake data by means of a multiple-pass 24-h recall. Two additional 24-h recalls were completed among a nested sample of 146 participants to adjust the single 24-h recall data of the total sample using the National Cancer Institute Method. Results show that median intake of all the fortification nutrients were above the estimated average requirement (EAR), with the only concern being folate in the WC. Between a quarter and a third of children in the WC, where maize porridge intake was significantly lower than in GTG, had a folate intake below the EAR. Nutrients that are not included in the fortification mix that remain a serious concern are calcium and vitamin D, with intake of dairy and vitamin D sources being very limited in both provinces. The improvement in micronutrient intakes of children is encouraging, however the outstanding nutrient deficiency risks need attention.https://www.mdpi.com/1660-4601/17/16/5924Publishers versio

Provincial Dietary Intake Study (PDIS) : energy and macronutrient intakes of children in a representative/random sample of 1–<10-year-old children in two economically active and urbanized provinces in South Africa

CITATION: Steyn, N. P. et al. 2020. Provincial Dietary Intake Study (PDIS): Energy and Macronutrient Intakes of Children in a Representative/Random Sample of 1–<10-Year-Old Children in Two Economically Active and Urbanized Provinces in South Africa. International Journal of Environmental Research and Public Health, 17(5). doi:10.3390/ijerph17051717The original publication is available at https://www.mdpi.com/journal/ijerphThe double burden of malnutrition is still prevalent in South Africa, hence the importance of a dietary survey to identify risks of under- and over-nutrition. A multistage stratified cluster random sampling design was applied in two economically active provinces, Gauteng (GTG) (N = 733) and Western Cape (WC) (N = 593). Field workers completed questionnaires, and a 24 h recall with children taking part aged 1–<10-years (N = 1326). Important findings were that 71% and 74%, respectively, of 3–<6-year-olds and 6–<10-year-olds had an energy intake below the estimated energy requirement (EER), while 66% 1–<3-year-olds had intakes above the EER. The percentage of children with a total fat intake below recommended levels decreased as age increased ((51%, 40% and 5%) respectively, for the three age groups). Similarly, the percentage of those who had a total fat intake above the recommendation increased with increasing age (4%, 11% and 26%, respectively, for the three age groups). Saturated fat intake above 10%E was highest in the youngest and oldest children (33% and 32%, respectively). The percentage of children with a free sugars intake above 10%E was 47%, 48% and 52% respectively, and 98–99% had a fibre intake that was less than recommended. Overall, the diet was not healthy, with the main food items being very refined, and the diet being high in salty snacks and sugary items, and low in fruit, vegetables and legumes.https://www.mdpi.com/1660-4601/17/5/1717/htmPublishers versio

Mean ± Standard Deviation Intake Values for 1–<10-Year-Old South African Children for Application in the Assessment of the Inflammatory Potential of Their Diets Using the DII® Method: Developmental Research

This study aimed to develop a set of mean &plusmn; standard deviation (SD) intake values for South African (SA) children for 36 of the 45 food parameters included in the original Dietary Inflammatory Index (DII&reg;) tool. The SA food composition database contains 30 of the 45 food parameters included in the original DII&reg;, and a supplementary database was developed for six of the food parameters not included in the SA database. The SA child mean &plusmn; SD intake of macronutrients, micronutrients and select flavonoids was calculated by age in years, using eight data sets from dietary surveys conducted in SA in the last three decades. A total sample of 5412 children was included in the calculation of the mean &plusmn; SD. The current study sample was determined to be representative of 1&ndash;&lt;10-year-old children in SA, and the plausibility of the mean intake values was confirmed by being in line with age-appropriate recommendations. Furthermore, an increase in energy, macronutrient, and most micronutrient intakes with increase in age was evident. The generated mean &plusmn; SD values for SA children can be used for calculation of the inflammatory potential of the dietary intake of SA children in the age range of 1&ndash;&lt;10-year-old children

Adolescents&rsquo; Perspectives on the Drivers of Obesity Using a Group Model Building Approach: A South African Perspective

Overweight and obesity increase the risk of a range of poor physiological and psychosocial health outcomes. Previous work with well-defined cohorts has explored the determinants of obesity and employed various methods and measures; however, less is known on the broader societal drivers, beyond individual-level influences, using a systems framework with adolescents. The aim of this study was to explore the drivers of obesity from adolescents&rsquo; perspectives using a systems approach through group model building in four South African schools. Group model building was used to generate 4 causal loop diagrams with 62 adolescents aged 16&ndash;18 years. These maps were merged into one final map, and the main themes were identified: (i) physical activity and social media use; (ii) physical activity, health-related morbidity, and socio-economic status; (iii) accessibility of unhealthy food and energy intake/body weight; (iv) psychological distress, body weight, and weight-related bullying; and (v) parental involvement and unhealthy food intake. Our study identified meaningful policy-relevant insights into the drivers of adolescent obesity, as described by the young people themselves in a South African context. This approach, both the process of construction and the final visualization, provides a basis for taking a novel approach to prevention and intervention recommendations for adolescent obesity

Adolescents' Perspectives on the Drivers of Obesity Using a Group Model Building Approach: A South African Perspective.

Overweight and obesity increase the risk of a range of poor physiological and psychosocial health outcomes. Previous work with well-defined cohorts has explored the determinants of obesity and employed various methods and measures; however, less is known on the broader societal drivers, beyond individual-level influences, using a systems framework with adolescents. The aim of this study was to explore the drivers of obesity from adolescents' perspectives using a systems approach through group model building in four South African schools. Group model building was used to generate 4 causal loop diagrams with 62 adolescents aged 16-18 years. These maps were merged into one final map, and the main themes were identified: (i) physical activity and social media use; (ii) physical activity, health-related morbidity, and socio-economic status; (iii) accessibility of unhealthy food and energy intake/body weight; (iv) psychological distress, body weight, and weight-related bullying; and (v) parental involvement and unhealthy food intake. Our study identified meaningful policy-relevant insights into the drivers of adolescent obesity, as described by the young people themselves in a South African context. This approach, both the process of construction and the final visualization, provides a basis for taking a novel approach to prevention and intervention recommendations for adolescent obesity

Provincial Dietary Intake Study (PDIS) : prevalence and sociodemographic determinants of the double burden of malnutrition in a representative sample of 1 to under 10-year-old children from two urbanized and economically active provinces in South Africa

CITATION: Senekal, M., et al. 2019. Provincial Dietary Intake Study (PDIS) : prevalence and sociodemographic determinants of the double burden of malnutrition in a representative sample of 1 to under 10-year-old children from two urbanized and economically active provinces in South Africa. International Journal of Environmental Research and Public Health, 16(18):3334, doi:10.3390/ijerph16183334.The original publication is available at http://www.mdpi.comThe objective of this study was to determine the prevalence and socio-demographic predictors of malnutrition in two urbanized economically active provinces (Gauteng N = 733, Western Cape N = 593) in South Africa. A multistage stratified cluster random sampling design was applied. Fieldworkers visited homes, measured children aged 1- +2 SD ≤ +3 SD] and 7.0% obese (BAZ > +3 SD). In 5– 1 (OR 2.39), while being in the third wealth quintile was protective (OR = 0.62). Results indicate that stunting and overweight/obesity are still present at concerning levels, especially in the under-five age group.https://www.mdpi.com/1660-4601/16/18/3334Publisher's versio

Adolescents’ Perspectives on the Drivers of Obesity Using a Group Model Building Approach: A South African Perspective

Overweight and obesity increase the risk of a range of poor physiological and psychosocial health outcomes. Previous work with well-defined cohorts has explored the determinants of obesity and employed various methods and measures; however, less is known on the broader societal drivers, beyond individual-level influences, using a systems framework with adolescents. The aim of this study was to explore the drivers of obesity from adolescents’ perspectives using a systems approach through group model building in four South African schools. Group model building was used to generate 4 causal loop diagrams with 62 adolescents aged 16–18 years. These maps were merged into one final map, and the main themes were identified: (i) physical activity and social media use; (ii) physical activity, health-related morbidity, and socio-economic status; (iii) accessibility of unhealthy food and energy intake/body weight; (iv) psychological distress, body weight, and weight-related bullying; and (v) parental involvement and unhealthy food intake. Our study identified meaningful policy-relevant insights into the drivers of adolescent obesity, as described by the young people themselves in a South African context. This approach, both the process of construction and the final visualization, provides a basis for taking a novel approach to prevention and intervention recommendations for adolescent obesity