RESUMEN
BACKGROUND: Reliable dietary data for children are necessary to investigate associations with health outcomes. The present study aimed to develop and validate a questionnaire to determine the frequency of intakes of specific healthy and unhealthy food groups in young children. METHODS: Participants were 5-9-year-old South African children (n = 920) from 10 urban schools. Their parents completed a demographic questionnaire and the food intake questionnaire with food pictures. Based on the literature, four healthy food groups (fruits, vegetables, milk, meat/fish/poultry/eggs) and six unhealthy food groups (hot and cold sugar-sweetened beverages, candy, salty snacks, cakes and fast foods) were included, with five different frequency responses. Six experienced nutritionists assessed the face validity and content validity. After pilot testing, construct validity and homogeneity were determined in the participants. Convergent validity was determined using urinary sodium and potassium concentrations as biological intake markers. RESULTS: Nutritionists confirmed face and content validity. Caregivers confirmed understanding of the questionnaire. Three factors explained 50.2% of the variance, with most unhealthy food groups as factor 1, fruits and vegetables as factor 2, and animal source protein and milk groups clustered with sugar-sweetened beverages as factor 3. The frequency of milk group, fruits and vegetables intake correlated negatively, whereas the frequency of salty snacks and fast foods intakes correlated positively with the urinary sodium:potassium ratio. CONCLUSIONS: The healthy and unhealthy food group questionnaire has advantages of low respondent burden, as well as acceptable content and convergent validity in South African children. The questionnaire may be used to investigate associations between food intakes and health outcomes.
Asunto(s)
Frutas , Verduras , Niño , Animales , Humanos , Preescolar , Sudáfrica , Encuestas y Cuestionarios , Potasio , Sodio , Conducta AlimentariaRESUMEN
BACKGROUND: Acute laparotomy for trauma or sepsis often prevents definitive closure due to need for relook laparotomy or to prevent abdominal compartment syndrome. Skin-only closure is widely used in our setting. In this study, we review the safety and effectiveness of this technique. METHODS: Patients presenting with intra-abdominal pathology undergoing acute laparotomy and then subsequent skinonly closure using 2-0 prolene were included in the study and followed postoperatively for a three-month period for adverse events stratified by Clavien-Dindo grading, and rate of definitive closure. RESULTS: During the study period, twenty-five patients underwent emergent laparotomy and skin-only closure. The median age of patients undergoing skin-only closure was 27 years (standard deviation 9.1). Six patients presented with major trauma and 19 presented with sepsis. Twenty-one patients underwent subsequent fascial closure. One patient was unable to undergo fascial closure and was managed as a planned ventral hernia. Fourteen patients developed a postoperative complication. There were no deaths and no readmissions to intensive care. Three further patients developed a ventral hernia. CONCLUSION: Skin-only closure, in carefully selected patients, is a feasible alternative to other temporary abdominal closure techniques in a resource-constrained setting.
Asunto(s)
Traumatismos Abdominales , Técnicas de Cierre de Herida Abdominal , Hernia Ventral , Traumatismos Abdominales/cirugía , Adulto , Hernia Ventral/cirugía , Humanos , Laparotomía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND & AIMS: Cancer is the second most common chronic disease and cause of death in the United States. Our aim was to evaluate the associations of sedentary behavior and nutrient intakes with total and cancer-specific mortality among US cancer survivors. METHODS: Data from 2371 cancer survivors collected by the US National Health and Nutrition Examination Survey between 1999 and 2014 were linked to the US mortality registry. Multivariable adjusted Cox proportional hazard models were used to estimate the hazard ratios (HR) and 95% confidence intervals (CI) for all-cause and cancer-specific mortality associated with sedentary time and nutrient intakes. The interaction between time spent on sedentary activities and nutrient intake was evaluated on additive and multiplicative scales. RESULTS: During a median observational period of 5.7 years, 532 total deaths occurred among cancer survivors, of which 180 were cancer-specific. A monotonic increasing linear relationship between time spent sitting and all-cause mortality was observed (HR = 1.15, 95% CI = 1.03, 1.28 per one standard deviation increment). The highest versus the lowest tertiles of intakes of dietary fiber, carotene, niacin, thiamine, riboflavin, vitamin B6, vitamin B12, and vitamin C were inversely associated with all-cause and cancer-specific mortality (HRs = 0.48 to 0.75). The inverse associations with all-cause mortality were more pronounced for combinations of low sedentary behaviour and high intakes of dietary fiber, carotenoids, vitamin B12, and vitamin C. CONCLUSION: Our findings support recommendations for cancer survivors to reduce time spent sedentary and to follow a balanced diet with adequate intakes of dietary fiber and micronutrients.
Asunto(s)
Supervivientes de Cáncer/estadística & datos numéricos , Dieta/mortalidad , Ingestión de Alimentos , Neoplasias/mortalidad , Conducta Sedentaria , Adulto , Anciano , Causas de Muerte , Femenino , Estudios de Seguimiento , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Neoplasias/fisiopatología , Encuestas Nutricionales , Modelos de Riesgos Proporcionales , Sistema de Registros , Estados UnidosRESUMEN
BACKGROUND: Information regarding circulating fatty acids (FA) in association with metabolic health in black Africans is scarce, while the usefulness of circulating FAs as biomarkers of dietary fat intake and predictors for medical conditions is increasing. OBJECTIVE: We compared eleven dietary and the levels of 26 plasma phospholipid FAs in metabolically healthy and unhealthy phenotypes in black South African adults. METHODS: Adults from the South African arm of the Prospective Urban and Rural Epidemiology study baseline (n = 711) were categorised into four groups, namely normal weight without metabolic syndrome (MetS) (MHNW), normal weight with MetS (MUNW), metabolically healthy overweight/obese (MHO) and metabolically unhealthy overweight/obese (MUO). Dietary and plasma phospholipid FAs were measured by a quantitative food frequency questionnaire and gas chromatography-tandem mass spectrometry, respectively. We compared dietary FAs, plasma phospholipid FAs, and estimated desaturase activity between the metabolic status groups using ANCOVA adjusted for age and energy intake. RESULTS: MetS was diagnosed in 35% of the participants. After adjustment for age and total energy intake, in comparison to the MHNW reference group, saturated dietary FAs (C14:0 to C18:0) and alpha-linolenic acid intakes were higher in both overweight/obese groups (MHO and MUO), while linoleic acid intakes were higher in the MUO group only. Plasma levels of most saturated FAs (C18:0 to C22:0) and PUFAs were higher, whereas selected MUFAs, palmitic acid, and estimated desaturase activities were lower in the overweight/obese groups. CONCLUSIONS: The overweight groups generally had higher fat intakes than normal-weight groups, but lower plasma levels of palmitic, palmitoleic, oleic, cis-vaccenic and estimated desaturase activities. Therefore, in this population, lower plasma levels of palmitic, palmitoleic, oleic, and cis-vaccenic acids and decreased estimated desaturase activities may be biomarkers of abnormal metabolic health in overweight/obese study participants.
Asunto(s)
Grasas de la Dieta/sangre , Ácidos Grasos/sangre , Síndrome Metabólico/sangre , Sobrepeso/sangre , Fosfolípidos/sangre , Adulto , Estudios de Casos y Controles , Estudios Transversales , Femenino , Cromatografía de Gases y Espectrometría de Masas , Humanos , Masculino , Síndrome Metabólico/etnología , Persona de Mediana Edad , Sobrepeso/etnología , Estudios Prospectivos , Sudáfrica/etnologíaRESUMEN
Background: Chronic non-communicable diseases (CNCDs) are increasing with grave consequences to countries' development. The purpose of this study was three-fold: (1) to determine challenges PURE study participants faced regarding CNCD interventions and what they required from a CNCD intervention programme, and (2) to explore courses of action Department of Health (DoH) officials thought would perform best, as well as (3) to determine what DoH officials perceive to be obstacles in addressing the CNCD epidemic. Design and methods: A subsample of 300 participants from the Prospective Urban and Rural Epidemiological study's Western Cape urban cohort and six key officers from the DoH were recruited to participate in this cross-sectional study. Questionnaires were used in face-to-face interviews with the PURE study participants and DoH officials, together with the multi-criteria mapper (MCM) interviewing method with the latter. Results: Most PURE participants were overweight/obese, but not keen to participate in weight loss interventions. They sought education on foods associated with weight gain, shopping lists, cooking lessons and recipes from CNCD intervention programmes. Department of Health officials regarded the integration of health services, community participation, amongst others as the most favourable options to address the CNCD epidemic. Conclusions: The integration of health services, community participation, food taxation and improving inter-sectoral partnerships were viewed as the most feasible options to address the CNCD epidemic according to the DoH officials. At community level, the needs for education and practical hints were expressed. Current CNCD interventions should be adapted to include the context-based needs of communities.
RESUMEN
An atypical case of Crimean-Congo haemorrhagic fever is presented. The diagnosis of the case in the presence of several comorbidities was complicated and illustrates the importance of maintaining a high index of suspicion for viral haemorrhagic fever in cases presenting with multisystem disease and an epidemiological history that could present opportunities for exposure to a haemorrhagic fever virus.
Asunto(s)
Fiebre Hemorrágica de Crimea/diagnóstico , Acidosis/diagnóstico , Comorbilidad , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/epidemiología , Cetoacidosis Diabética/diagnóstico , Diagnóstico Diferencial , Sobredosis de Droga/diagnóstico , Cefalea/etiología , Fiebre Hemorrágica de Crimea/complicaciones , Fiebre Hemorrágica de Crimea/epidemiología , Humanos , Hipertensión/epidemiología , Hipoglucemiantes/envenenamiento , Masculino , Metformina/envenenamiento , Persona de Mediana Edad , Mialgia/etiología , Obesidad/epidemiología , Hiperplasia Prostática/epidemiología , Trombocitopenia/etiologíaRESUMEN
BACKGROUND: Globally hypertension is stabilising, but in sub-Saharan Africa the incidence of hypertension remains on an increase. Although this might be attributed to poor healthcare and ineffective antihypertensive treatment, there is a limited understanding of population and individual-specific cardiovascular pathophysiology - necessary for effective prevention and treatment strategies in Africa. As there is a lack of longitudinal studies tracking the early pathophysiological development of hypertension in black populations, the African-PREDICT study was initiated. The purpose of this paper is to describe the detailed methodology and baseline cohort profile of the study. METHODS AND RESULTS: From 2013 to 2017, the study included 1202 black ( N = 606) and white ( N = 596) men and women (aged 20-30 years) from South Africa - screened to be healthy and clinic normotensive. At baseline, and each 5-year follow-up examination, detailed measures of health behaviours, cardiovascular profile and organ damage are taken. Also, comprehensive biological sampling for the 'omics' and biomarkers is performed. Overall, the baseline black and white cohort presented with similar ages, clinic and 24-hour blood pressures, but black adults had lower socioeconomic status and higher central systolic blood pressure than white individuals. CONCLUSIONS: The prospective African-PREDICT study in young black and white adults will contribute to a clear understanding of early cardiovascular disease development.
Asunto(s)
Presión Sanguínea , Enfermedades Cardiovasculares/diagnóstico , Hipertensión/diagnóstico , Proyectos de Investigación , Adulto , Población Negra , Enfermedades Cardiovasculares/etnología , Enfermedades Cardiovasculares/fisiopatología , Diagnóstico Precoz , Femenino , Humanos , Hipertensión/etnología , Hipertensión/fisiopatología , Estudios Longitudinales , Masculino , Selección de Paciente , Pronóstico , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Sudáfrica/epidemiología , Factores de Tiempo , Población Blanca , Adulto JovenRESUMEN
The rising prevalence of obesity and excessive adiposity are global public health concerns. Understanding determinants of changes in adiposity over time is critical for informing effective evidence-based prevention or treatment. However, limited information is available to achieve this objective. Cultural, demographic, environmental, and behavioral factors including socio-economic status (SES) likely account for obesity development. To this end, we related these variables to anthropometric measures in 1058 black adult Tswana-speaking South Africans who were HIV negative in a prospective study over five years. Body mass index (BMI) and waist circumference increased in both sexes, whereas triceps skinfold thickness remained the same. Over the five years, women moved to higher BMI categories and more were diagnosed with central obesity. Age correlated negatively, whereas SES, physical activity, energy, and fat intake correlated positively with adiposity markers in women. In men, SES, marital status, physical activity, and being urban predicted increases in adiposity. For women, SES and urbanicity increased, whereas menopause and smoking decreased adiposity. Among men, smokers had less change in BMI than those that never smoked over five years. Our findings suggest that interventions, focusing on the urban living, the married and those with the highest SES-the high-risk groups identified herein-are of primary importance to contain morbidity and premature mortality due to obesity in black South Africans.
Asunto(s)
Adiposidad/etnología , Población Negra , Estilo de Vida , Obesidad/epidemiología , Clase Social , Adulto , Índice de Masa Corporal , Ejercicio Físico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Circunferencia de la CinturaRESUMEN
Human immune virus subtype C is the most widely spread HIV subtype in Sub-Sahara Africa and South Africa. A profound structural insight on finding potential lead compounds is therefore necessary for drug discovery. The focus of this study is to rationalize the nine Food and Drugs Administration (FDA) HIV antiviral drugs complexed to subtype B and C-SA PR using ONIOM approach. To achieve this, an integrated two-layered ONIOM model was used to optimize the geometrics of the FDA approved HIV-1 PR inhibitors for subtype B. In our hybrid ONIOM model, the HIV-1 PR inhibitors as well as the ASP 25/25' catalytic active residues were treated at high level quantum mechanics (QM) theory using B3LYP/6-31G(d), and the remaining HIV PR residues were considered using the AMBER force field. The experimental binding energies of the PR inhibitors were compared to the ONIOM calculated results. The theoretical binding free energies (?Gbind) for subtype B follow a similar trend to the experimental results, with one exemption. The computational model was less suitable for C-SA PR. Analysis of the results provided valuable information about the shortcomings of this approach. Future studies will focus on the improvement of the computational model by considering explicit water molecules in the active pocket. We believe that this approach has the potential to provide much improved binding energies for complex enzyme drug interactions.
Asunto(s)
Infecciones por VIH/tratamiento farmacológico , Inhibidores de la Proteasa del VIH/farmacología , Proteasa del VIH/metabolismo , VIH-1/efectos de los fármacos , Dominio Catalítico/efectos de los fármacos , Entropía , VIH-1/metabolismo , Humanos , Enlace de Hidrógeno/efectos de los fármacos , Teoría Cuántica , Termodinámica , Estados Unidos , United States Food and Drug AdministrationRESUMEN
PURPOSE: To determine optimal body mass index (BMI) cut-points for the identification of cardiometabolic risk in black South African adults. METHODS: We performed a cross-sectional study of a weighted sample of healthy black South Africans aged 25-65 years (721 men, 1386 women) from the North West and Free State Provinces. Demographic, lifestyle and anthropometric measures were taken, and blood pressure, fasting serum triglycerides, high-density lipoprotein (HDL) cholesterol and blood glucose were measured. We defined elevated cardiometabolic risk as having three or more risk factors according to international metabolic syndrome criteria. Receiver operating characteristic curves were applied to identify an optimal BMI cut-point for men and women. RESULTS: BMI had good diagnostic performance to identify clustering of three or more risk factors, as well as individual risk factors: low HDL-cholesterol, elevated fasting glucose and triglycerides, with areas under the curve >.6, but not for high blood pressure. Optimal BMI cut-points averaged 22 kg/m2 for men and 28 kg/m2 for women, respectively, with better sensitivity in men (44.0-71.9 %), and in women (60.6-69.8 %), compared to a BMI of 30 kg/m2 (17-19.1, 53-61.4 %, respectively). Men and women with a BMI >22 and >28 kg/m2, respectively, had significantly increased probability of elevated cardiometabolic risk after adjustment for age, alcohol use and smoking. CONCLUSION: In black South African men, a BMI cut-point of 22 kg/m2 identifies those at cardiometabolic risk, whereas a BMI of 30 kg/m2 underestimates risk. In women, a cut-point of 28 kg/m2, approaching the WHO obesity cut-point, identifies those at risk.
Asunto(s)
Población Negra , Índice de Masa Corporal , Enfermedades Cardiovasculares/epidemiología , Síndrome Metabólico/epidemiología , Adulto , Anciano , Glucemia/metabolismo , Presión Sanguínea , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Estudios Transversales , Femenino , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Obesidad/sangre , Obesidad/complicaciones , Factores de Riesgo , Factores Socioeconómicos , Sudáfrica/epidemiología , Triglicéridos/sangre , Circunferencia de la CinturaRESUMEN
AIMS: This study aimed at investigating the use of metal chelators as potential metallo-ß-lactamase inhibitors (MBL). METHODS AND RESULTS: The minimum inhibitory concentration (MIC) of meropenem was ascertained alone and in combination with various concentrations of macrocyclic (1,4,7- triazacyclononane-1-glutaric acid-4,7-diacetic acid = NODAGA) peptide derivatives and acyclic (N,N,N',N'-Tetrakis(2-pyridylmethyl)ethylenediamine = TPEN and di-(2-picolyl)amine = DPA) metal chelators using the broth microdilution method. MICs of meropenem against carbapenem-resistant enterobacteriaceae (CRE) producing MBLs were decreased to concentrations as low as 0·06 mg l(-1) in the presence of some metal chelators. TPEN at 4 and 8 mg l(-1) showed the best activity by decreasing meropenem MICs to 0·5 and 0·06 mg l(-1) , respectively, for some New Delhi Metallo-beta-lactamase (NDM) and Verona integron-encoded metallo-ß-lactamase (VIM) -producing enterobacteriaceae. DPA at 8 and 16 mg l(-1) was also able to decrease meropenem MICs to 1 and 0·125 mg l(-1) , respectively, for these CREs. NODAGA peptide derivatives showed the least inhibition as 32 mg l(-1) was required for meropenem MICs to be decreased to 0·06 mg l(-1) against an NDM-1 producing isolate. CONCLUSION: The various metal chelators, TPEN, DPA and NODAGA peptide derivatives were able to inhibit the MBLs in decreasing order of activity, rendering CREs susceptible to meropenem. SIGNIFICANCE AND IMPACT OF THE STUDY: In the absence of new antibiotics, this study evaluated metal chelators as potential MBL inhibitors.
Asunto(s)
Antibacterianos/farmacología , Quelantes/farmacología , Tienamicinas/farmacología , Inhibidores de beta-Lactamasas/farmacología , Proteínas Bacterianas/genética , Proteínas Bacterianas/metabolismo , Evaluación Preclínica de Medicamentos , Enterobacteriaceae/efectos de los fármacos , Enterobacteriaceae/enzimología , Enterobacteriaceae/genética , Enterobacteriaceae/metabolismo , Meropenem , Metales/metabolismo , Pruebas de Sensibilidad Microbiana , beta-Lactamasas/genética , beta-Lactamasas/metabolismoRESUMEN
OBJECTIVE: The objective of this study was to determine the relationship between added sugar and dietary diversity, micronutrient intakes and anthropometric status in a nationally representative study of children, 1-8.9 years of age in South Africa. METHODS: Secondary analysis of a national survey of children (weighted n = 2,200; non weighted n = 2818) was undertaken. Validated 24-hour recalls of children were collected from mothers/caregivers and stratified into quartiles of percentage energy from added sugar (% EAS). A dietary diversity score (DDS) using 9 food groups, a food variety score (FVS) of individual food items, and a mean adequacy ratio (MAR) based on 11 micronutrients were calculated. The prevalence of stunting and overweight/obesity was also determined. RESULTS: Added sugar intake varied from 7.5-10.3% of energy intake for rural and urban areas, respectively. Mean added sugar intake ranged from 1.0% of energy intake in Quartile 1 (1-3 years) (Q1) to 19.3% in Q4 (4-8 years). Main sources of added sugar were white sugar (60.1%), cool drinks (squash type) (10.4%) and carbonated cool drinks (6.0%). Added sugar intake, correlated positively with most micronutrient intakes, DDS, FVS, and MAR. Significant negative partial correlations, adjusted for energy intake, were found between added sugar intake and intakes of protein, fibre, thiamin, pantothenic acid, biotin, vitamin E, calcium (1-3 years), phosphorus, iron (4-8 years), magnesium and zinc. The prevalence of overweight/obesity was higher in children aged 4-8 years in Q4 of %EAS than in other quartiles [mean (95%CI) % prevalence overweight 23.0 (16.2-29.8)% in Q4 compared to 13.0 (8.7-17.3)% in Q1, p = 0.0063]. CONCLUSION: Although DDS, FVS, MAR and micronutrient intakes were positively correlated with added sugar intakes, overall negative associations between micronutrients and added sugar intakes, adjusted for dietary energy, indicate micronutrient dilution. Overweight/obesity was increased with higher added sugar intakes in the 4-8 year old children.
Asunto(s)
Fenómenos Fisiológicos Nutricionales Infantiles/fisiología , Dieta , Micronutrientes , Sobrepeso/epidemiología , Delgadez/epidemiología , Antropometría , Niño , Preescolar , Ingestión de Energía/fisiología , Femenino , Humanos , Lactante , Masculino , Encuestas Nutricionales , Estado Nutricional , Prevalencia , Sudáfrica/epidemiologíaRESUMEN
OBJECTIVES: To examine the association between body composition (fat mass, lean mass and body mass index, BMI) and bone health (bone mineral density, BMD and fracture risk) in urban black South African women. DESIGN: A cross sectional study examining associations between body composition, dietary intake (food frequency questionnaire), habitual physical activity (Activity energy expenditure (AEE) measured using an accelerometer with combined heart rate monitor and physical activity questionnaire) and bone health (BMD using dual-energy X ray absorptiometry, DXA and fracture risk). SETTING: Urban community dwellers from Ikageng in the North-West Province of South Africa. PARTICIPANTS: One hundred and eighty nine (189) healthy postmenopausal women aged ≥43 years. RESULTS: Fat mass and lean mass were significantly associated with BMD and fracture risk when adjusted for potential confounders. However, lean mass and not fat mass remained significantly associated with femoral neck BMD (ß = 0.49, p <0.001), spine BMD (ß = 0.48, p< 0.0001) and hip BMD (ß = 0.59, p< 0.0001). Lean mass was also negatively associated with fracture risk (ß = -0.19 p =0.04) when both lean and fat mass were in the same model. CONCLUSION: Lean mass and fat mass were positively associated with femoral neck, spine and hip BMDs and negatively associated with fracture risk in urban black South African women. Our finding suggests that increasing lean mass rather than fat mass is beneficial to bone health. Our study emphasises the importance of positive lifestyle changes, intake of calcium from dairy and adequate weight to maintain and improve bone health of postmenopausal women.
Asunto(s)
Adiposidad/fisiología , Población Negra , Densidad Ósea/fisiología , Huesos/fisiología , Salud , Delgadez , Población Urbana , Absorciometría de Fotón , Adulto , Índice de Masa Corporal , Peso Corporal/fisiología , Huesos/anatomía & histología , Calcio/administración & dosificación , Estudios Transversales , Dieta/estadística & datos numéricos , Metabolismo Energético/fisiología , Femenino , Cuello Femoral/anatomía & histología , Cuello Femoral/fisiología , Fracturas Óseas/etiología , Humanos , Estilo de Vida , Persona de Mediana Edad , Actividad Motora/fisiología , Osteoporosis Posmenopáusica/etiología , Osteoporosis Posmenopáusica/prevención & control , Huesos Pélvicos/anatomía & histología , Huesos Pélvicos/fisiología , Posmenopausia/fisiología , Medición de Riesgo , Sudáfrica , Columna Vertebral/anatomía & histología , Columna Vertebral/fisiología , Encuestas y CuestionariosRESUMEN
BACKGROUND/OBJECTIVES: Age-related muscle and fat mass (FM) changes are ethnicity specific. We aimed to develop a cut-point for the muscle mass component of sarcopenia for black South African (SA) women, and to assess its predictive value, in comparison to established cut-points, to identify functional ability among older black SA women. SUBJECTS/METHODS: In a cross-sectional study, a sarcopenia cut-point was calculated from dual energy X-ray absorptiometry (DXA)-derived appendicular skeletal muscle mass (ASM) indexes (ASMI) from two young black SA reference groups. The new cut-point was compared with the most recent Foundation for the National Institutes of Health (FNIH) criteria (ASM <15.02 kg; and ASM(BMI) <0.512), an internationally accepted cut-point (ASMI <5.5 kg/m(2)) and a residual method adjusting for FM. All cut-points were then applied to 221 older black women to predict gait speed and handgrip strength. RESULTS: A cut-point of ASMI <4.94 kg/m(2) was derived from the young SA reference groups. Using this cut-point, 9.1% of older women were classified as sarcopenic, compared with 16.7-38.7% using other cut-points. The only cut-points that significantly predicted low functional ability (low gait speed and low handgrip strength) in older black women were the new SA cut-point and the FNIH ASM criterion. Multivariate logistic regression models for both these cut-points significantly predicted low handgrip strength (odds ratio (OR)=3.71, P=0.007 and OR=3.42, P=0.001, respectively) and low gait speed (OR=9.82, P=0.004 and OR=8.71, P=0.008, respectively). CONCLUSIONS: The new SA cut-point had similar or greater odds of predicting reduced functional ability in older SA women when compared with other internationally accepted cut-points.
Asunto(s)
Desarrollo de Músculos , Músculo Esquelético/diagnóstico por imagen , Sarcopenia/diagnóstico por imagen , Absorciometría de Fotón , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Países en Desarrollo , Femenino , Marcha , Fuerza de la Mano , Humanos , Persona de Mediana Edad , Pelvis , Guías de Práctica Clínica como Asunto , Prevalencia , Sarcopenia/epidemiología , Sarcopenia/etnología , Sarcopenia/fisiopatología , Sensibilidad y Especificidad , Sudáfrica/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: The aim of this study was to assess the vitamin A and anthropometric status of South African preschool children from four areas with known distinct eating patterns. METHODS: Serum retinol, anthropometric indicators, and dietary intake were determined for randomly selected preschool children from two rural areas, i.e. KwaZulu-Natal (n = 140) and Limpopo (n = 206); an urban area in the Northern Cape (n = 194); and an urban metropolitan area in the Western Cape (n = 207). RESULTS: Serum retinol <20 µg/dL was prevalent in 8.2% to 13.6% children. Between 3% (urban-Northern Cape) and 44.2% (rural-Limpopo) children had received a high-dose vitamin A supplement during the preceding 6 mo. Vitamin A derived from fortified bread and/or maize meal ranged from 65 µg retinol activity equivalents (24%-31% of the Estimated Average Requirement) to 160 µg retinol activity equivalents (58%-76% Estimated Average Requirement). Fortified bread and/or maize meal contributed 57% to 59% of total vitamin A intake in rural children, and 28% to 38% in urban children. Across the four areas, stunting in children ranged from 13.9% to 40.9%; and overweight from 1.2% to 15.1%. CONCLUSION: Prevalence of vitamin A deficiency was lower than national figures, and did not differ across areas despite differences in socioeconomics, dietary intake, and vitamin A supplementation coverage. Rural children benefited more from the national food fortification program in terms of vitamin A intake. Large variations in anthropometric status highlight the importance of targeting specific nutrition interventions, taking into account the double burden of overnutrition and undernutrition.
Asunto(s)
Población Negra , Estatura , Peso Corporal , Dieta , Deficiencia de Vitamina A/epidemiología , Vitamina A/sangre , Proteína C-Reactiva/metabolismo , Niño , Preescolar , Estudios Transversales , Ingestión de Energía , Femenino , Humanos , Lactante , Masculino , Estado Nutricional , Orosomucoide/metabolismo , Prevalencia , Factores Socioeconómicos , Sudáfrica/epidemiología , Encuestas y Cuestionarios , Vitamina A/administración & dosificación , Deficiencia de Vitamina A/sangreAsunto(s)
Lactancia , Fenómenos Fisiologicos Nutricionales Maternos , Embarazo , Anemia Ferropénica/prevención & control , Dieta , Suplementos Dietéticos , Femenino , Ácido Fólico/administración & dosificación , Humanos , Hierro de la Dieta/administración & dosificación , Defectos del Tubo Neural/prevención & control , Evaluación Nutricional , Atención Prenatal , Aumento de PesoRESUMEN
BACKGROUND: Obesity and other noncommunicable disease (NCD) risk factors are increasing in low- and middle-income countries. There are few data on the association between increased added sugar intake and NCD risk in these countries. OBJECTIVE: We assessed the relation between added sugar intake and NCD risk factors in an African cohort study. Added sugars were defined as all monosaccharides and disaccharides added to foods and beverages during processing, cooking, and at the table. DESIGN: We conducted a 5-y follow-up of a cohort of 2010 urban and rural men and women aged 30-70 y of age at recruitment in 2005 from the North West Province in South Africa. RESULTS: Added sugar intake, particularly in rural areas, has increased rapidly in the past 5 y. In rural areas, the proportion of adults who consumed sucrose-sweetened beverages approximately doubled (for men, from 25% to 56%; for women, from 33% to 63%) in the past 5 y. After adjustment, subjects who consumed more added sugars (≥10% energy from added sugars) compared with those who consumed less added sugars had a higher waist circumference [mean difference (95% CI): 1.07 cm (0.35, 1.79 cm)] and body mass index (in kg/m²) [0.43 (0.12, 0.74)] and lower HDL cholesterol [-0.08 mmol/L (-0.14, 0.002 mmol/L)]. CONCLUSIONS: This cohort showed dramatic increases in added sugars and sucrose-sweetened beverage consumption in both urban and rural areas. Increased consumption was associated with increased NCD risk factors. In addition, the study showed that the nutrition transition has reached a remote rural area in South Africa. Urgent action is needed to address these trends.
Asunto(s)
Dieta/efectos adversos , Sacarosa en la Dieta/efectos adversos , Transición de la Salud , Obesidad/etiología , Sobrepeso/etiología , Salud Rural , Salud Urbana , Adulto , Anciano , Índice de Masa Corporal , HDL-Colesterol/sangre , Estudios de Cohortes , Dieta/etnología , Sacarosa en la Dieta/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , Obesidad/sangre , Obesidad/epidemiología , Obesidad/etnología , Sobrepeso/sangre , Sobrepeso/epidemiología , Sobrepeso/etnología , Estudios Prospectivos , Factores de Riesgo , Salud Rural/etnología , Sudáfrica/epidemiología , Salud Urbana/etnología , Circunferencia de la Cintura/etnología , Adulto JovenRESUMEN
BACKGROUND AND AIMS: Simple, low-cost central obesity measures may help identify individuals with increased cardiometabolic disease risk, although it is unclear which measures perform best in African adults. We aimed to: 1) cross-sectionally compare the accuracy of existing waist-to-height ratio (WHtR) and waist circumference (WC) thresholds to identify individuals with hypertension, pre-diabetes, or dyslipidaemia; 2) identify optimal WC and WHtR thresholds to detect CVD risk in this African population; and 3) assess which measure best predicts 5-year CVD risk. METHODS AND RESULTS: Black South Africans (577 men, 942 women, aged >30years) were recruited by random household selection from four North West Province communities. Demographic and anthropometric measures were taken. Recommended diagnostic thresholds (WC > 80 cm for women, >94 cm for men; WHtR > 0.5) were evaluated to predict blood pressure, fasting blood glucose, lipids, and glycated haemoglobin measured at baseline and 5 year follow up. Women were significantly more overweight than men at baseline (mean body mass index (BMI) women 27.3 ± 7.4 kg/m(2), men 20.9 ± 4.3 kg/m(2)); median WC women 81.9 cm (interquartile range 61-103), men 74.7 cm (63-87 cm), all P < 0.001). In women, both WC and WHtR significantly predicted all cardiometabolic risk factors after 5 years. In men, even after adjusting WC threshold based on ROC analysis, WHtR better predicted overall 5-year risk. Neither measure predicted hypertension in men. CONCLUSIONS: The WHtR threshold of >0.5 appears to be more consistently supported and may provide a better predictor of future cardiometabolic risk in sub-Saharan Africa.
Asunto(s)
Población Negra , Enfermedades Cardiovasculares/epidemiología , Relación Cintura-Estatura , Adulto , África del Sur del Sahara/epidemiología , Glucemia/metabolismo , Presión Sanguínea , Índice de Masa Corporal , Colesterol/sangre , Estudios Transversales , Demografía , Diabetes Mellitus/epidemiología , Dislipidemias/epidemiología , Composición Familiar , Femenino , Estudios de Seguimiento , Hemoglobina Glucada/análogos & derivados , Hemoglobina Glucada/metabolismo , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Curva ROC , Factores de Riesgo , Triglicéridos/sangre , Circunferencia de la CinturaRESUMEN
OBJECTIVES: The aim of this study was to determine the best dietary diversity indicator to measure dietary diversity and micronutrient adequacy in children. METHODS: A national representative cross-sectional survey of children ages 1 to 9 y (N = 2,200) was undertaken in all ethnic groups in South Africa. A 24-h recall was done with the mother or caregiver of each child. A dietary diversity score (DDS), the number of food groups consumed at least once in a period of 24 h, was calculated for each child in accordance with 6-, 9-, 13-, and 21-food group (G) indicators and compared with a mean adequacy ratio (MAR). The nutrient adequacy ratio (NAR) was calculated for 11 micronutrients by comparing the distributions of estimated intakes with the Estimated Average Requirements for that micronutrient. The MAR was the average of all NARs. Correlations were done between MAR and DDS and sensitivity and specificity calculated for each group indicator. RESULTS: Pearson's correlations between food group indicators and MAR indicate that r values were all highly significant (P < 0.0001). There were no consistent or large differences found between the different group indicators although G13 and G21 appeared to be marginally better. Sensitivity and specificity values in the current study lay between DDS of 3 and 5, suggesting one of these as the best indication of (low) micronutrient adequacy. CONCLUSIONS: Overall results seem to indicate that any of the four G indicators can be used in dietary assessment studies on children, with G13 and G21 being marginally better. A cut-off DDS of 4 and 5, respectively, appear best.
Asunto(s)
Fenómenos Fisiológicos Nutricionales Infantiles , Ingestión de Energía , Micronutrientes/administración & dosificación , Evaluación Nutricional , Niño , Preescolar , Estudios Transversales , Dieta , Humanos , Lactante , Valor NutritivoRESUMEN
OBJECTIVE: To determine if insulin-like growth factor-1 (IGF-1) is a significant predictor of body fat percentage (%BF), lean body mass, and insulin resistance (IR) in black adolescents presenting with overnutrition and undernutrition. METHODS: A cross-sectional study was undertaken in 181 adolescents (111 girls, 70 boys, 13-20 years old) from a low socio-economic population in the North-West Province, South Africa. Anthropometric measurements were performed, and %BF and lean mass were assessed by air displacement plethysmography. Serum glucose, leptin, insulin, IGF-1 and IGF-binding protein-3 (IGFBP-3) were measured and homeostasis model assessment of IR (HOMA-IR) was calculated. Predictors of body composition and HOMA-IR were determined in multivariate linear regressions. RESULTS: Of the boys, 31% had a %BF >20%, whereas 42% of girls had a %BF >30%. Furthermore, 17.1% male and 18.9% female adolescents were stunted, indicating overnutrition and undernutrition in the same group. IGF-1 showed a negative association with %BF in both sexes, and a positive correlation with height-for-age z-score (HAZ) and lean mass, respectively, in the boys. IGF-1 correlated positively and physical activity correlated negatively with fasting insulin and HOMA-IR in the girls. In both sexes, leptin had the strongest association with %BF in multiple regressions. Leptin and Tanner stage were significant predictors of HOMA-IR in girls, but not in boys. CONCLUSIONS: IGF-1 was positively associated with lean mass and HAZ in boys, indicating a beneficial relationship with linear growth, but with IR in the girls, indicating possible adverse metabolic effects in the presence of high %BF and physical inactivity.