Validation of a short food group questionnaire to determine intakes from healthy and unhealthy food groups in 5-9-year-old South African children.

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.

Skin-only closure as a temporary abdominal closure technique in a rural setting - exploring role and safety profile.

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.

Diet and sedentary behaviour in relation to cancer survival. A report from the national health and nutrition examination survey linked to the U.S. mortality registry.

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.

Comparison of dietary and plasma phospholipid fatty acids between normal weight and overweight black South Africans according to metabolic health: The PURE study.

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.

Addressing non-communicable diseases in the Western Cape, South Africa.

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.

Atypical presentation of Crimean-Congo haemorrhagic fever: Lessons learned.

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.

The African Prospective study on the Early Detection and Identification of Cardiovascular disease and Hypertension (African-PREDICT): Design, recruitment and initial examination.

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.

Differences between bone mineral density, lean and fat mass of HIV-positive and HIV-negative black women

Objectives: To investigate the differences between bone mineral density (BMD), lean and fat mass of human immunodeficiency virus (HIV-) positive and HIV-negative black women and to investigate factors associated with low BMD. Methods: Case-control study of black women (n= 565) aged 29­65 years from Potchefstroom, North West province, South Africa, based on secondary analysis of data. Total BMD, left femur neck of the hip (LFN BMD), spine BMD, total fat, fat-free tissue mass and percentage body fat (%BF) were measured by dual-energy X-ray absorptiometry. Results: HIV-negative women had significantly higher median BMD, %BF, appendicular skeletal mass (ASM), ASM index, body mass index (BMI) and waist circumference than HIV-positive women. When the groups were matched for age and BMI, only spine BMD was marginally lower in HIV-positive women. In the total group, age, smoking and HIV status were associated with lower BMD, while calcium intake was positively associated with BMD. Similar variables were associated with BMD in HIV-negative women, while age and educational status were associated with BMD in HIV-positive women. Conclusion: Low BMD was more common among HIV-positive than HIV-negative women. Older HIV-positive women with low educational status are particularly at risk

Waist circumference percentiles of black South African children aged 10 - 14 years from different study sites

Background. Waist circumference (WC) is a useful predictor of cardiometabolic risk in children. Published data on WC percentiles of children from African countries are limited.Objectives. To describe age- and sex-specific Wpercentiles in black South African (SA) children from different study sites, and compare these percentiles with median WCpercentiles of African-American (AA) children.Methods. Secondary data on WC for 10 - 14-year-old black SA children (N=4 954; 2 406 boys and 2 548 girls) were extracted from the data sets of six studies. Smoothed WC percentile curves for boys and girls were constructed using the LMS method. The 50th percentile for age- and sex-specific WC measurements was compared across study sites and with AA counterparts.Results. Girls had higher WC values than boys from the 50th to 95th percentiles at all ages. The 50th WC percentiles of all groups of SA children combined were lower than those of AA children. When SA groups were considered separately, Western Cape children had median WC values similar to AA children, while rural Limpopo children had the lowest WC values. The 95th percentiles for Western Cape girls exceeded the adult cutoff point for metabolic syndrome (WC ≥80 cm) from age 11years.Conclusions. The differences in WC values for 10 - 14-year-old children across the six study sites highlight the need for nationally representative data to develop age-, sex- and ethnic-specific WC percentiles for black SA children. The results raise concerns about high WC among Western Cape girls

Results from the healthy active kids South Africa 2018 report card

Background. Healthy Active Kids South Africa (HAKSA) Report Cards were produced in 2007, 2010, 2014 and 2016. Objective. The 2018 Report Card aims to report on the latest available evidence relating to the physical activity (PA), nutrition and body composition of South African (SA) children and adolescents. Methods. A review was conducted using the following databases: PubMed; Africa Journals Online; and Africa-Wide (EBSCOhost). Articles published from January 2016 to September 2018 were included for review by the HAKSA scientific advisory group. Data were extracted, and a grade for each indicator was assigned based on the available evidence and the consensus of the scientific advisory group. This included 12 PA indicators, 6 nutrition indicators and 3 body composition indicators. Results. There was no evidence of a significant change in any of the indicators since the 2016 Report Card. Grades for certain indicators have been downgraded (from 2016) to bring these to the attention of relevant stakeholders and industry. These include food insecurity and grades that relate to the implementation of policy on PA and nutrition in the school environment, and on advertising and media relating to nutrition. Conclusion. Key priorities for action include: safe opportunities for physical activity; minimising the gap between policy and implementation (school culture and environment, and government strategies); and the double burden of over- and undernutrition, which relates to the continuing concern about food insecurity in SA. There is a need for further research, including surveillance, on all indicators, for future Report Cards

Socio-Demographic and Lifestyle Factors Predict 5-Year Changes in Adiposity among a Group of Black South African Adults.

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.

Investigation of the binding free energies of FDA approved drugs against subtype B and C-SA HIV PR: ONIOM approach.

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.

Body mass index cut-points to identify cardiometabolic risk in black South Africans.

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.

In vitro evaluation of metal chelators as potential metallo- ß -lactamase inhibitors.

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.

Added Sugar, Macro- and Micronutrient Intakes and Anthropometry of Children in a Developing World Context.

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.

Lean Mass Appears to Be More Strongly Associated with Bone Health than Fat Mass in Urban Black South African Women.

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.

Ethnic-specific cut-points for sarcopenia: evidence from black South African women.

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.

Vitamin A and anthropometric status of South African preschool children from four areas with known distinct eating patterns.

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.

Added sugar intake in South Africa: findings from the Adult Prospective Urban and Rural Epidemiology cohort study.

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.