Snack consumption frequency of children and adults in the Vaal region of Gauteng, South Africa.

Background: Energy-dense, nutrient-poor snacks are associated with an increased risk of non-communicable diseases (NCDs) and the double burden of malnutrition, especially among poor communities. Aim: To determine and compare the snacking preferences and consumption frequency of children and adults from a low SES community in South Africa. Setting: A preschool, primary school, and an elderly centre in Gauteng. Methods: A cross-sectional study with a convenience sample of 90 children (3-8 years) and 100 adults (≥ 18 years) to assess snack consumption frequency and preferences of children and adults by means of a snack survey. Mann-Whitney U test was used to determine the differences in preferences and snack consumption frequency of children and adults. Results: The most preferred and consumed snacks included fruits, potato chips, corn chips, sweets, and cookies. Children frequently ate more potato chips (p < 0.001), corn chips (p < 0.001), cheese curls (p < 0.001), and muffins (p = 0.024) than adults. In contrast, adults frequently consumed more peanuts or nuts (p = 0.024), savoury biscuits (p = 0.048) and biltong (p < 0.001) than children. Conclusion: Apart from fruits, the most preferred and frequently consumed snacks by the sample were highly processed snacks, which are low in fibre and high in added sugars, saturated fat, and sodium. Contributions: Findings from this study highlight current snack trends and can guide future nutrition education interventions on healthy snacking and in developing nutritious snacks for the South African community.

The Winning Weaning Food (WWF): The Development of a Complementary Food for Food-Insecure Infants and Young Children in Malawi.

Growing evidence exists for the benefits of adequate infant and young children feeding (IYCF) practices at the weaning stage (≥ 6 months), including optimal growth, building the immune system, cognitive development, healthy food preferences, and reduced mortality and morbidity rates. However, these outcomes are not universally experienced. To ensure that a developing country such as Malawi, where recent studies have shown high rates of food insecurity and malnutrition benefits from adequate IYCF, five nutrient-dense complementary foods (Recipes 1 to 5) were developed. Standardized food processing techniques were used in the preparation and combination of Malawian indigenous food samples. The developed food recipes were assessed for nutrient density and cultural acceptability through sensory evaluations. Recipe 5 emerged as the winning weaning food (WWF), with an overall acceptability rate of 65% (mean score of 5.82 ± 0.87). Unlike theoretical analysis with the ESHA Food Processor, statistical analysis did not show that Recipe 5 met the Codex Alimentarius recommendations for macro- and micronutrients. However, it showed that the micronutrient recommendations for iron (p = 0.0001; 95%CI) and zinc (p = 1.00; 95%CI) were partially met, but not those for calcium and vitamins A and D. The prototype and outcome of this pilot study will be invaluable for interventions aimed at combating food insecurity and malnutrition in Malawi.

Is obesity associated with iron status in the elderly? A case study from Sharpeville, South Africa.

OBJECTIVE: To investigate the relationship between poor Fe status and overweight or obesity in elderly respondents in South Africa. DESIGN: Cross-sectional, observational baseline survey. SETTING: Sharpeville, South Africa. SUBJECTS: A sample size calculation determined a representative sample of 104 randomly selected elderly (≥60 years) respondents. Measurements included weight, height, biochemical and haematological parameters. Measured BMI was used to categorise the respondents into normal weight, overweight and obese groups. RESULTS: The majority of the women were overweight (28·4%) or obese (54·6%); 58% of the respondents had normal Fe status, 15% were classified as Fe depleted, 9% as Fe deficient and 13% as Fe-deficient anaemic. Ten per cent of the respondents had low Hb levels with no other low Fe status parameters, and were thus anaemic due to other causes. A significant correlation (r = 0·318, P < 0·001) existed between BMI and high-sensitivity C-reactive protein (hs-CRP). hs-CRP was negatively correlated to serum Fe levels (r = -0·319, P < 0·001). No significant relationships existed between BMI and Fe status parameters. CONCLUSIONS: A coexistence of obesity and poor Fe status were observed in these elderly respondents. The positive relationship between hs-CRP and BMI indicated chronic inflammation in the higher BMI groups. The negative relationship between hs-CRP and serum Fe indicated that lower serum Fe levels were related to the inflammation linked with higher BMI. A relationship between obesity-related chronic, low-grade inflammation and poor Fe status has been found in adults, but the significance of the current study is that this relationship was also confirmed for elderly persons.

Socio-Economic Variables and Nutrient Adequacy of Women in the Vaal Region of South Africa.

The aim of this cross-sectional, observational baseline survey was to examine the association between nutrient intakes and selected socio-economic variables in 722 women, aged 19 to 90 years living in peri-urban settlements. Measurements included socio-demographic data and 24-hour recall dietary intake data. The results showed poor nutrient intakes with the Estimated Average Requirement (EAR) not met for the mean intakes of all nutrients except carbohydrates, phosphorus, and vitamin B12. The inadequate energy intakes were significantly higher among the women who had lower education (p = .015), lower income (p = .028), and were unemployed (p = .015). The epidemiological value of the study findings is in the contribution to the rationale of appropriate interventions such as income-generating projects as well as household agricultural projects to improve food and nutrient intakes.

Effect of drying and cooking on nutritional value and antioxidant capacity of morogo (Amaranthus hybridus) a traditional leafy vegetable grown in South Africa.

Morogo (vegetables in Tswana) is a green leafy vegetable from the Amaranthaceae family that can be harvested from wild growing or cultivated. The objective of this study was to determine the nutritional value, the total antioxidant capacity and selected bioactive compounds present in morogo leaves, and evaluate the effect of drying and cooking. Results showed that morogo contained a significant amount of protein (3.6 ± 0.1 g/100 g FW) and minerals which the level exceed 1% of fresh weight. The total antioxidant capacity (µmole TE/ 100 g FW) determined by DPPH and FRAP assays were 118.3 ± 15.3 and 128.4 ± 11.9 respectively. Total polyphenols (109.4 ± 7.5 mg GAE/100 g FW), vitamin C (36.6 ± 1.0 mg /100 g FW) and carotenoids represented by ß carotene (25.3 ± 1.3 mg /100 g FW) and xanthophylls (7.48 ± 0.31 mg /100 g FW) formed a significant part of bioactive compounds content of morogo leaves. Since the boiling can cause significant losses of compounds in the boiling water, it can be recommended to avoid cooking methods that can include a boiling step with discard of boiling water.

Presentation and interpretation of food intake data: factors affecting comparability across studies.

Non-uniform, unclear, or incomplete presentation of food intake data limits interpretation, usefulness, and comparisons across studies. In this contribution, we discuss factors affecting uniform reporting of food intake across studies. The amount of food eaten can be reported as mean portion size, number of servings or total amount of food consumed per day; the absolute intake value for the specific study depends on the denominator used because food intake data can be presented as per capita intake or for consumers only. To identify the foods mostly consumed, foods are reported and ranked according to total number of times consumed, number of consumers, total intake, or nutrient contribution by individual foods or food groups. Presentation of food intake data primarily depends on a study's aim; reported data thus often are not comparable across studies. Food intake data further depend on the dietary assessment methodology used and foods in the database consulted; and are influenced by the inherent limitations of all dietary assessments. Intake data can be presented as either single foods or as clearly defined food groups. Mixed dishes, reported as such or in terms of ingredients and items added during food preparation remain challenging. Comparable presentation of food consumption data is not always possible; presenting sufficient information will assist valid interpretation and optimal use of the presented data. A checklist was developed to strengthen the reporting of food intake data in science communication.

Breakfast, midday meals and academic achievement in rural primary schools in Uganda: implications for education and school health policy.

BACKGROUND: Underachievement in schools is a global problem and is especially prevalent in developing countries. Indicators of educational performance show that Uganda has done remarkably well on education access-related targets since the introduction of universal primary education in 1997. However, educational outcomes remain disappointing. The absence of school feeding schemes, one of the leading causes of scholastic underachievement, has not been given attention by the Ugandan authorities. Instead, as a national policy, parents are expected to provide meals even though many, especially in the rural areas, cannot afford to provide even the minimal daily bowl of maize porridge. OBJECTIVE: To assess and demonstrate the effect of breakfast and midday meal consumption on academic achievement of schoolchildren. DESIGN, MATERIALS AND METHODS: We assessed household characteristics, feeding patterns and academic achievement of 645 schoolchildren (aged 9-15 years) in Kumi district, eastern Uganda, in 2006-2007, using a modified cluster sampling design which involved only grade 1 schools (34 in total) and pupils of grade four. Household questionnaires and school records were used to collect information on socio-demographic factors, feeding patterns and school attendance. Academic achievement was assessed using unstandardized techniques, specifically designed for this study. RESULTS: Underachievement (the proportion below a score of 120.0 points) was high (68.4%); in addition, significantly higher achievement and better feeding patterns were observed among children from the less poor households (p<0.05). Achievement was significantly associated with consumption of breakfast and a midday meal, particularly for boys (p<0.05), and a greater likelihood of scoring well was observed for better nourished children (all OR values>1.0). CONCLUSION: We observed that underachievement was relatively high; inadequate patterns of meal consumption, particularly for the most poor, significantly higher scores among children from 'less poor' households and a significant association between academic achievement and breakfast and midday meal consumption.

The Impact of a Nutrition Programme on the Dietary Intake Patterns of Primary School Children

Objective: The aim of this study was to improve the dietary intake patterns and food choices of children aged 9-13 years in a periurban community.Methods: Two schools were randomly selected from within this periurban community. A nutrition education programme was implemented over one school term; with the testing of nutrition knowledge occurring pre- and post-intervention; and in the long term; with the experimental group only. A validated 24-hour recall questionnaire was completed pre- and post-intervention by both the control (n = 91) and experimental groups (n = 81); and in the long term; by the experimental group. Food models were used to assist in the estimation of portion sizes and identification of food items. The questionnaire was analysed using the computer software programme FoodFinder 3; with means and standard deviations calculated for macro- and micronutrients; and comparisons made with dietary reference intakes for specific age groups. A list was drawn up of the 20 most commonly consumed food items; based on weights consumed. Paired t-tests were conducted to assess significance in dietary intake and food choices after the intervention. Correlations between knowledge and dietary choices were determined among the experimental group in the long-term measurements.Results: Correlations linked protein intake to knowledge of proteins; and vitamin C intake to knowledge of fruit and vegetables. Fruit and vegetable intake remained very low. Refined sugars and fat were still consumed among the experimental group. The diet for both groups was based on carbohydrates.Conclusions: The objective of changing the dietary intake patterns of the children was not achieved. The intake of legumes; fruit and vegetables remained low. The lack of variety in intake results in a diet that does not meet the daily requirements of children

Serum concentration and dietary intake of vitamins A and E in low-income South African elderly.

BACKGROUND & AIMS: Adequate dietary intake of antioxidants is vital for the promotion of health, well being and longevity of the elderly. This study assessed the prevalence of vitamin A (retinol) and vitamin E (alpha-tocopherol) deficiency in a population of low-income South African elderly. METHODS: Serum vitamin A and vitamin E concentrations were determined in 235 persons aged 60-93 years in Sharpeville, South Africa. Dietary assessment was done using 24-h recall. Weight and height were measured to determine body mass index. RESULTS: The mean and standard deviation of serum levels in the elderly were 1.41+/-1.4 micromol/L for vitamin A and 2.1+/-1.1 mg/l for vitamin E. The proportion with deficient serum vitamin A was 28.2% and 26.5% for men and women respectively and 20.5% and 20.9% respectively for deficient vitamin E concentrations. Almost one-third of the subjects consumed less than 100% of the Estimated Average Requirement for both vitamins. Mean vitamin A intake was 426+/-666 microg in men and 368+/-811 microg in women, mean vitamin E intake for men and women was 5.4+/-5.2 microg and 4.0+/-0.5 mg respectively. The predominant macronutrient consumed was carbohydrate. No relationship existed between biochemical and dietary intake parameters of vitamins A and E. CONCLUSIONS: These findings indicate poor dietary intake and high prevalence of vitamins A and E deficiency among this elderly population. Sustainable community-based interventions are needed to address this nutritional vulnerability in this community.

Food variety and dietary diversity as indicators of the dietary adequacy and health status of an elderly population in Sharpeville, South Africa.

This cross-sectional, analytical study was a comprehensive health assessment focusing on dietary quality of 170 randomly selected elderly respondents in Sharpeville, South Africa. The methods included a sociodemographic, health food frequency questionnaire, 24h-recall questionnaires, and anthropometric and biochemical measurements. The low mean +/- standard deviation (SD) dietary diversity score (3.41 +/- 1.34) and food variety score (4.77 +/- 2.2) compared with poverty parameters confirmed household food insecurity in this community. Although three (n = 99, 58.6%) or two (n = 49, 28.9%) daily meals were mostly consumed, these were mainly carbohydrate-based and nutrient-deficient. The cereal group (2.01 +/- 0.81) had the highest mean food variety score +/- SD, followed by dairy (0.62 +/- 0.53) and flesh foods (0.40 +/- 0.53). When a mean adequacy ratio of 70% was used as a cut-off point for nutrient adequacy, it was found that the food variety score must be eight or higher and the dietary variety score must be at least six. These indicators thus have a high ability to identify those respondents with an inadequate diet but lower ability to identify those respondents with a nutritionally adequate diet. The data further showed a trend that with a higher food variety and dietary diversity, a better mean adequacy ratio is reached for this low-income group of elderly subjects. In conclusion, the results showed that food variety and dietary diversity scores give a fairly good assessment of the adequacy of the diet, and scoring dietary diversity is a significant, yet simple tool to identify elderly persons at risk of food and nutrition insecurity.

Impact of food and nutrition interventions on poverty in an informal settlement in the Vaal Region of South Africa.

UNICEF has stated that urban poverty is primarily found in squatter settlements. At present 13.5% of all South African households live in informal settlements. The major research question is to what extent does poverty influence the food, nutrition and health of informal-settlement dwellers. The purpose of the present study was to determine the depth of poverty in this community and to measure the possible effect that planned food and nutrition interventions may have on eliminating poverty in this area. Pre-tested questionnaires were administered to 340 randomly-selected caregivers. A validated quantified FFQ was administered by trained enumerators as the test measurement for dietary intake and food consumption patterns and 24 h recall was used as the reference measurement, and the data were analysed. A poverty model was used to measure the impact of extra income on the poverty levels of 190 households. Of the respondents 89% lived in Zn shacks and the average household size was 4.9 individuals. The unemployment rate was 94.2% for respondents and 64.9% for their partners. The majority of households (68.8%) had an income of

Poverty, household food insecurity and nutrition: coping strategies in an informal settlement in the Vaal Triangle, South Africa.

OBJECTIVES: The objective of this study was to determine household food security and coping strategies of an informal settlement in the Vaal Triangle. STUDY DESIGN: A survey study design was used. METHODS: Pre-tested socio-demographic questionnaires were administered to 357 randomly selected caregivers and 149 children aged 9-13 years old. A validated quantified food frequency questionnaire (QFFQ) and 24-h recall were used to measure dietary intake and food consumption patterns and the Cornell hunger scale to determine coping strategies. Data were statistically analysed for means and standard deviations. RESULTS: The results indicated that the majority of caregivers (68.8%) had an income of