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Dietetics And Human Nutrition

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Browsing Dietetics And Human Nutrition by Author "Biggs, Chara."

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    Current dietary practice of South African dietitians in the treatment symptomatic uncomplicated diverticular disease.
    (2017) March, Tanya.; Biggs, Chara.
    Introduction: There is a global rise in diverticular disease (DD) in Westernized countries although the prevalence in South Africa (SA) is unknown. This has a significant effect, not only on the quality of life but also economically as the requirement for surgical interventions and hospital admissions have increased, putting additional pressure on healthcare systems. Dietary approaches to the treatment of DD differ and are contradictory. The traditional restrictive low fiber diet approach recommends the avoidance of insoluble fiber including nuts, seeds, popcorn and corn while the International Current Consensus Guidelines (ICCG) from a number of countries such as Italy, Poland, Denmark, America, Great Britain, advocate a liberal unrestricted high fiber diet (HFD). Although the ICCG have concluded that the consumption of nuts, seeds and popcorn does not appear to exacerbate DD symptoms and complications, there has been anecdotal evidence that their inclusion may worsen symptoms and provoke attacks in some patients suffering with symptomatic uncomplicated DD (SUDD). There are also conflicting views as to whether fiber supplementation is necessary in SUDD. Aim: The aim was to determine dietary treatment methods used by registered dietitians (RDs) practicing in SA when treating SUDD and to determine their beliefs regarding the ICCG for SUDD, trigger foods and the use of fiber, prebiotic and probiotic supplements. Methods: Snowball sampling was used in this quantitative descriptive study to identify 155 RDs in SA who treated SUDD. The RDs completed a closed and open-ended self-administered questionnaire. Results: Diverticular disease was treated by 75% of dietitians in the private sector compared to 25% in the government sector. A third of the dietitians treated less than five patients per year and a third treated two or more patients per month. Their approach to treatment was not significantly different. A significant portion (77%) disagreed with the ICCG and 79% identified foods (including seeds, nuts, pips, wheat, popcorn and fruits), which they believed triggered symptoms. None supplemented with bran and only 1.3% recommended insoluble fiber. Supplementation with prebiotics was considered least beneficial (20%) compared to 74% who routinely prescribed probiotics. The main probiotic species prescribed were Lactobacillus acidophilus, Bifidobacterium lactis, Bifidobacterium longum, Bifidobacterium bifidum, Lactobacillus casei, Lactobacillus rhamnosous, Lactobacillus plantarum and Streptococcus thermophiles. Only 7%, however, prescribed an evidence based strain. Many RDs (74%) felt that patients responded well to their treatment with significant improvement in symptoms and had a decreased relapse rate. Conclusion: The majority of dietitians practicing in SA do not support the ICCG advocating a liberal, unrestricted HFD as the appropriate dietary approach for the treatment of SUDD. An individual treatment approach for each patient was reported throughout the study. Practice regarding the use of prebiotics and probiotics was not evidence-based.
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    The hydration status, fluid and carbohydrate intake of male adolescent soccer players during training in Pietermaritzburg, KwaZulu-Natal.
    (2012) Gordon, Reno.; Biggs, Chara.; Kassier, Susanna Maria.
    Adolescent athletes of this era are more pressurized than adolescents of previous generations to perform at an optimum level (Micheli & Jenkins 2001, p49). The importance of winning can result in adolescent athletes developing inappropriate nutritional practices such as neglecting hydration and consuming insufficient carbohydrate (Micheli & Jenkins 2001, p57). Consuming insufficient fluid leads to dehydration which reduces a soccer player’s ability to continue training. Consuming inadequate carbohydrate reduces performance and blood glucose levels during training. This study aimed to determine the hydration status, fluid and carbohydrate intake of male, adolescent soccer players during training. A cross-sectional study was conducted among 122 amateur male, adolescent soccer players (mean age = 15.8 ± 0.8 years; mean BMI = 20.4 ± 2.0 kg/m2). The players’ hydration status before and after training, was measured using urine specific gravity and percent loss of body weight. Their carbohydrate intake, as well as the type and amount of fluid consumed, were assessed before, during and after training. A questionnaire was administered to determine the players’ knowledge regarding the importance of fluid and carbohydrate for soccer training. The study had an 87.1% response rate. The mean environmental conditions did not predispose players to heat illness. However, the players were at risk of developing heat illness during six of the 14 training sessions. Although the mean urine specific gravity indicated that players were slightly dehydrated before and after training, 43.8% of players were very or extremely dehydrated before training and 53.6% after training. A few (3.3%) were extremely hyperhydrated before training and after training (7.0%). On average players lost less than 1% of body weight during training and less than 3% of players dehydrated more than 2%. Players consumed mainly water before (289.17 ± 206.37 ml), during (183.20 ± 158.35 ml) and after (259.09 ± 192.29 ml) training. More than 90% stated that water was the most important fluid to consume before, during and after training. Very few (4.7%) correctly stated that carbohydrate should be consumed before, during and after training. Players were found to be slightly dehydrated before and after training and therefore were not consuming enough fluids during training. Players consumed inadequate amounts and types of fluid and carbohydrate. This not only compromises their performance but also health. Players were not aware of the importance of fluid and carbohydrate for soccer training. This study is unique in that it focused on the carbohydrate and hydration practices of socioeconomically disadvantaged adolescent soccer players during training. The study sample therefore represents a high risk group about which there is limited published data both locally and internationally. This study generated important baseline information which was lacking before on the hydration status, fluid and carbohydrate intake of adolescent soccer players in South Africa.
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    The nutrient quality and labelling of ready-to-eat snack foods with health and or nutritional claims.
    (2018) Bursey, Andrea Susan.; Biggs, Chara.
    Aim: The incidence of non-communicable diseases (NCDs) and obesity in South Africa is increasing at an alarming rate. The nutrition transition and urbanisation has contributed to the adoption of a diet of highly processed, convenience foods. The development of nutrient marketing has the potential to influence purchasing and consumption behaviour. Nutrient content and health claims are prevalent across convenience foods, it is important to determine whether these claims are accurate and whether these foods possess superior qualities to other similar products to prevent the misleading of consumers. This study was conducted to determine the nutrient quality and labelling of South African-produced ready-to-eat (RTE) snack foods displaying health and or nutrition claims. Objectives: To determine: the types of claims displayed on RTE snack foods and the accuracy of these claims; the average nutrient content per category of snack food items; the accuracy of reported total energy content compared to the energy content calculated using the conversion factors in the R146 labelling legislation; and the eligibility of current claims once the R429 legislation is implemented. Method: A descriptive analysis method was used in this study. The study sample consisted of 93 South African-produced RTE snack food products displaying health and or nutrition claims on the label. The following product categories were included in the study: oat, corn or rice cakes; crisps or chips; pretzels and crackers; protein snack bars; fruit bars or snacks; energy or high-performance bars; trail mix; chocolates; biscuits and popcorn. The compliancy of each type of claim, according to the R146 labelling legislation, was investigated. The mean nutrient content per product category was calculated and compared to the mean across the sample. The reported total energy content was compared to the calculated total energy content, as specified in the R146 legislation. The nutrient profile score of products in the sample was analysed using the proposed R429 nutrient profiling model (NPM) to determine whether current health and nutrition claims will be valid once the new legislation is implemented. Results: Nutrient content claims were the most commonly displayed health and or nutrition claim amongst products, twenty three out of 91 (25.3%) nutrient content claims displayed were non-compliant according to the R146 labelling legislation. Items with comparison claims were compliant according to the legislation, however the overall nutrient profile of two of the items with claims were desirable. In terms of the calculated versus reported total energy content, 64 products (68.8%) had a higher reported total energy content than calculated using conversion factors. The R429 NPM deemed that only 22 (23.7%) of the products would be eligible to make health and or nutrition claims once the R429 legislation is implemented. Conclusion: The results found in this study highlight the need for more stringent regulation of nutrition labelling in South Africa. The proposed R429 labelling legislation may have a drastic effect on current nutrition labelling amongst food manufacturers. It can be concluded that the claims displayed on RTE snack food products are not always accurate and regulatory compliance is therefore important to stipulate amongst food manufacturers. A multi-pronged approach including the strengthening of public nutrition education may be needed to improve food choices which may reduce the incidence of NCDs and obesity in South Africa. The standardisation of front-of-package (FOP) labelling with the proposed legislation may improve the current labelling practices in South Africa. This study has highlighted areas where work can be done to improve public health in South Africa.
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    The prevalence and degree of dehydration in rural South African forestry workers.
    (2008) Biggs, Chara.; Maunder, Eleni Maria Winifred.; Paterson, Marie.
    South African forestry workers are predisposed to dehydration due to the heavy physical activity they perform in impermeable regulation safety clothing in hot and often humid environments where the availability of a variety of suitable fluids at reasonable temperatures is limited. As dehydration reduces both physical and mental capacity the potential consequences include decreased productivity and an increased risk for injury. The aim of this cross sectional observational study was to determine the prevalence and severity of dehydration in rural forestry workers in both winter (minimum and maximum daily temperatures 3-22°C) and autumn (minimum and maximum daily temperatures 14-27°C). The convenience sample included 103 workers in autumn (Nelspruit, n=64 males, n=39 females, mean age 37.32 years, mean BMI 22.3 kg/m2) and 79 in winter (Richmond, n=68 males, n=11 females, mean age 25.85 years, mean BMI 22.2 kg/m2). The sample included chainsaw operators, chainsaw operator assistants, debarkers and stackers. The risk of heat illness was moderate in Nelspruit (average daily temperature 21.1°C 67% rh) and low in Richmond (average daily temperature 17.0°C 39% rh). The prevalence of dehydration was determined by urine specific gravity (USG) measurements. Percent loss of body weight in the course of the shift was used to determine the severity of dehydration. In Nelspruit 43% (n=43) and in Richmond 47% (n=37) of the forestry workers arrived at work dehydrated (USG>1.020 g/ml). Pre break this had increased to 49% (n=49) in Nelspruit and 55% (n=33) in Richmond. By the end of shift the number of dehydrated forestry workers had significantly increased to 64% (n=64, p≤0.001) in Nelspruit and 63% (n=42, p=0.043) in Richmond. A minimum of 21% (n=2) in Nelspruit and 23% (n=15) in Richmond of the forestry workers had lost more than 2% of their body weight which could significantly decrease work capacity and work output as well as mental and cognitive ability. Dehydration was not related to season (winter/autumn), gender or job category. In Nelspruit 23% (n=23) and in Richmond 13% (n=10) arrived at work overhydrated (USG<1.013 g/ml). Pre break this had decreased to 14% (n=14) in Nelspruit and 10% (n=6) in Richmond. By the end of shift 4% (n=4) in Nelspruit and 2% (n=1) in Richmond had remained overhydrated and without correcting for fluid and food intake, 5% (n=5) had gained over 2% of their body weight in Nelspruit while none had gained weight in Richmond. Overhydration was not related to season (winter/autumn), gender or job category. Physical symptoms at the end of shift included tiredness (24%), toothache (13%) and headaches (10%) although these did not correlate to end of shift USG readings (p=0.221). The fluid requirements for male workers (n=8) who did not eat or drink across the shift was 439 ml per hour. The contractors were unaware of how much fluid should be supplied to workers and how much fluid they actually supplied. The only fluid provided by the contractors was water at the ambient air temperature which was the main source of fluid for the majority. Some forestry workers brought a limited variety of other fluids including amahewu, tea and cold drinks to work. At least 40% of the work force investigated, started their shift already compromised to work to capacity (USG>1.020 g/ml). The prevalence of dehydration had increased by the break emphasizing the need to begin drinking early on in the shift. The majority of forestry workers were dehydrated at the end of the shift. A significant proportion was dehydrated to the extent (>2%) that both work capacity and mental ability would be significantly compromised. A select group of forestry workers were drinking excessive amounts of fluid and were therefore susceptible to potentially fatal dilutional hyponatremia especially as water was the primary source of fluid. Dehydration in both autumn and winter was identified as being a significant but preventable risk. As a consequence of overhydration, a small group of forestry workers may be susceptible to dilutional hyponatremia. Fluid intake guidelines for males of 450 ml per hour appeared to be safe and were within the recommendations of the American College of Sports Medicine. Fluid guidelines for females need investigation.
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