Masters Degrees (Dietetics And Human Nutrition)

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Improving the nutritional composition of identified popular home-prepared complementary foods in selected rural and urban areas of KwaZulu-Natal, South Africa.
(2023) Sokhela, Hlengiwe Sinenhlanhla Charmaine.; Govender, Laurencia.; Siwela, Muthulisi.
Nutritional management of adult patients hospitalised with covid-19 by dietitians in KwaZulu-Natal.
(2023) Ebrahim, Naseera.; Pillay, Kirthee.
Background: The outbreak of a novel coronavirus disease (COVID-19) in December 2019, led to a worldwide pandemic. Over the past three years, over 4 million people in South Africa (SA) have been infected with COVID-19, which mainly affects the respiratory system. The presence of existing co-morbidities influences the severity of the illness, and the long-term prognosis. Patients who require hospitalisation for respiratory support are often critically ill and, in most cases, cannot consume enough nutrients. Although dietitians have been involved in the nutritional management of patients hospitalised with COVID-19, there were no guidelines on the nutritional management of COVID-19 available for them to use and they were not trained on its management. There is no consensus on how dietitians managed COVID-19 and which nutritional management guidelines they consulted. Aim: This study aimed to determine how dietitians managed adult patients hospitalised with COVID-19 in KwaZulu-Natal (KZN). Objectives: (i) to determine which nutritional guidelines dietitians used in the management of adult COVID-19 patients; (ii) to identify the challenges that dietitians faced when nutritionally managing adult COVID-19 patients; (iii) to determine whether dietitians took or estimated anthropometric measurements in bed-bound and mobile adult COVID-19 patients; (iv) to determine whether dietitians assessed malnutrition risk in adult COVID-19 patients, and if so, which nutrition screening tools were used; (v) to determine if dietitians recommended unconventional mega-doses of micro- and immunonutrient supplements for the management of adult COVID-19 patients and the reasons for use. Method: A cross-sectional descriptive study, which included dietitians employed in the public and private sectors in KZN was conducted. An electronic self-administered questionnaire was developed and used to collect data via the online platform Google Forms. Initially, the KZN Department of Health (DOH) and the Association for Dietetics in South Africa (ADSA) assisted with distributing the link to the study to dietitians in KZN. However, after an initial poor response, the data collection period was extended and the researcher was granted permission to directly contact and invite dietitians to participate, using publicly-available contact details. Data were collected between 14 August 2022 and 31 March 2023 and analysed using the Statistical Package for Social Sciences (SPSS) version 25. Results: Of the forty-two dietitians who participated in this study, 52.4% (n=22) were KZN DOH-employed dietitians and 31% (n=13) were ADSA members. Seven-percent (n=3) of the dietitians were both KZN DOH-employed dietitians and ADSA members and approximately 10% (n=4) of the dietitians were neither KZN DOH-employed dietitians nor ADSA members. An equal number of dietitians worked in private hospitals (n=16; 38.1%) and in public districtlevel hospitals (n=16; 38.1%). A significant number of dietitians began treating COVID-19 patients from the start of the pandemic or during and/or after the first wave of infection (p=0.001). Just over half of the dietitians were no longer treating any COVID-19 patients at the time of data collection (n=22; 52.4%) (p<0.001). Sixty-nine percent (n=29) of dietitians consulted a nutrition society for recommendations on the nutritional management of COVID-19 patients. The European Society for Parenteral and Enteral Nutrition (ESPEN) expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection were most used in the current study. The most frequently used values for calculating macronutrient requirements were: 25-30 kCal/kg/day for energy, 1.2-1.5 g/kg/day for protein, 30% of the total energy requirement (TER) for fat and 50-60% of TER for carbohydrates. Dietitians also reported using actual body weight (ABW) (n=13; 31.0%) or estimated body weight (n=19; 45.2%) to calculate nutritional requirements (p=0.004). Individual challenges faced by the dietitians were similarly grouped. There was significant disagreement among the dietitians that a lack of support and resources (p<0.001) and nutrition-related external factors were challenges they experienced (p<0.001). Anthropometry was assessed in all patient groups, with the main methods used being estimated weight, height and body mass index (BMI) for patients who were bed-bound and unconscious (n=31; 73.8%) (p=0.003). Actual weight, height and BMI were assessed in patients who were fully mobile (n=35; 83.3%) (p<0.001). There was also a significant agreement amongst the dietitians that COVID-19 patients did not feel well enough to have their anthropometric measurements taken. Half of the dietitians reported using a nutrition screening tool to screen for malnutrition (n=21; 50%) and a significant number of dietitians (n=13; 61.9%) used the Nutrition Risk Screening 2002 (NRS-2002) tool (p<0.001). Only 12 dietitians (28.6%) recommended the use of mega-doses of micro- and immunonutrient supplements in their COVID-19 patients, with an overall significant agreement that mega-doses could benefit the patient (p=0.012). All 12 dietitians who recommended mega-doses of micro and immunonutrient supplements did not report any adverse side-effects in their patients (p<0.001), and most (n=10; 83.3%) noticed an improvement in the condition of their COVID-19 patients (p=0.039). Conclusion: This was one of the first studies in SA to investigate the nutritional management of adult patients hospitalised with COVID-19. Although dietitians were involved in treating COVID-19 patients from the onset of the pandemic, most were not treating any COVID-19 patients at the time of data collection. Most dietitians consulted the ESPEN practical recommendations on the nutritional management of critically ill patients to manage their COVID-19 patients. There was no significant consensus amongst the dietitians that medical conditions and complications were challenges faced by the dietitians. Depending on the degree of mobility of the COVID-19 patient, anthropometry was assessed in COVID-19 patients, either by estimation or actual measurements. The most common malnutrition screening tools used by dietitians were the NRS-2002 and the Malnutrition Universal Screening Tool (MUST). Megadosing of micro- and immunonutrient supplements was not popular among the dietitians in the current study and further studies are needed in this area.
Knowledge and counselling practices of healthcare workers related to HIV and infant feeding in Ethekwini.
(2019) Nuns, Kate Abby.; Pillay, Kirthee.
Introduction: Breastfeeding is recognised globally as the single most effective child survival strategy for children under the age of five years. It is associated with much health, cognitive and economic benefits. Thus, the World Health Organization (WHO) recommends exclusive breastfeeding for infants for the first six months of life, followed by the introduction of appropriate complementary foods with continued breastfeeding until two years of age. This recommendation has been adopted and included in the South Africa Infant and Young Child Feeding (IYCF) policy for all mothers, including those living with human immunodeficiency virus (HIV). Although breastfeeding does carry a small risk of HIV transmission, the benefits of breastfeeding far outweigh this risk. With the South African Prevention of Mother-to-Child Transmission of HIV (PMTCT) programme now including the use of maternal antiretroviral therapy (ART), mother-to-child transmission rates have been successfully reduced. However, what has not improved successfully is the rate of breastfeeding in the country, despite recommendations in the IYCF policy. Poor IYCF counselling is a problem in South Africa and is thought to be one of the reasons for the country‟s poor breastfeeding rates. Healthcare workers are responsible for counselling mothers on IYCF practices. While it is very important to update HIV and IYCF guidelines based on new evidence, on-going changes to these guidelines can be confusing and overwhelming for healthcare workers. It can result in inappropriate IYCF counselling and in turn inappropriate IYCF practices by mothers. Mothers living with HIV require accurate and consistent information to make informed feeding decisions. Whether healthcare workers in eThekwini, KwaZulu-Natal (KZN) are knowledgeable and up-to-date with IYCF recommendations in the context of HIV is not known. Aim: To assess the knowledge and counselling practices of healthcare workers, primarily doctors and nurses, employed at eThekwini, KZN regional state hospital antiretroviral (ARV), paediatric and antenatal departments, regarding IYCF in the context of HIV. Objectives: (i) To determine the knowledge of healthcare workers on IYCF in the context of HIV in eThekwini, KZN. (ii) To determine if healthcare workers have attended formal training on IYCF in the context of HIV in eThekwini, KZN. (iii) To determine if healthcare workers feel they require training on IYCF in the context of HIV in eThekwini, KZN. (iv) To determine if antiretroviral (ARV) clinics, antenatal departments and paediatric departments all have a role in IYCF counselling of mothers living with HIV in eThekwini, KZN. (v) To determine the level of confidence that healthcare workers have regarding counselling mothers on IYCF in the context of HIV in eThekwini, KZN. Method: A self-administered questionnaire was developed for this study based on IYCF recommendations included in the National Department of Health South Africa (NDoH) 2013 IYCF policy, the 2017 amendment of the IYCF policy and the 2015 National Consolidated Guidelines for the PMTCT and the Management of HIV in Children, Adolescents and Adults. The questionnaire was administered to 188 healthcare workers, primarily doctors and nurses, working in ARV, antenatal and paediatric departments from three regional hospitals (Addington Hospital, Prince Mshiyeni Memorial Hospital and RK Khan Hospital) in eThekwini, South Africa. Results: The participants in all three departments were not knowledgeable on IYCF in the context of HIV with a mean knowledge score of 51.7% (SD±14.1) for the overall group. The knowledge scores did not differ significantly across departments. Only 47.3% (n=89) of the participants had attended formal training on IYCF in the context of HIV. The vast majority of participants (n=171; 91.4%) felt they required more training. All three departments were found to have a role in IYCF counselling of mothers living with HIV, with antenatal departments counselling pregnant women living with HIV more frequently than ARV and paediatric departments. Overall, the group indicated an above average confidence score regarding the IYCF counselling of mothers living with HIV. Attendance of the training did not equate to improved knowledge scores. Conclusion: This study aimed to assess the knowledge and counselling practices of healthcare workers regarding IYCF in the context of HIV. It was found that healthcare workers across all three departments were not knowledgeable on IYCF in the context of HIV. Less than half of the healthcare workers in the study had attended formal training on IYCF in the context of HIV. The majority of healthcare workers felt they required more training on the topic. The ARV, paediatric and antenatal departments at the three hospitals were all found to be involved in IYCF counselling of mothers living with HIV. Overall, the healthcare workers were confident about counselling mothers living with HIV on IYCF. The findings from this study highlight an urgent need for effective and on-going training of healthcare workers on IYCF in the context of HIV, in order to improve knowledge and to ensure that counselling practices of healthcare workers are in line with the national policies and guidelines that exist.
The motives and challenges facing South African vegans and the nutritional quality of their diet.
(2020) Kohidh, Sansha.; Wiles, Nicola Laurelle.
Introduction: A vegan diet is a voluntarily chosen plant-based diet that excludes all meat and animal products and includes wholegrains and legumes, fruit and vegetables, nuts and seeds and healthy fats. There are many different motives that influence an individual to become vegan including ethical motives, environmental motives and health motives. Internationally, many studies have been conducted to investigate these motives along with the nutritional intake and quality of the vegan diet. This diet is also becoming increasingly popular in South Africa, yet there is a paucity of studies that have been conducted to determine what motivates South Africans to follow this diet, what challenges they face while following the diet and what the nutritional quality of their diet is. Aim: To determine the motives of South African vegans, challenges faced and the nutritional quality of the South African vegan diet. Objectives: To determine the demographic characteristics of South African vegans; the motives that influenced the decision to become a vegan; challenges associated with following a vegan diet and how these challenges are overcome; and to determine the nutritional quality of dietary intake compared to recommendations (EARs) consumed and identify the variety of food groups and types of processed food in the vegan diet. Methods: A cross-sectional study in the form of an online questionnaire was conducted using South African vegans who were part of the South African Vegan Society online group on Facebook. The questionnaire consisted of four sections. Section one obtained information regarding the demographics of South African vegans. Section two obtained information on the main motives for following a vegan diet. Section three obtained information on the challenges experienced while following a vegan diet and how these challenges were overcome. Section four obtained information on the nutritional quality of the vegan diet which included a veganspecific Food Frequency Questionnaire (FFQ) with 291 food items and one 24-hour recall. Results: The first two sections of the online questionnaire were completed by 205 respondents, of which 82.4% (n = 169) were female and 17.6% (n = 36) were male. The respondents were predominately White (82.4%, n = 169), resided in the Gauteng province (43.9%, n = 90), were more likely to be single (53.2%, n = 109) and belonged to the 18-29 (29.3%, n = 60) and 40-49 age category (22.0%, n = 45). Most of the respondents had followed a vegan diet for one to less than three years (38.5%, n = 79). A significant number of respondents did not engage in smoking (83.9%, n = 172) but did consume alcoholic beverages less than once a week (60.0%, n = 123) (p<0.0005). Most of the respondents participated in varying amounts and intensities of physical activity (84.9%, n = 174) and made use of nutritional supplements (72.7%, n = 149). There was a significant agreement that ethical concern for animals (p<0.0005); followed by protecting the environment (p < 0.0005); and the effect of animal product consumption on climate change (p < 0.0005) were the main motivating factors for choosing to become a vegan. Most of the respondents reported that their initial motivation to become a vegan had not changed (71%, n = 146) and there was a significant agreement that experimenting with food assisted the respondents during their transition into the vegan diet (p < 0.0005). Section three of the questionnaire was completed by 197 respondents. Over one third of the respondents reported that it was “easy” to transition into the diet (35.1%, n = 72) and their initial emotions were enthusiasm and excitement (29.3%, n = 60). A significant number of respondents reported that they did not experience any financial challenges following the diet (74.6%, n = 176) and that their main challenge was finding vegan meal options in a restaurant (p < 0.0005). The respondents in this study overcame any challenges by conducting research on the internet and agreed that vegan recipes were easily accessible (p < 0.0005). The respondents significantly agreed that a vegan diet was nutritionally complete and adequate for a healthy lifestyle (p < 0.0005). The FFQ was completed by 113 respondents. Respondents consumed a wide variety of fruit; most often bananas (22.4%, n = 46) at least once a day, leafy-vegetables- most often cooked spinach (24.9%, n = 51) at least once a week, non-leafy vegetables- most often cooked broccoli (36.1%, n = 76) at least once a week. The starches most often consumed were whole-wheat bread (18.0%, n = 37) once a week, grains and cereals- most often white or brown basmati rice (20.0%, n = 41) once a month, peas and beans- most often chickpeas (32.2%, n = 66) at least once a week, fats- most often olive oil (20.5%, n = 42) at least once a day, snacks- most often potato chips (19.0%, n = 39) at least once a month. Desserts most often consumed were eggless cake (17.1%, n = 35) at least once a month, sweeteners- most often brown sugar (17.1%, n = 35) at least once a day and beverages- coffee decaffeinated or regular (29.3%, n = 60) at least once a day. The most commonly consumed plant-based milk alternative and meat alternative was soy milk (21.0%, n = 43) consumed at least once a day and soya products (28.8%, n = 59) at least once a week respectively. The 24-hour recall was completed by 134 respondents. The mean total energy of the respondents was 7471.15 kJ (SD = 3093.39). Males had a mean total energy of 7893.76 kJ (SD = 3415.37) and females had a mean total energy of 7374.22 kJ (SD = 3023.43). All respondents met the estimated average requirement (EAR) for protein (56 g for males and 46 g for females), carbohydrates (130 g) and the percentage of total energy for fat (10 - 35%). The respondents mean intake for protein was 74.73 g (SD = 52.28), carbohydrates 190.40 g (SD = 190.40) and fat 62.34 g (SD = 62.34), which contributed 18.5%, 47.36% and 33.7% respectively, of total energy in the diet. Females consumed significantly greater amounts of added sugar than males (M = 20.51 g) vs (M= 13.18 g). Both gender categories met their EARs for fibre, iron, vitamin C, vitamin B6, vitamin A, thiamine, riboflavin, folate and vitamin K. The respondents had a decreased intake of cholesterol, saturated fat and mono-unsaturated fatty acids and higher intakes of poly-unsaturated fatty acids. Females met their EARs for zinc and niacin, 9.02 mg and 15.32 mg respectively, while males were below their EAR, consuming 9.8 mg and 15.59 mg respectively. Males met their EAR for vitamin E consuming 20.32 mg, while females were below their EAR, consuming 13.56 mg of vitamin E. The respondents were shown to be lacking in calcium, sodium, vitamin D and vitamin B12. Conclusion: This study revealed that although veganism is widespread in South Africa, White females living in Gauteng were more likely to be following this lifestyle and be members of the South African Vegan Society online group on Facebook. Their main motive for following the diet was preventing cruelty towards animals and protecting the environment and its resources. This suggests that South African vegans are concerned about animal rights and the environment and their knowledge about veganism should be further investigated. The main challenge faced by the respondents was finding vegan options in restaurants. Therefore, restaurants that are vegan-specific or have vegan options available are recommended to list their restaurants online and upload their menus to assist vegans, as the internet was commonly used for research among this group. Major retail supermarkets are recommended to increase their stock and variety of options of vegan products especially plant-based milk and meat alternatives as these products are widely consumed. Research has shown that the vegan diet is linked to many potential health benefits, yet there is concern regarding whether the diet leads to nutrient deficiencies over time. As veganism is growing in South Africa, this study highlights the need for fortified food products and nutritional supplements to reduce nutrient deficiencies in the vegan diet. Longitudinal studies will also assist in examining trends and sustainability of a vegan diet in South Africa as well as determine whether nutrient deficiencies develop over time.
Anthropometric status and dietary habits of registered nurses, enrolled nurses and enrolled nursing auxilliaries workng at a private hospital in Pietermaritzburg, KwaZulu-Natal.
(2021) Yegambaram, Leah Bianca.; Pillay, Kirthee.
The prevalence of overweight and obesity has been increasing over the years, particularly in South Africa (SA). A major contributor to this is poor lifestyle choices such as unhealthy diets and sedentary lifestyles. The rise in overweight and obesity is alarming as both are major risk factors for non-communicable diseases (NCDs). Overweight and obesity are also becoming more prevalent among healthcare professionals, specifically nurses. However, nurses are expected to lead by example and should be role models to the patients they care for. Nurses are the backbone of healthcare facilities and being overweight or obese impacts both on themselves and on their patients. Factors contributing to overweight and obesity among nurses include consuming meals late, eating during stressful periods, low physical activity levels and working shifts. Aim: This study aimed to investigate the anthropometric status and dietary habits of registered nurses (RNs), enrolled nurses (ENs) and enrolled nursing auxiliaries (ENAs) working at a private hospital in Pietermaritzburg (PMB), KwaZulu-Natal (KZN). Objectives: (i) to determine the anthropometric status of RNs, ENs and ENAs working at a private hospital in PMB, KZN; (ii) to determine the dietary habits of RNs, ENs and ENAs working at a private hospital in PMB, KZN; (iii) to determine the factors contributing to the anthropometric status and dietary habits of RNs, ENs and ENAs working at a private hospital in PMB, KZN; (iv) to determine the prevalence of NCDs among RNs, ENs and ENAs working at a private hospital in PMB, KZN. Method: A cross-sectional descriptive study was conducted on RNs, ENs and ENAs working at a private hospital in PMB, KZN. A self-administered questionnaire was developed to obtain data on demographic characteristics, lifestyle factors, body image and weight and eating habits. Anthropometric status was determined using selected anthropometric indices including weight, height, body mass index (BMI) and waist circumference (WC). Dietary habits was assessed using a food frequency questionnaire (FFQ) and a single 24-hour recall. The 24-hour recall was analysed using the Medical Research Council (MRC) Food Finder software programme version 1.0. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 22. Results: The study sample consisted of 130 nurses; 40.8% (n=53) were RNs, 36.9% (n=48) were ENs, 2.3% (n=3) were midwives, 19.2% (n=25) were ENAs and one was a clinical nurse specialist in the neonatal intensive care unit (NICU). A significant number of the participants were either overweight (25.4%; n=33) or obese class I (29.2%; n=38) (p<0.0005). Most participants did not smoke (82.3%; n=107) or consume alcohol (59.2%; n=77). Only 50% (n=65) of participants exercised. A significant number (63.1%; n=82) indicated that they were not satisfied with their body shape/size and did not feel that they were at a healthy body weight (60%; n=78). The majority of participants underestimated their BMI using the Stunkard figure rating scale (76.9%; n=100). The majority of participants stated they had tried to lose weight before (64.6%; n=84). The most common weight loss methods were cutting down on fast foods/takeaways (67.9%; n=57) (p=0.001) and exercising (63.1%; n=53). A significant number of nurses agreed that they were role models to their patients (70.8%; n=92) and believed it was important for a nurse to have an ideal body weight (92.3%; n=120). The majority of participants skipped meals (83.8%; n=109) with the only significantly skipped meal being breakfast (63.3%; n=69). A significant number of participants prepared their own meals at home (84.6%; n=110). Participants significantly agreed that time [M (mean)=3.98; p<0.0005], cost (M=3.26; p=0.021), emotions/stress (M=3.61; p<0.0005) and convenience (M=3.38; p<0.0005) were factors that influenced their meal choices. There was significant agreement that a lack of time to prepare meals (M=3.69; p<0.0005), lack of time to eat at work (M=4.04; p<0.0005), emotions/stress (M=3.30; p<0.0010) and healthy food not being available to buy at work (M=3.22; p<0.0036), were factors preventing nurses from eating healthily. The most common food item bought at the hospital cafeteria was pies (21.5%; n=17). Fruit (52.3%; n=68), sweets (34.6%; n=45) and sugar-sweetened soft drinks (32.3%; n=42) were consumed at least once a day. The mean BMI for females (33.6 kg/m2) was significantly higher than that for males (28.1 kg/m2) (p=0.043). Most male participants had a WC above 94 cm (63.6%; n=7), while the majority of females (88.2%; n=105) had a WC above 80 cm. The mean BMI for non-smokers (BMI=33.8 kg/m2) was significantly higher than that of smokers (29.6 kg/m2) (p=0.030). A higher BMI was associated with less snacking. The mean BMI for those who skipped supper (36.3 kg/m2) was significantly higher than for those who ate supper (32.0 kg/m2) (p=0.013). The mean BMI for those who skipped meals (33.8 kg/m2) was significantly higher than for those who did not skip meals (29.6 kg/m2) (p=0.005). The FFQ showed that the starches most frequently consumed were brown and white bread/rolls, white rice, phutu (crumbly maize meal porridge) and potatoes without skin. Sweets, chips (crisps), biscuits and chocolates were also frequently eaten. In the meat, poultry, fish, eggs and meat substitutes group, eggs, processed meats and chicken cuts with skin were frequently (n=65) of participants exercised. A significant number (63.1%; n=82) indicated that they were not satisfied with their body shape/size and did not feel that they were at a healthy body weight (60%; n=78). The majority of participants underestimated their BMI using the Stunkard figure rating scale (76.9%; n=100). The majority of participants stated they had tried to lose weight before (64.6%; n=84). The most common weight loss methods were cutting down on fast foods/takeaways (67.9%; n=57) (p=0.001) and exercising (63.1%; n=53). A significant number of nurses agreed that they were role models to their patients (70.8%; n=92) and believed it was important for a nurse to have an ideal body weight (92.3%; n=120). The majority of participants skipped meals (83.8%; n=109) with the only significantly skipped meal being breakfast (63.3%; n=69). A significant number of participants prepared their own meals at home (84.6%; n=110). Participants significantly agreed that time [M (mean)=3.98; p<0.0005], cost (M=3.26; p=0.021), emotions/stress (M=3.61; p<0.0005) and convenience (M=3.38; p<0.0005) were factors that influenced their meal choices. There was significant agreement that a lack of time to prepare meals (M=3.69; p<0.0005), lack of time to eat at work (M=4.04; p<0.0005), emotions/stress (M=3.30; p<0.0010) and healthy food not being available to buy at work (M=3.22; p<0.0036), were factors preventing nurses from eating healthily. The most common food item bought at the hospital cafeteria was pies (21.5%; n=17). Fruit (52.3%; n=68), sweets (34.6%; n=45) and sugar-sweetened soft drinks (32.3%; n=42) were consumed at least once a day. The mean BMI for females (33.6 kg/m2) was significantly higher than that for males (28.1 kg/m2) (p=0.043). Most male participants had a WC above 94 cm (63.6%; n=7), while the majority of females (88.2%; n=105) had a WC above 80 cm. The mean BMI for non-smokers (BMI=33.8 kg/m2) was significantly higher than that of smokers (29.6 kg/m2) (p=0.030). A higher BMI was associated with less snacking. The mean BMI for those who skipped supper (36.3 kg/m2) was significantly higher than for those who ate supper (32.0 kg/m2) (p=0.013). The mean BMI for those who skipped meals (33.8 kg/m2) was significantly higher than for those who did not skip meals (29.6 kg/m2) (p=0.005). The FFQ showed that the starches most frequently consumed were brown and white bread/rolls, white rice, phutu (crumbly maize meal porridge) and potatoes without skin. Sweets, chips (crisps), biscuits and chocolates were also frequently eaten. In the meat, poultry, fish, eggs and meat substitutes group, eggs, processed meats and chicken cuts with skin were frequently consumed. The fruit and vegetables most frequently consumed were non-starchy vegetables, fresh fruit and fruit juice. Full cream milk, sunflower oil, tub/soft margarine and cheddar cheese were the dairy and fats eaten most often. Tea and water were consumed more often than sugar-sweetened beverages. Overall, the most frequently consumed foods were full cream milk, sunflower oil, tea, white sugar, fresh fruit, brown sugar, brown bread/rolls, tub/soft margarine, sweets and white bread/rolls. Conclusion: There was a high prevalence of overweight and obesity among the participants. According to WC, the majority of nurses had an increased risk for metabolic complications. However, most participants were not diagnosed with a NCD. Factors associated with a high BMI included being female, not smoking, skipping meals, skipping supper, less snacking and cost of meals. Nurses consumed both healthy and unhealthy foods. Overall, there was a higher intake of carbohydrates and protein and a lower intake of dietary fibre. Despite the many hours that they spend caring for patients, nurses should also pay attention to their own health and well-being. Nurses should be supported in their efforts to achieve and maintain a healthy weight and lead a healthy lifestyle.
Body mass index, body image and possible factors related to weight loss practices of female undergraduate students on the Pietermaritzburg campus, University of Kwazulu-Natal.
(2019) Lubisi, Zethembiso Desiree; Kassier, Susanna Maria.; Mkhwanazi, Blessing Nkazimulo.
South Africa is undergoing epidemiological transition, characterized by an increasing prevalence of obesity, especially among women. Among those 15 to 24 years of age, the prevalence of overweight and obesity at 40.9% is cause for concern, as it is associated with the development of non-communicable diseases of lifestyle. However, 18.1% of women in the above age category, indicated that they are unhappy with their current weight. Body image is related to an individual’s perception of the attractiveness of their own body, and has an impact on actual weight and weight management practices. Body image dissatisfaction refers to the negative perceptions and feelings a person has about their body and can be affected by factors such as body shape and appearance, body weight gain attitudes, and cultural norms regarding an ideal body size. In this respect, university students are of particular interest, as they are known to experience a number of stressors during the transition from secondary- to tertiary education that contributes to unhealthy eating habits, a decreased level of physical activity and subsequent weight gain. Objectives To determine the Body Mass Index (BMI), body image and factors related to weight loss practices among female undergraduate students on the Pietermaritzburg (PMB) campus of the University of KwaZulu-Natal (UKZN). Methods A cross sectional descriptive survey of conveniently sampled female undergraduate students on the PMB campus (N=316), UKZN was conducted. Weight and height were measured by trained fieldworkers for the calculation of BMI. Data was collected by means of a self-administered questionnaire to determine the socio-demographic characteristics, physical activity level, nutrition knowledge, body perceptions, weight management practices and dietary diversity of study participants. Results The majority of participants (86.7%), were black African and registered for study within the College of Agriculture, Engineering and Science (45.6 %). The mean age of the study sample was 20 ± 2 years. Participants mainly resided in private accommodation (44.3%), followed by 38.6% living in university residences. The majority (72.7%) were funded by the National Student Financial Aid Scheme (NSFAS). Participants who prepared their own meals, did so 3.7 ± 2.3 times per week, with 84.3% reporting that they prepared their own meals most days of the week. Most consumed take-aways (91.1%), with 61.2% doing so on a weekly basis. Nearly half (48.1%) of the participants had a normal BMI, followed by 19% being overweight. Furthermore, 13.3% were classified as obese class I, while 12.6% were classified as obese class II. Only 4.4% were underweight, while 2.5% were classified as obese class III. The majority (46.8%) could be classified as being moderately physically active, followed by those with a low level of physical activity at 38.6%. Only 14.6% were classified as having a high level of physical activity. A nutrition knowledge score of ≥ 50% was achieved by 63.8% of participants, followed by a third (34.3%) who had a score of less than 50%. The most noteworthy findings were that participants were not aware that starchy foods should form the basis of most meals, and that drinking boiled water does not facilitate weight loss. An assessment of participant weight management practices, revealed that 59.1% weighed themselves, with 61.0% reporting that they do so monthly. Despite the fact that the majority of participants (70.0%) classified their current body weight as normal, 56.4% had attempted weight loss. Of those who had not attempted weight loss, the majority (37.5%) indicated that the reason for not attempting weight loss, was that they were satisfied with their body weight, followed by 35% indicating that they perceived their body weight as normal. The majority of participants who attempted weight loss, resorted to healthy weight loss practices (50.9%), followed by 42.0% who made use of a combination of healthy and unhealthy weight loss practices. In terms of body image perceptions, the difference between perceived (“feel”) and ideal body size was calculated, rendering a Feel Ideal Index (FID) score of 0.4 ± 1.33, indicating that participants desired to be thinner. The majority of participants (45.0%) had a medium dietary diversity as was indicated by the consumption of 6 to 11 food groups, followed by more than a third of participants (35.6%) having a high dietary diversity score due to the consumption of more than 11 food groups. One out of five participants (19.4%) consumed diets that lacked diversity. Conclusion Body image perception and level of body image satisfaction were the most important determinants of whether participants engaged in weight management practices. This was illustrated by participants who had never attempted weight loss, indicating that the reason why they have never attempted weight loss was because they “perceived their current body weight to be normal” and that they are “satisfied with current weight”. An increase in BMI was positively associated with an increase in body image dissatisfaction (BID), resulting in overweight and obese participants attempting to lose weight. It was also noted that a larger proportion of participants indicated that they have attempted weight loss, and did so using healthy weight loss practices such as exercise, diet and reduced portion sizes. Participants desired body sizes that were thinner than their perceived current body size. This was illustrated by a positive mean FID index score of 0.4 ± 1.33. Although those with a high BMI desired a large body size, it was thinner than what they perceived themselves to be. Furthermore, participants living in university residences and private accommodation, had a higher BMI than those who lived at home. Those with a higher physical activity level (PAL), weighed themselves more often when compared to those who were less active. This may suggests that participants were engaged in physical activity to improve appearance. However, it could also be an indicator that participants were physically active for the promotion of health, general wellbeing and for social reasons. Significant relationships between nutrition knowledge score and BMI, as well as dietary diversity score were not documented. However, participants with a good nutrition knowledge score perceived their current weight to be lower than those with a poor nutrition knowledge score.
Practices and perceptions of registered dietitians regarding the use of carbohydrate counting and barriers associated with it in the dietary management of type 1 diabetes mellitus.
(2019) Dimitriades, Megan Esme.; Pillay, Kirthee.
Introduction: Diabetes mellitus (DM) is one of the most prevalent chronic diseases worldwide with an estimated 451 million people currently living with diabetes between the ages of 18-99 years. Approximately 87-91% of people with diabetes in high-income countries have type 2 diabetes mellitus (T2DM), while 7-12% have type 1 diabetes mellitus (T1DM). In South Africa, there are an estimated 2.3 million people living with diabetes and of those people, 5-15% have T1DM. The diabetic should receive individualised nutrition therapy, which includes promoting and supporting healthy eating by achieving and maintaining body weight and individual glycaemic goals. Carbohydrate counting is a meal planning method that alongside the adjustment of insulin assists in managing and maintaining blood glucose levels and is commonly used in the management of T1DM. With carbohydrate counting, the individual is taught to identify carbohydrates in foods (carbohydrate awareness) and determine the amount of carbohydrates that are consumed at one time. They are then taught to give the correct amount of insulin depending on the portion of carbohydrate eaten to prevent hyperglycaemia and hypoglycaemia, and maintain normal blood glucose levels. Carbohydrate counting has been shown to improve glycaemic control as well as quality of life, however, it must be taught by someone who has clinical expertise in the field, such as an experienced registered dietitian. Although international guidelines recommend that carbohydrate counting be offered to all newly diagnosed patients with T1DM, there are currently no recommendations specific to the South African population and little or no information regarding practices and perceptions of dietitians regarding carbohydrate counting. Aim: This study aimed to determine the practices and perceptions of registered dietitians regarding the use of carbohydrate counting and the barriers associated with it in the dietary management of T1DM. It also aimed to determine if there is a need for further training on carbohydrate counting amongst dietitians in KZN. Objectives: i) To determine which dietary management approach is most commonly used by dietitians in KZN when educating patients with T1DM. ii) To determine if dietitians in KZN use carbohydrate counting in the dietary management of patients with T1DM. iii) To determine the perceptions of dietitians in KZN towards the use of carbohydrate counting in the dietary management of T1DM. iv) To determine the barriers which prevent dietitians in KZN from using carbohydrate counting in the dietary management of T1DM. v) To determine if dietitians in KZN see a need for further education/training in the area of carbohydrate counting. Method: A cross-sectional descriptive study was conducted via a link to a questionnaire on SurveyMonkey that was attached to an email. The link was distributed to the dietitians who were members of the Association of Dietetics in South Africa (ADSA) in KZN. The KZN Department of Health (DOH) uploaded the survey on their intranet website under the surveys section, where the DOH dietitians could access the survey. Data was analysed using the IBM Statistical Package for Social Sciences (SPSS) version 26.0. Results: Sixty-nine dietitians participated in the survey, 78% (n=54) of which qualified at the University of KwaZulu-Natal (UKZN). Although the majority (76.8%; n=53) of the dietitians indicated that they gave dietary management advice to patients with T1DM, a significant 85.5% (n=59) indicated that most of their patients presented with T2DM (p<0.05). The glycaemic index, portion control using the healthy eating plate, carbohydrate counting using nutritional labels, carbohydrate counting using household measures and carbohydrate awareness i.e. making patients aware of which foods contain carbohydrate, were all significant dietary management approaches used by dietitians (p<0.05). The majority of the dietitians (60.9%; n=42) indicated that they had not received additional training on diabetes management. Dietitians agreed that they required further training or education on the use of carbohydrate counting as a dietary management approach to manage patients with T1DM (p<0.05). Dietitians agreed that there were numerous barriers to their use of carbohydrate counting in the management of diabetes. These barriers included a lack of training, confidence and experience, patient illiteracy, lack of financial resources, time, blood glucose records and poor patient motivation. Dietitians agreed that carbohydrate counting was useful as a dietary management approach (p<0.05) and that it was an essential part of the dietary management of T1DM (p<0.05). Conclusion: Although dietitians in KZN stated that they used carbohydrate counting as a dietary management method, their practices varied. There was a willingness amongst dietitians working in both the private and public sectors to receive more training on carbohydrate counting and to apply it to patient care. Although dietitians agreed that carbohydrate counting was a useful and essential method in the dietary management of T1DM, a number of barriers prevented the use of this method. A lack of training, confidence and experience influenced whether or not dietitians taught their patients to carbohydrate count. There is a potential for carbohydrate counting to be used by the dietitians in KZN who participated in the study. However, further training and resources are required. This study has highlighted a need for South African guidelines on the dietary management of T1DM, as there is currently none in place.
Early life factors associated with stunting and overweight at 12 months in infants enrolled in the Mother and Child in the Environment (MACE) study, Durban.
(2019) Jarvie, Penelope Anne.; Wiles, Nicola Laurelle.; Naidoo, Rajen.; Veldman, Frederick Johannes.
Abstract available in PDF.
An exploration of the impending 2018 sugar-sweetened beverage tax on the purchases of Black African women, shopping at the Edendale mall in Pietermaritzburg.
(2019) Ilangila, George Richard.; Wiles, Nicola Laurelle.; Van Onselen, Annette.
Introduction: The incidence of death from non-communication diseases (NCDs) is escalating steadily. Rapid urbanisation and changing diets in the developing countries are currently producing a “silent emergency” called overnutrition or obesity. Several studies conducted in South Africa have shown that obesity is more severe among females than males, particularly in the Black African race group. Recent literature suggested that the consumption of sugarsweetened beverages (SSBs) could have contributed towards this problem. Fiscal interventions such as taxes are increasingly being recognised worldwide as an effective tool that can help to combat the obesity epidemic at a population level. The increased price of SSBs is an important factor that could influence the purchasing decisions of consumers. Increased negative health effects of SSBs have led to action to be taken in order to limit their consumption. In conjunction with this, on February 2016, the South African Government decided to consider the use of fiscal policies by introducing taxes on SSBs in order to improve the health standards of the public. At the time of this study the SSBs tax had not been implemented, however it was important to investigate what effect the impending tax would have on the current SSB purchasing practices of Black African women. Aim: Investigating the impact of the impending 2018 sugar-sweetened beverage tax on the purchases of Black African women aged 19 and older, shopping at the Greater Edendale Mall in Pietermaritzburg. Objectives: To determine the demographic characteristics of Black African women who purchase SSBs; to determine the types of SSB Black African women are purchasing; to assess the frequency of SSB purchases by Black African women; to investigate the factors that influence Black African women to purchase SSBs and to determine the effect of the impending 2018 SSB tax on respondent purchases of SSBs. Methods: A cross sectional study with aim of investigating the impact of the impending 2018 sugar-sweetened beverage tax was conducted among 439 Black African women aged 19 and older, shopping at the Greater Edendale Mall in Pietermaritzburg. Non-probability sampling was used to recruit the respondents. A five-part questionnaire was used to gather demographic information; characteristics of respondents who purchase the SSBs; the types of SSBs iii purchased; the frequency of purchases; what motivated the respondents to purchase SSBs; and what impact the impending SSBs tax would have on SSB purchases once implemented. Results: The study population consisted of 439 Black African women. The mean age of the respondents was 33.69 years with minimum and maximum ages of 19 and 55 respectively. Around two thirds (n=328, 74.7%) had an education level of matric or up to Grade 12. Only one third (n=111, 25.4%) had a post matric qualification. Among all SSBs purchased by respondents, carbonated fizzy drinks were the most frequently purchased beverage (n= 391, 89.0%), while sport drinks were purchased least frequently (0.9%, n=4) ahead of energy drinks (n=5, 1.1%). Squashes, concentrates and syrups (Juices) were the second most frequently purchased SSBs (n=25, 4.9%), followed by flavoured water drinks (n=15, 3.4%). Most respondents (n=396, 90.2%) indicated that they purchased SSBs between one and four times a month. Price and taste were rated as being significantly important factors that influenced respondents to purchase SSBs, whilst design and packaging, recommendation by friends/family and loyalty to the product were less important factors. Most respondents (n=359, 82.0%) reported that they were not aware of the impending SSB tax. The main findings of the study revealed that nearly half of the respondents (n=213, 48.5%) indicated the intention to continue purchasing and consume their preferred beverages as usual despite the price increase due to the SSBs tax. Around one-third of respondents (n= 151, 35.1%) reported that they would reduce their SSB purchases and start consuming smaller amounts of SSBs. Few respondents (n=68, 15.5%) indicated that they would switch to cheaper drinks whilst very few (n=4, 1.0%) would opt to stop purchasing SSBs. The results of sub-group analysis in relation to the impact of impending tax depending on education level and income status revealed the existence of a significant negative correlation for price with education. A significant number of respondents with matric and less (n=188, 62.8%) indicated that they will continue purchasing SSBs as usual after the implementation of SSBs tax while significantly more of those with a higher education level (n=73, 78.5%) confirmed their intention to reduce SSB purchases. Most respondents, who earned up to R5553 as their monthly total household income (n=96, 63.2% and n=29, 19.1%), indicated that they would either continue purchasing SSBs as usual or switch to cheaper drinks respectively. iv Conversely, respondents with a higher income including those who earned R44949 per month and above (n=3, 0.7%), between R18545 – R44948 (n=35, 8.0%) as well as between R10010 – R 18544 (n=37, 8.4%) indicated that they will reduce their SSB purchases once the tax had been implemented. Conclusion: The findings from this study highlight the need to further investigate the long term effect of SSB consumption contributing to overweight and obesity, particularly in Black African women and their family members. Since differences in SSB purchases were observed depending on education and income status of the respondents, the high frequency of consumption of added sugars from carbonated fizzy drinks by respondents and their family members entails more exploration. This would give direction for appropriate policies and initiatives, along with the SSB tax that could promote healthier dietary intake habits and reduce the burden of obesity related NCDs in Black African women and their family members.
Awareness, attitudes and response to the sugar-sweetened beverage tax among consumers in Pietermaritzburg, KwaZulu-Natal.
(2019) Baijnath, Nikita.; Pillay, Kirthee.
Introduction: Obesity and overweight have been identified as serious health problems both globally and in South Africa. One of the contributing factors to this epidemic is the consumption of sugar-sweetened beverages (SSBs), high in sugar and energy. Sugar-sweetened beverages are defined as: ‘beverages that contain added caloric sweeteners such as sucrose, high fructose corn syrup or fruit juice concentrates’ and include soft drinks, fruit drinks, sports/energy drinks, vitamin water drinks, sweetened ice tea and lemonade. The South African Minister of Finance implemented the sugar-sweetened beverage (SSB) tax on 01 April 2018, as part of a multidisciplinary strategy to alleviate the obesity problem. The tax is calculated according to the direct proportion of added sugar at 2.1 cents per gram of sugar that exceeds 4 g per 100 ml, resulting in an approximate 20% increase in the price of SSBs. Given that the SSB tax is relatively new in South Africa, there is a need to assess the awareness, attitudes and responses of South African consumers to the tax. Aim: This study aimed to assess the awareness, attitudes and response to the sugar-sweetened beverage tax among consumers in Pietermaritzburg, KwaZulu-Natal. Objectives: (i) To determine if consumers in Pietermaritzburg, KwaZulu-Natal are aware of the SSB tax (ii) To determine the demographic characteristics of consumers who are aware of the SSB tax in Pietermaritzburg, KwaZulu-Natal (iii) To determine the attitudes of consumers in Pietermaritzburg, KwaZulu-Natal towards the SSB tax (iv) To determine the response of consumers in Pietermaritzburg, KwaZulu-Natal to the SSB tax, in terms of purchasing behaviour. Methods: An observational cross-sectional study was conducted at seven shopping centres in Pietermaritzburg, using a self-administered questionnaire, developed for this study. The questionnaire was used to gather data on demographic characteristics, awareness and response to the SSB tax. Data was analysed using the IBM Statistical Package for Social Science (SPSS) version 23.0. Results: The participants were mostly 18-30 year old Indian or African consumers, with a low income and in possession of a matric certificate or tertiary qualification. A significant number of consumers were aware of the South African SSB tax (58.1%; n=229), however, almost half did not know when it was implemented (47.6%; n=109). Indian and white consumers were significantly more aware of the SSB tax compared to African consumers (p<0.0005). In addition, awareness increased according to income level (more than R40 000 per month) and age (31-50 year olds) (p<0.0005). The consumers were divided in their attitudes towards the SSB tax. Nearly equal amounts of participants were in agreement (35.8%; n=141) or disagreement (37.0%; n=146) with the SSB tax. Furthermore, many believed that it would benefit the country in terms of the economy or health (43.6%; n=100). However, some felt that they could not afford the tax (21.8%; n=50) or felt that the money would go to the government and not benefit the public (12.7%; n=29). Many also believed that the South African economy would be negatively affected in terms of job losses (41.1%; n=162). However, there was neither significant agreement nor significant disagreement that the SSB tax would reduce obesity or consumption rates of SSBs. In addition, many indicated that the government should not interfere with the beverage choices of South Africans (41.9%; n=165). About half of the participants stated that they would make healthier beverage choices, following the implementation of the SSB tax (53.6%; n=211). Moreover, half of the consumers indicated that they would opt for water (50.8%; n=200). Other common alternatives included 100% fruit juice (49.2%; n=194) and milk and milk products (30.2%; n=119). Finally, most participants suggested that they would like the government to help reduce the prevalence of obesity by supporting an increase in nutrition education (27.3%; n=68) and physical activity (22.5%; n=56). Conclusion: This study aimed to assess the awareness, attitudes and response to the SSB tax among consumers in Pietermaritzburg, KwaZulu-Natal. The majority of the consumers were aware of the South African SSB tax; however, almost half did not know when it was implemented. Indian and White consumers, between the ages of 31 and 50 years old, earning more than R40 000 per month, were the most aware of the South African SSB tax. Half of the consumers were in favour of the SSB tax and felt that it would improve health. The same number also indicated that they would choose water as an alternative, if SSBs were no longer affordable to them, followed by 100% fruit juice and milk and milk products. The differences in attitudes towards the SSB tax show that there is a need for consumers to know more about the SSB tax. Hence, more awareness campaigns are required. Future research should investigate the impact of the SSB tax on health, obesity rates and the economy.
Nutritional composition and consumer acceptability study of different preparations of edamame soy beans.
(2017) Taylor, Leandra Antoinette.; Veldman, Frederick Johannes.
The aim of this study was to determine the nutritional composition and physical properties of dry mature and roasted mature Edamame beans and to compare, through sensory evaluation, the consumer accessibility of these products in grade 5 learners. Soy beans have been known and recognised for centuries as a plant food that, when compared with other plants, is high in protein. For this reason, soy beans have historically been called ‘meat of the field’. The overall energy content of the Edamame soy beans remained unchanged after undergoing oven and microwave roasting. Even though the microwave roasted soy bean samples appeared to have a higher macronutrient content when compared to oven roasted soy bean samples, it is important to recognize the fact that microwave roasting causes more water loss, which has a concentrating effect on the macronutrients. Forty-one grade 5 learners participated in a sensory evaluation, conducted at Cato Crest Primary School in Durban, KwaZulu-Natal. In this study, learners preferred the Edamame above their usual sweet-flavoured snacks. The learners however, preferred samples that had strong "sweet" and monosodium glutamate flavours. Results from this study suggest that the different roasting methods of Edamame beans do not yield products that are significantly different in terms of nutritional quality. Yet, microwave roasting caused more fluid loss. This makes microwave roasting ideal to process Edamame soy beans due to improved shelf life. Edamame soy beans are a healthier source of protein in comparison to peanuts as it provides good quality protein with a lower fat content. It provides all of the essential amino acids for adults and children and would be a good alternative source of protein if made more available to those at risk of malnutrition.
Food insecurity and related coping strategies among undergraduate students at the Univeristy of KwaZulu-Natal, Pietermaritzburg campus.
(2015) Poinoosawmy, Padmini Shivani.; Veldman, Frederick Johannes.; Kassier, Susanna Maria.
Background: As a country, South Africa could be viewed as food secure. However, a substantial number of households in the country are food insecure. Education is commonly viewed as an opportunity for improving human and social resources. However, at 15% per annum, the South African university graduation rate is globally one of the lowest. As a significant number of South African students enrolling in tertiary education come from previously disadvantaged households characterised by social and economic adversity, the relationship between the latter and low university throughout rates cannot be overlooked. Objective: The purpose of this study was to investigate food insecurity and related coping strategies among undergraduate students enrolled at the University of KwaZulu-Natal, Pietermaritzburg campus. Design: A cross-sectional descriptive study design was chosen. Setting: Main, life science and commerce campuses of the University of KwaZulu-Natal, Pietermaritzburg campus were used as setting for the study. Subjects: Subjects included for this study were registered undergraduate students on financial aid and non-recipients of financial aid (N=800). Methods: Data collection was conducted by means of a questionnaire developed for the purpose of the study in addition to a modified version of the HFIAS as well as an adapted version of the Coping Strategy Index. Results: The mean age of the study sample was 20.5± 2.0 years. The gender distribution was 41.1% males and 58.9% females. The mean BMI of the study sample was 24.3(±4.8) kg/m2 with 35.8% of the study sample being overweight and obese. Female students had a higher prevalence of overweight (25.1%) and obesity (19.5%) when compared to males, who had a 16.1% prevalence of overweight and 7.0% obesity rate. Over half (54.3%) of participants were non-recipients of financial aid, while 45.8% students were on financial aid. Of the latter, 72.1% were sponsored by NSFAS. During term, 41.6% students lived at student residence, followed by who 32.5% resided at off campus accommodations and 25.9% living at home. Nearly two thirds (60.0%) of students were trying to find a part time job while studying of which 17.3% found employment. Three quarters (75.9%) received an additional source of income of which, 69.4% were not on financial aid and 30.6% were on financial aid. It was reported that 17.6% of students were assisting their families/friends/partner financially. Of the latter sub-sample, 87.2% were on financial aid. Students’ weekly food expense was R132.96. More than half (57.9%) the students were found being the hungriest at the end of the semester and close to/during exam time and at midday or mid-afternoon, with a higher prevalence of these reports coming from students on financial aid (28.0%). More than four out of ten (43.4%) students reported not having enough money for food of which, 55.0% were on financial aid. It was reported that 77.0% of the students were not able to eat a variety of food due to the lack of financial resources with 54.2% of students reporting this shortage occurring at every month end. As far as students who resided in student residence were concerned, 73.0% had their food stolen. The most frequently consumed foods included starchy food (bread, rice, maize-meal, samp, potato and pasta), fats (cooking oil, margarine and mayonnaise), tea, coffee, breakfast cereals and porridge, chicken, eggs and salty snacks. The frequency of consuming fruit was higher than that of vegetables, despite the consumption of both fruits and vegetables being low. More than seven out of ten (72.4%) students were facing food insecurity. While those on financial aid were more likely to be food insecure when compared to non-recipients of financial aid, 77.6% of the study sample limited the variety of their food consumed. The three most severe conditions of food insecurity (running out of food, going to bed hungry because there is no food and, going the whole day and night without food), were experienced by 12.5% of the students. In order to cope with food insecurity and lack of food, the three most frequently used coping strategies were borrowing money (66.5%), borrowing food (34.5%) and selling assets (19.3%). Significantly more students on financial aid adopted coping strategies when compared to those who were not on financial aid. Conclusion: Overweight and obesity was more prevalent among food insecure females than males. There was a lack of dietary diversity among the study sample; especially students on financial aid who faced a high prevalence of food insecurity. Food insecurity and the concomitant coping strategies adopted by students affect their physical and emotional well-being and this may hinder their academic performance. Hence, sustainable remedial measures should be implemented to address food security among undergraduate students registered for study at the Pietermaritzburg campus of University of KwaZulu-Natal.
To determine the impact of dietary calcium from dairy, and/or total dairy intake on the body mass index of Grade 2 leaners in Pietermaritzburg.
(2018) Galliers, Joanne Louise.; Wiles, Nicola Laurelle.; Tyler, Nicola Claire.
Introduction: International and local figures show a steep rise in the incidence of overweight and obesity in both adults and children, with more children suffering from overweight, obesity and their associated diseases of lifestyle than ever before. The aetiology of overweight and obesity is complex, with many interrelated factors involved. The South African government implemented the Food Based Dietary Guidelines in an attempt to guide the public on making healthy food choices. One of the guidelines encourages the public to “have milk, maas or yoghurt every day” due to the beneficial health effects of these dairy products. South African studies investigating the calcium intake of different age groups have shown children to consume inadequate amounts of calcium. A recent national survey showed the age group of 7 to 8 years old in particular, to have the lowest calcium intake of all age groups studied. Several international studies have shown dairy products, and specifically milk, to have an inverse relationship with Body Mass Index (BMI) in both adult and paediatric subjects. However, other international studies have provided conflicting results. No such study has been conducted in South Africa, and so the need arose to investigate a possible association between dairy products and childrens’ BMI. Aim: To determine the impact of dietary calcium from dairy and/or total dairy intake, on the body mass index of Grade 2 learners in Pietermaritzburg. Objectives: To determine the following regarding Grade 2 learners: the prevalence of overweight and obesity by interpreting their BMI; their calcium intake from dairy, and their total dairy intake; the contribution of dairy products to meeting their calcium requirements; whether a relationship exists between their dietary calcium (from dairy), and/or total dairy intake and their BMI; and possible barriers to dairy intake. Method: A cross sectional study was conducted on 91 Grade 2 learners from quintile 5 (fee-paying) schools in Pietermaritzburg. A three-part questionnaire, comprised of an anthropometric section, demographic questions, and a semi-quantitative food frequency questionnaire (FFQ) were administered to the parents/guardians of the Grade 2 learners. The BMI of the learners was compared to both the World Health Organization (WHO) and International Obesity Task Force (IOTF) classifications for overweight and obesity. The calcium intake was obtained from the FFQ, and compared to the Estimated Average Requirement (EAR) for calcium for 4 to 8 year olds. The dairy intake was also determined, and compared to the recommended national guidelines. Results: The study population comprised 57% female and 43% male learners, of whom 40.7% were Black African, 27.5% were White, 17% were Indian and 13.2% were Coloured. Of these learners, 28.6% (WHO) and 24.2% (IOTF) were overweight and 19.8% (WHO) and 15.4% (IOTF) were obese. More female learners were overweight than male learners, but a greater percentage of male learners were obese than female learners. Calcium intake from dairy was significantly below the EAR of 800 mg per day for 75.8% (n=69) of learners, with the average intake from the FFQ recorded as 615.2 mg. The mean number of dairy servings per day was 2.03, also below the recommended number of 3 servings of dairy per day. No relationship between BMI and calcium, or BMI and total dairy intake was established. Despite the low intake of dairy, no significant barriers to the consumption of dairy were identified. Conclusion: Grade 2 learners do not consume enough dairy products in their diet, and are therefore unable to meet the calcium requirements for their age. Greater effort is required by government, schools, health professionals and parents/guardians to promote, and encourage children to consume more dairy products. Further research on this topic is recommended, where the impact of lower fat and sugar containing dairy products on body fat (as opposed to BMI) can be investigated.
Investigating the consumption of processed meat, meat and meat alternatives and related factors affecting their purchases and consumption amongst undergraduate students at the University of KwaZulu-Natal, Pietermaritzburg campus.
(2017) Birkett, Megan Ann.; Veldman, Frederick Johannes.; Kassier, Susanna Maria.
Due to the recent publication by the International Agency of Cancer Research (2015a) that indicated that processed meat was carcinogenic and red meat probably carcinogenic, the consumption and knowledge of processed meat in the undergraduate students at University of KwaZulu-Natal was a concern. Due to the limited published research available on the subject, therefore, this study aims to investigate the consumption of processed meat, meat and meat alternatives and related factors affecting their purchases and consumption amongst undergraduate students at the University of KwaZulu-Natal, Pietermaritzburg campus. A cross-sectional study was conducted on undergraduate students at the University of KwaZulu-Natal on the Pietermaritzburg Campus (N=189). The students were requested to complete a questionnaire consisting of socio-demographic questions, socio-economic questions, a food frequency and nutrition knowledge questions. For the purpose of the study, the questionnaire was developed using current literature and expert input from the study supervisor. The results showed that the students consumed eggs and cold meat the most frequently, every day compared to other meat alternatives and meat. Legumes and fast foods were eaten the least by the majority of the participants. They indicated eating it “never or less than once a month” when compared to other meat and meat alternatives. The participants also considered price to be the main factor when deciding which food to purchase, followed by taste. It was also evident that the students had a poor overall level of nutrition knowledge regarding good sources of protein, fat content, salt content and general health of meat, processed meat and meat alternatives. The results of this study show similarities between previously published studies regarding factors when considering purchasing and nutrition knowledge. Due to the lack of locally published research concerning the consumption and knowledge of students regarding meat, processed meat and meat alternatives, this study forms a reference point to the importance of the need of nutrition education in undergraduate students at the University of KwaZulu-Natal.
The current infant feeding practices and related factors of Indian and Zulu mothers with 0-9 month old infants attending well baby clinics in Durban-North.
(2017) Mkhize, Zanele Prudence.; Kassier, Susanna Maria.; Veldman, Frederick Johannes.
Background: Currently there are no studies that have been conducted regarding infant feeding practices for Indian mothers neither comparing Indian mothers with other race in South Africa. Thus, this may be the first study and further research may be conducted. Objective: The objective of the study was to determine and compare the infant feeding practices and factors influencing these practices of Indian and Zulu mothers with 0-9 month’s old infants attending well-baby clinics in Durban-North of the Ethekwini District, KwaZulu-Natal. Design: A descriptive cross-sectional survey of mothers was performed. Subjects and setting: Four hundred and fifty participants (50%) Indian and (50%) Zulu mothers with infants aged 0-9 months attending Tongaat community health centre, Verulam and Trenance Park Clinics were included in the study conducted between August and October 2016. Outcome measures: A data collection tool included four indicators: (1) socio-demographic characteristics; (2) infant feeding practices (3) mother’s knowledge, attitude, perception and beliefs regarding infant feeding as well as (4) resources that could influence infant feeding practices) which were measured and compared using Chi-square test and independent samples t-test. Results: High prevalence of breastfeeding immediately after delivery was reported by both groups of Indian (95.5%) and Zulu (90.1%) mothers. However, there was a statistically significant difference between race and food/liquids given to infants before six months of age. The exclusive breastfeeding rate was (37.8%) for Indian infants and (64%) for Zulu infants, by the age of six months. The majority of mothers on both groups decided on their own to feed infants other foods and/ or liquids. For Indian mothers, returning back to work was the main reason to feed infants something other than breast milk, whereas the Zulu mothers reported to feel that their infants were hungry. Overall, clinical staff were the predominant source of infant feeding information. Conclusion: This study confirmed that breastfeeding is a universal infant feeding practice. However, there are challenges that influence the practice of appropriate infant feeding.
Perceived barriers to lifestyle modification, motivation, knowledge and service needs of diabetic adults and their health care providers in Chennai, Tamil Nadu, India.
(2017) Stalin, Sharona.; Pillay, Kirthee.
Introduction: Over 415 million people worldwide live with diabetes mellitus, of which 50% live in five countries: China, India, the United States of America, Brazil and Indonesia. The number of people with diabetes is predicted to rise to 552 million by 2030 and may affect up to 79.4 million individuals in India. Diabetes mellitus is a chronic, non-communicable disease resulting in increased blood glucose levels. Poor control of diabetes leads to the development of complications that affect quality of life and health, and may even lead to death. Diabetics face many barriers such as time constraints, lack of knowledge, fear or depression, lack of self-motivation and lack of support from family and medical personnel. Barriers faced by health care providers (HCPs) are inadequate knowledge on treatment and management of diabetes, focusing on acute management rather than the preventive care, delay in clinical response to poor control and competing care demands. Given the fact that a large percentage of the world’s diabetics live in India, more research is needed to investigate the barriers that diabetics and their HCPs face in this unique region. Aim: This study aimed to evaluate the barriers to lifestyle modification, motivation, knowledge and service needs of diabetic adults and their HCPs in Chennai, Tamil Nadu, India. Location: The study was conducted in Apollo Specialty Hospital, Vanagaram, Chennai, India. Objectives: (i) To identify the barriers to lifestyle modification as perceived by South Indian Type 2 diabetic adults. (ii) To identify the barriers to motivation, knowledge and service needs as perceived by South Indian Type 2 diabetic adults. (iii) To identify the challenges as perceived by HCPs in providing education, motivation and services to their diabetic patients. Method: A sample of 50 male and female adults with type 2 diabetes from a private specialty hospital in Chennai were randomly selected to participate in this study. Participants had to be type 2 diabetic, aged between 18 to 70 years; diagnosed for more than one year; with not more than two other co-morbidities, excluding pre-renal or renal failure; latest glycosylated haemoglobin (HbA1c) available and previously been seen by a dietician. For HCPs (n=25) comprising of nurses, doctors and dieticians, the inclusion criteria were that they had to have been practicing for more than a year. Separate questionnaires were developed for the diabetic patients and for the HCPs. The patient questionnaires were conducted in an interview format and in the language (English or Tamil), preferred by the patients. The HCPs completed the questionnaires on their own. Results: The diabetic patients in this study ranged in age between 41 to 68 years and had a mean body mass index (BMI) of 26.8 kg/m2. The mean HbA1c was 8.05% and most patients had hypertension alone, as a comorbidity. In general, patients felt that they had no barriers to glucose monitoring, although 28% indicated that being busy with family was a barrier. Common barriers to exercise were being busy with work or family (72%) as well as fear and pain (44%). The most common barriers to healthy eating were eating away from home (52%; n=26), cost or expense of healthy foods (52%; n=26) and taste of food (46%; n=23). Extrinsic motivation significantly influenced the decision to take medication (p=0.001), check blood glucose levels (p=0.001) and keep health care appointments (p<0.05). Exercise was the only habit this sample followed regularly due to intrinsic motivation (p=0.030). Significantly, 82% of patients indicated that they understood their disease condition (p<0.05), whilst a significant small number reported that they would benefit from a workshop that provided knowledge and skills to help manage their diabetes (p=0.001). Most patients had confidence in treatment and advice obtained from health care providers (p=0.001), and their own skills and knowledge to prepare healthy meals (p<0.05). Most patients understood their disease condition and complications (p<0.05). A higher income (p=0.031) and consuming a mixed diet (p<0.05) was associated with higher HbA1c levels amongst patients. A significant positive correlation was found between BMI and HbA1c, as well as between BMI and income. Patients following a vegetarian diet were found to have a lower HbA1c. Health care providers (HCPs) felt that they had sufficient skills for lifestyle counselling (p=0.001), but also reported that their biggest barrier to counselling was time constraints (p=0.026). Health care providers indicated that patients found following an eating plan the most difficult to maintain (88%), followed by exercise (48%). Health care providers all agreed that patients should be assigned responsibility for self-care (p<0.05), even though healthcare providers indicated that important barriers to lifestyle changes were unwillingness to change (p<0.05), insufficient knowledge on complications (p=0.008) and lack of support from co-workers or bosses (p=0.005). There was a significant positive correlation between the experience level of the healthcare providers and the frequency with which they motivated and supported lifestyle changes (rho = 0.547, p =0.005) and how confident they were that they had the knowledge or skills needed to teach their patients (rho =0.406, p=0.004). The experience level of the HCPs and the frequency with which they referred patients to other team members (rho = 0.767, p <0.05) and how confident they were that they had the skills for lifestyle counselling (rho = 0.577, p =0.003), were also significantly positively correlated. Conclusion: For patients, being busy with family, work or other tasks was a common barrier to glucose monitoring and exercise, while a diet plan was not commonly used to control blood glucose levels. Overall, patients were satisfied with the services provided by their HCPs and were keen to participate in online medical support from health care providers. According to HCPs, patients found following an eating plan and exercise the most difficult to adhere to, while glucose monitoring and taking medication were the least difficult to adhere to. All healthcare providers agreed that patients should be assigned responsibility of self-care. According to HCPs, unwillingness to change, insufficient knowledge on complications and lack of support from co-workers or bosses, were the most important barriers to lifestyle counselling. Time constraints also prevented HCPs from counselling their patients adequately. In general, the more experienced HCPs were more likely to motivate and support lifestyle changes, more confident in their knowledge or skills and more likely to refer patients to other health care team members. It is evident that this sample need to place greater emphasis on dietary management of diabetes. They could benefit from regular information updates on how to effectively manage their diabetes.
Breakfast consumption and the relationship to to socio-demographic and lifestyle factors of undergraduate students in the School of Health Sciences at the University of KwaZulu-Natal.
(2017) Seedat, Raeesa.; Pillay, Kirthee.
Introduction: Breakfast is commonly regarded as the most important meal of the day. The consumption of breakfast has been linked to various health benefits, and is widely acknowledged in available literature. There is improved nutrient intake in those who consume breakfast compared to those who skip breakfast. Consumption of breakfast leads to positive health behaviour, improved stress management, feeling energetic and making less unhealthy snack choices. On the other hand, neglecting breakfast can have negative implications, such as fatigue and decreased concentration. Furthermore, skipping breakfast is positively correlated with obesity risk. The high prevalence of overweight and obesity in South Africa could be linked to poor breakfast consumption habits and requires further investigation. Several studies have illustrated a high prevalence of breakfast skipping amongst the university student population worldwide, due to affordability and time management. It could be assumed that students studying towards qualifications in health sciences would be more inclined towards regular breakfast consumption, as part of a healthy lifestyle; however, further research is required to investigate this. Due to the paucity of data amongst South African university health science students, this study aimed to investigate breakfast consumption and the relationship to socio-demographic and lifestyle factors of undergraduate students in the School of Health Sciences, at the University of KwaZulu-Natal (UKZN). Aim: To investigate breakfast consumption and the relationship to socio-demographic and lifestyle factors of undergraduate students in the School of Health Sciences at UKZN. Objectives: • To investigate breakfast consumption and the factors that influence breakfast consumption in undergraduate students in the School of Health Sciences at UKZN. • To determine the socio-demographic and lifestyle profile of undergraduate students in the School of Health Sciences at UKZN. • To determine if there was a correlation between breakfast consumption, socio-demographic profile, lifestyle indicators and Body Mass Index (BMI) among undergraduate students in the School of Health Sciences at UKZN. Methods: A cross-sectional, descriptive study was conducted on undergraduate students in the School of Health Sciences at UKZN, based at the Westville campus. A self-administered questionnaire consisting mainly of close-ended questions was used to collect data. Weight and height measurements were taken and used to calculate BMI. Results: Most participants were between 19 to 20 years of age, were females, lived at the university residence and were in their first year of study. Most reported their health status to be good or fair, did not smoke or consume alcohol and were physically active. Breakfast was consumed by 82.1% (n=284), however, only 50.5% (n=143) consumed it daily. Breakfast consumption was associated with lower levels of fatigue and higher levels of alertness. Ready to eat or instant breakfast cereals, tea or coffee, eggs and leftovers were popular breakfast choices. Reasons for consuming breakfast included: to satisfy hunger, for energy, to be alert, prevent fatigue and for health reasons. Breakfast was skipped due to a lack of time and a lack of appetite. A significant number of those who did not eat breakfast were in their third year of study, were smokers and consumed fast foods or take-away foods frequently. Daily breakfast intake was found among a significant proportion of Indian and white participants, those who lived at home and those whose parents or family were responsible for purchasing groceries. This study found no relationship between breakfast consumption and BMI. Conclusion: The majority of students at the School of Health Sciences at UKZN consumed breakfast; however, not all consumed it regularly. Breakfast was consumed to achieve satiety, provide energy, be alert, prevent fatigue and for health reasons. Barriers to breakfast consumption included a lack of time and a lack of appetite. There was no relationship between breakfast consumption and BMI. Given its health and nutritional benefits, regular breakfast consumption should be encouraged among university students.
Prevalence of overweight and obesity and body image perception amongst black South African female nurses practicing in Durban, KwaZulu-Natal, South Africa.
(2018) Ramgolam, Yovenita.; Biggs, Chara.
Abstract available in PDF file.
Dietary supplement use among dietetics students at the University of KwaZulu-Natal.
(2017) Pillay, Lynelda.; Pillay, Kirthee.
Introduction: A dietary supplement is a product, which aims to add nutritional value to the diet. The use of dietary supplements is favoured among many countries, with a steady increase in use. There are many groups that are known to make use of dietary supplements such as females, the elderly, health professionals, gym goers, pregnant women, children under the age of 18 years and university students. University students are a group that are known to make use of dietary supplements in order to improve their academic performance, increase energy and promote overall general health. It is assumed that students studying towards a nutrition-related degree such as dietetics would be more likely to use dietary supplements, due to their interest in and exposure to nutrition. However, there is a lack of published data investigating the prevalence of dietary supplement use, factors associated with use and reasons for use among South African university students, studying towards a nutrition-related degree. Therefore, this study aimed to assess the use of dietary supplements by dietetics students at the University of KwaZulu-Natal (UKZN). Aim: The aim of the study was to assess the use of dietary supplements by students registered for a Bachelor of Science or a Post Graduate Diploma in Dietetics, at UKZN. Objectives: a) To determine the prevalence of dietary supplement use among dietetics students at UKZN. b) To determine the factors associated with dietary supplement use among dietetics students at UKZN. c) To determine the reasons for use of dietary supplements among dietetics students at UKZN. Methods: A cross-sectional, descriptive study was conducted using students registered for a Bachelor of Science or a Post Graduate Diploma in Dietetics, at UKZN. A self-administered questionnaire consisting of both open and close-ended questions was developed to collect data. The sample comprised of 139 dietetics students. Results: The use of dietary supplements was reported by 23% of the dietetic students. The most commonly used supplement among the students was Centrum (multivitamin) (21.9%, n=7), followed by calcium supplements (15.6%, n=5). There was a significant relationship between use of dietary supplements and gender and race. White and Indian students used dietary supplements more than the other race groups (p<0.05). Females (p=0.018) and students who lived at home were more likely to consume dietary supplements (46.9%; n=15) (p=0.008). Fourth year students (34%) used dietary supplements the most. There was no relationship between dietary supplements and physical activity, eating habits or ability to meet dietary requirements. Common reasons for using dietary supplements were to strengthen the immune system, improve energy levels and enhance health. Expense (32.7%; n=35), adequate diet (22.4%; n=24), deem it unnecessary/waste of money (15.0%; n=16) and unsure about supplements (14.0%; n=15), were statistically significant reasons for not using a dietary supplement (p<0.05). A significant proportion of the sample (72.2%) indicated that their source of information on dietary supplements was the internet (p=0.011), followed by dietetics/nutrition lectures (41.7%). About 73.3% (n=22) of the students who used supplements indicated that they had experienced an overall improvement in physical health after use of dietary supplements (p=0.016). Other results achieved included: more energy (53%; n=16) and better memory/concentration (53.3%; n=16). Furthermore, half of the sample that used supplements (50%; n=15) reported an improved resistance to illness/ability to fight illnesses earlier. Just over half the sample (51.4%) indicated that they planned to use a dietary supplement in the future. Conclusion: There was a low prevalence of use of dietary supplements among dietetics students at UKZN. Factors such as race, gender, residence and year of study influenced the use of dietary supplements. Use of dietary supplements was more common among white and Indian students, females and those in the fourth year of study. Dietary supplements were used to strengthen the immune system, improve energy levels and enhance health. The high cost of supplements was the main deterrent to use of dietary supplements.
The opinion of KwaZulu-Natal dieticians regarding the use of a whole foods plant based vegan diet in the managment of non-communicable diseases.
(2018) Janse Van Rensburg, Laura May.; Wiles, Nicola Laurelle.
Introduction: A whole foods plant based vegan diet (WFPBVD) is one that promotes the intake of fruit, vegetables, wholegrains, nuts and seeds. To date, many international studies have investigated a WFPBVD’s effect on non-communicable diseases (NCDs) mainly obesity, type 2 diabetes, cholesterol and heart disease. The positive outcome of these studies has resulted in some international doctors turning to a WFPBVD as a treatment method. South Africa is transitioning from infectious to NCDs such as heart disease, cancers, chronic respiratory disease and diabetes which are currently presenting a threat to health and development. Most of these NCDs can be reduced by eliminating the risk factors associated with them. Studies have shown that adopting a WFPBVD is beneficial in both the prevention and the treatment of NCDs. Dieticians are experts in the field of nutrition and therefore it was imperative to gather their opinion of this diet to assess whether they consider is a suitable treatment option for the prevention of NCDs. Aim: To determine whether dieticians would use a WFPBVD to address NCDs by assessing their opinion toward the benefits and barriers of this diet. Objectives: To determine the dieticians knowledge and attitude of a WFPBVD including definitions and use of the diet in practice; to determine the opinion toward the perceived benefits and barriers of the diet including health and personal benefits, information availability and personal barriers. Methods: A cross-sectional study was conducted on KZN dieticians registered with the Association for Dieticians in South Africa. The study involved the use of an online survey questionnaire consisting of four parts. Results: The study was completed by 101 dieticians of which 95% were female and 5% were male. Respondents were predominantly White (71.3%, n=72) followed by Black African (18.8%, n=19) with the lowest response rate from the Indian (9.9%, n=10) population. Most of the subjects obtained their qualification from the University of KwaZulu-Natal (66.3%). The sample was represented by 44.6% (n=45) of government employed dieticians and 47.5% (n=48) of private practicing dieticians (PPDs). Government dieticians were significantly more likely to be referred patients with cancer, non-communicable diseases (NCDs), HIV/AIDS and TB, liver disease and renal disease compared to non-government dieticians. All but one dietician was familiar with the term vegan and 52% of the sample was familiar with the term ‘whole foods plant based diet’. There was significant agreement that a vegan diet could be nutritionally adequate (p<0.011), but insignificant agreement that a vegan diet made up whole plant based foods could be nutritionally adequate. Subjects reported that training on a PBD at university level was inadequate however a significant sample (p<0.05) was confident in prescribing a PBD in practice and interested in improving their knowledge on this topic. The strongest perceived benefits of a WFPBVD reported were “It is associated with an improved fibre intake”, “It encourages a lower saturated fat intake due to reduced animal products” and “it is associated with reduced risk of constipation”. There was disagreement with the statements “It is an easy diet to follow” and “It is a suitable option in low-income households”. The strongest barrier reported to prescribing a WFPBVD were, “There is not enough awareness around whole food plant based vegan diets for the public” and “People prefer to consume meat and animal by-products”. Conclusion: While dieticians felt that they did not receive adequate training on a PBD at university level, they did report confidence in prescribing this type of meal plan and interest in learning more about this topic. Using a WFPBVD in the treatment and prevention of NCDs is a topic that has been studied on an international level but not yet on a national level. NCDs were reported as a major reason for referral in both government and non-government dieticians and therefore this diet could be a potential treatment option. Dieticians however did not feel that this lifestyle would be suitable in low income communities which may be an interesting topic for future research. Barriers in this study included lack of public awareness about this lifestyle as well as resistance to changing current dietary habits. However, the health benefits of a WFPBVD were seen as being significantly more important than the personal benefits of this diet. Dieticians are at the forefront of nutritional communication to the public. Developing platforms to provide more training and learning opportunities to health care providers and the public on a WFPBVD may be beneficial.

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