An assessment of the nutritional status of a representative sample of an urban African population has not previously been conducted, nor the extent to which the traditional diet has been abandoned for a western diet. To meet this end, a cross-sectional analytic study was carried out on a representative sample (N=1146) of the urban African population, aged 3 - 64 years in 1990. Particular attention was paid to specific at-risk groups viz. preschoolers (aged 3 - 6 years; N=163), adolescents (aged 15 - 18 years; N=119) and adults (19 - 44 years; N=649). The interrelationships of dietary intake with socio-economic status, demographic indicators as well as measures of urban exposure were also examined. A further aim was to determine the extent to which this rapidly urbanising population ' s macronutrient profile had shifted from a traditional towards a western atherogenic dietary pattern. This analytic study was nested in a community-based descriptive survey on risk factors for cardiovascular disease. A multi-staged, proportional sampling strategy was used. Quotas were used in the final stage of sampling, based on the age/sex distribution of a 1988 census conducted by the local authorities. Dietary data were collected by means of the 24-hour recall method, by Xhosa -speaking registered nurses who had received intensive training. Anthropometric measurements were taken, and blood samples were drawn according to standard procedures. Socio-demographic questions elicited information on the physical environment and facilities, educational level and employment status. Information was also elicited regarding urban exposure relating to lifetime migration history, thus incorporating retrospective temporality into the study des ign. From these data, an index of urban exposure was established by calculating the percentage of life spent in an urban environment. Univariate analyses of dietary, anthropometric and biochemical vitamin status were used for the descriptive components of the study of the three specific at-risk age categories. Bivariate analyses examined the effects of selected proxies of socio-economic status, and urban exposure on dietary intake. Finally, multiple linear regressions were performed on the preschoolers (N=163) and adult sample, aged 15 - 64 years (N=983) incorporating additional indicators of socio-economic status as predictors, and dietary intake data as outcome measures. Correspondence analysis further explored the relationships between dietary atherogenicity (using the Keys score) and other risk factors for degenerative disease.

Thesis (M.Sc. (Chemical Pathology)) --University of Limpopo, 2013 / Objectives: The present study investigated how the serum lipids responded to a high-fat meal in black South African subjects with different APOE genotypes, a population that until recently was reported to be consuming a traditional diet of low fat and high carbohydrates. Methods: Sixty students (males and females) of the University of Limpopo, Turfloop Campus were successfully genotyped using Restriction Fragment Length Polymorphism (RFLP) and grouped into four APOE genotype groups; ε2, ε2/ε4, ε3 and ε4. Only thirty-three subjects volunteered to participate in the oral fat-tolerance test (OFTT), but two were excluded for having abnormal total cholesterol (6.05 mmol/l) and LDL cholesterol (3.12 mmol/l) so only 31 subjects were left. The numbers per group were ε2=5, ε2/ε4=8, ε3=9 and ε4=9. After an overnight fast blood was drawn for measurements of baseline serum parameters. Subjects were administered a high fat meal 30 minutes after the baseline blood sample was drawn. Blood was drawn at intervals of 20, 40, 60, 120, 180, 240, 300 and 360 minutes for measurements of postprandial serum parameter levels. Serum parameters measured were triglyceride, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, glucose and insulin. Results Mean levels of serum lipids at baseline in mmol/l were as follows; group 1[TG=0.69(0.55-0.81), TCHOL=3.10±0.29, HDL-C=1.12±0.32, LDLC= 1.67±0.28]; group 2 [TG=0.61(0.53-1.00), TCHOL=2.98±0.53, HDLC= 1.20±0.37, LDL-C=1.43±0.37]; group 3 [TG=0.67(0.28-0.86), TCHOL=2.96±0.54, HDL-C=1.22±0.30, LDL-C=1.46±0.47]; group 4 [TG=0.76(0.51-1.16), TCHOL=3.27±0.51, HDL-C=1.12±0.17, LDLC= 1.79±0.47]. There was no significant difference in the mean levels of baseline triglyceride, total cholesterol, low density lipoprotein cholesterol, and high density lipoprotein cholesterol between the APOE groups hence no significant difference in the response to a fatty meal. Conclusions There was no significant change in serum lipid concentrations after a fatty meal in individuals with different APOE genotypes in a population that consume a traditional diet of low fat and high carbohydrates. Due to the small sample size, the results should be interpreted with caution. A larger study is recommended to ascertain the role of APOE genotypes on serum lipid response to a fatty meal in Black South African population.

Thesis ( Mnutr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Background: The rising prevalence of non-communicable diseases (NCD) is cause for concern. Improving dietary quality is a key health promotion strategy aimed at reducing NCD morbidity and mortality. Assessments that quantify “risky” dietary behaviours are worthwhile, and may help to identify high risk individuals, that would benefit from targeted interventions. Purpose: Discovery Vitality is a wellness incentive business associated with Discovery Health medical aid in South Africa. This study developed a Dietary Behaviour Score (DBSPHR) that measured degrees of compliance of Discovery Vitality members with the “spirit of dietary guidance”. It further categorized scores and identified members who may be at risk for developing NCDs due to poor dietary compliance. Methods: The DBSPHR included proportionally weighted components related to the consumption of fruit, vegetables, low fat dairy, whole-grain foods, lean meat, chicken and discretionary fat. The study population included adult South African members of Discovery Vitality, who had completed the programme’s on-line health risk assessment (PHR) between the 1st February 2010 and 31st January 2011. Stratified random sampling was used (n=1600). Half the sample included members who participated in Vitality’s HealthyFoodTM benefit (HFB) programme. The different Vitality Status groups were equally represented, and reflect degrees of engagement with the programme. Genders were equally represented. DBSPHR data were categorized as: Poor (Score 0-18), Inadequate (18.5-22.5), Fair (23-26), Good (26.5-29), Excellent (29.5-36). DBSPHR data was analyzed for variables: Vitality status, HFB participation, smoking, physical activity, alcohol consumption, body mass index (BMI), age and gender. The relationships between continuous response variables and nominal input variables were analysed using analysis of variance (ANOVA). When ordinal response variables were compared versus a nominal input variable, non-parametric ANOVA methods were used. Further, the Mann-Whitney test or the Kruskal-Wallis test was used. A p-value of p < 0.05 was considered to represent statistical significance, and 95% confidence intervals were used to describe the estimation of unknown parameters. Results: Of the sample, 67.13% of members had DBSPHRs that were considered “poor” or “inadequate”. The mean DBSPHR of the sample was 20.47 points. Women achieved better DBSPHRs than men (p<0.01). Greater engagement with the Vitality programme was associated with better DBSPHRs (p<0.01). There was no significant difference between the mean DBSPHR of members participating in the HFB and Non-HFB members, however the HFB was not assessed as an intervention. Members with “risky” lifestyle behaviours such as; inactivity, smoking and consuming alcohol excessively, demonstrated lower DBSPHR than members without these risks. Obese members achieved significantly lower DBSPHRs than normal weight and overweight members (p<0.01). Conclusions: It is concerning that Discovery Vitality members did not perform better than the general global standard of inadequate compliance with the “spirit of dietary guidance”. Engagement with the Vitality programme seems to positively impact on dietary compliance. Members at an increased risk for NCD morbidity and mortality due to; aging, obesity, smoking, inactivity or non-compliance with alcohol consumption guidelines, demonstrated lower DBSPHRs compared to members without these risks. Targeted interventions aimed at addressing “risky” dietary and lifestyle behaviours may benefit these members. / AFRIKAANSE OPSOMMING: Agtergrond: Die styging in voorkoms van nie-oordraagbare siektes (NOS) is rede tot kommer. Verbetering van dieetkwaliteit is ‘n sleutel gesondheidsbevordering strategie gemik daarop om NOS morbiditeit en mortaliteit te verminder. Assesserings wat “riskante” dieetgedrag kwantifiseer is waardevol en mag help om hoë risiko individue te identifiseer wat sal baatvind by geteikende intervensies. Doel: Discovery Vitality is ‘n welwees motiveringsbesigheid wat geassosieer is met Discovery Health mediese fonds in Suid-Afrika. Hierdie studie het ‘n dieet-gedragstelling (“Dietary Behaviour Score - DBSPHR”) ontwikkel wat die graad van nakoming van Discovery Vitality lede gemeet het aan die “gees van leiding oor dieet”. Dit het verder tellings gekategoriseer en lede geïdentifiseer wat ‘n verhoogde risiko vir die ontwikkeling van NOS mag hê as gevolg van swak nakoming van dieet. Metodes: Die DBSPHR het proporsioneel geweegde komponente bevat, verwant aan die inname van vrugte en groente, laevet suiwelprodukte, volgraan voedsels, maer vleis, hoender en diskresionêre vet. Die studiepopulasie het volwasse Suid-Afrikaners ingesluit wat lede van die Discovery Vitality program was en wat die program se aanlyn gesondheidsrisiko assessering tussen 1 Februarie 2010 en 31 Januarie 2011 voltooi het. Gestratifiseerde, ewekansige steekproeftrekking was gebruik (n=1600). Helfte van die steekproef het lede ingesluit wat aan Vitality se HealthyFoodTM voordeel program deelgeneem het. Die verskillende Vitality Status groepe was gelyk verteenwoordig en reflekteer verskillende grade van interaksie met die program. Geslagte was gelyk verteenwoordig. DBSPHRs data was gekategoriseer as: Swak (Telling 0-18), Onvoldoende (18.5-22.5), Matig (23-26), Goed (26.5-29), Uitstekend (29.5-36). DBSPHR data was vir die volgende veranderlikes geanaliseer: Vitality status, deelname aan die HealthyFoodTM voordeel, rook, fisiese aktiwiteit, alkohol inname, liggaamsmassa indeks (LMI), ouderdom en geslag. Die verhouding tussen aaneenlopende reaksie veranderlikes en nominale inset veranderlikes was geanaliseer deur die gebruik van analise van variansies (ANOVA). Wanneer ordinale reaksie veranderlikes vergelyk was teenoor ‘n nominale inset variansie, was nie-parametriese ANOVA metodes gebruik. Verder was die Mann-Whitney toets of die Kruskal-Wallis toets gebruik. ‘n P-waarde van p < 0.05 was gesien as verteenwoordigend van statistiese beduidendheid en 95% sekerheidsintervalle was gebruik om die skatting van onbekende parameters te beskryf.Resultate: Van die studie monster het 67.13% van die lede DBSPHRs getoon wat gereken was as “swak” of “onvoldoende”. Die gemiddelde DBSPHR van die steekfproef was 20.47 punte. Vroue het beter DBSPHR as mans behaal (p<0.01). Meer interaksie met die Vitality program was geassosieer met beter DBSPHRs (p<0.01). Daar was geen beduidende verskille tussen die gemiddelde DBSPHR van lede wat aan die HealthyFoodTM voordeel program deelneem en die lede wat nie aan die program deelneem nie, alhoewel die HealthyFoodTM voordeel nie geëvalueer was as ‘n intervensie nie. Lede met “riskante” lewenstyl gedrag soos onaktiwiteit, rook en hewige alkoholinname het laer DBSPHR getoon as lede sonder hierdie risiko’s. Vetsugtige lede het laer DBSPHR behaal as normale gewig en oorgewig lede (p<0.01). Gevolgtrekking: Dit is ‘n bron van kommer dat Discovery Vitality lede nie beter vertoon het as wat blyk ‘n algemene globale standaard van gebrekkige nakoming van die “gees van leiding oor dieet” te wees nie. Interaksie met die Vitality program blyk ‘n positiewe impak te hê op dieet nakoming. Lede wat ‘n verhoogde risiko gehad het vir NOS morbiditeit en mortaliteit as gevolg van veroudering, vetsugtigheid, rook, onaktiwiteit of verontagsaming van alkohol inname riglyne het ook laer DBSPHRs getoon in vergelyking met lede sonder hierdie risiko’s. Geteikende intervensies gemik op die aanspreek van riskante dieet en lewenstyl gedrag mag tot voordeel van hierdie lede wees.

MENVSC / Department of Ecology and Resource Management

Submitted in fulfillment of the requirements for the Degree Magister Technologiae: Consumer Science Food and Nutrition, Durban University of Technology, 2014. / Introduction: Dietary diversity is an indicator of access and measurement of household food security as it relates to income, location and seasonality. Dietary diversity is measured by physically counting the number of individual foods as well as food groups consumed over a given reference period. When dietary diversity is accurately measured, nutrient adequacy will be easily predicted. In order to measure dietary diversity accurately, it is important to determine household food security. Insufficient food and resources often result in food insecurity which leads to little or no dietary diversity. Poor populations suffer most from achieving dietary diversity because they consume a standard diet based on starchy staple food with limited fruits and vegetables resulting in multiple nutrient deficiencies. Rural communities rely on seasonal food variety in order to obtain fruits and vegetables needed by the body to limit nutrient deficiencies. Some seasons are more productive than others. Rural communities also use various coping strategies to deal with food insecurity in all four seasons. High levels of unemployment as well as a lack of nutrition education results in most rural households unable to cater for dietary diversity. Aim: The aim of the study is to determine the effect of seasonal food variety, dietary diversity and nutrient adequacy on the nutritional status of women in rural areas. Method: A hundred women in this community were weighed and measured and BMI determined and classified according to the WHO cut-off points for BMI. Waist circumference was measured in order to determine the waist-to-height ratio indication risk of metabolic syndrome. Twenty four hour recall questionnaires were used to determine actual intake compared to dietary reference intake (DRIs). Food Frequency Questionnaires for a period of seven days were completed captured and analysed using the SPSS version for descriptive statistics in order to determine food diversity. Coping strategies were determined by Focus Group interviews with community members in order to identify the various strategies used in time of food shortages. The severity of these strategies was determined by the community. Seasonal food consumption patterns and dietary intake behaviour were assessed over the four seasons. The highest frequency score (7) x severity weight (1-4) x10 strategies = maximum score of 140. Thus the higher the score the more food insecure the community is. Results: Food production from crops differs in different seasons. Food insecurity is high in summer and autumn due to a low number of food items harvested from crops. The community cope less in summer and autumn due to less crops available. The community is more food insecure in spring and winter due to the high number of food items harvested from crops. The community cope better in winter and spring due to the high level of available crops. Anthropometric measurements indicated that 41.2% of women between 31 and 50 and 49% of women between 51 and 70 years of age had a BMI of 30 and above. About 44% of total women are obese and 29% are pre obese. Only 26% had a normal weight. The 24 hour recall analysis indicates that the high level of obesity is due to the fact that a high number of participants consume large amount of carbohydrates every day. Conclusion: Overall results in this study indicated that this rural community is food insecure, on a higher level during summer and autumn, which leads to the consumption of undiversified diets. The women are malnourished and obese with a risk of metabolic syndrome. The information obtained in this study can be used to formulate strategies to develop interventions that can be used to access sufficient food in rural area in order to improve food insecurity, dietary diversity and, therefore, nutrient adequacy.

Submitted in fulfillment of the requirements for the degree Master Technology: Consumer Science Food and Nutrition, Durban University of Technology, Durban, South Africa, 2014. / Food security is a global concern and the insecurity thereof is prevalent in South Africa even though the country is deemed to be secure in terms of food availability. The study was conducted to determine the socio-economic, health and nutrition and food security status of the community living in the Valley of a Thousand Hills in KwaZulu Natal, in addition to analysing their coping strategies. Two hundred and fifty seven respondents were required to participate in this study. Data were collected by interviewing the respondents using pre-designed and pre-tested questionnaires; socio demographic questionnaires, dietary intake questionnaires- namely 24 hour recall and Food Frequency Questionnaire (FFQ) and the coping strategy questionnaires were used. Lastly anthropometric measurements were taken to determine BMI. A prevalence of extreme poverty exists as a magnitude of the high unemployment rate, out of which 75.8% had been unemployed for more than 3 years. The household monthly income was less than R500 per month for 37.3% of the respondents. The mean Food Variety Scores (FVS) (±SD) for all foods consumed from the food groups during seven days was 22.45 (±10.32), indicating a low food variety score. In this study the food group diversity is summarized as the majority of the respondents (91.1%, n=226) being classified with a good dietary diversity score using 6-9 food groups. The mean of the three 24-Hour recall nutrient analysis indicated a deficient intake by both men and women in all of the nutrients (100% of the men and women could not meet the DRI’s for energy and calcium) except for the mean (±SD) carbohydrate intake by men aged 19-50 (214.71 ± 80.22). The main source of food intake was from the carbohydrate food group with an insufficient intake of animal products, dairy products and fruits and vegetables respectively; contributing to the macro and micro nutrient inadequacies. Ninety six percent of this community experienced some level of food insecurity with the worst Coping Strategy Index food insecurity score being 117 out of a possible 175. Four percent of this community was classified as being food secure. Overweight and obesity were the most exceptional anthropometric features by the women respondents with 26.5% (n=66) being overweight and 57% (n=142) obese. The men’s anthropometric features were predominantly normal weight. This study has established poverty and unemployment as being the principal contributors for the food insecurity experienced by the populace and poor dietary intakes. The low food variety diet consumed by the respondents resulted in the DRI’s not achieved for most nutrients. The majority of the respondents only consumed two meals a day, as a coping strategy to reduce/prevent temporary food insecurity. Intervention strategies are needed to improve the food security status and dietary intake of the community members to overcome the crisis of malnutrition. / M

Urban agriculture is a strategy poor urban, informal settlement residents adopt to reduce poverty and improve food security and child nutrition. It is widely asserted in the literature and development circles that household vegetable gardens can provide a significant percentage of recommended dietary allowances of macro- and micro-nutrients in the diets of pre-school children. These children are vulnerable in terms of food access and nutrition. The first five years of a child’s life are crucial to psychological well-being. This study set out to determine the impact of home gardens on access to food, dietary diversity and nutrient intake of pre-school children in an informal settlement in Eatonside, in the Vaal Region, Johannesburg, South Africa. The home gardening project was undertaken in five phases, namely the planning phase; a baseline survey (including quantitative food intake frequencies, 24-hour recall, individual dietary diversity questionnaires and anthropometric measurements); a training programme on home gardens; planting and tending the gardens and evaluating the impact of home gardens on access to food, dietary diversity and nutrient intake of pre-school children. Children aged two to five years (n=40) were selected to participate in the study. The sample population consisted of 22 boys and 18 girls. The children were categorised into three groups at the start of the project: children of 24-35 months (four boys and one girl), 36-47 months (four boys and five girls) and 48-60 months (14 boys and 12 girls). All but 10 per cent of the children’s consumption of foods in the food groups increased. At the start of the project, low consumption rates were observed for white tubers and roots, vitamin A-rich fruit, other fruit and fish. After the gardening project, the number of children consuming vegetables increased considerably. There was an increase in the intake of food groups over the period of the project. The number of children consuming vitamin A-rich increased the most, with all children (45 per cent improvement) consuming vitamin A-rich vegetables at the end of the project, compared with just over half at the start of the project. The consumption of vegetables increased with 78 per cent of the children consuming beans and 33 per cent beetroot. Most children (95 per cent) consumed cabbage, carrots and spinach post-home gardening. Seventy eight percent of children consumed beans by the end of the project, but only a third of the children had consumed beetroot during the post-project survey period. Intakes of all nutrients considered in the study improved by the end of the project, except for energy and calcium, which dropped marginally, but both remained at around 50 per cent below requirements. Twenty five percent of boys (24-35 months) were underweight and below the 50th percentile at the pre- and post-project stages. The same boys were severely stunted (on average -4.41 standard deviations below the third percentile). Of the boys aged 36-47 months, 25 per cent were stunted pre-project, but by the end of the project, this number had decreased to 50 per cent. Twenty one per cent of the older boys (48-60 months) were within their normal height for age. Twenty five per cent of girls were underweight (36-47 months). A slight change was observed in the 36-47 month group, where the mean changed from -0.14 standard deviations (below 50th percentile) pre-project to -0.5 (below 50th percentile) post-project. All girls aged 24-35 months were below -2 standard deviations pre-project. After the home gardening project, the figure dropped to 50 per cent. For girls aged 36-47 months, 25 per cent were below -3 standard deviations after the project, compared with 20 per cent pre-project. Height-for- age for girls aged 36-47 months dropped by 10 per cent below -2 standard deviation post-home gardening. Girls from 24 to 35 months were severely stunted [-3.02 (below 3rd percentile) pre- and -2.31 (below 5th percentile) post-project]. Stunting was observed in 36-47 months girls who had means of -2.39 (below 3rd percentile) and 1.86 (below 25th percentile) both pre-and post-gardening respectively and were at risk of malnutrition. The older girls were well nourished with means of height-for-age at -0.88 (below 50th percentile) pre-project and -0.92 (below 50th percentile) post-project. Home-gardening improved food access, dietary diversity, energy, protein, carbohydrate, fat, fibre, vitamin A and iron intakes, but did not make a significant impact on the malnutrition of the children in the project or ensure adequate intakes. Home gardens had a positive impact on height-for-age scores; but had no significant impact on mean weight-for-age and height-for-weight z-scores of the pre-school children. Increases in carbohydrate and fat intakes were shown to have the only significant impact on the children’s nutritional status and only with regard to improving height-for-age scores. The results show that the gardens did not have the expected impact on children’s nutrition, but confirm that increases in incomes from gardening are likely to have a greater impact through savings from consuming produce grown and selling produce to buy energy-dense foods for the children. This needs to be considered in nutrition interventions. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2010.

MSCPNT / Department of Nutrition / Hypertension remains a major public health problem that needs different comprehensive health strategies to deal with it. Indigenous vegetables, Blackjack in particular, have been shown to possess anti-hypertensive properties that are attributed to bioactive chemical substances such as phytochemicals, fiber, antioxidants as well as micronutrients that include potassium, magnesium, calcium, vitamin C, zinc, iron and copper. The use of indigenous vegetables in combination with the conventional hypertension treatment may reduce hypertensive conditions; hence, the purpose of this study was to determine Blackjack nutritional knowledge and consumption by hypertensive patients. A cross-sectional study employing both quantitative and qualitative methods was conducted on 275 hypertensive participants at Mphambo and Mutale Health Centers, Vhembe District of Limpopo Province, South Africa. A questionnaire was used to collect data on participants’ Blackjack nutritional knowledge, Blackjack availability around their households as well as their Blackjack consumption patterns and nutritional status. The Blackjack nutritional knowledge data was triangulated with focus group discussions and participants’ nutritional status was assessed by anthropometric and dietary intake methods. The body mass index (BMI) was calculated and dietary intake frequency from selected foods was determined. Blood pressure was measured using Microlife automatic blood pressure monitor. The findings indicated that most hypertensive participants had poor knowledge of the nutritional importance of Blackjack and its associated medicinal contribution on hypertension management. Participants were unable to mention different diseases that can be prevented or managed by Blackjack, which was mostly consumed once a week with porridge during the summer season. Hypertensive patients were consuming high amounts of sodium and less amounts of minerals that are known to regulate blood pressure, such as potassium and magnesium. Hypertensive patients had high prevalence of overweight and obesity and most were either in hypertension stage 1 or stage 2. Lack of Blackjack nutritional knowledge may have contributed to a decreased consumption of Blackjack by hypertensive patients. The health professionals should promote the nutritional benefits of Blackjack in rural areas, particularly to hypertensive patients to raise awareness of Blackjack’s benefits in disease prevention and management. / NRF