No description available.

Introduction: Stunting in childhood predisposes to obesity, increasing the risk for chronic diseases of lifestyle in adulthood (i.e. the double burden of disease). Objectives: To gain insight into the eating patterns and anthropometric nutritional status of children (<7 years) and adults (25 to 64 years) in the rural- and urban Free State. Methods: Dietary intake was measured in 60 rural- and 116 urban children; and 553 rural- and 419 urban adults using 24- hour recall and food frequency questionnaires. Anthropometric data was measured using WHO guidelines. Results: Mean energy intake was 4254 kJ for rural children younger than two years (56,9% carbohydrates; 17,2% protein; 25,7% fat) and 3292kJ for urban children younger than two years (64,2% carbohydrates; 19,5% protein; 20,1% fat). The percentage of energy from carbohydrates and protein were within prudent dietary guidelines (carbohydrates (CHO): 45-65%; protein: 5-20%), while the percentage energy from fat was lower than the recommended 30-40%. Mean energy intake for rural children older than two years was 5581kJ (57,5% carbohydrates; 16,9% protein; 28,7% fat) and 4220kJ for urban children (65,5% carbohydrates; 17,9% protein; 20,3% fat). As in the younger children, the percentage of energy from carbohydrates and protein were within prudent dietary guidelines (CHO: 45-65%; protein: 10-30%; fat: 25-35%) except for fat intake which was lower than recommended among urban participants. The average energy intake for all men was 8040 kJ (61% carbohydrates; 17,8% protein; and 24,3% fat) and for all women in the current study was 7243 kJ (61,7% carbohydrates; 17,3% protein and 24,5% fat). Macronutirent distributions were thus within prudent guidelines (CHO: 45-65%; protein: 10-35%; fat: 20-35%). The energy intake was below the estimated energy requirements (EER) range of 10143 kJ for sedentary men and 7947 kJ for sedentary women. More than half (65,6%) of rural females and two-thirds (66,2%) of urban females were overweight or obese (bodymass- index (BMI) >25kg/m2). Fewer men were overweight or obese (23,3% rural men and 16% urban men). A significantly larger percentage of urban than rural men (urban: 61,0%; rural: 43,6%) had a normal BMI (18,5 to 24,9 kg/m2) (p=0.007). A third (33,1%) of rural men and 23% of urban men were underweight (BMI <18,5kg/m2). Mean BMI for men was within the normal range at 20 kg/m2. For women mean BMI fell in the overweight range at 28 kg/m2. Significantly more urban than rural men had a normal waist circumference (<94 cm) (p=0.002) and similarly, significantly more urban (32%) than rural women (24,4%) had a normal waist circumference (<80 cm) (p=0.03). Significantly more rural than urban men had a waist circumference >94 cm (p=0.01), placing them at risk for developing chronic diseases of lifestyle (CDLs). About one-fifth (17,8%) of rural and 19,4% of urban women were at risk (>80 cm). Significantly more rural women (57,9%) were at high risk of developing CDLs (>88cm) than urban women (48,6%) (p=0.02). Median waist circumference for rural women was 92 cm (high risk) and for urban women 87cm (at risk). The median waist circumference for rural men was 78,5 cm (normal) and for urban men 76 cm (normal). Rural children were more often underweight (weight-for-age <-2 standard deviations (SD))(rural: 31,7%; urban: 17,3%) than urban children. In contrast to what was expected, urban children were more often stunted (height-forage <-2SD) than rural children (rural: 38,4%; urban: 44,0%). Prevalence of wasting (weight-for-height <-2SD) was similar in rural and urban children (rural: 11,9%; urban: 10,1%). A double burden of undernutrition in children and overweight in caretakers was confirmed in this sample, with 63,2% of stunted- and 66,7% of underweight rural children and 71,9% of stunted- and 66,7% of underweight children in urban areas living with an overweight/obese caregiver. Conclusion: A double burden of disease and nutrition transition were confirmed in both rural- and urban communities.

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Conducted within the hospice setting, this unique study assessed the prevalence of altered taste perception and its potential relationship with nutritional status in a group of 56 advanced cancer patients who had not received any recent radiotherapy or chemotherapy, compared to 46 age matched healthy controls. An assessment was made of the impact of altered taste perception on quality of life in this group of cancer patients. Taste perception was objectively measured using the International standard for sensory appraisal (lSOI991) and nutritional status assessed using upper arm anthropometry, bioelectrical impedance analysis, weight and hand grip dynanometry. A 3-day weighed intake technique was used to estimate dietary intake, and quality of life assessment was based on the Hospital Anxiety and Depression scale (Zigmund and Snaith, 1983). Results indicate that cancer patients exhibited lower 'bitter' thresholds (increase bitter taste sensitivity) compared to age matched controls an effect which was not related to tumour type. Results of this study also highlight the impact that changes in taste perception have on quality of life, which is pivotal in the appropriate management of altered taste perception in palliative care. ',- \, Heightened olfactory perception was also evident in cancer patients exhibiting heightened gustatory perception. Biochemical analysis suggests that Tumour Necrosis Factor a and associated acute phase response may be associated with increased bitter taste sensitivity. Within the cancer group, heightened bitter perception was associated with a reduced protein intake. These results have demonstrated that in a terminally ill group, dietary management should focus on altered taste perception, aiming to maximise quality of life. Based on these results, a 4-week intervention was undertaken using omega 3 fatty acid (fish oil capsules) in a subsequent group of advanced cancer patients, aimed at manipulating the acute phase response and lNFa production. This demonstrated no changes in taste perception. However, the intervention was associated with attenuation of weight loss and an alteration in fatty acid composition of lipid membrane. These preliminary results suggest the value of further studies to investigate the effects of omega 3 fatty acids on taste perception and other associated symptoms in cancer patients. Moreover, the challenges to recruitment and retention of patient in studies in the terminally ill are highlighted.

The advantages of anti-retroviral (ARV) treatment in human immunodeficiency virus (HIV) infected patients are well documented. Although it has been noted that food security impacts on treatment success and quality of life, very few studies have investigated the impact of food supplementation in HIV-infected patients. This study determined the impact of a nutrition intervention (meatballs and spaghetti in tomato sauce) on parameters of nutritional status (including foods bought or consumed, food security and anthropometry) in HIV-infected participants on ARV therapy. The study formed part of a larger study titled: âImproving the effectiveness of AIDS treatment while strengthening prevention in the Free State Province, South Africa (FEATS)â. The FEATS study had three objectives that included: to develop a view of treatment success, develop a more complete model of the determinants of treatment success and understand the nature of links between treatment and prevention. The study took place in 12 of the 16 phase I ARV therapy assessment sites (primary health care facilities) in the Free State province. This sub-study described sociodemographic status, household information, symptoms experienced as a result of taking HAART and food supplements received from the government in a control (no nutrition intervention) and experimental (nutrition intervention) group. The impact of the intervention on foods bought or consumed by the household, food security and anthropometry were determined in both groups after the intervention in the experimental group. Socio-demographic and household information, symptoms experienced as a result of taking ART, food supplements received from the government, food bought or consumed by the household and household food security were assessed using questionnaires completed in personal interviews with participants. Anthropometric status was assessed by trained fieldworkers (adherence supporters) using recognised techniques and included height, weight, and waist circumference. Participants in the experimental group received two tins (410 g tins) of meatballs and spaghetti in tomato sauce per week for a median period of 15 months. These were delivered by the adherence supporters during routine visits to the households of participants. A total of 260 participants were included in the study (135 in the control group and 125 in the experimental group). The mean age of both the groups (control and experimental) was similar at 38 years for the control and 37.3 years for the experimental group with a standard deviation of [-1.8;2.9]. The majority of participants were of African race (99.3% in the control and 97.6% in the experimental group) and female (80% in the control and 81.6% in the experimental group). A large percentage had never been married (43% in the control and 45.5% in the experimental group). Most had a low level of formal education. About 65% had access to a flush toilet and more than 80% had electricity. About one in three participants reported experiencing side effects as a result of ARV therapy. These included tiredness (8.1% in the control and 10.4% in the experimental group), dizziness (8.1% in the control and 7.2% in the experimental group), skin rash (5.9% in the control and 10.4% in the experimental group) and nausea (6.7% in the control and 4% in the experimental group). Less than 80% of participants in the current study had received food supplementation from the government Nutrition Supplementation Programme in the past. Although food and nutrient intake cannot be estimated very accurately from information related to foods bought or consumed, they do give an idea of what foods are available in the household. From this list it was concluded that a large percentage of households frequently bought and consumed starchy staple foods (mealie meal, rice, bread and potatoes), vegetable oil and sugar. As far as foods containing protein are concerned, a large percentage of households did purchase and consume dairy products (milk, sour milk or yoghurt), chicken and eggs. In both the control and experimental groups the percentage of households that bought or consumed breakfast cereals, legumes (dried peas, lentils and beans), and fruits and vegetables were relatively low. In addition, more costly protein sources such as red meat, fish and cheese were not bought or consumed by a large percentage of participants. Only a few changes in the foods bought or consumed occurred after intervention, and these were unlikely to be related to the nutrition intervention. In both groups, participants reported that they often do not have enough to eat (31.1% in the control and 30.4% of the experimental group), the food that they buy does not last (40.6% in the control and 48.4% in the experimental group) and they worry whether they will run out of food. Households that had children, also struggled to feed them a balanced meal (53.8% of the control and 46.0% of the experimental group), and reported that the children in the household were not eating enough (46.2% in the control and 41.9% in the experimental group). After intervention participants in the experimental group worried less about running out of food (50.4 % before intervention and 37.2% after intervention, [-25.5;0.9]), and fewer reported that they could not afford a balanced meal (50.8% before intervention and 39.2% after intervention,[-23.0;-0.4]). Fewer respondents that had received the food supplement felt that the food that they eat just did not last (49.2% before intervention and 35.0% after intervention,-26.0;-2.4]). This statistically significant change in the experimental group could possibly be ascribed to the food supplements that were provided as part of the intervention. For all anthropometric parameters the control and experimental groups were very similar at baseline. Mean body mass index (BMI) of participants was 24.7kg/m2 in both groups. About one in every 10 participants was underweight according to their BMI and 50% of all participants had a normal weight. A relatively large percentage of respondents in both groups were either overweight (26.4% in the control and 21.7% in the experimental group) or obese (14.7% in the control and 18.8% in the experimental group), putting them at risk for chronic non-communicable diseases. More than half of respondents also had a waist circumference in the high risk category. Mean waist circumference in the control group was 85.7cm and 83.7cm in the experimental group. After intervention, no significant changes in anthropometric variables were observed in the experimental group. Other than a small improvement in some measures of food security, the nutrition intervention that was implemented in this study did not have a significant impact on foods bought or consumed, or anthropometric variables of HIV-infected participants on ARV therapy. Possible reasons for this lack of improvement in these parameters could be that the amount of food supplement provided was not enough to make a significant contribution to food intake, especially if it was shared with family members. The food supplement could also have replaced other foods instead of supplementing the usual diet. Other forms of supplementation, such as ready-to-use therapeutic foods, may be of more benefit to food insecure HIV-infected patients.

The glycaemic index (GI) concept was introduced as a means of classifying different sources of carbohydrates (CHO) and CHO-rich foods in the diet, according to their effect on postprandial glycaemia since different carbohydrate containing foods have different effects on blood glucose responses. The GI is defined as the incremental area under the blood glucose response curve of a 50 g glycaemic (available) carbohydrate portion of a test food expressed as a percentage of the response to the same amount of glycaemic CHO from a standard food taken by the same subject. Though not the only factor that will determine whether the food should be included in the diet or not, the GI can be used alongside current dietary guidelines like the Food Based Dietary Guidelines and exchange lists to guide consumers in choosing a particular food with a predicted known effect on blood glucose levels and homeostasis. Variation in the GI values for apparently similar foods may reflect both methodologic factors as well as true differences in the physical and chemical characteristics of the specific food. Differences in GI values of similar foods could also be due to inherent botanical differences from country to country. Two similar foods may also have different ingredients, different processing methods or different degree of gelatinisation resulting in significant variation in the rate of CHO digestion and consequently the GI value. Methodological variables which include food-portion size, the method of blood sampling, sample size and subject characteristics, standard food, available CHO, volume and type of drinks consumed with test meals can markedly affect the interpretation of the glycaemic responses and the GI value obtained. Tiger Brands commissioned an independent assessment of the GIs of three Albany Superior⢠breads namely Best of Bothâ¢, Brown⢠and Whole Wheat⢠bread carried out under strictly standardised conditions using methods complying with the most recent internationally accepted methodology. Methods Twenty healthy, fasting male volunteers, aged 18-27 years, each randomly consumed six different test meals consisting of 50 g available carbohydrates from three different test foods (three types of Albany Superior breads) and one type of standard food (glucose) (repeated three times in each subject) according to a Latin square design. Finger-prick capillary blood was collected fasting and within 10-15 min after the first bite was taken for every 15 min time interval for the first hour and thereafter for every 30 min time interval for the second hour, using One Touch Ultra⢠test strips and One Touch Ultra⢠glucometers (Lifescanâ¢). The AUC and GI for the three different breads, were calculated using the mean of the three glucose responses (standard meals) as standard. Statistically significant differences were also determined. Results The mean GIs were 78.44, 72.01 and 79.62 for Whole Wheatâ¢, Brown⢠and Best of Both⢠bread respectively. No statistically significant differences were found between the GIs of the three different Albany Superior⢠breads. Conclusions From the study it can be concluded that the three different Albany Superior⢠breads fell between the intermediate and high categories. Recommendations It is recommended that the methodological guidelines determined by the GI Task Force should be followed. It is also important to inform patients and consumers that in using the GI to choose CHO foods it is a fact that physiological responses to a food may vary between individuals and that it is normal for a specific food to have a high GI in some individuals and a medium or even a low GI in others. For labeling purposes it is recommended that the GI is presented as a mean with 95% confidence intervals.

The prevalence of infertility in Africa is overshadowed by the high population growth rate in this continent. The number of infertile black African women seeking treatment is on the increase due to the fact that more black women are concentrating on their careers and postponing having children. The desire to reproduce is a highly motivating factor in most marriages and failure to do so places a lot of stress on the couple. Infertile women in most parts of Africa are treated as outcasts due to their infertile status. In most cases these women are either abused or divorced by their husbands. In sub-Saharan Africa, sexually transmitted diseases are the most common causes of infertility. Other causes of infertility in women include endometriosis, anovulation, tubal diseases, cervical factors and unexplained infertility. Anorexia and bulimia nervosa, as well as obesity, produce alterations in the reproductive system of women. Obesity has an effect on ovulation and on the outcomes of in vitro fertilization and assisted reproduction therapy. Anorexia nervosa on the other hand, has also been associated with amenorrhoea and oligoamenorrhoea. Insulin resistance is another factor that is linked to polycystic ovarian syndrome and infertility. Insulin resistance has also been shown to be prevalent in obese individuals, especially those with android fat distribution. Lowering insulin resistance by weight loss, results in spontaneous ovulation. The main objective of this study was to determine the anthropometrical and biochemical parameters in infertile black South African women. A total of sixty participants attending the Unit for Reproductive Health, Universitas Hospital, Bloemfontein were included in the study. Anthropometrical data measured included: body mass index; waist-to-hip ratio; waist circumference; neck circumference and body fat percentage. Blood samples were also obtained to determine the levels of fasting insulin, glucose, thyroid-stimulating hormone, luteinizing hormone, follicle-stimulating hormone, leptin, prolactin, progesterone, testosterone and C-reactive protein. The results of this study show that tubal factor infertility was the most prevalent cause of infertility and the second highest cause of infertility was male factors. The median age of the subjects of this study was 32 years. Sixty percent of the subjects had a gynoid fat distribution. More than a third of the subjects had a body mass index of more than 25 kg/m² and none of the subjects in this study had a body mass index of less than 18.5 kg/m². Eighty five percent of the subjects had a body fat percentage of more than 32 percent. These results indicate that obesity is a problem among these subjects. Biochemical parameters indicate that the median concentrations of the reproductive hormones were normal. Only 35 percent of the subjects had hyperinsulinaemia. Almost all of the subjects (83.6%) had leptin concentrations above normal. Median C-reactive protein level was also normal. No association was found between body mass index and C-reactive protein and insulin. An association was established between leptin concentrations and body mass index and the correlation between these two parameters was very strong. An association was also found between android fat distribution and hyperinsulinaemia. The high rate of obesity among the subjects of this study, places the subjects of this study at a risk of developing metabolic syndrome and other obesity-related factors. Their obesity status may also be a contributory factor to their infertile status. There should, be increased awareness of the impact of obesity on infertility and on their general health. Increased physical activity and healthy food choices should be encouraged among black infertile women. Black women should still be made aware of the fact that there are facilities available for treatment of infertility.

The prevalence of overweight and obesity in college and health science students is increasing. This study determined whether eating practices and nutrition knowledge are associated with body weight in nursing science students. The study also evaluated the association between socio-demographic factors and body weight status. A cross-sectional survey of 161 full time undergraduate nursing science students (31.7 % male and 68.3 % female), aged 18 and above, were chosen randomly from the University of Fort Hare. Validated questionnaires were used to determine the socio-demographic factors, eating practices and nutrition knowledge. Eating practices were determined by means of a 24-hour recall and a short food frequency questionnaire. Standard techniques involving a calibrated platform electronic scale and stadiometer, as well as a standard tape measure were used to measure weight, height, waist and hip circumference so as to calculate body weight status (Body mass index (BMI), Waist circumference (WC), and Waist hip ratio (WHR)). Descriptive statistics were used to describe the data, including, frequencies and percentage for categorical variables and means and standard deviations or medians and percentiles for continuous data. The underweight, normal weight and overweight/obese groups were compared by means of 95 % confidence intervals for median differences. This study showed that less than half of the students (46.0 %) were of normal weight (58.8 % male students compared to 40.0 % female students). The prevalence of overweight and obesity was more common among female students compared to males (36.4 % and 21.8 % versus 21.6 % and 9.8 %, respectively). In contrast, 9.8 % male students were underweight compared to 1.8 % females. Sixty two students had WC values above the cut off points (⥠88 cm: F; ⥠102 cm: M) while sixty students had WHR values above the cut off points (⥠0.8: F; ⥠0.9: M). Important observations of the usual daily food intake showed that less than the daily recommended number of food portions from the food groups were consumed for milk and milk products (92.6% of students); vegetables (97.5 %) and fruits (42.2 %). More than the recommended number of portions per day was consumed for meat and meat alternatives (81 %), sweets and sugar (77.8 %), fats and oils (50 %). The recommended number of servings per day was only met for bread and cereals (82.7 %). Median daily energy intake for female students (5543.3 kJ) was significantly lower than that of males (6333.3 kJ). For all students the median energy and fat intakes were relatively low, while carbohydrate and protein intakes were higher than the RDA. Usual meal patterns showed that 59 % of students ate three meals daily and the most frequently skipped meal was breakfast. Foods most often consumed on a daily basis were salt/stock/royco (85.8 %), margarine/oils/fats (67.9 %), sugar (58.6 %), bread (55.6 %) and cereal (34.7%). Foods most often not consumed included low fat/skim milk (76.5 %), alcohol (73.5 %), cremora (48.2 %), soy mince/legumes, baked beans, dried beans/peas and lentils (45.7 %), and peanut butter (42.6 %). A significant higher percentage of underweight (14.3 %) than overweight/obese (1.3 %) individuals consumed bread and cereals below the recommended daily requirements. More overweight/obese (72.5 %) than underweight (28.6 %) students ate chips/crisps on a daily basis. Fat consumption in underweight students was significantly less than that of overweight/obese students. Significantly more overweight/obese (90 %) than underweight (57.1 %) students ate sweets and chocolate on a daily basis, and significantly more underweight (57.1 %) than normal weight (16.2 %) students consumed low fat/ skim milk on a daily basis. Of 162 students, 69.3 % were uninformed of the food groups to eat the most and 24.9 % of which food groups to eat least, according to dietary guidelines. The recommended daily portions from the food groups were not known by the students: 85.7 % of students did not know the daily recommended servings for bread, cereal and pasta, 54.7 % did not know the recommended servings for vegetables and 54.7 % did not know the recommended serving for meat, poultry, fish dry beans, eggs and nuts. Over 60.2 % did not know the daily recommended servings for milk and milk products. Over 55.3 % of students knew the recommended servings for fruits, 92.6 % knew foods with high fiber content, 50.3 % knew that peanut butter has a high fat content, while 96.3 % knew the best sources of beta carotene. The median percentage for correct answers obtained in the nutrition knowledge test was 56.3 %. Of 162 students, 34.2 % scored less than 50 % while 65.8 % scored more than 50 % in a nutrition knowledge questionnaire. There was no statistical significant difference between BMI categories in terms of the score in the nutrition knowledge test. However, significantly more underweight (63.5 %) than overweight/obese (1.4 %) students knew the recommended servings for milk, cheese and yoghurt. Significantly more normal weight students (20.3 %) than overweight/obese (8.8 %) students knew the daily recommended servings for bread, cereal, rice and pasta. Significantly more overweight (95.0 %) than underweight (71.1 %) students knew carrot as a good source of Ã-carotene. In conclusion, healthy eating practices need to be emphasized in this group while ensuring an adequate awareness campaign. The findings suggest the need for strategies designed to improve competence in the area of nutrition, especially with respect to information relating to guidelines for healthy eating practices and healthy weight management. Nutritional education for female students, especially related to body weight management is recommended. Interventions for the prevention and control of obesity must go much further than simply prompting nutrition knowledge.

INTRODUCTION A wide range of factors, including underlying, immediate and basic factors, play a role in the development of malnutrition. Globally, the prevalence of malnutrition is highest in Sub-Saharan African, with the HIV pandemic further compromising the situation. Both underweight and stunting are threatening the health of children younger than five years old, with the Northern Cape having the highest percentage of stunted children in South Africa. Malnutrition is still the leading cause of mortality and morbidity in children younger than five years old. The main aim of this study was to determine which of the underlying, immediate and basic factors contributing to malnutrition are prevalent in the Northern Cape. METHODS Fifty-four malnourished children 0 to 60 months admitted to Kimberley Hospital Complex and Upington Hospital were included in the study. Inclusion criteria included all malnourished children 0 to 60 months admitted to paediatric or infant care units between August 2007 and July 2008with a weight-for-age below 80% of expected weight, with an RtHC and whose mother/ caregiver was present to sign the informed consent form. The anthropometric measurements of both the child and mother/caregiver were taken. Blood values of the child that were available in the files were consulted. Socio-demographic, household, maternal information, medical history of the child, infant feeding information and adherence to the FBDG were noted on a questionnaire during a structured interview conducted with the mother/caregiver. RESULTS Factors contributing to malnutrition were categorized into the immediate, underlying and basic factors as set out in the UNICEF conceptual framework of the causes of malnutrition. Some of the socio-demographic findings associated with malnutrition included rural households, male children, education level and marital status of the mother. Educated and married mothers were less likely to have a malnourished child. Anthropometric findings showed that low birth weight and the size of the childâs mother were associated with malnutrition, with undernourished and obese mothers having a higher chance of having a malnourished child. Household food insecurity and inadequate nutrition information received on care practices were often contributing factors. Most of the malnourished children included in the study were marasmic. The medical history of the child indicated that even though all the children had an RtHC, the cards were often completed incorrectly. Clinic attendance was poor and the screening for HIV and TB was insufficient as the childrenâs statuses were mostly unknown. Significantly more children were up to date with their immunizations, but significantly fewer children were up to date on their vitamin A supplementation. The NSP was not accessed effectively and even children that did access the NSP were found to be malnourished after eight months on the programme. Some of the other household and maternal findings related to malnutrition included a big household with more than five family members, a high birth order of more than four children and if the child had any siblings that had died of malnutrition related illnesses. The education levels of the mothers were generally low and health and feeding information given at clinics did not have a significant impact. Information on infant feeding showed that exclusive breastfeeding is still a challenge and mothers are not effectively using milk alternatives when breastfeeding is ceased. Cup feeding was not practiced, and the use of bottles can increase the risk of diarrhoea. Children are either introduced to solid foods too early (before six months) or too late (after six months). When the application of the FBDG was evaluated, the study found that children had high intakes of fats, salt, sugar and sugary foods and tea and low intakes of animal proteins, fruit and vegetables and milk (after breastfeeding was ceased). CONCLUSIONS Inadequate access of available interventions programmes such as the NSP, immunizations, vitamin A supplementation, screening and treatment of diseases such as HIV and TB was noted. Parents were generally uneducated, especially regarding infant and young child feeding and the importance of correct food for the prevention of malnutrition. Household factors were a major challenge, especially in rural areas. Low levels of schooling and poverty are basic factors contributing to malnutrition that are prevalent in the Northern Cape. RECOMMENDATIONS Maternal and community education are some of the most important interventions to combat malnutrition in the Northern Cape. Intervention programmes at facilities should be strengthened to empower health care professionals and the community they serve to prevent and manage severe malnutrition. Detecting malnourished children earlier in the communities by using the MUAC to screen children is recommended. The management of severe malnutrition according to the 10 Steps of the WHO should be implemented at all levels of care.

Hypertension is responsible for a large and increasing proportion of the global disease burden and is becoming increasingly significant in low-income countries. The aim of this study was to determine the association of body weight, 25-hydroxy vitamin D, sodium and potassium intakes, physical activity levels and genetic factors, with the prevalence of hypertension in a low income, black urban community. Various factors influence blood pressure, with especially body weight showing a strong relationship with hypertension. More than half of this study population suffered from hypertension and the majority was overweight or obese, increasing the risk for disease and premature death. All indices of abdominal obesity and body fatness, including BMI, WHtR, adiposity index and waist circumference were significantly related to blood pressure, supporting weight loss as first line intervention for treatment and prevention of hypertension and its accompanying disease burden in this population. Findings also suggest the use of WHtR to screen for hypertension in this population. Higher blood pressure levels are associated with lower levels of vitamin D and low vitamin D levels have been linked to obesity markers. Although the majority of participants in this study were overweight/obese, almost 96% had adequate vitamin D status, despite expected low vitamin D intakes. HIV status did not influence vitamin D status directly, but through BMI. The latitude and high levels of sun exposure could have been responsible for the favorable vitamin D status in the participants. Results confirm the inverse relationship between vitamin D status and hypertension reported by other researchers, but found that this relationship seemed to be dependent on BMI in this study population. Lower sodium intakes accompanied with increased potassium intakes are recommended for the prevention and treatment of hypertension. The blood pressure elevating effect of sodium have been found to be even more profound in black population groups, urging investigation into this possible race-related cause of hypertension. Sodium intakes, as reflected by urinary sodium excretion, were high in this study. Association between sodium intakes and systolic, diastolic and mean arterial pressure were found, with higher sodium intakes being associated with elevated blood pressure levels, indicating the need for dietary sodium reduction strategies to control hypertension in this population. Despite high sodium intakes and low potassium intakes, no association was found between sodium or potassium intakes and the prevalence of hypertension. Increased activity is often advocated as first line treatment in the prevention of hypertension, even when weight loss is not achieved. The majority of participants in this study reported being sedentary or low active. No significant association could be shown between activity level and the prevalence of hypertension. Although HIV status showed a negative correlation with BMI, no correlation could be found between HIV status and activity level. Chronic diseases such as hypertension are likely the result of more than one gene and multiple variants of each gene that interacts with different environmental factors, with each combination making a small contribution to overall homeostasis, function, and therefore health. The high risk polymorphisms of the AGT (M235T and -217); GRK4 (A142V, A486V) and CYP11B2 genes did not seem to play a major genetic role in the high prevalence of hypertension in this population. Only GRK4 (R65L) showed an association with the prevalence of hypertension and a weak negative correlation with mean arterial pressure. Results show that overweight/obesity and excessive sodium intake are the major contributors towards hypertension in this study population. Intervention programmes should focus on preventative strategies that create awareness to promote weight loss and encourage lower salt consumption.