Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Aim: To assess the effects of initial nutritional status on the responses to a school feeding programme (SFP) among school children in the Millennium Villages Project (MVP), Siaya District, Kenya. Objectives: To establish baseline data on the dietary intake, prevalence of undernutrition, body composition, prevalence of anaemia, body iron stores and vitamin A status in order to assess the impact of the SFP over a 30-month period on the same outcomes. Further, the study assessed the effect of initial nutritional status on the responses to the SFP on growth, the prevalence of anaemia, body iron stores and vitamin A status. Methods: In the MVP, a school meal additional to the children’s usual daily food intake was provided consisting of locally available foods (containing whole fish omena and beef). The meals contributed approximately 25% of the Estimated Energy Requirement (EER), 70% of the Estimated Average Requirement (EAR) for protein, and 18% of EAR for fat. A school meal, additional to the children’s usual daily food intake, was introduced to the control group 6 months into the study as a project scale up initiative. The meal provided 15% EER, 49 % EAR for protein and 10% EAR for fat. A total of 235 children participated in the study and were followed up for 30 months, with 118 in the MVP and 117 in the control group. Statistical analysis included descriptive, Pearson’s chi-square test, repeated measures ANOVA and multivariate logistic regression models. Results: The mean subject age was 7.9 years (2.0 SD) at baseline, and half (51.4%) were boys. More than half of the children (66%) had energy intakes less than the EER. At baseline, the prevalence of stunting, wasting and underweight was 16.9%, 6.0% and 3.6% respectively. Prevalence of linear growth deficit based on height-for-age z-score ≤-1 standard deviation was 48%. Anaemia was higher in the MVP group (82.2%; P < 0.0001) compared to controls (58.1%) while depleted body iron stores was observed in 10.7% of the children. Half of the children in the control group and 30% in the MVP group had an inadequate vitamin A status while 11% of the children had infection/inflammation. At six months after initiation of the intervention, anaemia prevalence was reduced to 41.2% among the controls and 9.3% in the intervention group (P < 0.001). Among the MVP group, children with initial inadequate nutritional status based on weight-for-age z-score WAZ ≤ -1 SD had a higher (P < 0.01) height velocity (2.3 cm/six months) by the 24th month study interval compared to those who had an initial adequate nutritional status based on weight-for-age z-score WAZ > -1 SD. Conclusion: SPF menus were associated with potential for improved growth, gain in lean body mass and reduced anaemia prevalence when inadequate nutritional status was present at baseline. / AFRIKAANSE OPSOMMING: Doel: Om die verband tussen skoolkinders se aanvanklike voedingstatus en die respons op ’n skoolvoedingsprogram (SVP) in die Millennium Villages Project (MVP), Siaya-distrik, Kenia, te bepaal. Doelwitte: Om basislyn data te versamel ten opsigte van dieetinname, prevalensie van ondervoeding, liggaamssamestelling, prevalensie van anemie, ysterstore en vitamine A status ten einde die impak van die SVP oor ‘n 30-maande periode op genoemde uitkomste te bepaal. Verder het die studie ook die effek van aanvanklike voedingstatus op die respons tot die SVP bepaal ten opsigte van groei, die prevalensie van anemie, ysterstore en vitamine A status. Metode: In die MVP is ‘n skoolmaaltyd addisioneel tot die kinders in beide studiegroepe se daaglikse voedselinname voorsien. Die SVP se spyskaarte het bestaan uit plaaslik beskikbare voedsel (bevattende die vissoort omena en beesvleis) en het ongeveer 25% van die kinders se geraamde energievereistes (EER), 70% van hul proteïenvereistes (EAR) en 18% van hul vetvereistes (EAR) voorsien. ‘n Skoolmaaltyd is addisioneel tot die kinders in die kontrolegroep se gewoontelike daaglikse voedselinname ingesluit 6 maande na aanvang van die studie as deel van die MVP se uitbreidingsinisiatief. Dié maaltyd het in 15% van die kinders se energievereistes (EER), 49% van hul proteïenvereistes (EAR) en 10% van hul vetvereistes (EAR) voorsien. Altesaam 235 kinders is by die studiegroep ingesluit – 118 in die MVP en 117 in kontrolegroepe – en is vir 30 maande bestudeer. Statistiese ontleding het beskrywende ontleding, Pearson se chi-kwadraattoets, ANOVA met herhaalde metings, en multivariansie logistiese regressiemodelle ingesluit. Resultate: Die gemiddelde ouderdom van die kinders by basislyn was 7.9 jaar (2.0 SD) en die helfte (51.4%) van die respondente was seuns. Meer as die helfte van die kinders (66%) het ‘n energieinname minder as die EER getoon. By basislyn was die prevalensie van belemmerde groei, uittering en ondergewig onderskeidelik 16.9%, 6.0% en 3.6%. Die voorkoms van onvoldoende lengtegroei gebaseer op lengte-vir-ouderdom z-telling < -1SD was 48%. Anemie was hoër in die MVP groep (82.2%; p<0.0001) vergeleke met die kontroles (58.1%), terwyl 10.7% uitgeputte ysterstore getoon het. Onvoldoende vitamine A status het voorgekom in die helfte van die kinders in die kontrolegroep en 30% van die MVP groep, en infeksie / inflammasie was teenwoordig in 11% van die kinders. Die voorkoms van anemie op ses maande na aanvang van intervensie het verbeter tot 41.2% in die kontrolegroep en 9.3% in die intervensiegroep (P < 0.001). Op 24 maande het kinders met aanvanklike onvoldoende voedingstatus (WAZ < -1SD) in die MVP-groep groter lengtetoename (2.3 cm/6 maande) getoon as hul groepgenote met aanvanklike voldoende voedingstatus gebaseer op WAZ > -1 SD (P < 0.01). Gevolgtrekking: Die skoolvoedingsprogram spyskaarte het die potensiaal getoon tot ‘n verbetering in groei, toename in maer liggaamsmassa en ‘n verlaagde voorkoms van anemie onder kinders wie se basislynvoedingstatus onvoldoende was.

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Background: Synbiotics, probiotics and prebiotics are being added to infant formula. This study was an in-depth evaluation of research on infants fed infant formula containing synbiotics, probiotics or prebiotics and was carried out in two phases. Phase one included two systematic reviews that assessed if synbiotics, probiotics or prebiotics led to improved growth and clinical outcomes in formula fed full term and preterm infants. Phase two included two studies: A systematic review compared the methodological quality and outcomes of industry and non-industry sponsored randomized controlled trials (RCTs) and a descriptive study evaluated how the food industry applies the knowledge and evidence gained from probiotics, prebiotics or synbiotics research in infants. The research questions were: Does the consumption of probiotics, prebiotics or synbiotics supplemented infant formula lead to improved clinical outcomes in infants? Is there an association between source of funding and methodological quality, clinical outcomes and author’s conclusions in trials using probiotics, prebiotics or synbiotics supplemented formula in infants? Does the food industry use the evidence gained through probiotics, prebiotics and synbiotics research trials on infants for the benefit of the general paediatric population? The hypotheses were: Consumption of probiotics, prebiotics or synbiotics by infants leads to improved clinical outcomes; The source of funding in research trials using probiotics, prebiotics or synbiotics supplemented formula in infants is associated with outcomes in favour of the sponsor’s products and authors’ conclusions; Methodological qualities of non-industry sponsored trials are equivalent to industry sponsored trials; Evidence gathered through probiotics, prebiotics and synbiotics research is implemented by the food industry. Methods: Phase one: Both systematic reviews on preterm and full term infants: Cochrane methodology was followed using RCTs which compared preterm or full term formula containing probiotics, prebiotics or synbiotics to conventional infant formula with / without placebo among healthy preterm or full term infants. The mean difference (MD) and corresponding 95% confidence intervals (CI) were reported for continuous outcomes, risk ratio (RR) and corresponding 95% CI for dichotomous outcomes. Phase two: In the systematic review, Cochrane methodology was used to assess the risk of bias of included RCTs. Association between source of funding and risk of bias, clinical outcomes and conclusions were assessed. In the descriptive study, all listed companies that manufacture infant food products with added synbiotics, probiotics or prebiotics for infants were identified and invited to participate. A letter of invitation was sent and if they expressed willingness to take part in the study, a questionnaire with a written consent form was sent. Descriptive statistics and associations between categorical variables were to be tested using a Chi-square test. Results: Phase one: Review on preterm infants: 8 studies were included. Probiotics increased stool frequency with no effect on other clinical outcomes. Prebiotics increased stool frequency and bifidobacteria counts only. Review on full term infants: 25 studies were included. Synbiotics improved stool frequency but had no effect on other clinical outcomes. Probiotics did not have an effect on any clinical outcome. Prebiotics increased weight gain and stool frequency with no effect on other outcomes. Phase two: Systematic review: 67 studies were included, majority were funded by food industry. There was no significant association between the source of funding and four domains (sequence generation, allocation concealment, blinding, selective reporting), majority of reported clinical outcomes or authors’ conclusions. Source of funding was significantly associated with two domains (incomplete outcome data, free of other bias), antibiotic use and conclusions on weight gain. Descriptive study: 25 companies were identified and invited to participate. No company agreed to participate in the survey for different reasons. Conclusions Phase one: Review on preterm infants: There is not enough evidence to state that supplementation with probiotics or prebiotics results in improved growth and clinical outcomes in exclusively formula fed preterm infants. Review on full term infants: There is not enough evidence to state that supplementation of term infant formula with synbiotics, probiotics or prebiotics does result in improved growth or clinical outcomes in term infants. There is no data available to establish if synbiotics are superior to probiotics or prebiotics. Phase two: Systematic review: In RCTs on infants fed infant formula containing probiotics, prebiotics or synbiotics, the source of funding does not influence majority of outcomes in favour of the sponsors’ products. More non-industry funded research is needed to further assess the impact of funding on reported clinical outcomes and authors’ conclusions. Descriptive study: Due to companies refusing to participate in this study, no conclusion could be drawn on how the food industry applies evidence gained through probiotics, prebiotics or synbiotics research on infants. More transparency is needed from the infant formula manufactures on how they apply the evidence gained from probiotic, prebiotic or synbiotic research on infants. / AFRIKAANSE OPSOMMING: Agtergrond Synbiotika, probiotika en prebiotika word gereeld by baba formule gevoeg. Hierdie studie was 'n in-diepte evaluering van navorsing oor babas gevoed met formule melk wat synbiotika, probiotika of prebiotika bevat en is uitgevoer in twee fases. Fase een het twee sistematiese oorsigte ingesluit wat die rol van synbiotika, probiotika en prebiotika op verbeterde groei en kliniese uitkomste van formule gevoede volterm babas en vroeg gebore babas evalueer het. Fase twee het bestaan uit twee studies: 'n sistematiese oorsig wat die metodologiese kwaliteit en uitkomste van die bedryf en nie-bedryf geborgde ewekansige gekontroleerde proewe (RCTs) evalueer het, asook 'n beskrywende studie wat die kennis en toepassing van bewyse oor die effektiewiteit van probiotika, prebiotika of synbiotika in die voedsel industrie bestudeer het. Die hipotese stellings was: verbruik van probiotika, prebiotika of synbiotika by babas lei tot verbeterde kliniese uitkomste; die bron van befondsing vir synbiotics, probiotika of prebiotika navorsing beïnvloed uitkomste ten gunste van die borg se produkte; bewyse ingesamel deur middel van probiotika, prebiotika en synbiotika navorsing word geïmplementeer deur die voedselindustrie. Metodes Fase een: Beide sistematiese oorsigte op volterm en premature babas: Cochrane metodes is gevolg deur ewekansige, gekontroleerde studies wat vol termyn of premature formule met probiotika, prebiotika of synbiotika met konvensionele baba formule met / sonder plasebo onder gesonde volterm of premature babas bestudeer. Die gemiddelde verskil (MD) en die ooreenstemmende 95% vertrouensintervalle is gebruik vir deurlopende uitkomste, risiko verhouding (RR) en die ooreenstemmende 95% CI vir tweeledige uitkomste. Fase twee: In die sistematiese oorsig is Cochrane metodiek gebruik om die risiko van vooroordeel van ingesluite ewekansige, gekontroleerde studies te evalueer. Assosiasie tussen bron van befondsing en die risiko van vooroordeel, asook kliniese uitkomste en gevolgtrekkings was beoordeel. In die beskrywende studie, is alle genoteerde maatskappye wat babavoeding produkte vervaardig met bygevoegde synbiotika, probiotika of prebiotika vir babas geïdentifiseer en uitgenooi om deel te neem. 'n Uitnodigingsbrief is vir die relevante maatskappye gestuur om hul bereidwilligheid om deel te neem te bevestig. Indien hulle wel bereid was om deel te neem was 'n vraelys met 'n skriftelike toestemming vorm gestuur. Beskrywende statistiek en assosiasies tussen kategoriese veranderlikes was getoets met behulp van 'n Chi-kwadraat toets. Resultate Fase een: Oorsig oor premature babas: 8 studies was ingesluit. Probiotika verhoog stoelgang frekwensie met geen effek op ander kliniese uitkomste. Prebiotika verhoog ook stoelgang frekwensie en slegs bifidobakteriële tellings. Oorsig oor die vol termyn babas: 25 studies was ingesluit. Synbiotika verbeter stoelgang frekwensie, maar het geen effek op ander kliniese uitkomste gehad nie. Probiotika het nie 'n effek op enige kliniese uitkoms gehad nie. Prebiotika verhoog gewigstoename en stoelgang frekwensie met geen effek op ander uitkomste. Fase twee: Sistematiese oorsig: 67 studies was ingesluit, en die meerderheid was befonds deur die voedsel bedryf. Daar was geen beduidende assosiasie tussen die bron van befondsing en vier gebiede (toekenningsvolgorde, toekenningsverberging, studie verblinding, selektiewe verslaggewing), en die meerderheid van gerapporteerde kliniese uitkomste of skrywers se gevolgtrekkings. Die bron van befondsing was beduidend verbind met twee gebiede (onvolledige uitslag data, vry van ander vooroordeel), antibiotika gebruik en gevolgtrekkings op gewigstoename. Beskrywende studie: 25 maatskappye is geïdentifiseer en genooi om deel te neem. Geen maatskappy het ingestem om deel te neem aan die studie om verskillende redes. Gevolgtrekkings Fase een: Oorsig oor premature babas: Daar is nie genoeg bewyse dat die aanvulling met probiotika of prebiotika resultate in verbeterde groei en kliniese uitkomste in uitsluitlik formule gevoede premature babas tot gevolg het nie. Oorsig oor die volle termyn babas: Daar is nie genoeg bewyse om te sê dat die aanvulling van term baba formule met synbiotika, probiotika of prebiotika lei tot verbeterde groei of kliniese uitkomste in termyn babas. Daar is geen inligting beskikbaar om te stel of synbiotika beter is as probiotika of prebiotika nie. Fase twee: Sistematiese oorsig: In studies op babas gevoed met formule melk wat probiotika, prebiotika of synbiotika bevat het, het die bron van befondsing nie meerderheid van die uitkomste in die guns van die borge se produkte beïnvloed nie. Meer nie-industrie befondsde navorsing is nodig om verder die impak van befondsing op kliniese uitkomste en skrywers se gevolgtrekkings te evalueer. Beskrywende studie: Aangesien al die maatskappy deelname geweier het, kon geen gevolgtrekking gemaak word of die voedsel bedryf bewyse oor die gebruik van probiotika, prebiotika of synbiotika toepas nie. Meer deursigtigheid is nodig van die formule vervaardigers oor hoe hulle die bewyse oor die gebruik van probiotika, prebiotika of synbiotika toepas.

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Background: Irritable bowel syndrome (IBS) is a common gastrointestinal (GI) disorder. GI symptoms and impaired quality of life affect between 10-20% of all adults, corresponding to about 25-50% of all patients who visit a gastroenterologist’s clinic. In recent years, several novel mechanisms of IBS that likely relate to previously established theories have been identified. Inflammation, postinfectious low-grade inflammation, immunological and genetic predisposition along with altered microbiota are critical in IBS development, while several dietary factors may also play a role in this syndrome. However, none of these factors accounts for the full repertoire of IBS symptoms, and the pathophysiology of this condition is not fully understood. The overarching aim of this study was to investigate the nutrient intakes, GI microbiota and the effect of Lactobacillus plantarum (L.plantarum) 299v in IBS patients. Sub-aims: 1) Update healthcare professionals on current probiotic information and provide an overview of probiotic treatment approaches, with special emphasis on IBS, 2) conduct a well designed randomised, double blind, placebo-controlled trial (RCT) with L. plantarum 299v as part of an intervention and establish whether a course of probiotics may alleviate undesirable symptoms of IBS and improve quality of life, 3) assess nutrient intake in patients with irritable bowel syndrome (IBS) compared to dietary recommendations, 4) validate and assess the reproducibility of food records and 5) identify possible nutrient risk components for establishing GI microbiota involved in IBS and as part of an intervention, determine whether a course of probiotics may alter stool microbiota. Results: 1) A review article published by the author provides an overview of current probiotic treatment options to health care professionals and indicates certain probiotics are a promising therapeutic treatment option for management of IBS symtpoms, 2) the effects of the single strain probiotic, L. plantarum 299v, supplementation was evaluated in a RCT. Compared to placebo, the probiotic supplementation showed no significant reduction in GI symptom severity scores, particularly abdominal pain relief. Quality of life was also not improved in the treatment versus control group. Both the treatment and placebo groups improved significantly over the trial period, indicating a large placebo effect, 3) nutrient intakes of the IBS patients compared to current dietary reference recommendations indicates that this group of patients are at risk for nutrient inadequacies in key macro and micronutrients, 4) the validity and reliability of the dietary data showed good reliability but poor validity as measured by plasma fatty acids and 5) the GI microbiota composition in the phenotypically different diarrhoea-predominant IBS (D-IBS) vs. constipation-predominant IBS (C-IBS) showed that D-IBS patients had significantly lower counts of Lactobacillus plantarum compared to C-IBS patients. The probiotic had no significant effects on the GI microbiota as measured by quantitative polymerase chain reaction (qPCR). It was found that nutrient intakes had a significant impact on the microbiota. Lower fibre intakes were associated with higher Bacteroides spp., lower Bifidobacteria bifidum and Lactobacillus plantarum counts in both IBS groups. Conclusion: Taken together, L.plantarum 299v did not alleviate the GI symptoms of IBS, nor was it associated with significant changes in the GI microbiota. IBS patients may be at risk of key nutrient inadequacies. The influence of nutrient intakes on the GI microbiota provides an attractive explanation as a potential pathophysiological factor for IBS. / AFRIKAANSE OPSOMMING: Agtergrond: Prikkelbare derm-sindroom (PDS) is ‘n algemene gastro-intestinale (GI) stoornis. GI simptome affekteer die lewenskwaliteit van 10-20% van alle volwassenes. Dit stem ooreen met ongeveer 25-50% van alle pasiënte wat ‘n gastroënteroloog konsulteer. Verskeie oorspronklike meganismes vir die ontwikkeling van PDS is onlangs identifiseer. Inflammasie, post-infektiewe lae-graadse inflammasie, immunologiese en genetiese vatbaarheid tesame met veranderde mikrobiota is krities vir die ontwikkeling van PDS. Sekere dieetfaktore mag ook bydraend wees tot hierdie sindroom. Geen van hierdie faktore is egter verantwoordelik vir die volle spektrum van PDS simptome nie en die patofisiologie van die toestand word ook nog nie ten volle verstaan nie. Die oorkoepelende doel van hierdie studie is om nutriëntinname, GI mikrobiota en die uitwerking van L.plantarum 299v in PDS pasiënte bepaal. Sub-doelwitte: 1) Om gesondheidswerkers in te lig aangaande die nuutste inligting oor probiotika en om ‘n oorsig van probiotika behandelingsopsies te verskaf, met spesiale klem op PDS, 2) om ‘n goed beplande ewekansige, dubbel-blinde, plasebo-beheerde kliniese studie met L.plantarum 299v as deel van die intervensie uit te voer om sodoende te bepaal of ‘n kursus probiotika ongewensde simptome van PDS kan verbeter en lewenskwaliteit sodoende verhoog, 3) om nutriëntinname in pasiënte met PDS te bepaal vergeleke met dieet aanbevelings, 4) om die geldigheid en herhaalbaarheid van voedselrekords te bepaal en 5) om moontlike nutriënt risikokomponente vir die ontwikkeling van GI mikrobiota betrokke in PDS te identifiseer en om as deel van ‘n intervensie te bepaal of ‘n kursus probiotika stoelgang mikrobiota patrone verander. Resultate: 1) ‘n Oorsigartikel gepubliseer deur die kandidaat dui probiotika aan as ‘n belowende terapeutiese opsie in die behandeling van PDS simptome, 2) die effek van ‘n enkelstam probiotikum, L.plantarum 299v, is evalueer deur ‘n ewekansige, dubbel-blinde, plasebo-beheerde kliniese studie. Vergeleke met die plasebo, het probiotiese aanvulling geen betekenisvolle vermindering in die GI simptome in PDS pasiënte tot gevolg gehad nie. Lewenskwaliteit het ook nie verbeter in die behandelde versus die kontrole groep nie. Beide die behandelde en plasebo groepe het aansienlik verbeter oor die studietydperk, wat ‘n groot plasebo effek aandui, 3) nutriëntinname van die PDS groep vergeleke met huidige dieetaanbevelings, dui daarop dat hierdie groep pasiënte ‘n risiko het vir die ontwikkeling van kern nutriënttekorte (makro- en mikronutriënte), 4) die geldigheid en betroubaarheid van die dieetdata dui op goeie betroubaarheid, maar swak geldigheid soos bepaal deur plasma vetsure en 5) die dermkanaal mikrobiotiese samestelling in die verskillende fenotipes, diarree-oorheersende PDS (D-PDS) vs. konstipasie-oorheersende PDS (K-PDS) dui daarop dat D-PDS pasiënte aansienlike minder Lactobacillus plantarum gehad het vergeleke met K-PDS pasiënte. Die probiotikum het geen beduidende uitwerking op die oorheersende mikrobiota gehad nie, soos gemeet deur kwantitatiewe polimerase kettingreaksie (kPKR). Daar is gevind dat dieet ‘n beduidende impak op die mikrobiota gehad het. Daar is ‘n verband tussen laer vesel inname en hoёr Bacteroides spp. en laer Bifidobacteria bididum en Lactobacillus plantarum tellings gevind in beide PDS groepe. Gevolgtrekking: Die L.plantarum 299v enkelstam probiotikum het nie die gastrointestinale simptome van PDS pasiënte verlig nie en daar is ook geen beduidende veranderinge in die mikrobiota gevind nie. PDS pasiënte mag ‘n verhoogde risiko toon vir kern nutriënttekorte. Die invloed van nutriëntinname op GI mikrobiota verskaf ‘n belowende verduideliking as ‘n potensiële patofisiologiese faktor in PDS.

Thesis (MNutr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Objective To develop and test a marketable, Continuing Professional Development (CPD) accredited training manual focused on the role of medical nutrition therapy (MNT) for healthcare professionals (HCP) of the multidisciplinary Type 1 and Type 2 Diabetes Mellitus (DM) management team. Methods The study consisted of two components: (a) development of the MNT manual and (b) testing of the MNT manual. The development of the MNT manual consisted of seven steps: (1) needs assessment and problem definition; (2) literature search; (3) draft one of the MNT manual; (4) peer review; (5) draft two of the MNT manual; (6) evaluation by means of a survey; and (7) the final MNT manual. The testing of the MNT manual’s impact on knowledge had a test-retest design which consisted of seven steps: (1) DM knowledge questionnaire development; (2) participant recruitment; (3) questionnaire pilot; (4) initial knowledge testing; (5) self-study of MNT manual; (6) retesting of knowledge; (7) statistical analysis. Results From the literature a total of 132 published documents were selected for inclusion in the MNT manual after grading of the information. The first draft was compiled and sent for peer review and language editing. Recommended changes were made and the second draft was developed and sent to 79 registered dietitians (RDs) who volunteered to complete a survey after reading the MNT manual. The survey indicated that the majority were satisfied with the content, which in turn led to the final MNT manual.The questionnaire was compiled using the content of the MNT manual and creating 10 questions per section of the manual. The pilot was conducted using 10% (n = 7) of the total sample. Minor changes were made. For knowledge testing, participants included RDs between the ages of 23 and 60 years, registered with the Health Professions Council of South Africa. A test-retest design was used. Participants scored a mean of 57.5% on the initial knowledge questionnaire (KQ1), ranging between 33.6% and 79.8%. They lacked knowledge on: management of the hospitalised patient; diabetes and exercise; diabetes and religion; gestational diabetes; supplements commonly used by diabetics; diabetes in prisons; diabetes in children; the function, side-effects and contra-indications of metformin. The mean score on the second knowledge questionnaire (KQ2) increased to 90.5%, with the lowest score 50.4% and the highest 99.2%.There were two questions where participants scored < 50% (mean of n = 79) which related to the type of insulin regime most suitable during Ramadan and risk factors for Type 2 DM in children. Data were also analyzed according to various socio-demographic variables, but only one significant difference was found between groups. Conclusions and implications There is adequate research available to develop a comprehensive guide for HCP on the nutritional management of DM. Such an MNT manual should be marketed for CPD purposes to encourage HCP to improve their DM management skills, as seen by the dramatic improvement in DM management knowledge of the RDs participating in this research. Future studies may include knowledge testing of other HCP, as well as testing to determine if the newly acquired information is put into practice to the benefit of DM patients. / AFRIKAANSE OPSOMMING: Objektiewe Die ontwikkeling en toets van 'n bemarkbare, Voortgesette Professionele Ontwikkeling (VPO) geakkrediteerde handleiding oor die rol van mediese voedings terapie (MVT) vir mediese personeel van die multi-dissiplinêre Tipe 1- en Tipe 2 Diabetes Mellitus (DM) behandelings span. Metodes Die studie het bestaan uit 2 komponente: (a) die ontwikkeling van die MVT handleiding en (b) die toets van die MVT handleiding. Die ontwikkeling van die MVT handleiding het bestaan uit sewe stappe: (1) assesering van benodighede en probleem definisie, (2) literatuursoektog; (3) aanvanklike konsep van die MVT handleiding; (4) eweknie evaluasie; (5) volgende konsep weergawe van die MVT handleiding; (6) evaluering deur ‘n meningsopname; en (7) die finale MVT handleiding. Die toets van die MVT handleiding se impak op die kennis het 'n toets-hertoets ontwerp gehad wat bestaan het uit sewe stappe: (1) DM kennis vraelys ontwikkeling; (2) deelnemer werwing; (3) toets van vraelys; (4) toets van aanvanklike kennis; (5) selfstudie van die MVT handleiding; (6) hertoetsing van kennis; en (7) statistiese analise. Resultate Uit die literatuur is 132 gepubliseerde dokumente gekies vir insluiting in die MVT handleiding na gradering van die kwaliteit van die inligting. Die aanvanklike konsep is ontwikkel, taalversorg en eweknie geevalueer. Aanbevole veranderinge is gemaak en die tweede konsep is ontwikkel en gestuur aan 79 dieetkundiges wat vrywillig die MVT handleiding gelees het en aan ‘n meningsopname deelgeneem het. Uit die meningsopname was dit duidelik dat die meerderheid tevrede was met die inhoud, wat gelei het tot die finale MVT handleiding.Die vraelys is opgestel met 10 vrae per afdeling van die MVT handleiding, en getoets deur 10% (n = 7) van die totale aantal deelnemers, waarna geringe veranderinge gemaak is. Vir kennis toetsing, is dieetkundiges tussen die ouderdomme van 23 en 60 jaar, wat geregistreer is by die Raad vir Gesondheidsberoepe van Suid-Afrika, ingesluit. Deelnemers het 'n gemiddeld behaal van 57.5 % op die aanvanklike kennis vraelys, met kennis wat gewissel het tussen 33.6% en 79.8%. Hulle het aanvanklik gebrekkige kennis gehad oor: die behandeling van die hospitaal pasiënt; diabetes en oefening; diabetes en godsdiens; swangerskaps diabetes; aanvullings gebruik deur diabete; diabetes in gevangenisse; pediatriese diabetes; asook die funksie, newe-effekte en kontra-indikasies van metformien. Die gemiddelde telling op die tweede kennis vraelys het toegeneem tot 90.5%, met ‘n laagste telling van 50.4% en hoogste van 99.2%. Daar was 2 vrae waar deelnemers < 50% (gemiddelde % van n = 79) behaal het. Hierdie vrae het verband gehou met die mees geskikte insulien behandeling tydens Ramadan en risikofaktore vir Tipe 2 DM in kinders. Data is ontleed volgens verskeie sosio-demografiese veranderlikes, maar slegs een beduidende verskil is tussen groepe gevind. Gevolgtrekkings en implikasies Daar is voldoende navorsing beskikbaar om ‘n omvattende handleiding vir mediese personeel oor die rol van voeding in die behandeling van DM te ontwikkel. So 'n MVT handleiding moet bemark word vir VPO doeleindes om mediese personeel aan te moedig om hul DM bestuursvaardighede te verbeter, soos gesien deur die dramatiese verbetering in DM bestuur kennis van die huidige deelnemers. Toekomstige navorsing kan die bepaling van kennis verbetering van ander mediese professies insluit, en of die verbeterde kennis in die praktyk DM pasiënte bevoordeel.

Thesis (Mnutr)--Stellenbosch University, 2003. / ENGLISH ABSTRACT: INTRODUCTION: Malnutrition is a silent emergency. WHO estimates that 55% of all child deaths in developing countries are associated with malnutrition. Inadequate dietary intake and disease are the two immediate causes of malnutrition. The underlying causes are household food insecurity, inadequate maternal and child-care and poor water/ sanitation and inadequate health services. Stunting is a major problem in pre-school children in South Africa. This indicates a long term inadequate dietary intake. Furthermore, the initiation of breastfeeding in South Africa is about 90%, and the duration thereof tends to be less than 3 months after birth. A great majority of children in this country consume a diet deficient in energy and of poor nutrient density to meet their micronutrient requirements. The aim of this study was to identify feeding practices of infants that could contribute to the development of malnutrition. METHOD: This was a cohort study with a prospective experimental design. Forty-four of the original 73 mother-infant pairs that were recruited, were interviewed monthly on feeding practices of the infants. Anthropometric measurements (weight and height of the infants) were measured monthly. RESULTS: Weight-for-age Z-scores dropped significantly with age from around 4 months, when weaning had started. Inadequate dietary intake, more specifically weaning practices and breastfeeding practices, were identified as the immediate cause that could contribute to the development of malnutrition in this community. Except for the positive relationship between the level of education of the father and an increase in HAZ over time, growth was not affected by socio-economic and demographic factors in this community. This is probably because of the fact that there were very small differences in socio-economic and demographic factors. CONCLUSION: Weaning and breastfeeding practices should be addressed in all nutrition education programmes. / AFRIKAANSE OPSOMMING: INLEIDING: Wanvoeding is 'n stil gevaar. Die WGO skat dat daar 'n verband is tussen wanvoeding en ongeveer 55% van alle kindersterftes in ontwikkelende lande. 'n Onvoldoende dieetinname en siekte is die twee onmiddellike oorsake van wanvoeding. Onvoldoende huishoudelike voedselsekuriteit, onvoldoende moeder- en kindsorg en swak sanitasie en watervoorsiening asook onvoldoende gesondheidsorg is die onderliggende oorsake. Dwerggroei is 'n groot probleem in Suid-Afrika onder voorskoolse kinders. Dit dui op 'n langdurige onvoldoende dieetinname. Bydraend hiertoe, is die aanvang van borsvoeding in Suid-Afrika ongeveer 90%, maar die duurte van borsvoeding is minder as 3 maande na geboorte. Die meerderheid van alle kinders in Suid-Afrika se dieet het 'n tekort aan energie en die nutriëntdigtheid van hulle diëte voldoen nie aan hulle daaglikse behoeftes ten opsigte van mikronutriënte nie. Die doel van hierdie studie was om voedingspraktyke te identifiseer wat kan bydra tot die ontwikkeling van wanvoeding. METODE: Dit was 'n kohortstudie met 'n prospektiewe eksperimentele ontwerp. Vier-en-veertig van die oorspronklike aanvanklike moeder-babapare wat gewerf is, is maandeliks ondervra met betrekking tot die voedingspraktyke van die baba en antropometriese metimgs (gewig en lengte van die baba) is maandeliks geneem. RESULTATE: Z waardes van gewig vir ouderdom het beduidend gedaal namate die kinders ouer geword het, veral vanaf 4 maande, toe spening begin het. 'n Onvoldoende dieetinname, meer spesifiek spenings- en borsvoedingspraktyke, is geïdentifiseer as die onmiddellike oorsake wat tot die ontwikkeleing van wanvoeding kan bydra in hierdie gemeenskap. Daar was 'n positiewe verband tussen lengtegroei (Z waardes van lengte vir ouderdom) en die vlak van opvoeding van die vader. Groei is nie deur die ander sosio-ekonomiese en demografiese faktore beïnvloed nie, moontlik as gevolg van die klein verskille in sosio-ekonomiese en demografiese eienskappe van die studie populasie. GEVOLGTREKKING: Spenings- en borsvoedingpraktyke behoort aandag te geniet in alle voedingsvoorligtings-programme.

Thesis (Mnutr)--Stellenbosch University, 2004. / ENGLISH ABSTRACT: Objective: To assess the impact of a continuous auditing process on nutritional support in a tertiary paediatric intensive care unit. Design: Prospective, longitudinal audit initiated in 1994. Re-auditing took place almost every 2 years: 1994-1995, 1997-1998 and 2001, leading to completion of the audit cycle. Setting: An 8 bed Paediatric Intensive Care Unit (PICU) in StMary's Hospital London. Subjects: All ventilated patients admitted for more than a complete 24-hour period were included in the audit. The units' standard daily fluid charts were used for data collection. Data was collected until discharge from PICU or a maximum of 10 days. Incomplete and imprecise data was disregarded during the data analysis process. Outcome measures and interventions: The outcome measures include time taken to initiate nutritional support, the route of feeding and delivery of calories by day 3, judged by the Estimated Average Requirements (EAR) for energy. Feeding algorithms and protocols introduced after each audit: nasogastric feeding algorithm following the 1994-1995 audit, blind nasojejunal tube insertion technique and related feeding algorithms after the audit in 1997-1998. Results: Time taken to initiate enteral feeding was reduced from 15 hours (1994- 1995) to 5.5 hours (2001). The proportion of parenterally fed patients fell from 11% (1994-1995) to 1% (200 1 ). The proportion of enterally fed patients via the nasojejunal route rose from 1% (1994-1995) to 20% (2001). An increase was noticed in patients reaching 50% and 70% of energy requirement by day 3 following admission was documented: 7% in1994-1995 to 35% in 2001 for 70% of EAR (p = 0.0008) and 18% in 1994-1995 to 58% in 2001 for 50% of EAR. (p< 0.0001) Conclusion: This audit process demonstrates the effectiveness of continuous auditing in an intensive care unit in improving the quality of nutritional support. This is possible only with a multi-disciplinary team approach. / AFRIKAANSE OPSOMMING: Doel: Om die impak van 'n deurlopende ouditerings proses op die voedingsondersteuning in 'n tersi~re pediatriese intensiewesorg-eenheid te evalueer. · Studie Ontwerp: 'n Prospektiewe, longetudinale oudit is in 1994 geYnisieer. Herouditee·ring het ongeveer elke 2 jaar plaasgevind: 1994-1995, 1997-1998 en 2001. Dit het tot die voltooiing van 'n ouditering siklus gelei. Plek: 'n Agt-bed Pediatriese lntensiewesorgeenheid (PISE) in StMary's Hospitaal London, Engeland. Pasiente: Alle geventilleerde pasiente wat opgeneem was vir !anger as 'n volledige 24 uur-periode is by die oudit ingesluit. Die eenheid se standard daaglikse vogkaarte dokumentasie is gebruik vir data-insameling. Data-insameling het plaasgevind tot en met ontslag vanuit die PISE vir 'n maksimum van 10 dae. Onvolledige en onakkurate data is uitgesluit tydens die data analise proses. Uitkomste en Intervensie: Die uitkomste is gemeet deur die impak van die ouditerings proses te evalueer ten opsigte van tydsduur voordat daar voedings geYnisieer is, die voedingsroete en die hoeveelheid energie gelewer teen dag 3, vergelyk met die geskatte gemiddelde energie behoefte. Voedings-algoritmes en protokolle is geYmplementeer na elke oudit: nasogastriese voedings-algoritmes is na die 1994-1995 oudit geYmplimenteer, 'n blinde nasojejunale buisinplasingstegniek en I relevante voedings algoritmes het na die 1997-1998 oudit gevolg. Resultate: Die tydsduur om voedingondersteuning te inisieer het van 15 ure (1994- 1995) tot 5.5 ure (2001) verminder. Die persentasie pasiente wat parenterale voeding ontvang het, het gedaal van 11% (1994-1995) tot 1% (2001), met 'n toename in enterale voeding via die nasojejunale roete van 1 %(1994) tot 20% (2001). 'n Toename in pasiente wat meer as 50% en 70% van hul energie behoefte bereik het teen dag 3 is opgemerk: 7% in 1994-1995 en 35% in 2001 het meer as 70% van die geskatte gemiddelde behoefte vir energie ontvang. (p=0.0008) Agtien persent het in 1994-1995 en 58% in 2001 meer as 50% van hul gemiddelde energie behoeftes bereik (p < 0.0001). Gevolgtrekking: Hierdie ouditerings proses demonstreer die effektiewiteit van deurlopende ouditering in 'n intensiewesorg-eenheid deur die verbetering van die kwalitiet van voedingondersteuning. Dit is slegs moontlik met 'n multidissiplinere span benadering.

Thesis (Mnutr)--Stellenbosch University, 2003. / ENGLISH ABSTRACT: INTRODUCTION: The objective of this pilot study was to evaluate the effects of a new micronutrient, glutamine, pre- and probiotic enriched liquid nutritional supplement on the nutritional status and immunity of adults living with HIV/AIDS. The study was designed as a prospective randomised double-blind placebo-controlled trial. Subjects were HIV-infected male and female adult volunteers (n = 47) from a community-based hospice centre in a peri-urban area in a resource-poor setting and were included irrespective of duration or clinical stage of HIV/AIDS. None of the subjects received antiretroviral therapy. METHOD: The intervention involved the daily ingestion of 40g (200 ml reconstituted) of either the enriched test product or an lsocalorie carbohydrate placebo for a period of 12 weeks. Anthropometric assessment (weight, height and triceps skinfold thickness; mid-upper arm, waist and hip circumferences) was performed at baseline and thereafter every 4 weeks (4 times). Biochemical (serum total protein, serum albumin and C-reactive protein) and haematological (full blood count and immunophenotyping) assessment was performed at baseline and again after week 12. RESULTS: Statistical analysis of baseline values was performed with Wilcoxon two-sample tests for comparison between the supplemented and placebo groups. Outcomes were evaluated using analysis of variance with Shapiro-Wilk tests and thereafter either pair-wise t-tests or sign tests (for nonparametric data) were used. Thirty-two subjects completed the trial, 14 in the supplemented group and 18 in the placebo group. Weight increased significantly in the supplemented group (2.73 ± 3.53 kg, P = 0.013). Triceps skinfold thickness increased significantly in both the supplemented (p = 0.047) and placebo group (p = 0.001). No other significant anthropometric change was observed. Serum albumin increased significantly in the supplemented group (p = 0.003) and was associated with a significant decline in C-reactive protein (p = 0.028). Haemoglobin decreased significantly in both groups. A significant decline in CD4+ count was observed in the placebo group while the decline in the supplemented group did not reach significance. CONCLUSION: Oral nutritional supplementation in limited quantities was well tolerated for a period of 3 months. This study demonstrated that an enriched nutritional supplement was able to promote weight gain and ameliorate hypoalbuminaemia and possibly inflammation in adults living with HIV/AIDS in the short to medium term. The enriched nutritional supplement does not appear to have an effect on the immunity of people with HIV/AIDS. The small sample is a limitation of the study and the conclusions pertain to the test product as a whole and not to any of its respective ingredients. Although further studies are required to evaluate long-term feasibility, these findings suggest that the use of an enriched nutritional supplement has a role in the management of weight loss in persons with HIV/AIDS. / AFRIKAANSE OPSOMMING: INLEIDING: Die doel van hierdie loodsstudie was om die uitwerking van 'n nuwe mikronutriënt, glutamien, pre- en probiotika verrykte voedingsaanvulling in vloeistof vorm te ondersoek. Die studie is ontwerp as 'n prospektiewe ewekansige dubbelblinde plasebogekontroleerde toets. Proefpersone was MIV-geïnfekteerde manlike and vroulike vrywilligers (n = 47) van 'n gemeenskapsgebaseerde hospitium in a semi-stedelike gebied in 'n hulpbron-arme omgewing. Proefpersone is ingesluit ongeag die duur of kliniese graad van MIVNIGS. Geen proefpersoon het antiretrovirale behandeling ontvang nie. METODE: Die intervensie het die daaglikse inname van 40g (200 ml gerekonstitueer) van óf die toetsproduk óf 'n isokaloriese koolhidraatplasebo gedurende 'n 12 week periode behels. Antropometriese evaluering (gewig, lengte en trisepsvelvoudikte; midbo-arm-, middel- en heupomtrekke) is uitgevoer met aanvang en daarna weer elke 4 weke (4 keer). Biochemiese (serum totale protein, serumalbumien en C-reaktiewe protein) en hematologiese (volbloedtelling en immunofenotipering) evaluering is uitgevoer met aanvang en weer na 12 weke. RESULTATE: Statistiese verwerking van basislyndata is gedoen deur middel van Wilcoxon twee-steekproef toetse waarmee vergelyking tussen die aangevulde en plasebogroep uitgevoer is. Studiegevolge is geëvalueer deur verspeidingsanalise met behulp van Shapiro-Wilk toetse waarna óf paargewyse t-toetse óf tekentoetse (vir nie-parametriese data) gebruik is. Twee-en-dertig proefpersone het die studietydperk voltooi, 14 in die aangevulde groep en 18 in die plasebogroep. Gewig het betekenisvol toegeneem in die aangevulde groep (2.73 ± 3.53 kg, p = 0.013). Triseps velvoudikte het betekenisvol toegeneem in beide die aangevulde (p = 0.047) en die plasebogroep (p = 0.001). Geen ander betekenisvolle antropometriese veranderinge is waargeneem nie. Serumalbumien het betekenisvol gestyg in die aangevulde groep (p = 0.003) en het gepaard gegaan met 'n betekenisvolle daling in C-reaktiewe protein (p = 0.028). Hemoglobienwaardes het in beide groepe betekenisvol gedaal. 'n Betekenisvolle daling in CD4+ telling is waargeneem in die plasebogroep terwyl die daling in die aangevulde groep nie betekenisvol was nie. GEVOLGTREKKING: Mondelingse voedingsaanvulling van 'n beperkte hoeveelheid was goed aanvaar en verdra oor 'n 3-maande tydperk. Hierdie studie toon dat 'n verrykte voedingsaanvulling in staat is om gewigstoename te bevorder en om hipoalbumienemie en moontlik ook inflammasie te verlig in volwassenes met MIVNIGS oor 'n kort tot medium tydperk. Die verrykte voedingsaanvulling blyk nie 'n effek op die immuniteit van mense met MIVNIGS te hê nie. Die klein steekproef is 'n beperking van die studie en die gevolgtrekkinge is slegs van toepassing op die toetsproduk as 'n geheel en nie op enige van die onderskeie bestanddele daarvan nie. Hoewel verdere studies nodig geag word om langtermyn uitvoerbaarheid te ondersoek, dui hierdie bevindinge daarop dat die gebruik van 'n verrykte voedingsaanvulling 'n rol speel in die beheer van gewigverlies in persone met MIVNIGS.

Thesis (MNutr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Perceptions held by Masters Students of the NOMAa track module on ‘Nutrition, Human Rights and Governance’ Introduction and Objectives The interdisciplinary NOMA Track module on ‘Nutrition, Human Rights and Governance’ was developed jointly by four higher learning institutions in three countries (Norway, South Africa and Uganda). The module was incorporated into the respective Masters programmes in nutrition and consisted of three study units each of six weeks duration. The units were presented consecutively in the three countries and built on one another, totalling 18 weeks. Objectives The main aim of the study was to document perceptions of Masters students who completed the module. The objectives were to compare the perceptions of students about the study units in different countries, to document how students anticipated utilising their newly-acquired knowledge and to make recommendations for the development of similar interdisciplinary modules. Methodology A cross-sectional study design with a mixed methods approach was used. The sampling frame consisted of all registered students enrolled in the module. Informed written consent for both voluntary participation as well as voice recording of interviews was obtained from all participants. Data was extracted from students’ quantitative evaluation of each study unit. An interpretative methodological approach was used to elicit narrative accounts of students’ perceptions of the module during in-depth telephonic interviews. An inductive process was followed to identify emerging themes. The code list thus compiled was used to analyse unstructured data by using a text analysis computer programme. Results Twenty NOMA students enrolled at different universities participated in the study. The module was described as a life-changing experience and the way the module was structured and conducted in both developed and developing countries was highly rated. Interactive teaching styles optimised the learning experience. Presentations by a variety of experts and study visits served to enrich theoretical human rights principles by giving practical examples and by comparing implementation of these principles under varying conditions. The main difference between the study units in the different countries related to time-management and different teaching styles employed by lecturers. Transnational and interdisciplinary education provided this group of students the opportunity to enhance various professional attributes. Their willingness to learn from others provided them with valuable insight about the diverse nature of different population groups and their cultural differences. Without this understanding, poor communication, intolerance and prejudice might create barriers to optimal treatment or education of a client/community requiring professional advice. Students applied their newly acquired knowledge about human rights principles and the link with nutrition by utilising teaching opportunities, and indicated that they intended to incorporate a human rights approach in future endeavours. Conclusion The interdisciplinary NOMA Track module empowered a group of students to utilise the principles of a human rights-based approach in an appropriate manner. NOMA students developed an understanding of their new role as nutrition professionals, being challenged to interact in a globalized world if they want to make a meaningful contribution to the realisation of the right to food for all. Lessons learned from the implementation of the module will be useful to inform further decision-making on how to integrate a focus on human rights into training in nutrition at Stellenbosch University. / AFRIKAANSE OPSOMMING: Persepsies van Meesterstudente oor die NOMAb-opsie module oor ‘Voeding, Menseregte en Bestuur’ Inleiding en Doelwitte Die interdissiplinêre NOMA-module opsie oor ‘Voeding, Menseregte en Bestuur’ is gesamentlik ontwikkel deur vier hoër opleidingsinstansies in drie lande: Noorweë, Suid Afrika en Uganda. Die module is geïnkorporeer in die toepaslike meestersgraadkursusse in voeding. Dit het bestaan uit drie studie-eenhede wat elkeen 6 weke geduur het (in totaal 18 weke) en opeenvolgend aangebied is in die drie lande. Doelwitte Die hoofdoel van die studie was om persepsies van meesterstudente wat die module voltooi het te dokumenteer. Die doel was om sodanige persepsies oor die studie-eenhede in verskillende lande te vergelyk, om te dokumenteer op watter wyse studente verwag om die nuwe kennis te benut en om aanbevelings te maak vir die ontwikkeling van soortgelyke interdissiplinêre modules. Metode ‘n Dwarssnit studieontwerp met ‘n gemengde metode benadering is gevolg. Die steekproefraamwerk het bestaan uit alle geregistreerde studente wat ingeskryf het vir die module. Ingeligde, geskrewe toestemming vir vrywillige deelname asook om stemopnames van onderhoude te maak, is van alle deelnemers verkry. Data is onttrek uit studente se kwantitatiewe evaluering van elke studie-eenheid. ‘n Metodologiese benadering van interpretasie is gevolg om ‘n narratiewe weergawe van studente se persepsies te ontlok gedurende in-diepte telefoniese onderhoude. Temas is induktief geïdentifiseer en ‘n ooreenstemmende kodelys is gebruik om ongestruktureerde data te analiseer met ʼn teksanalise rekenaarprogram. Resultate Twintig NOMA studente, ingeskryf by verskillende universiteite, het deelgeneem aan die studie. Die module is beskryf as ʼn lewensveranderende ondervinding. Die wyse waarop die module gestruktureer en aangebied is in beide ontwikkelde en ontwikkelende lande, is hoog op prys gestel. Die interaktiewe onderrigstyl het die leerervaring optimaal bevorder. Aanbiedings deur verskeie kundiges en studiebesoeke het daartoe bygedra dat teoretiese menseregte-beginsels verbreed is deur praktiese voorbeelde te verskaf. Die implementering van hierdie beginsels onder verskillende omstandighede is vergelyk. Die grootste verskille tussen die studie-eenhede in die onderskeie lande het verband gehou met tydsbesteding en dosente se verskillende onderrigstyle. Transnasionale en interdissiplinêre onderrig het hierdie groep studente geleentheid gegun om verskeie professionele vaardighede te ontwikkel. Hul bereidheid om by ander te leer het waardevolle insae gegee in die diverse aard van verskillende populasiegroepe en kultuurverskille. Daarsonder kon struikelblokke ontstaan het weens swak kommunikasie, onverdraagsaamheid en vooroordele. Dit kan verhoed dat optimale behandeling of onderrig verskaf word aan ʼn kliënt/gemeenskap wat professionele advies benodig. Studente het hul nuut-verworwe kennis oor menseregte-beginsels en die verband met voeding toegepas in onderriggeleenthede en het onderneem om ‘n menseregte-benadering te volg in toekomstige ondernemings. Gevolgtrekking Die interdissiplinêre NOMA-module opsie het ʼn groep studente bemagtig om die beginsels van ʼn menseregte-benadering op ʼn toepaslike wyse te gebruik. NOMA studente verstaan nou hul nuwe rol as kundiges in voeding, naamlik dat hulle uitgedaag word tot interaksie in ʼn globaliserende wêreld, as hulle ʼn merkbare bydrae wil lewer tot die verwesenliking van die reg tot voldoende voedsel vir almal. Lesse wat geleer is uit die implementering van die module sal waardevol wees wanneer daar besluite geneem word oor die beste manier waarop ʼn menseregte fokus ingesluit kan word in voeding-opleiding by Stellenbosch Universiteit.

Thesis (Mnutr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Inappropriate feeding practices are a major cause of malnutrition in young children. Within this context, it has been well documented that the incidence of malnutrition rises sharply during the period from six to 18 months of age in most countries. Complementary feeding typically covers the period from six to 24 months of age. Renewed focus has been placed on the promotion of breastfeeding. Similar attention should be paid to complementary feeding. Six percent of deaths per year are preventable through good complementary feeding practises. To improve infant nutrition it is important to know the local infant and young child feeding practises present in communities but also to identify and understand the underlying factors that influence these practises. Aim The study aimed to describe the various factors that influence complementary feeding practices of infants aged 6 – 12 months in 2 communities (Avian Park and Zweletemba) in the Breede Valley district of the Western Cape. Methods The study was conducted from May – July 2012. A descriptive study design was used. A qualitative approach was followed with the use of focus group discussions with mothers / primary caregivers, fathers and grandmothers of infants aged 6 – 12 months. Results The findings of this study provide insight into different aspects regarding early cessation of breastfeeding that could lead to early introduction of complementary foods. In both Avian Park and Zweletemba the age of introduction of liquids and solids ranged from birth to 12 months. Various liquids such as water, over the counter medicine, high concentrated sugar beverages and low nutrient beverages were given to infants from as young as two days post-partum by means of a feeding bottle. Cow’s milk was also introduced before six months of age for reasons such as affordability, availability and because cow’s milk does not need boiling water for reconstitution like formula milk, especially when access to electricity is inadequate. Infants from both communities also received meelbol (flour and water beverage) fed either via feeding bottles (as a beverage) or as porridge fed to the infant with a spoon. Porridge (especially rice cereal and maize meal porridge) was introduced to infants from one week post-partum and infants from both areas also received family “food from the pot” before the age of 6 months. In this study it was found that it was most often a female (either the mother or the grandmother) in the household who was responsible for buying and preparing food and for feeding the infant. Health care workers, members of the mothers’ household as well as community members were identified as key role players in conveying information regarding breastfeeding and complementary feeding from birth to 1 year. Various factors were identified in this study that influenced suboptimal infant feeding practises in Avian Park and Zweletemba. The main factors identified were i) health, ii) physiological, iii) nutritional, iv) educational, v) behavioural, vi) financial and vii) social factors. Other aspects mentioned were viii) demographic and x) commercial factors. Conclusion Results indicated that the current practices and factors influencing the feeding practices in Avian Park and Zweletemba were similar there was very little to no cultural differences between the two communities in terms of current practices and influencing factors. The findings of this study have highlighted the importance of involving all household members in interventions, as well as the larger community in a public nutrition approach. Factors influencing current feeding practises should be considered carefully when planning future interventions to improve infant feeding practises. / AFRIKAANSE OPSOMMING: Onvanpaste voedingspraktyke is ‘n groot oorsaak van wanvoeding in jong kinders. Binne hierdie konteks is dit goed gedokumenteer dat die voorkoms van wanvoeding skerp styg gedurende die tydperk vanaf ses tot 18 maande ouderdom in die meeste lande. Komplimentêre voeding dek tipies die tydperk van ses tot 24 maande oud. Hernude fokus word geplaas op die bevordering van borsvoeding. Komplimentêre voeding behoort soortgelyke aandag te kry. Ses persent van sterftes per jaar is voorkombaar deur goeie komplimentêree voedingpraktyke. Om kindervoeding te verbeter is dit belangrik om bekend te wees met plaaslike baba- en jong kind praktyke in gemeenskappe, en ook om die onderliggende faktore wat hierdie praktyke beïnvloed te identifiseer en verstaan. Doelwit Hierdie studie het gepoog om die verskillende faktore ten opsigte van die komplimentêre voeding praktyke van babas tussen 6 – 12 maande te beskryf in 2 gemeenskappe (Avian Park en Zweletemba) in die Breede Vallei distrik van die Wes-Kaap. Metodes Die studie is uitgevoer vanaf Mei – Julie 2012. ‘n Beskrywende studie ontwerp is gebruik. ‘n Kwalitatiewe benadering is gevolg met die gebruik van fokusgroepbesprekings met moeders / primêre versorgers, vaders en oumas van babas tussen 6 – 12 maande. Resultate Die bevindinge van hierdie studie voorsien insae in die verskillende aspekte van die vroeë beëindiging van borsvoeding wat kan lei tot vroeë bekendstelling van komplimentêre voeding. In beide Avian Park en Zweletemba het die ouderdomme van insluiting van vloeistowwe en vaste stowwe gewissel van geboorte tot 12 maande.Verskeie vloeistowwe soos water, oor-die-toonbank-medisyne, hoë konsentrasie suiker drankies en lae voedingswaarde drankies was aan babas gegee so vroeg as twee dae post-partum deur middel van ‘n voedingsbottel. Koeimelk was ook gegee voor 6 maande, om redes soos bekostigbaarheid, beskikbaarheid en omdat koeimelk nie kookwater benodig vir hersamestelling soos formule melk nie, veral in situasies waar toegang tot elektrisiteit onvoldoende is. Babas van beide gemeenskappe was ook meelbol (meel en water drankie) gevoer óf via voedingsbottels (as ‘n vloeistof) of as ‘n pap wat gevoer word met ‘n lepel. Pap (veral ryspap en mieliemeelpap) was gegee vanaf een week post-partum en babas van beide gebiede het ook familie kookkos ontvang “vanuit die pot” voor 6 maande. In hierdie studie is bevind dat dit heel dikwels ‘n vrou (óf die moeder of ouma) in die huishouding is wat verantwoordelik is vir die koop en voorbereiding van voedsel asook die voer van die baba. Gesondheidswerkers, lede van die moeder se huishouding sowel as lede van die gemeenskap is geïdentifiseer as belangrike rolspelers in die oordrag van inligting oor borsvoeding en komplimentêre voeding vanaf geboorte tot een jaar. Die belangrikste faktore geïdentifiseer was verwant aan: i) gesondheid, ii) fisiologie, iii) voedingswaarde , iv) opvoedkunde, v) gedrag, vi) finansies en vii) sosiale faktore. Ander aspekte genoem is: vii) demografiese en x) kommersiële faktore. Gevolgtrekking Resultate het aangedui dat die huidige voedingpraktyke soortgelyk was in Avian Park en Zweletemba en dat daar baie min kulturele verskille tussen die twee gemeenskappe was in soverre huidige praktyke en faktore wat dit beïnvloed. Die bevindinge van hierdie studie het die belangrikheid daarvan uitgelig om al die lede van die huishouding, sowel as die breër gemeenskap in te sluit in intervensies met ‘n openbare voeding benadering. Faktore wat die huidige babavoeding praktyke beïnvloed moet versigtig oorweeg word tydens die beplanning van toekomstige intervensies om babavoeding praktyke te verbeter.

Thesis (MNutr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Introduction and purpose The aim of the study was to determine the renal handling of a once-off bolus dietary protein load in patients treated for nephroblastoma. Patients who have been managed for nephroblastoma always have suboptimal amounts of kidney tissue as a result of their medical management which includes nephrectomies, chemotherapy and or radiotherapy. Little data are available indicating the extent of renal impairment expected in such patients as a result of their disease and management. The study was to determine whether the use of regular screening tests such as serum urea, creatinine and urine microalbumin, in conjunction with a dietary protein load could help detect early progressive deterioration of kidney function in nephroblastoma patients. Methodology The study was a quantitative non-randomised intervention study in which patients served as their own control before and after a protein load. Thirty-four participants were included in the study. Each participant was provided with a supplemental protein drink providing 2 g/kg body weight of protein. Serum creatinine, urea and urine microalbumin were assessed at baseline and four hours after the intervention. These pre- and post intervention biochemical values were then analysed together with descriptive data relating to the participants, such as age, stage of nephroblastoma, aspects of medical management and the period of time since they had been treated for nephroblastoma, and statistical relationships were assessed. Data were collected from May 2010 to November 2010. Results Descriptive statistics indicated that the mean [± Standard deviation (SD)] age of the population was 92 (± 55) months, the mean age at diagnosis was 41 (± 27) months and the mean age from the diagnosis to the time of the study was 51 (± 53) months. There was a statistically significant increase (p = 0.00) in serum urea post intervention; however, no significant difference was noted between pre- and post intervention serum creatinine and urine microalbumin values. The stages of nephroblastoma failed to show a statistical correlation with the response to the dietary protein bolus load in terms of the difference in pre- and post intervention biochemical data. No statistical correlation was found between post-pubescence and response to the protein load. Similiarly, no statistical correlation could be demonstrated for a longer period between the diagnosis and the time of this study, on the one hand, and the prevalence of high values in the biochemical data, on the other. Conclusion The study was unable to demonstrate statistically that participants managed for nephroblastoma had poor renal handling of a once-off dietary protein load in terms of the objectives specified. The study had limitations including a small population with even smaller subgroups of participants, therefore results of the study need to be interpreted in context to the size of the population. / AFRIKAANSE OPSOMMING: Doel Die doel van die studie was om die renale hantering van ’n eenmalige bolus dieetproteïenlading by pasiënte wat vir nefroblastoom behandel word, te bepaal. Pasiënte wat vir nefroblastoom behandel word, het altyd ‘n subopitmale hoeveelheid nierweefsel as gevolg van hulle mediese behandeling wat nefrektomies, chemoterapie en / of radioterapie insluit. Min data is beskikbaar omtrent die omvang van die nierbelemmering wat in sulke pasiënte verwag word as gevolg van hulle siekte en behandeling. Die studie is uitgevoer om te bepaal of die gebruik van gereelde siftingstoetse soos serum-ureum, kreatinien en mikroalbuminurie, in samewerking met ‘n dieetproteïenlading, kan help om vroeë progressiewe agteruitgang van nierfunksie in nefroblastoom pasiënte, op te spoor. Metodologie Die studie was ‘n kwantitatiewe nie-ewekansige intervensie studie waar pasiënte as hul eie kontrole gedien het voor en na ‘n proteïenlading. Altesaam 34 deelnemers is by die studie betrek. Elke deelnemer het ’n proteïenaanvullingsdrankie ontvang wat 2 gram proteïen per kilogram liggaamsgewig voorsien het. Serumkreatinien, serum-ureum en mikro-albuminurie is op die basislyn sowel as vier uur na die intervensie gemeet. Hierdie biochemiese waardes voor en na die intervensie is daarna saam met beskrywende data van die deelnemers – soos ouderdom, stadium van nefroblastoom, aspekte van mediese behandeling en tydsverloop sedert behandeling vir nefroblastoom – ontleed. Statistiese verwantskappe is vervolgens beoordeel. Data is vanaf Mei 2010 tot November 2010 ingesamel. Resultate Beskrywende statistieke het op ’n gemiddelde [± Standaard afwyking (SA)] populasie-ouderdom van 92 (± 55) maande, ’n gemiddelde diagnose-ouderdom van 41(± 27) maande en ’n gemiddelde ouderdom van 51(± 53) maande vanaf diagnose tot en met die studie gedui. Ná die intervensie is ’n statisties beduidende toename (p = 0.00) in serum-ureum opgemerk, hoewel daar geen beduidende verskil in serumkreatinien en mikro-albuminurie waardes, voor en na behandeling, was nie. Biochemiese data voor en na die intervensie het geen statistiese verwantskap tussen die stadium van nefroblastoom en die reaksie op die dieetproteïenlading getoon nie. Boonop is geen statistiese verwantskap opgemerk tussen post-pubesensie en die reaksie op die proteïenlading, of tussen ’n langer tydsverloop tussen die diagnose en die studie en die voorkoms van hoë waardes in die biochemiese data nie. Gevolgtrekking Wat die studie-doelwitte betref, kon die navorsing nie statisties bewys dat deelnemers wat vir nefroblastoom behandel word, swak renale hantering van ’n eenmalige dieetproteïenlading toon nie. Die beperkinge van die studie sluit ‘n klein populasie met selfs kleiner subgroepe in; die resultate van die studie moet derhalwe in die konteks van die grootte van die populasie, geÏnterpreteer word.