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

Thesis (MNutr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Objectives: To measure the impact on nutrition knowledge; to ascertain the opinions and practices related to nutrition and physical activity, tuck shop visits, and dietary quality of Grade 4 learners; as well as the perceptions on and acceptability of the ‗Fun Food Game‘ (FFG) as nutrition education tool as evaluated in selected Grade 4 learners and educators. Design: A before-after, experimental study with analytical components. Setting: A purposive sample of four schools in the City of Cape Town district of the Western Cape province. Schools A and B in a higher socio-economic area served as intervention school (HIS) and control school (HCS), whereas schools C and D were in a lower socio-economic area and served as intervention school (LIS) and control school (LCS). Subjects: Grade 4 English-speaking boys (n=85), girls (n=90) and Life Orientation educators (n=10). Methods: Pre-tested questionnaires were used to determine change in nutrition knowledge, opinions and practices, both related to nutrition and physical activities in a pre-and post-setting, as well as the perceptions on and acceptability of FFG as a nutrition education (NE) tool for Grade 4 learners and educators. A ‗Dietary Diversity Questionnaire‘ was used to establish the ‗Dietary Diversity Score‘ (DDS), and to note tuck shop visits. Questionnaires were pre-tested in a pilot study. Results: Increased nutrition knowledge and improved opinion on nutrition and physical activities were measured in all schools, but practices related to nutrition and physical activities as well as visits to the tuck shop showed mixed results. In the pre- and post-setting, a DDS of 5 was measured in the HIS and HCS, with a DDS of 5 in the pre- and 6 in the post-setting in the LIS and LCS. Fewer learners had a DDS<4 in the post-setting. Consumption of most food groups and eating breakfast were higher in the post-setting. Bringing lunch boxes to school scored lower in the intervention schools. More tuck shop visits were reported in the LIS and LCS. Most (80% n=8) educators indicated a strong need for NE for themselves. All educators indicated self-learning as a means of familiarising themselves with the content of NE. Sources of nutrition advice included magazines (90% n=9), the Internet (80% n=8) and textbooks (70% n=7). A strong need for NE was expressed by all educators; however, they stated that it should not increase their work load. Educators ‗strongly agreed‘ that the educational nutrition board game FFG can be classified as ‗Health Promotion‘. Overall, learners indicated that playing FFG was a positive experience. Conclusion: Playing FFG and/or having an increased awareness regarding nutrition and physical activities at schools could have had a positive impact on nutrition knowledge and behaviour that could have resulted in positive behaviour, but no definite conclusion can be made in this regard. Nutrition behaviour was more positively influenced in the lower socio-economic schools. Implementing the Health Promoting Schools concept, where Nutrition Education Programmes form part of a multi-component strategy, is recommended. / AFRIKAANSE OPSOMMING: Doel: Om die impak van voedingskennis, opinies en praktyke verwant aan voeding en fisiese aktiwiteite, snoepiebesoeke asook dieetkwaliteit van Graad 4 leerders te bepaal, sowel as die persepsie en aanvaarbaarheid van ‗Fun Food Game‘ (FFG) as hulpmiddel in voedingsopleiding soos geëvalueer deur geselekteerde Graad 4 leerders en -onderwysers. Ontwerp: ‗n Voor-na, eksperimentele studie met analitiese komponente Omgewing: ‗n Doelbewuste groepskeuse van vier skole. Skole A en B in ‗n meer gegoede area het as intervensie skool (HIS) en kontrole skool (HCS) gedien, terwyl skole C en D in ‗n minder gegoede area as intervensie skool (LIS) en kontrole skool (LCS) gedien het in die Stad Kaapstad distrik van die Westelike Provinsie. Deelnemers: Graad 4 Engelssprekende seuns (n=85), dogters (n=95) en Lewensoriënteringsonderwysers (n=10) Metodes: Voorafgetoetsde vraelyste is gebruik om te bepaal of voedingskennis, opinies en praktyke beide verwant aan voeding en fisiese aktiwiteite, voor en na die studie verander het, asook die persepsie en aanvaarbaarheid van FFG as ‗n hulpmiddel in voedingsopleiding vir geselekteerde Graad 4 leerders en onderwysers. ‗n Dieetdiversiteit Vraelys (‗Dietary Diversity Questionnaire‘ – DDQ) is gebruik om ‗n Dieetdiversiteit Telling (‗Dietary Diversity Score‘ – DDS), sowel as snoepiebesoeke te bepaal. ‗n Loodsstudie is uitgevoer om die vraelyste te toets. Resultate: ‗n Toename in voedingkennis en verbeterde opinies oor voeding en fisiese aktiwiteite is in alle skole gevind, maar praktyke oor voeding en fisiese aktiwiteite, asook snoepiebesoeke het gemengde resultate getoon. In die voor- en na-toetsing is ‗n DDS van 5 in HIS en HCS bepaal, met ‗n DDS van 5 in die voor- en 6 in die na-toetsing in LIS en LCS. Minder leerders het ‗n DDS<4 in die na-toetsing gehad. Inname van die meeste voedselgroepe sowel as ontbyt het in die skole toegeneem. Die bring van kosblikke het in die intervensie skole verminder. Die hoogste frekwensie snoepiebesoeke kom voor by die LIS en LCS. Meeste (80% n=8) onderwysers het ‗n sterk behoefte aan voedingsopleiding vir hulself aangedui. Alle onderwysers dui aan dat die inhoud van voedingskennis deur selfleer verhoog word. Tydskrifte (90%, n=9), Internet (80%, n=8) en handboeke (70%, n=7) word as bronne van voedingsadvies beskryf. ‗n Sterk behoefte vir opvoedkundige voedingsopleiding is deur al die onderwysers aangedui, maar sonder dat dit hul werkslading moet verhoog. Die onderwysers is ―sterk oortuig‖ daarvan dat die opvoedkundige voedingsbordspeletjie FFG, as ―Gesondheidsbevordering‖ geklassifiseer kan word. In die algemeen het leerders dit baie positief ervaar om FFG te speel. Samevatting: Die speel van FFG en/of ‗n groter bewusmaking van voeding en fisiese aktiwiteit wat by die skole plaasgevind het, kon ‗n positiewe impak op voedingskennis en -gedrag gehad het, wat kon lei tot positiewe gedrag, maar geen definitiewe gevolgtrekking kan gemaak word in die verband nie. Voedingsgedrag in die mindergegoede skole is meer positief beïnvloed. Implimentering van die Gesondheidsbevorderende Skole konsep, waar Voedingsopleidingsprogramme deel vorm van ‗n multi-komponent strategie, word aanbeveel.

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Research aim The study aimed to explore the associations between agricultural biodiversity, household food security and dietary diversity in households with children aged 24 to 59 months in two rural areas of Kenya, of which one had higher rainfall and agricultural biodiversity than the other. Methods Study sample and location The study adopted a cross-sectional analytical approach to investigate the associations in resource in poor households in two rural areas; Akithii and Uringu of Kenya. Of the 525 households randomly selected, 261 were from Uringu division and 264 from Akithii division. Two independent cross-sectional surveys were conducted; Phase one in September to October 2011 (during the dry season) while Phase 2 took place in March 2012 (during the rainy season). A questionnaire was developed to gather information on the socio-demographics of the household, breastfeeding and infant feeding practices, immunization and childhood illnesses. Dietary intake was measured during each season by conducting a repeated 24-hour recall (24-hr recall) with the mother/care giver of the household. A nutrient adequacy ratio (NAR) was calculated for each nutrient as the percent of the nutrient meeting the recommended dietary intake (RDI) value for that nutrient. A mean adequacy ratio (MAR) was calculated for 11 nutrients as the mean of the NARs of these nutrients. Dietary diversity was measured using data from the 24-hour recalls and classifying it into nine food groups. A dietary diversity score (DDS) was calculated based on each different food group which was consumed during the period of recall up to a maximum of nine if the food had been consumed from each of the nine groups. Household food security (HFS) was measured using the Household Food Insecurity Access Scale (HFIAS). The agricultural biodiversity was calculated by counting the number of different crops and animals eaten either from domestic sources or from the wild. Weight and height measurements of children and their mothers/care givers were taken. Weight for age (WAZ), height for age (HAZ) and weight for height z (WHZ) scores were determined for children, while body mass index (BMI) measurements were calculated for the adult women. The relationships between continuous response variables and nominal input variables were analyzed using appropriate analysis of variance (ANOVA) or pooled, paired and independent mean T-tests when only two groups were involved. Results Dietary intake was low with the majority of households not meeting the RDIs for most nutrients. The MAR was 61.3%; 61.8% for Phase 1 and 2 respectively. The DDS was low at 3.3 ±1.2 for both Phases. The majority of households were food insecure with a HFIAS mean of 12.8 ± 6.19 and 10.9 ± 7.49 for Phase 1 and 2 respectively. Agricultural biodiversity was low with a total of 26 items; 23 domesticated and 3 from the natural habitat. Two food items from the natural habitat originated from plants and one from animals. Exclusive breastfeeding up to the recommended six months was practiced at low rates of 23.4% while 39.3% of mothers in both divisions introduced complementary foods before 6 months of age. Stunted growth among the children was high at a mean of 30.5% (n=291). Boys had higher stunted growth rates in both divisions compared to the girls. A significant positive relationship was established between the number of contributors to household income with height for age z-scores (HAZ) scores of the children (Spearman r=-0.15, p=0.02). The number of household assets also significantly influenced HAZ scores (Spearman r=-0.17, p=0.01), the higher the number of household assets, the lower HAZ scores were. During Phase 1 (dry season) (pooled t-test, p<0.001), levels of food insecurity were higher compared to Phase 2 (wet season) (pooled t-test, p<0.001); showing the influence of season on food security. Phases 1 & 2 showed that Akithii had a significantly higher level of food insecurity (Mann-Whitney U; p<0.01), and a lower DDS (chi-square test, p<0.001) compared to Uringu. Children in Akithii consumed a less diversified diet than those in Uringu. Agricultural biodiversity was positively and significantly related to: HFIAS (Spearman r=-0.10, p=0.02); DDS (ANOVA, p<0.001); all NARs (Spearman, p<0.05) and MAR (Spearman, p<0.001).This implies that households with higher agricultural biodiversity were more likely to be food secure, have higher dietary diversity levels and a diet comprising a higher nutritional value. DDS was significantly correlated to MAR and NARs of all the nutrients studied in this study. Findings showed that DDS was also consistently significantly inversely correlated to Household Food Insecurity Access Prevalence (HFIAP) (R =-0.185, t (N-2)-3.889), p=0.0001). This correlation showed that an increase in dietary diversity inversely affected HFIAS. A significant relationship was found between HFIAP and MAR (ANOVA, p=0.00268); indicating that households with a higher MAR were more likely to be food secure. There was a significant correlation between the BMI of the mother/care giver and the WAZ scores of the children (r=0.1410, p<0.001); indicating that higher HAZ scores were found in mothers with higher mean BMI values. There was a significant difference between households with and without children with stunted growth in DDS (ANOVA; p=0.047) and HFIAS (ANOVA; p=0.009) but not with agricultural biodiversity score (ANOVA; p=0.486). The agricultural biodiversity mean score for households with children presenting with stunted growth were, however, lower at 6.8, compared to 7.0 for those with normal growth however the p value was not significant. This indicates that households with children with stunted growth and those without are significantly different in DDS and HFIAS but not regarding agricultural biodiversity. This further implies that the potential of DDS and HFIAS to be used as proxy measures for stunting be further explored. Conclusion Agricultural biodiversity has a positive impact on household food security, dietary diversity, dietary adequacy and child growth. Food security is closely linked to dietary diversity and dietary adequacy; therefore improving one is likely to improve the other two and impact positively on child growth status. Interventions to improve child health and food security in resource poor rural households should aim at increasing dietary diversity through agricultural biodiversity. / AFRIKAANSE OPSOMMING: Navorsingsdoel Die studie is daarop gemik om die assosiasies tussen die landbou-biodiversiteit, huishoudelike voedselsekerheid en dieetdiversiteit in huishoudings met kinders tussen die ouderdomme van 24 tot 59 maande in twee landelike gebiede van Kenia, waarvan een 'n hoër reënval en landbou-biodiversiteit as die ander gehad het, te verken. Metodes Studie steekproef en plek Die studie het 'n deursnit-analitiese benadering aangeneem om die assosiasies te ondersoek in hulpbron-arm huishoudings in twee landelike gebiede; Akithii en Uringu van Kenia. Van die 525 huishoudings wat ewekansig gekies is, was 261 van Uringu afdeling en 264 van Akithii afdeling. Twee onafhanklike deursnit-opnames is uitgevoer; fase een in September tot Oktober 2011 (tydens die droë seisoen), terwyl Fase 2 in Maart 2012 (gedurende die reënseisoen) plaasgevind het. 'n Vraelys is ontwikkel om inligting oor die sosio-demografie van die huishouding, borsvoeding en babavoeding praktyke, immunisering en kindersiektes in te samel. Dieetinname is gemeet tydens elke seisoen deur die uitvoer van 'n herhaalde 24-uur herroep met die moeder / versorger van die huishouding. 'n Voedingstof toereikendheidsverhouding (VTR) is bereken vir elke voedingstof, uitgedruk as die persentasie van die voedingstof wat voldoen aan die aanbevole dieetinname (ADI) waarde vir daardie voedingstof. 'n Gemiddelde toereikendheidsverhouding (GTR) is bereken vir 11 voedingstowwe uitgedruk as die gemiddelde van die VTR‘s van hierdie voedingstowwe. Dieetdiversiteit is gemeet deur data vanuit die 24-uur herroepe, geklassifiseer in nege voedselgroepe. 'n Dieetdiversiteit telling (DDT) is bereken op grond van elke verskillende voedselgroep wat gedurende die tydperk van herroep ingeneem is tot 'n maksimum van nege, indien die voedsel verbruik is uit elk van die nege groepe. Huishoudelike voedselsekerheid (HVS) is gemeet deur die huishoudelike voedselonsekerheid toegangskaal (HVOTS) te gebruik. Die landbou-biodiversiteit is bereken deur die som te bereken van die aantal verskillende gewasse en diere geëet óf van huishoudelike bronne óf uit die natuur. Gewig en lengte metings is geneem van die kinders en hul moeders / versorgers. Gewig vir ouderdom (GVO), lengte vir ouderdom (LVO) en gewig vir lengte (GVL) Z-tellings is bepaal vir die kinders, terwyl die liggaamsmassa-indeks (LMI) metings bereken is vir die volwasse vroue. Die verhoudings tussen aaneenlopende reaksie veranderlikes en nominale inset veranderlikes is ontleed met behulp van toepaslike analise van variansie (ANOVA) of saamgevoegde, gepaarde en onafhanklike gemiddelde T-toetse, indien slegs twee groepe betrokke was. Resultate Dieetinname was laag en die meerderheid van huishoudings het nie aan die ADIs vir die meeste voedingstowwe voldoen nie. Die GTR is 61,3% en 61,8% vir onderskeidelik fase 1 en 2. Die DDT is laag; 3,3 ±1,2 vir beide fases. Die meerderheid van huishoudings was voedselonseker met 'n gemiddelde HVOST van 12,8 ±6,19 en 10,9 ±7,49 vir onderskeidelik fase 1 en 2. Landbou-biodiversiteit was laag met 'n totaal van 26 items, 23 huishoudelike en 3 vanuit die natuurlike habitat. Twee voedselitems uit die natuurlike habitat was afkomstig van plante en een vanaf diere. Eksklusiewe borsvoeding, tot die aanbevole ses maande, was laag en beoefen deur 23,4%, terwyl 39,3% van die moeders, in beide streke, komplimentêre voedsel voor 6 maande ouderdom bekendgestel het. Vertraagde groei onder die kinders was hoog met 'n gemiddeld van 30,5% (n=291). Seuns het hoër vertraagde groei in beide streke in vergelyking met dogters getoon. ʼn Beduidende positiewe verhouding is gevind tussen die aantal bydraers tot huishoudelike inkomste en lengte vir ouderdom z-tellings (LOZ) van die kinders (Spearman r=-0,15, P=0,02). Die aantal huishoudelike bates het ook LOZ tellings (Spearman r=-0,17, P=0,01) aansienlik beïnvloed; hoe hoër die aantal huishoudelike bates, hoe laer die LOZ tellings. Tydens fase 1 (droë seisoen) (saamgevoegde t-toets, p<0.001), was vlakke van voedselonsekerheid hoër in vergelyking met fase 2 (nat seisoen) (saamgevoegde t-toets, p <0.001), wat die invloed van die seisoenaliteit op voedeselsekerheid uitwys. Fase 1 en 2 het gewys dat Akithii ʼn beduidende hoër vlak van voedselonsekerheid gehad het (Mann-Whitney U; p<0.01) en ʼn laer DDT (chi-square toets, p<0.001) in vergelyking met Uringu. Kinders in Akithii het ʼn dieet laer in diversiteit ingeneem as die in Uringu. Landbou-biodiversiteit is positief en beduidend verwant aan: HVOTS (Spearman r = -0,10, P = 0,02); DDT (ANOVA, p<0.001), alle VTR‘s (Spearman, p <0.05) en GTR (Spearman, p <0.001). Dit impliseer dat huishoudings met 'n hoër landbou-biodiversiteit, meer geneig is om voedselseker te wees, hoër dieetdiversiteit vlakke en ʼn hoër voedingswaarde het. DDT is beduidend gekorreleer aan GTR en VTT‘s van al die voedingstowwe wat bestudeer is in hierdie studie. Bevindinge het getoon dat DDT konsekwent en beduidend omgekeerd gekorreleer is met huishoudelike voedselonsekerheid toegang prevalensie (HVOTP) (R=-0,185, t(N-2)-3,889), p=0,0001). Hierdie korrelasie toon dat 'n toename in dieetdiversiteit HVOTS omgekeerd beïnvloed het. ʼn Betekenisvolle verhouding is gevind tussen HVOTP en GTR (ANOVA, p=0,00268); wat aandui dat huishoudings met 'n hoër GTR meer geneig is om voedselsekerheid te toon. Daar is 'n beduidende korrelasie tussen die LMI van die moeder / versorger en die GOZ tellings van die kinders (r=0,1410, p<0.001), wat aandui dat hoër LOZ tellings gevind is in moeders met hoër gemiddelde LMI waardes. Daar is 'n beduidende verskil tussen huishoudings met en sonder kinders met dwerggroei se DDT (ANOVA; p=0.047) en HVOTS (ANOVA; p=0.009) maar nie die landbou-diversiteit telling nie (ANOVA; p=0.486). Die gemiddelde landbou-diversiteit telling vir huishoudings met en sonder kinders met dwerggroei is egter laer met 6.8 in vergelyking met 7.0 vir die met normale groei. Die p-waarde is egter nie beduidend nie. Dit dui aan dat huishoudings met kinders met dwerggroei en daarsonder beduidend verskillend is ten opsigte van DDT en HVOTS, maar nie met landbou-diversiteit in die studie nie. Dit impliseer verder dat die potensiaal van DDT en HVOTS om gebruik te word as alternatiewe metings vir dwerggroei verder ondersoek moet word. Gevolgtrekking Landbou-biodiversiteit het 'n positiewe impak op huishoudelike voedselsekerheid, dieetdiversiteit, dieettoereikendheid en groei van kinders. Voedselsekerheid is nou gekoppel aan dieetdiversiteit en dieettoereikendheid, daarom sal die verbetering van die een waarskynlik die ander twee positief beïnvloed asook ʼn positiewe impak hê op die groei van kinders. Intervensies vir die verbetering van kindergesondheid en voedselsekerheid in hulpbron-arm landelike huishoudings moet poog om dieetdiversiteit te verhoog deur landbou-biodiversiteit.

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Introduction: An association between maternal human immunodeficiency virus (HIV) infection and Necrotizing Enterocolitis (NEC) in preterm infants has been reported. The impact of probiotics in an HIV-exposed very low birth weight (VLBW) infant on the occurrence of NEC is uncertain at present; however it is known that probiotics have protective effects against inflammation and prevent NEC. Postnatal growth restriction is a major issue in preterm, especially extremely-low-birth-weight (ELBW) infants and probiotics have been found to improve feeding tolerance in preterm infants. Human milk oligosaccharides (HMO) also known as the prebiotics of human milk, are known to have bifidogenic and anti-adhesive effects. Infants that receive human milk show a reduced incidence of NEC compared to those who receive infant formula. Very little is known about the composition of breast milk in the HIV-infected mother. Objective: The primary objective of the study was to assess the effect of probiotics on the incidence and severity of NEC in high-risk infants born to HIV-positive and HIV-negative women. The secondary objectives were to assess the effect of probiotic administration on feeding tolerance and growth outcomes of HIV-exposed but uninfected preterm infants, to describe the HMO composition of HIV-infected mothers breast milk and lastly to determine if HMO composition affects the incidence of NEC in HIV-exposed preterm very low birth weight infants. Patients and Methods: A randomized, double blind, placebo controlled trial was conducted for the period July 2011 to August 2012. HIV-exposed and HIV-unexposed premature (<34 weeks gestation) infants with a birth weight of ≥500g and ≤1250g were randomized to receive either a probiotic or a placebo. The probiotic consisted of 1x109 CFU, L. rhamnosus GG and B. infantis per day and was administered for 28 days. NEC was graded according to Bell’s criteria. Anthropometrical parameters and daily intakes were monitored. Breats milk samples were analysed for oligosaccharide content. Results: 74 HIV-exposed and 110 HIV-unexposed infants were enrolled and randomized (mean birth-weight, 987g; mean gestational 28.7 weeks). The incidence of death and NEC did not differ significantly between the HIV-exposed and unexposed groups but a significantly higher NEC incidence was found in the control group. There was no difference in the average daily weight gain for treatment groups or HIV exposure. The HIV-exposed group achieved significantly higher z-scores for length and head circumference at day 28 than the unexposed group (p<0.01 and p=0.03, respectively). There were no differences in the incidence of any signs of feeding intolerance and abdominal distension between the groups. Our results show significantly higher absolute concentrations of 2’-fucosyllactose, laco-N-tetraose and lacto-N-fucopentaose 1 and higher relative abundance of 3’-sialyllactose, difucosyl-lacto-N-tetraose and fucosyl-disialyllacto-N-hexaose in HIV-infected compared to -uninfected Secretor women. DSLNT concentrations were significantly lower in the breast milk of mothers whose infants developed NEC compared to infants without NEC. Conclusion: Probiotic supplementation reduced the incidence of NEC in the premature infants; however results failed to show a lower incidence of NEC in HIV-exposed premature infants. Probiotic supplementation did not affect growth outcomes or the incidence of any signs of feeding intolerance in HIV-exposure. The data confirms previous reports that HIV-infected mothers have higher 3’sialyllactose milk concentrations. Most intriguing though, the data also indicates that low levels of DSLNT in the mother’s milk increase the infant’s risk for NEC, which is in accordance with results from previously published animal studies and warrants further investigation. / AFRIKAANSE OPSOMMING: Inleiding: ʼn Verwantskap tussen moederlike menslike immuniteitsgebreksvirus (MIV) en nekrotiserende enterokolitis (NEK) in premature babas is aangemeld. Die impak van probiotika in ʼn MIV-blootgestelde baie lae geboortemassa (BLGM) baba op die voorkoms van NEK is tans nog onseker, maar dit is wel bekend dat probiotika ʼn beskermende effek het teen inflammasie en die voorkoms van NEK. Nageboortelike groei beperkings is ʼn groot probleem in premature, veral ekstreme lae geboortemassa (ELGM) babas. Daar is gevind dat probiotika voeding toleransie in premature babas kan verbeter. Menslike melk oligosakkariede (MMO), ook bekend as die prebiotika van menslike melk, is bekend om bifidogeniese en anti-kleef effekte te hê. Babas wat moedersmelk ontvang toon ʼn verlaagde voorkoms van NEK in vergelyking met diegene wat baba formule melk ontvang. Baie min inligting is bekend oor die samestelling van borsmelk in die MIV-positiewe moeder. Doel: Die primêre doel van die studie was om die effek van probiotika op die voorkoms en die graad van NEK in hoë risiko babas van MIV-positiewe en MIV-negatiewe vroue te bepaal. Die sekondêre doelwitte was om die effek van probiotika op voeding verdraagsaamheid en groei uitkomste van MIV-blootgestelde, maar nie- geinfekteerde premature babas te evalueer sowel as die MMO samestelling van MIV-positiewe moeders se borsmelk te beskryf en laastens om die invloed van die MMO samestelling op die voorkoms van NEK in baie lae geboortegewig MIV-blootgestelde premature babas te beskryf. Pasiënte en Metodes: ʼn Gerandomiseerde, dubbelblinde, plasebo-beheerde studie is vir die tydperk Julie 2011 tot Augustus 2012 onderneem. MIV-blootgestelde en nie-blootgestelde premature (<34 weke) babas met 'n geboorte gewig van ≥500g en ≤1250g was ewekansig verdeel om probiotika of plasebo te ontvang. Die probiotika het bestaan uit 1x109 kolonie vormende eenhede, L. rhamnosus GG en B. infantis per dag en is toegedien vir 28 dae. NEK is gegradeer volgens Bell se kriteria. Antropometriese parameters en daaglikse inname is gemonitor. Borsmelk monsters is geanaliseer vir oligosakkaried inhoud. Resultate: 74 MIV-blootgestelde en 110 MIV-nie-blootgestelde babas is ingesluit en ewekansig ingedeel (gemiddelde geboorte gewig, 987g, gemiddelde gestasie 28,7 weke). Die voorkoms van die sterftes en NEK het nie beduidend verskil tussen die MIV-blootgestelde en nie-blootgestelde groepe nie, maar 'n beduidende verskil is gevind vir NEK voorkoms tussen die studie en die kontrole groep. Daar was geen verskil in die gemiddelde daaglikse gewigstoename tussen die behandelings groepe of MIV-blootstelling nie. Die MIV-blootgestelde groep het beduidend hoër z-tellings vir lengte en kopomtrek op dag 28 getoon teenoor die nie-blootgestelde groep (p <0.01 en p = 0,03, onderskeidelik). Daar was geen verskille in die voorkoms van voeding onverdraagsaamheid en abdominale distensie tussen die twee groepe nie. Ons resultate dui op aansienlik hoër absolute konsentrasies van 2'-fucosyllactose, laco-N-tetraose en lakto-N-fucopentaose 1 en hoër relatiewe voorkoms van 3'-sialyllactose, difucosyl-lakto-N-tetraose en fucosyl-disialyllacto-N-hexaose in MIV-positiewe vroue in vergelyking met-negatiewe Sekretor vroue. DSLNT konsentrasies was aansienlik laer in die melk van moeders wie se babas NEK ontwikkel het in vergelyking met babas sonder NEK. Gevolgtrekking: Probiotika aanvullings verminder die voorkoms van NEK in premature babas, maar die resultate kon nie ʼn laer voorkoms van NEK in MIV-blootgestelde premature babas bewys nie. Probiotiese aanvulling het geen invloed op groei uitkomste of die voorkoms van voeding onverdraagsaamheid in MIV-blootstelling getoon nie. Die data bevestig vorige verslae wat aandui dat MIV-besmette moeders hoër 3'sialyllactose borsmelk konsentrasies het. ʼn Interessante aspek is dat lae vlakke van DSLNT in die moeder se melk beduidend is van ʼn verhoogde risiko vir NEK, wat in ooreenstemming is met die resultate uit voorheen gepubliseerde dier studies en regverdig verdere ondersoeke.

Thesis (Mnutr)--Stellenbosch Univresity, 2004. / ENGLISH ABSTRACT: INTRODUCTION: The aim of this study was to investigate post-immigration BMI changes in a South African immigrant population and how dietary intake and habitual physical activity reflect these changes. The study was designed as a cross-sectional, observational survey. Thirty-six volunteers aged 20 - 50 years were included in the sample. Volunteers were South African immigrants in the Atlanta area, USA, who have lived in the USA for more than 6 months but less than 5 years. METHOD: Subjects were required to complete four questionnaires including a selfadministered socia-demographic, physical activity and food frequency questionnaire. The weight history questionnaire containing measurements including height, weight and waist circumference was completed by the investigator. RESULTS: A significant increase in BMI was indicated for both male (p=0.036) and female (p=0.0009) subjects. The increase in BMI for two age categories, 20-29 years (p = 0.018) and 30-39 years (p = 0.006), was also significant. Forty five percent of females reported an energy intake above the Estimated Energy Requirement (EER) for active individuals. Reported saturated fatty acid intake (13% of TE) exceeded the Acceptable Macronutrient Distribution Range (AMOR). The prevalence of inadequate n-3 and n-6 PUFA as well as fibre intake was high, especially in men. Sixty four percent of the population had a 'low active' physical activity level (PAL). CONCLUSION: The observed increase in post-immigration BMI implies that the South African immigrant population, similar to other immigrant populations, has adopted to some extent, the lifestyle and dietary habits of the general US population. As a result, the South African immigrant population may also be subject to increased chronic disease risk. / AFRIKAANSE OPSOMMING: INLEIDING: Die doel van hierdie studie was om die veranderinge in liggaamsmassa index (LMI) wat met immigrasie gepaard gaan in In Suid-Afrikaanse immigrant populasie te ondersoek, asook hoe die populasie se dieet en fisieke aktiwiteit hierdie veranderinge reflekteer. Die studie was In dwarssnit, observasie opname. Die steekproef het bestaan uit 36 vrywilligers (20 - 50 jaar oud). Respondente was deel van In Suid-Afrikaanse immigrant populasie in die Atlanta area, VSA, wat vir langer as 6 maande en korter as 5 jaar in die VSA woonagtig was. METODE: Respondente is versoek om vier vraelyste te voltooi insluitende In sosiodemografiese, fisieke aktiwiteit, -en voedsel frekwensie vraelys. Antropometriese metings, insluitende massa, lengte en middelomtrek is deur die navorser op die massa geskiedenis vraelys aangeteken. RESULTATE: In Betekenisvolle toename in LMI vir beide mans (p=0.036) en vroue (p=0.0009) is gevind. Die toename in LMI vir respondente 20-29 jaar (p = 0.018) en 30- 39 jaar (p = 0.006) was ook betekenisvol. Vyf-en-veertig persent vroue se energie inname was hoër as die aanbevole daaglikse inname vir aktiewe individue. Die populasie se versadigde vetsuur inname (13% van totale energie) was hoër as die aanvaarbare makronutriënt verspreiding. Die prevalensie vir onvoldoende innname van n-3 en n-6 poli-onversadigde vetsure, asook vesel inname was hoog, veralonder mans. Vier-en-sestig persent van die populasie se fisieke aktiwiteit vlak is geklassifiseer as 'lae aktiwiteit' . GEVOLGTREKKING: Die waargenome toename in LMI impliseer dat die studie populasie, soortgelyk aan ander immigrant populasies, die lewensstyl en dieet gewoontes van die algemene Amerikaanse populasie tot In sekere mate aangeneem het en is dus ook onderhewig aan die gevolglike toename in risiko vir kroniese siekte van lewensstyl.

Thesis (Mnutr)--University of Stellenbosch, 2003. / ENGLISH ABSTRACT: Pregnancy and growth have been found to have a detrimental effect on the micronutrient status of adolescent girls. Dietary studies in adolescents have shown serious shortfalls in their dietary iron and folate intake. The competition for nutrients between the fetus and a pregnant adolescent may carry the risk of complications such as intrauterine growth retardation, pre-eclampsia, both maternal and fetal intrapartum mortality, the increased risk of birth injuries and low birth weight. The aim of the study was to assess the nutritional status of rural black, pregnant teenagers attending the antenatal clinic at Siloam Hospital in the Limpopo Province, with special emphasis on iron and folic acid intake, and evaluation of the newborn babies in terms of weight status and neural tube defects. The nutritional status was determined in 40 pregnant and 40 non-pregnant adolescent girls. The pregnant girls were selected during their first visit to the antenatal clinic, and the non-pregnant girls were selected from nearby schools. The demographic and dietary history questionnaires were used to collect information from the subjects. The dietary intake of the subjects was collected by the completion of a pre-tested quantified food frequency questionnaire. The anthropometric questionnaire was used to get information from the pregnant adolescents and the control group. The infant anthropometric measurements questionnaire provided information on the infant and the outcome of birth. Blood was collected from the pregnant adolescent girls and the control subjects. Anaemia was observed in 57.5% of the pregnant and 27.5% of the non-pregnant adolescents (haemoglobin <Il g/dl and <12 g/dl, respectively). The prevalence of low serum ferritin « 12 ug/L) and low transferrin saturation « 16%) was high in both the pregnant (30% and 60% respectively) and the non-pregnant adolescents (17% and 72.5% respectively). Iron deficiency was observed in 45% of the pregnant girls and 35% of the control subjects. The prevalence of iron deficiency anaemia in the pregnant girls (30%) and the control subjects (22.5%) was high. Low red blood cell folate in pregnant and non-pregnant girls was uncommon. Low serum vitamin BI2 was common in most of the pregnant girls. Analysis of the quantitative food frequency questionnaire (QFFQ) that was completed for 80 of the pregnant and non-pregnant girls showed that 55% had low dietary iron intakes «67% of the RDA) (p = 0.7307). Forty-five percent of the pregnant girls reported taking iron supplements. The QFFQ showed 20% of pregnant girls with low intake of folate (p = 0.0577). Forty-five percent of pregnant girls also reported taking folate supplements. Anthropometric measurements of pregnant girls and their dietary intake could not be correlated to the birth outcome. The social profile of the subjects did not seem to influence their iron and folate status and the outcome of pregnancy. The findings in this study showed that pregnant adolescents appeared to be similar to the non-pregnant adolescent girls socio-economically, anthropometric and nutritionally. We recommend that educational programmes targeted at adolescents and teenagers in the Siloam area should reach girls that could potentially fall pregnant. An educational programme must include: reproductive needs (avoidance of sex or safe sex); nutritional needs, especially targeted at improving nutritional status to meet future reproductive needs; early booking at the antenatal clinic and effective supplementation during pregnancy. The need to improve the dietary and nutrient intake of the adolescent girls should be addressed within the current framework of the Integrated Nutrition Programme (!NP). A food fortification programme with essential micronutrients such as iron, folic acid, zinc and Vitamin A to improve the micronutrient status should be promoted among the adolescent girls. / AFRIKAANSE OPSOMMING: Daar is bevind dat swangerskap en groei 'n nadelige effek het op die mikronutriëntstatus van vroulike adolessente. Dieetstudies in adolessente het ernstige tekortkominge in dieetyster- en folaatinnames getoon. Die kompetisie vir nutriente tussen die fetus en die swanger adolessent kan verantwoordelik wees vir komplikasies soos intra-uterine groeivertraging, preeklampsie, verhoogde mortaliteit van beide moeder en baba tydens kraam, 'n verhoogde risiko vir geboortebeserings en lae geboortegewig. Die doel van die studie was om die effek van voedingstatus by swart, swanger tieners by die voorgeboortekliniek in Siloam Hospital in die Limpopo-provinsie te bepaal, met spesifieke verwysing na die yster- en foliensuurinname, asook die evaluering van die pasgebore babas in terme van gewig en neurale buis defekte. Die voedingstatus van 40 swanger en 40 nie-swanger adolessente meisies IS bepaal. Die swanger meisies is ewekansig geselekteer gedurende die eerste besoek aan die voorgeboortekliniek , en die nie-swanger meisies is geselekteer by nabygeleë skole. Die demografiese en dieetgeskiedenisvraelyste is gebruik om inligting van die proefpersone in te samel. Voorafgetoetste gekwantifiseerde voedselfrekwensie vraelyste is gebruik om die voedselinname van proefpersone te bepaal. Antropometriese vraelyste is gebruik om antropometriese inligting van die swanger adolessente en die kontrole groep. Die antropometriese vraelys vir babas is gebruik om inligting ten opsigte van die baba aan te teken asook die verloop van die swangerskap. Bloedmonsters is van die swanger tieners en die kontrole groep ingesamel. Anemie is waargeneem by 57.5% van die swanger en 27.5% van die nie-swanger adolessente (hemoglobien <Il g/dl en <12 g/dl onderskeidelik). Die voorkoms van lae serum ferritien « 12 ugIL) en lae transferrienversadiging « 16%) was hoog by beide die swanger (30% en 60%) en die nie-swanger adolessente (17.5% en 72.5% onderskeidelik). Ystergebrek is in 45% van die swanger meisies en in 35% van die kontrole groep waargeneem. Die voorkoms van ystergebrekanemie in die swanger meisies (30%) en die kontrole groep (22.5%) was hoog. Lae rooibloedselfolaat by swanger en nie-swanger meisies is nie algemeen waargeneem nie. Lae serum vitamien B12 was algemeen by die meeste swanger meisies. Ontleding van die gekwantifiseerde voedselfrekwensievraelys (KVFV) wat vir 80 van die swanger en nie-swanger meisies voltooi is, het getoon dat 55% 'n lae dieetysterinname gehad het «67% van die ADT) (p=0.7307). Vyf-en- veertig persent van die swanger meisies het bevestig dat hulle ystersupplemente gebruik het. Die gekwantifiseerde voedselfrekwensievraelys (KVFV) het getoon dat 20% van die swanger meisies 'n lae folaatinname het (0.0577). Vyf-en-veertig persent van die swanger meisies het ook genoem dat hulle folaatsupplemente gebruik het. Die antropometriese metings van swanger meisies en dieetinname kon nie gekorreleer word met die verloop van die geboorte nie. Dit blyk dat die sosiale profiel van die meisies nie 'n effek op die yster- en folaatstatus en op die verloop van swangerskap gehad het nie. Die bevindinge van hierdie studie toon dat swanger en nie-swanger adolessente meisies sosio-ekonomies, antropometries en nutrisioneel dieselfde voorkom. Dit word aanbeveel dat voorligtingsprogramme vir adolessente en tieners in die Siloam-area meisies moet bereik wat moontlik swanger sal word. 'n Voorligtingprogram moet die volgende insluit: reproduktiewe behoeftes (vermyding van seks of veilige seks); voedingbehoeftes, veral geteiken om voedingstatus te verbeter om ten einde toekomstige voorplantingsbehoeftes te vervul; vroeë besoeke aan die voorgeboortekliniek en effektiewe supplementering gedurende swangerskap. Die behoefte om die dieet en nutriëntinname van adolessente meisies te verbeter moet binne die huidige raamwerk van die Geintegreerde Voedingsprogram aangespreek word. 'n Voedselfortfiseringsprogram met essensiële mikronutriënte soos yster, foliensuur, sink en vitamien A om die mikronutriëntstatus van adolessente meisies te verbeter, moet bevorder word.

Thesis (MNutr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Objectives: The objectives of this study were to determine the nutritional content/ contribution of intravenous (IV) fluid and electrolyte administration on the total feeding prescription of intensive care unit (ICU) patients. Methods: Retrospective review of ICU charts of consecutive patients (>18 years) with APACHE II scores ≥10 and on ≥72 hours nutrition therapy (NT) admitted to a medical/surgical ICU. Total fluid, electrolyte, energy and macronutrient intake from nutritional and non-nutritional sources were reviewed from ICU admission until discharge, discontinuation of NT or death for ≤7 days. Energy and protein delivery were compared to calculated targets of 25.4 – 28.6kCal/kg and 1.3 – 1.5g/kg respectively. Summary statistics, correlation coefficients and appropriate analysis of variance were used to describe and analyse the data. Results: A total of 71 patients (49% male), average age 49.2 ± 17.1, average APACHE II score 21.0 ± 6.1, 68% medical and 32% surgical, were included. Fluid and nutrient intake were reviewed over a mean of 5.7 ± 1.1 days. Mean daily fluid delivery was 3.2 ± 0.6L. IV fluid therapy (IVFT) contributed 32.0 ± 12.0% to total fluid delivery (TFD), whereas IV drug administration, including fluids used for reconstitution and dilution purposes, contributed 20.7 ± 8.1% to TFD. Balanced electrolyte solutions (BES) were the crystalloid of choice, prescribed in 91.5% of patients with a mean daily volume (MDV) of 0.5 ± 0.4L. Hypertonic low molecular weight (LMW) 130/0.4kD hydroxyethyl starch (HES) was the colloid of choice, prescribed in 78.9% of patients with a MDV of 0.2 ± 0.1L. Potassium salts were the most frequently prescribed IV electrolyte supplement (IVES), prescribed in 91% of patients (±20 – 60mmol per administration). NT was initiated within 14.5 ± 14.1 hours. The majority (80%) received enteral nutrition (EN). The mean daily energy delivered was 1613 ± 380kCal (25.1kCal/kg), meeting 93.6 ± 17.7% of mean target range (MTR). Mean daily protein delivery (PD) was 72 ± 22g (1.1g/kg), meeting 82.8 ± 19.9% of MTR. Non-nutritional energy sources (NNES), mostly derived from carbohydrate-containing IV fluids, contributed 10.1 ± 7.5% to total energy delivered (156kCal/d). Mean cumulative energy and protein balance was -674.0 ± 1866.1kCal and -86.0 ± 106.9g respectively. The majority (73%) received >90% of the minimum energy target but only 49% >90% of minimum protein target; 59% of those with energy intake 90-110% of target had adequate protein intake. A significant negative correlation was found between cumulative energy/protein balance and the time to initiation of NT (energy: r=-0.28, p=0.02; protein: r=-0.32, p=0.01). Conclusion: In this ICU BES are the crystalloid of choice and hypertonic LMW 130/0.4kD HES the colloid of choice for IVFT. Potassium salts are the most frequently prescribed IVES. NNES added significantly to energy delivery and should be included in the calculation of feeding prescriptions to avoid the harmful effects of overfeeding. Early initiation of EN with conventional products which are energy rich is insufficient to achieve adequate PD. EN formulae with a more favorable nitrogen to non-protein energy ratio could help to optimise PD during the first week of ICU care. / AFRIKAANSE OPSOMMING: Doelwitte: Die doelwit van hierdie studie was om die voedingswaarde/ bydrae van intraveneuse (IV) vog en elektroliet toediening tot die totale voedings voorskrif van pasiënte in ‘n intensiewe sorg eenheid (ISE) te bepaal. Metodes: Retrospektiewe bestudering van die ISE kaarte van agtereenvolgende pasiënte (>18 jaar) opgeneem in ‘n mediese/chirurgie ISE en met APACHE II tellings ≥10 en ≥72 ure voedingsterapie (VT). Totale vog, elektroliet, energie en makronutriënt inname vanaf voedingsverwante en nie-voedingsverwante bronne is vanaf ISE opname tot en met ontslag, staking van VT of sterfte, vir ≤7 dae hersien. Energie en proteiën inname is vergelyk met berekende doelwitte van 25.4 – 28.6kKal/kg en 1.3 – 1.5g/kg onderskeidelik. Beskrywende statisitiek, korrelasie koeffisiënte en toepaslike analises van variansie is gebruik vir data analise. Resultate: 71 pasiënte (49% mans), gemiddelde ouderdom 49.2 ± 17.1, gemiddelde APACHE II telling 21.0 ± 6.1, 68% medies en 32% chirurgie, is ingesluit. Vog en voedingstof inname is hersien oor ‘n gemiddelde tydperk van 5.7 ± 1.1 dae. Gemiddelde vog inname was 3.2 ± 0.6L/dag. IV vog terapie (IVVT) het 32.0 ± 12.0% bygedra tot totale vog inname (TVI). IV medikasie toediening, insluitende die herkonstruksie en verwatering van medikasie, het 20.7 ± 8.1% bygedra tot TVI. Die mees voorgeskrewe kristalloiëd en kolloiëd vir IVVT was gebalanseerde elektroliet oplossings (GEO), voorgeskryf in 91.5% van pasiënte (gemiddeld 0.5 ± 0.4L/dag), en hipertoniese lae molekulêre gewig (LMG) 130/0.4kD hidroksie-etiel stysel (HES), voorgeskryf in 78.9% van pasiënte (gemiddeld 0.2 ± 0.1L/dag), onderskeidelik. Die mees voorgeskrewe IV elektroliet supplement was kalium soute, voorgeskryf in 91% van pasiënte (±20 – 60 mmol per toediening). VT is binne 14.5 ± 14.1 ure geinisieër. Die meerderheid (80%) het enterale voeding (EV) ontvang. Die gemiddelde daaglikse energie inname van 1613 ± 380kCal (25.1kKal/kg) het 93.6 ± 17.7% van die gemiddelde doelwit rykwydte (GDR) bereik. Die gemiddelde daaglikse proteiën inname van 72 ± 22g (1.1g/kg) het 82.8 ± 19.9% van die GDR bereik. Nie voedings-verwante energie bronne (NVEB), meestal vanaf koolhidraat-bevattende IV vloeistowwe, het 10.1 ± 7.5% tot totale energie inname (TEI) bygedra (156kKal/d). Die gemiddelde kumulatiewe energie en proteiën balans was -674.0 ± 1866.1kKal en -86.0 ± 106.9g onderskeidelik. Die meerderheid (73%) het >90% van die minimum energie doelwit (ED) bereik. Slegs 49% het >90% van die minimum proteiën doelwit (PD) bereik. Opsomming: Die kristalloiëd en kolloiëd van keuse vir IVT is GEO en hipertoniese LMG 130/0.4kD HES onderskeidelik. Kalium soute word mees algemeen voorgeskryf. NVEB dra beduidend by tot TEI en moet inaggeneem word tydens die berekening van voedingsvoorskrifte ten einde oorvoeding te voorkom. Vroeë inisiëring van EV met konvensionele energie-ryke EV produkte is onvoldoende om genoegsame proteiën inname te verseker. EV produkte met ‘n gunstiger stikstof tot nie-proteiën energie verhouding sal help om proteiën inname gedurende die eerste week van intensiewe sorg te optimaliseer.Slegs 59% van pasiënte met genoegsame energie inname (90-110% van ED) het hul minimum PD bereik. Daar was ‘n beduidende negatiewe korrelasie tussen kumulatiewe energie/proteiën balans en die tyd tot inisiëring van VT (energie: r=-0.28, p=0.02; proteiën: r=-0.32, p= 0.01).

Thesis (MNutr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Introduction: Intensive lifestyle intervention in people with Type 2 Diabetes Mellitus (T2DM) is associated with weight loss, significant reductions in HbA1c% and a reduction in cardiovascular disease risk factors. Small towns unfortunately experience a deficit of dieticians, thus limiting access to lifestyle intervention. Furthermore, a limited number of South African studies have evaluated the effect of dietary habits, anthropometric status, activity level (AL) and dietician-led medical nutrition therapy (MNT) on glycaemic control in patients with T2DM. This study thus aimed to identify the association between glycaemic control and lifestyle habits in adults with T2DM living in Thabazimbi. The role of the dietician with regard to optimal glycaemic control was also investigated with great interest. Methods: Individuals (>18 years) with T2DM who had a recent HbA1c test result and no acute infection/illness were included in the study over a 7 month recruitment period. Weight, height and waist circumference were measured, AL and dietetic contact evaluated, and dietary habits assessed by means of a structured questionnaire. Six home-measured post-prandial glucose (PPG) measurements and HbA1c% were used to evaluate glycaemic control. Results: A total of 62 (59.7% males) patients were included. The mean age was 60.13 ±10.85 years and mean T2DM disease duration was 121 ±96.56 months. Only 6.45% of participants had a normal Body Mass Index classification. Most (90.32%) participants had a substantially increased waist circumference (WC). Half of the participants had a sedentary/low AL, whilst 48.39% had an active/moderately active AL. Almost all (95%) participants indicated it was necessary for persons with DM to consult a dietician for MNT, however only 63% of participants actually consulted one. Mean dietary compliance was 74.53 ±10.93%. The average HbA1c% and PPG of participants were respectively 7.50 ±1.62% and 8.90 ±3.21mmol/l. A significant negative association (r=-0.31; p=0.02) was found between HbA1c% and percentage dietary compliance. The number of dietetic sessions completed and average PPG were also significantly [(r=0.40; p=0.001), (r=-0.34; p=0.01)] associated with percentage dietary compliance. In turn PPG had a significant positive (r=0.30; p=0.02) association with DM disease duration. Both the good HbA1c and good PPG control groups had significantly (p=0.01, p=0.04) better dietary habits than the poor HbA1c and PPG control groups. When compared to the poor PPG group, the good PPG group made significantly (p=0.04) better dietary decisions with regard to the main meal’s carbohydrate quality and quantity. Body Mass Index, WC, AL and extent of dietetic contact didn’t play a significant role in the glycaemic classification (good vs. poor) of participants. Conclusion: The longer T2DM is present, the worse PPG control becomes. Optimal dietary habits play a significant positive role in both the long- and short term glycaemic control of people with T2DM in Thabazimbi. The choice and portion size of the main meal’s carbohydrates has been identified to be the most important dietary role-player in the glycaemic control of this study population. This study also shows that if individuals with DM spend enough time with a dietician, it could potentially contribute to better dietary compliance and subsequent better glycaemic control. / AFRIKAANSE OPSOMMING: Inleiding: Intensiewe leefstyl intervensie onder diegene met Tipe 2 Diabetes Mellitus (T2DM) word geassosieer met gewigsverlies, beduidende verlaging in HbA1c% asook ’n vermindering in verskeie kardiovaskulêre-siekte risiko faktore. Plattelandse dorpies beleef egter ’n tekort aan dieetkundiges, wat gevolglik toegang tot leefstyl intervensie beperk. Daar is ook ’n beperkte hoeveelheid Suid-Afrikaanse studies wat die impak van eetgewoontes, antropometriese status, aktiwiteitsvlak en dieetkundige-begeleide dieetterapie op glisemiese beheer in T2DM pasiënte evalueer. Die doel van die studie was dus om die verband tussen glisemiese beheer en leefstyl gewoontes in volwassenes met T2DM in Thabazimbi te bepaal. Die rol van die dieetkundige met betrekking tot optimale glisemiese beheer was ook met groot belangstelling nagevors. Metodes: Diegene (>18 jaar) met T2DM wat oor ’n onlangse HbA1c toets uitslag beskik het en nie enige akute siektes/infeksie gehad het nie, is oor ’n 7 maande werwingsperiode ingesluit. Gewig, lengte en middel-omtrek was gemeet, aktiwiteitsvlak en dieetkundig-kontak bepaal, en eetgewoontes geassesseer m.b.v. ’n gestruktueerde vraelys. Ses tuis-bepaalde na-ete bloedsuiker lesings en HbA1c% was gebruik om glisemiese beheer te evalueer. Resultate: Twee-en-sestig (59.7% mans) pasiënte het aan die studie deelgeneem. Die gemiddelde ouderdom was 60.13 ±10.85 jaar en die gemiddelde T2DM duurte 121 ±96.56 maande. Slegs 6.45% van die deelnemers het ’n gesonde Liggaam-Massa-Indeks gehad. Meeste (90.32%) deelnemers se middel-omtrek was ook ruimskoots verhoog. Die helfte van die deelnemers het ’n passiewe/lae aktiwiteitsvlak gehad, terwyl 48.39% ’n aktief/matig-aktiewe aktiwiteitsvlak gerapporteer het. Amper al (95%) die deelnemers het aangedui dat mense met T2DM ’n dieetkundige moet raadpleeg vir dieetterapie. Slegs 63% van die deelnemers het egter werklik ’n dieetkundige vir diabetes dieetterapie geraadpleeg. Gemiddelde dieet-gehoorsaamheid was 74.53 ±10.93% en die gemiddelde HbA1c % en na-ete bloedsuiker vlakke van deelnemers was onderskeidelik 7.50 ±1.62% en 8.90 ±3.21mmol/l. Daar was ’n beduidende negatiewe verband (r=-0.31; p=0.02) tussen HbA1c % en persentasie dieet-gehoorsaamheid. ’n Beduidende verband was ook tussen persentasie dieet-gehoorsaamheid en die hoeveelheid voltooide dieetterapie sessies (r=0.40; p=0.001) asook die gemiddelde na-ete bloedglukose vlak (r=-0.34; p=0.01) geïdentifiseer. Na-ete bloedglukose het ook ’n beduidende positiewe (r=0.30; p=0.02) verband met die duurte van diabetes getoon. Beide die goeie HbA1c en goeie na-ete glukose groepe het beduidend (p=0.01, p=0.04) beter eetgewoontes as die swak HbA1c en swak na-ete glukose groepe gehad. Die goeie na-ete glukose groep het veral beduidend (p=0.04) beter dieet keuses m.b.t die hoofmaal se koolhidraat kwaliteit en kwantiteit gemaak. Lengte-Massa-Indeks, middel-omtrek, aktiwiteitsvlak en die mate van dieetkundige kontak het nie ’n beduidende rol in die glisemiese klassifikasie (goed teenoor swak) van deelnemers gespeel nie. Gevolgtrekking: Na-ete bloedsuiker beheer word al hoe slegter hoe langer T2DM teenwoordig is. Optimale eetgewoontes speel ’n beduidende positiewe rol in beide die lang- en kort-termyn glisemiese beheer van mense met T2DM in Thabazimbi. Die keuse en porsie grootte van die hoofmaal se koolhidrate blyk die belangrikste dieet rolspeler in die glisemiese beheer van die studie populasie te wees. Die studie dui ook aan dat as mense met T2DM genoeg tyd saam met ’n dieetkundige deurbring, dit moontlik kan bydra tot beter dieet-gehoorsaamheid en gevolglik beter glisemiese beheer.

Thesis (MSc (Dietetics))--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: The aim of the study was to contribute to the nutritional well-being of 0 - 24 month old children who attend primary health care clinics (PHC) in Duncan Village, an urban slum. This was to be achieved by first formulating essential nutrition-related message topics and second by formulating recommendations for optimising the accessibility of services, including nutrition-related messages, aimed at mothers attending PHC clinics in Duncan Village. In order to formulate targeted and relevant nutrition-related messages for mothers attending the PHC clinics (Phase I of the research) the need for more information on the six focus areas for intervention that were identified in the previous Duncan Village Day Hospital (DVDH) study" was determined. This was done through key-informant interviews and studying other relevant published research. Eleven research questions related to the six focus areas were subsequently formulated to guide further research. Non-scheduled structured interviews were conducted with mothers with children in specific age groups until data saturation was achieved. A total of 31 interviews were thus conducted at the homes of participants and observation data was also collected at the same time. Three focus groups with corresponding participant categories were also conducted to check the information obtained through the interviews. Two focus groups were conducted with grandmothers to serve as a further form of checking research but also to obtain a different perspective on the research questions. The data available for the formulation of the message topics was analysed qualitatively by hand. The focus areas and the research questions gave a specific focus to the analysis process and the unprocessed data was available in these broad predetermined categories. All the information from all sources (DVDH study, the non-scheduled structured interviews with mothers, focus groups with mothers and grandmothers and observation data) was studied, interpreted and integrated for each identified category. During this process key-factors, which need to be addressed in nutrition-related messages essential for the well-being of infants attending PHC clinics in Duncan Village, were identified. The final step in the analysis process was the formulation of message topics based on these key-factors. During the analysis process it became clear that some of the identified key factors were not suitable for the formu lation of nutrition-related message topics but rather give insight into the total context of the mothers attending the clinics in Duncan Village. It was evident that the information contained in the key factors could be used by health workers to identify and assist vulnerable mothers. These key-factors led to the formulation of relevant help topics. Eighteen main message topics and 16 help topics were formulated. The message topics included topics on: self-development, household food security, breastfeeding, good feeding practices, mothers' health and nutrition and hygiene practices. in Phase 2 of the study the accessibility of services, including nutrition-related messages, to mothers attending PHC clinics in Duncan Village was determined. This was done by determining how mothers inDuncan Village experience the clinics where they could be exposed to nutrition-related messages and by determining the experiences of health care workers with mothers as clients as well as with service delivery. This information was obtained through focus group discussions with different participant categories. These categories included mothers with children in the same age groupings as in Phase I who had either attended clinic for all the child's immunisations or who had not attended clinic for all the child's immunisations or who had attended clinics outside Duncan Village for immunisation purposes. Pregnant women who had either attended antenatal clinics or had not attended antenatal clinics were also included. The last participant category involved health workers. This category included health workers from the obstetric unit where mothers from Duncan Village give birth, the primary health care clinics and community health care workers. The data obtained was analysed with ATLAS/ti, computer software specifically designed for qualitative data analysis. Twelve code families were created during the analysis process, each family referring to a specific aspect of accessibility of services provided at the PHC clinics. A detailed description of each code family is presented after which six networks were compiled. The data and networks were used to create a framework for data interpretation. According to the framework it is proposed that the final elements in the process of providing accessible nutrition-related messages to clients at clinics are (1) that the clients must attend the clinic and (2) that appropriate nutrition-related messages must be available. Problems with interpersonal and organisational aspects of service delivery were found to be two of the most important aspects that influence accessibility of clinic services and therefore nutrition-related messages at the clinics. The last phase of the study (Phase 3) involved the formulation of recommendations to the relevant authorities about targeted and relevant nutrition-related message topics to be included in the education of mothers and pregnant women as well as recommendations to optimise accessibility of nutrition-related messages at the three PHC clinics in Duncan Village and the obstetric unit where mothers of Duncan Village give birth. A total of fifteen recommendations were formulated based on the frndings and recommendations of Phase I and Phase 2. These recommendations focus especially on the necessity for the municipality to create a health empowering environment at the clinics, on the provision of appropriate nutrition-related messages at the clinics and on the need to reach vulnerable mothers. The importance of involving the community in these processes was also emphasised in the recommendations. It is concluded that the implementation of the recommendations will contribute to the nutritional well-being of all young children in Duncan Village and could play an important role in realising the rights of children living in the area. / AFRIKAANSE OPSOMMING: Die doel van die studie was om 'n bydrae te maak tot die voedingswelstand van 0-24 maandoue kinders wat prirnere gesondheidsorg (PGS) klinieke in Duncan Village, 'n verarmde stedelike gebied, besoek. am die doel te bereik is daar eerstens beplan om essensiele voedingsverwante boodskappe te formuleer. Tweedens is daar beplan om aanbevelings vir die optimalisering van die toeganklikheid van gesondheidsorgdienste vir rna's wat die klinieke bywoon, insluitend die toeganklikheid van voedinsgverwante boodskappe, te maak. Voordat relevante voedingsverwante boodskappe vir rna's wat die klinieke in Duncan Village besoek, geformuleer kon word, was meer inligting nodig oor die ses fokusareas vir intervensie wat in die vorige Duncan Village Daghospitaal studie bepaal is. Die bepaling van watter inligting nodig was, is gedoen deur sleutelinformantonderhoude en die bestudering van ander relevante gepubliseerde navorsing. Na aanleiding hiervan is elf navorsingsvrae wat verband hou met die ses fokusareas geformuleer. Nie-geskeduleerde, gestruktureerde onderhoude is vervolgens met 111a's met kinders in spesifieke ouderdomsgroepe gehou totdat dataversadiging bereik is. 'n Totaal van 31 onderhoude is met respondente gehou by hul huise, waartydens die onderhoudvoerder ook sekere waamemingsdata ingesamel het. Drie fokusgroepe is ook met rna's met kinders in ooreenstemmende kategoriee gehou om die inligting na te gaan wat deur die onderhoude ingesamel is. Twee fokusgroepe is ook met oumas gehou om die data verder na te gaan maar ook om 'n ander perspektief op die navorsingsvrae te verkry. Die data wat verkry is, is kwalitatief met die hand geanaliseer. Die fokusareas en die navorsingsvrae het 'n spesifieke fokus aan die analiseproses gegee en die ongeprossesseerde data was beskikbaar in hierdie bree vooraf gedetermineerde kategoriee. Die inligting van aile bronne (DVDH-studie, die nie-geskeduleerde gestruktureerde onderhoude met die rna's, die fokusgroepe met die rna's en oumas asook die observasie data) is bestudeer, geinterpreteer en geintegreer vir elke geidentifiseerde kategorie. Gedurende hierdie proses is sleutelfaktore geidentifiseer wat aangespreek moet word in essensiele voedingsverbandhoudende boodskappe wat gemik is om die voedingswelstand van klein kinders wat die PGS-klinieke in Duncan Village besoek te verbeter. Die finale stap in die analiseproses was die formulering van boodskaponderwerpe. Die onderwerpe is gebaseer op die geidentifiseerde sleutelfaktore Dit het duidelik geword tydens die analiseproses dat sommige van die sleutelfaktore nie geskik was vir die formulering van voedingsverbandhoudende boodskaponderwerpe nie, maar dat dit eerder insig verskaf in die totale lewenskonteks van die rna's. Die inligting in hierdie sleutelfaktore kan wei gebruik word deur gesondheidswerkers om kwesbare ma's te identifiseer en by te staan. Hierdie sleutelfaktore het dus tot die formulering van relevante hulpboodskappe gelei. Agtien voedingsverbandhoudende en 16 hulpboodskappe is geformu leer. Die boodskaponderwerpe sluit in onderwerpe oor selfontwikkeling, huishoudelike voedselsekuriteit, borsvoeding, goeie voedingspraktyke, gesondheid van die rna en voeding- en higienepraktyke. Tydens Fase 2 van die studie is die toeganklikheid van PGS dienste, insluitend voedingsverbandhoudende boodskappe vir rna's, bepaal. Dit is gedoen deur te bepaal hoe mas in Duncan Village die kliniekdienste ondervind, waar hulle aan hierdie boodskappe blootgestel kan word asook die ondervindinge van die gesondheidswerkers met die rna's en die diensleweringsproses. Hierdie inligting is deur middel van fokusgroepbesprekings met verskillende deelnemerskategoriee ingesamel. Hierdie kategoriee het rna's ingesluit wat die klinieke in Duncan Village besoek het vir a.l die spesifieke kinders se immunisasies maar ook ma's wat nie kinders geneem het vir al hul immunisasies nie of wat hul kinders na klinieke buite Duncan Village geneem het. Swanger vroue wat die voorgeboortelike klinieke besoek het asook die wat nie die klinieke besoek het nie, is ook ingesluit. Die laaste kategorie wat betrek is, was gesondheidswerkers. Hierdie kategorie het werkers van die kraamafdeling van die nabygelee hospitaaI en die primere gesondheidsorgklinieke ingesluit. Beide professionele verpleegpersoneel en gemeenskapsgesondheids= werkers van die klinieke is betrek. Die data wat verkry is, is met ATLAS/ti, 'n rekenaarprogram spesifiek geskep vir die analise van kwalitatiewe data, ontleed. Twaalf kodefamilies is geskep tydens die analiseproses. Elke familie verwys na 'n spesifieke aspek van toeganklikheid van dienste by die klinieke. 'n Gedetailleerde beskrywing van elke kodefamilie is gegee asook ses netwerke. Die data en die netwerke is gebruik om 'n raamwerk vir data-intepretasie te skep. Die raamwerk postuleer dat die finale elemente in die proses van die verskaffing van toeganklike voedingsverbandhoudende boodskappe by klinieke die volgende is: (1) kliente moet die kliniek besoek en (2) toepaslike voedingsverbandhoudende boodskappe moet beskikbaar wees. Probleme met interpersoonlike en organisatoriese aspekte van dienslewering is geidentifiseer as die twee belangrikste aspekte wat toeganklikheid van kliniekdienste en daarom ook toeganklikheid van voedingsverbandhoudende boodskappe beinvloed. Die laaste fase van die studie (Fase 3) het die formulering van aanbevelings aan die relevante owerhede behels Die aa.nbevelings handel oor die insluiting van toepaslike voedingsverbandhoudende boodskappe by die gesondheidsonderrig van ma's en swanger vroue sowel as aanbevelings oor die optimalisering van toeganklikheid van dienste by die PGS klinieke en die kraamafdeling waar Duncan Village rna's geboorte gee. Vyftien aanbevelings gebaseer op die bevindinge van Fases I en 2 is geformuleer . Die aanbevelings fokus veral op die nocdsaaklikheid vir die plaaslike owerheid om 'n atmosfeer van gesondheidbemagtiging by die klinieke te skep, die nodigheid om toepaslike voedingsverbandhoudende boodskappe by die klinieke te verskaf en die belangrikheid daa.rvan om kwesbare rna's te bereik. Die noodsaaklikheid om die gemeenskap te betrek in hierdie prosesse is ook benadruk. Samevattend kan gese word dat die implementasie van die aanbevelings sal bydra tot die voedingswelstand van alle jong kinders in Duncan Village en dat dit 'n belangrike bydrae kan lewer tot die realisering van die regte van kinders in die area.