Objectives: The goal of this project was to determine the nutritional needs of preschool age children to help guide intervention development. The research aims were 1) to examine and describe young child (ages one to five) nutritional status as it relates to key nutrients associated with stunting and wasting; 2) to determine what key macro- and micro-nutrient deficiencies (primarily iron and zinc) are associated with wasting and stunting. Methodology: Study sample: Sixty-seven families with children ages one to five who participating in routine health care clinic visits during the UK Shoulder to Shoulder Global health brigade visits. Study design: A cross-sectional survey was conducted collecting demographic data, medical history, and dietary intake. Objective measures of height/length and weight were completed; and blood samples were drawn to measure serum micronutrient levels. Nutrition Data System for Research (NDSR) identified nutrient intakes for analytical comparison based on growth parameters. Nutritional and health status were compared to food security and World Health Organization growth reference points of standard deviations on Z-scores of height-for-age and weight-for-age. Analyses: Chi Square, ANOVA, and binary logistic regression tests were run using Statistical Analysis System (SAS) Results: Low serum levels of zinc and iron corresponded to low levels of dietary intake of zinc and iron, limited food security and moderate stunting z = -0 to 1.99 Standard Deviation. Conclusion: This study will inform a comprehensive nutritional intervention for this population. The evidence that specific nutrients are limiting will focus the health promotion objectives.

Background: A significant portion of lactating women in less developed countries have vitamin A (VA) deficiency. Lactation has substantial effects on a mother’s metabolism and VA is known to be needed in multiple biological processes, including growth, vision, immunity, and reproduction. Objective: The objective of this pilot study was to utilize metabolomics profiling to conduct a broad, exploratory assessment of differences in plasma metabolites associated with low VA status versus adequacy in lactating women. Methods: Plasma samples from lactating women who participated in a survey in Samar, Philippines, were selected from a cross-sectional study based on plasma retinol concentrations indicating low (VA-; n=5) or adequate (VA+; n=5) VA status (plasma retinol <0.7 or >1.05 µmol/L). The plasma results collected from six metabolomics assays (oxylipins, endocannabinoids, bile acids, primary metabolomics, aminomics, and lipidomics) were compared by group, using liquid chromatography mass spectrometry. Results: Twenty-eight metabolites were significantly different in the VA- versus VA+ status, with 24 being lipid mediators (p<0.05). The lipid mediators demonstrated lower concentrations of the arachidonic acid- and eicosapentaenoic acid-derived oxylipins, as well as lysophospholipids and sphingolipids, in the VA- group (p<0.05). Chemical similarity enrichment analysis identified HETEs, HEPEs, and DiHETEs as significantly different oxylipin clusters (p<0.0001, false discovery rate (FDR) p<0.0001), as well as sphingomyelins, saturated lysophosphatidylcholines, phosphatidylcholines, and phosphatidylethanolamines (p<0.001, FDR p<0.01). Conclusions: The multi-assay nutritional metabolomics profiling of low VA status compared with adequacy in lactating women demonstrated reduced lipid mediator concentrations. Future studies with stronger study designs and a large and more diverse population are needed to validate these preliminary results.

D. Tech. (Food Service Management, Department of Hospitality, Tourism and PR Management, Faculty of Human Sciences)|, Vaal University of Technology| / Background South Africa is one of the developing countries faced with the co-existence of undernutrition and overnutrition, often experienced within the same household. On the one hand, hunger, undernutrition and micronutrient deficiencies are linked to poverty and household food insecurity. Simultaneously, South Africans are exposed to ‘nutrition in transition’, where overweight and chronic diseases of lifestyle, such as diabetes mellitus, cardiovascular diseases and cancer are on the rise as part of the overnutrition profile. Sound nutrition is important throughout the lifecycle to combat under- and overnutrition and nutrition-related diseases. In urban areas, the grandmother or another senior female family member is often responsible for caring for the children in the household during the day. This includes physical, emotional and nutritional care. It is therefore essential for the caregiver to have good nutrition knowledge, to provide not only in her own needs, but also in those of the children. A nutrition education programme is one strategy for improving the nutrition knowledge of caregivers of children. Objective The primary objective in this study was to develop, tailor, implement and evaluate a nutrition education programme (NEP) for Sesotho-speaking females and caregivers of children in the Boipatong Township in the Vaal Region of South Africa and to test its impact in the short and longer term. Nutrition knowledge regarding four South African food-based dietary guidelines (FBDGs) was empirically tested before and after the intervention and then compared to a control group. In addition, dietary intake was assessed to detect any changes after the intervention in the medium term. Methodology In this both quantitative and qualitative methodologies were applied. Two frameworks, the United Nations Children’s Fund (UNICEF) Framework of Malnutrition (2004) and the Food and Agriculture Organisation (FAO) Framework for Nutrition Education (1997), gave structure to the planning, implementation and evaluation of the research project. This study’s nutrition education programme was based on a socio-ecological model to guide behavioural change in terms of healthy food choices. In the preparation phase, a situational analysis was performed by means of a cross-sectional analytical design using descriptive statistics. Socio-demographic and self-reported health information was obtained. Nutrition knowledge, based on the South African food-based dietary guidelines (FBDGs), was measured, and dietary intake was assessed and compared with the estimated average requirements (EARs) for their age categories. Phase two, the formulation phase, used an experimental design. The acceptability and understanding of the existing national nutrition education (NE) material for individuals with low living standards (LSM) was investigated in this phase of the nutrition education programme (NEP). A culturally tailored booklet was developed in English, translated into Sesotho, pilot tested and implemented as part of the nutrition education programme. Lesson plans were developed and pilot tested. A non-randomised control trial was used in the implementation and evaluation phases. The effect of the nutrition education programme on nutrition knowledge was quantitatively measured in a pre- and post-test design at each discussion session in the short term, using paired t-tests in the experimental group of caregivers. The evaluation phase tested the impact of the nutrition education in the longer term. Nutrition knowledge was measured quantitatively in a before-after intervention test design by means of a self-completed structured questionnaire, based on the four South African FDBGs included in the programme. A control group who was not subjected to any intervention was used to complete the same questionnaire before and after the intervention in the same time period as the experimental group. In the experimental group, dietary intake was assessed before and after the intervention to detect changes in dietary intake. No dietary intake was measured in the control group, as changes could be attributed to influences beyond the control of this study. Two randomly selected focus groups of the experimental group were run to provide deeper insight into their perceptions regarding the acceptability and understanding of the NEP and NE material. Results The situational analysis of the preparation phase revealed a poor community that displayed typical patterns of nutrition in transition, at risk of malnutrition. The median age of the sample of caregivers was 44 years (IQR 32-62). Income and consumption poverty was confirmed by 80.5 percent of households spending R300 or less on food, with 75 percent of households having between four and seven people living in the dwelling. Dietary results were indicative of food poverty and poor food choices, possibly due to monetary constraints. A low energy intake (median 5323 kJ/day; IQR 3369-7949), was observed. Only 13.9 percent reached the estimated energy requirement (EER) of 7855 kJ per day for their age category. The overall mean average requirements of the diet was 0.7 but the possiblity of micronutrient deficiencies could not be excluded with a MAR of 0.6 for vitamins and minerals respectively. The median nutrition knowledge was 50 percent (IQR 42-54%) The lowest score was obtained for the FBDG ‘Enjoy a variety of food’ (33.4%; 95% CI 1.1), followed by the FBDG on animal protein (40.3%; 95% CI 1.0). It was decided to augment these two FBDGs with the plant protein FBDG (54.3%; 95% CI 1.8). Despited a relatively good knowledge measured in the caregivers, none of the plant protein food items appeared in the top 20 food items most frequently consumed. The formulation phase included the testing of existing nutrition education material. Messages were well understood (60.5%). However, caregivers found the images contained in the pamphlets and the design of the pamphlets confusing. A definite need was identified for new, culturally acceptable NE material in the caregivers’ home language, Sesotho (74%). During the implementation phase the lectures were presented and the change in the short-term nutrition knowledge of the FBDGs was measured at every session by means of a pre-post-test design. The median age of the caregivers was 63 years (52-78). A significant change in nutrition knowledge was found for each FBDG in terms of the mean number of questions answered correctly by the participants between the results of each pre- and post-test. In the evaluation phase, the impact of the NEP was measured in the Boipatong experimental group and compared, regarding nutrition knowledge, to a control group in the longer term (three months after completion of the intervention). Median nutrition knowledge before the intervention was 49 percent (IQR 46-57) compared to 70 percent (IQR 68-73) after the intervention – an increase of 21 percent. In contrast, the control group showed an increase of only five percent. The results showed that the eating habits of many of the caregivers still fell substantially short of internationally recognised standards (estimated energy requirement (EER) and estimated average requirement (EAR)), and this could contribute to undernutrition as well as to an increased risk of diet-related chronic disease. A median kilojoule intake of 4788 kJ (IQR 3415-6596) per day before and 4651 kJ (IQR 3369-6664) per day after the intervention was registered. Carbohydrate foods remained an important source of energy. Calcium presented a major concern, as none of the participants reached the EAR despite a slight increase in the intake of milk (volume and frequency) after the intervention, as validated by the top 20 food lists and as measured by a nutrient average requirement (NAR) of 0.1 to 0.7 before and after the intervention respectively. The mean average requirements (MAR) remained relatively stable, at 0.7 (median) before the intervention and 0.6 after the intervention. The NEP thus had an insignificant positive effect on dietary intake, except for calcium, iodine and vitamin C intake, which showed significant increases. No relationships could be found between the MAR as an indicator of dietary quality and nutrition knowledge. However, this does not mean that an NEP is not a suitable strategy. Changes in food choices and dietary intake should be measured in the longer term, since lifestyle changes are challenging to adopt when people, especially those in deprived communities, do not have the financial means to make healthy food choices. Conclusion When planning nutrition education strategies to improve the health status of communities in deprived areas, one is faced with the difficulty of households with a low socio-economic status and poor dietary intake, which increases the risk of food and nutrition insecurity. The nutrition education programme, developed, tailored and implemented as an intervention strategy to address an identified need of caregivers, was effective in improving nutrition knowledge. Four of the South African dietary guidelines were used in the nutrition education programme tailored to the specific profile that emerged from the situational analysis and the development of supportive nutrition education material. Lesson plans and the Sesotho and English booklets are available for use in other nutrition education programmes. The study contributed to the understanding of food choices of the urban community of Boipatong as well as of the nutrient inadequacies observed. Nutrition knowledge alone is not enough to bring about changes in food choices when the means to do so are lacking. Poverty and nutrition are closely linked and thus difficult to separate.

Background: Children in South Africa are still affected by micronutrient deficiencies and children living in farm communities are especially vulnerable. African Leafy Vegetables (ALVs) are well endowed with micronutrients such as iron, zinc and vitamin A and might contribute to the nutritional status of children. However, these vegetables have been perceived as “poor people’s food” and over the years knowledge of and use of ALVs has decreased. Aim: This study assessed the potential contribution of ALVs to the nutritional status of children in a semi-rural farm community. Method: In this cross-sectional study, anthropometric indices, serum iron, zinc and retinol concentrations were determined in school children aged 5−13 years (n=155). Dietary intake of iron, zinc and vitamin A was evaluated by three 24-hour diet recalls of children (n=154). The iron, zinc and β-carotene content of selected ALVs was determined. Knowledge of and use of ALVs by primary caregivers was established using focus group discussions (FGDs). Descriptive statistics, independent t-tests, the Pearson Chi-Square Test and Mann-Whitney U Test were used. Anthropometric data were analysed using the World Health Organization Reference 2007 data. Dietary data were analysed using FoodFinder (version 3). Qualitative data from FGDs were translated, transcribed and color-coded to generate emerging themes. Results: Stunting (11%) was the most prevalent anthropometric indicator of malnutrition. This was supported by the low socio-economic status of households. Deficiency prevalence in iron (serum ferritin <15 μg/L; 15.5%) and vitamin A (serum retinol <20 μg/dL; 3.2%) was low. Zinc deficiency was the most prevalent (serum zinc <65 μg/dL; 74.8%) deficiency. Median dietary intake of iron, zinc and vitamin A was generally above the Estimated Average Requirement. ALVs were potentially good sources of iron, zinc and β-carotene and could contribute substantially to the Recommended Dietary Allowance for these nutrients in children, without taking into account inhibiting factors that might affect the bioavailability. Iron content of the ALVs studied ranged from 1.4−3.2 mg/100 g edible portion. Amaranthus cruentus was the best source of iron. Zinc content of the ALVs ranged from 0.7−1.4 mg/100g edible portions, with Cleome gynandra having the highest zinc composition. The β-carotene content of the ALVs ranged from 182−314 μg RAE/100 g edible portion, with both Amaranthus cruentus and Cleome gynandra being the best sources. Knowledge of ALVs and their use was indigenous and was transferred between generations. Caregivers had positive attitudes towards the use of ALVs. Conclusion: Although the prevalence of deficiencies was not severe (with exception of zinc deficiency), micronutrient deficiencies exist in the rural farm community studied. ALVs are potentially good sources of iron, zinc and β-carotene and might contribute to the nutritional status of school children. Knowledge of ALVs and the positive attitude and perceptions regarding their use by primary caregivers implied a potentially positive future response to interventions promoting consumption of ALVs in order to contribute to the alleviation of micronutrient deficiencies. / Thesis (MSc (Nutrition))--North-West University, Potchefstroom Campus, 2013.

Background: Children in South Africa are still affected by micronutrient deficiencies and children living in farm communities are especially vulnerable. African Leafy Vegetables (ALVs) are well endowed with micronutrients such as iron, zinc and vitamin A and might contribute to the nutritional status of children. However, these vegetables have been perceived as “poor people’s food” and over the years knowledge of and use of ALVs has decreased. Aim: This study assessed the potential contribution of ALVs to the nutritional status of children in a semi-rural farm community. Method: In this cross-sectional study, anthropometric indices, serum iron, zinc and retinol concentrations were determined in school children aged 5−13 years (n=155). Dietary intake of iron, zinc and vitamin A was evaluated by three 24-hour diet recalls of children (n=154). The iron, zinc and β-carotene content of selected ALVs was determined. Knowledge of and use of ALVs by primary caregivers was established using focus group discussions (FGDs). Descriptive statistics, independent t-tests, the Pearson Chi-Square Test and Mann-Whitney U Test were used. Anthropometric data were analysed using the World Health Organization Reference 2007 data. Dietary data were analysed using FoodFinder (version 3). Qualitative data from FGDs were translated, transcribed and color-coded to generate emerging themes. Results: Stunting (11%) was the most prevalent anthropometric indicator of malnutrition. This was supported by the low socio-economic status of households. Deficiency prevalence in iron (serum ferritin <15 μg/L; 15.5%) and vitamin A (serum retinol <20 μg/dL; 3.2%) was low. Zinc deficiency was the most prevalent (serum zinc <65 μg/dL; 74.8%) deficiency. Median dietary intake of iron, zinc and vitamin A was generally above the Estimated Average Requirement. ALVs were potentially good sources of iron, zinc and β-carotene and could contribute substantially to the Recommended Dietary Allowance for these nutrients in children, without taking into account inhibiting factors that might affect the bioavailability. Iron content of the ALVs studied ranged from 1.4−3.2 mg/100 g edible portion. Amaranthus cruentus was the best source of iron. Zinc content of the ALVs ranged from 0.7−1.4 mg/100g edible portions, with Cleome gynandra having the highest zinc composition. The β-carotene content of the ALVs ranged from 182−314 μg RAE/100 g edible portion, with both Amaranthus cruentus and Cleome gynandra being the best sources. Knowledge of ALVs and their use was indigenous and was transferred between generations. Caregivers had positive attitudes towards the use of ALVs. Conclusion: Although the prevalence of deficiencies was not severe (with exception of zinc deficiency), micronutrient deficiencies exist in the rural farm community studied. ALVs are potentially good sources of iron, zinc and β-carotene and might contribute to the nutritional status of school children. Knowledge of ALVs and the positive attitude and perceptions regarding their use by primary caregivers implied a potentially positive future response to interventions promoting consumption of ALVs in order to contribute to the alleviation of micronutrient deficiencies. / Thesis (MSc (Nutrition))--North-West University, Potchefstroom Campus, 2013.

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Cette étude s’inscrit dans le cadre du projet « Pôle francophone africain sur le Double Fardeau Nutritionnel » (DFN) du laboratoire TRANSNUT, centre collaborateur OMS sur la transition nutritionnelle du Département de Nutrition de l’Université de Montréal, en collaboration avec ses partenaires au Burkina Faso, à savoir l’Institut de Recherche en Sciences de la Santé (IRSS) et l’Institut Supérieur des Sciences de la Population (ISSP). Elle est l’une des premières à s’intéresser au double fardeau de la malnutrition en Afrique francophone. Cette étude avait pour objectif de démontrer l’existence du double fardeau de la malnutrition parmi les adultes de Ouagadougou au Burkina Faso, d’en donner l’ampleur et d’identifier ses liens avec les facteurs du mode de vie. Plus spécifiquement, elle visait à décrire les carences nutritionnelles, les facteurs de risque cardiométabolique (FRCM), et la typologie du double fardeau de la malnutrition; examiner les caractéristiques du mode de vie des adultes et leurs liens avec le double fardeau de la malnutrition selon les conditions économique, et enfin d’examiner l’association entre inflammation subclinique, les carences nutritionnelles et les FRCM selon les facteurs du mode de vie. Ces objectifs faisaient suite à nos principales hypothèses qui stipulaient que : parmi les adultes de Ouagadougou, le phénotype de double fardeau de la malnutrition le plus fréquemment observé est l’association de surpoids/obésité avec une ou plusieurs carences nutritionnelles, surtout chez les femmes, puis qu’une alimentation de piètre qualité, en lien avec de mauvaises conditions socioéconomiques et de vie est associée tant aux FRCM qu’aux carences nutritionnelles, contribuant ainsi au double fardeau de malnutrition, et enfin qu’un état d’inflammation subclinique joue un rôle de médiateur entre le mode de vie et aussi bien les carences nutritionnelles que les FRCM. Afin de répondre à ces objectifs, une étude transversale descriptive et analytique a été conduite auprès d’un échantillon aléatoire de 330 adultes âgés de 25 à 60 ans recrutés au sein de l’Observatoire de Population de Ouagadougou, situé à la partie nord de la ville. Cet échantillon a été subdivisé en terciles du score de possessions matérielles, proxy du statut socioéconomique, avec 110 personnes respectivement dans chaque strate de niveau socioéconomique bas, moyen et élevé. Chaque participant a fourni des données sociodémographiques, anthropométriques, cliniques et comportementales; il a aussi fourni un échantillon de sang. Les principales variables de l’étude étaient les suivantes : l’âge, les conditions socioéconomiques (insécurité alimentaire, éducation et proxy du revenu), le mode de vie (les apports alimentaires et la qualité de l’alimentation, l’activité physique, la consommation d’alcool et de tabac, la perception de l’image corporelle, le stress psychosocial); l’inflammation subclinique; les FRCM [surpoids/obésité, tension artérielle élevée (TAE) ou hypertension artérielle (HTA), hyperglycémie, dyslipidémie et insulino-résistance]; les carences nutritionnelles (maigreur, anémie, carence en fer et en vitamine A). Des phénotypes de double fardeau de la malnutrition ont été identifiés en combinant FRCM et carences nutritionnelles. Les résultats ont montré une prévalence élevée de surpoids/obésité, d’obésité abdominale, d’hypertension artérielle, d’hyperglycémie, de résistance à l’insuline et du taux de lipoprotéine de haute densité (HDL-C) bas, respectivement de 24,2 %, 12,5 %, 21,9 %, 22,3 %, 25,1 % et 30,0 %. En utilisant les seuils plus sensibles de la Fédération Internationale du Diabète (FID), l’obésité abdominale, la tension artérielle élevée (TAE), l’hyperglycémie était respectivement de 23,5 %; 36,1 % et 34,5 %. Des carences nutritionnelles étaient également présentes, l’anémie, la carence en fer et en vitamine A, ainsi que la maigreur atteignant respectivement 25,5 %, 15,4 %, 12,7 % et 9,7 % de la population étudiée. Les femmes étaient significativement plus touchées que les hommes autant par les FRCM que par les carences nutritionnelles. Le double fardeau de la malnutrition touchait 23,5 % des personnes et même 25,8 % avec les seuils de la FID pour l’obésité abdominale, la TAE, et l’hyperglycémie. Les deux principaux phénotypes observés étaient : l’association de « surpoids/obésité avec au moins une carence en micronutriment », touchant 7,8 % (11,8 % ♀ vs. 3,4 % ♂) des personnes et l’association d’au moins un FRCM autre que le surpoids/obésité avec au moins une carence en micronutriment, qui touchait 9.0 % (12,4 % ♀ vs. 5,4 % ♂) des personnes. La prévalence de ces phénotypes était plus élevée en utilisant les seuils de la FID plutôt que les seuils de l’OMS. Près de 72,9 % des personnes ou 81,2 % (seuils de la FID) avaient au moins un FRCM. Nous avons identifié à partir de l’analyse typologique, deux schémas alimentaires; « urbain » et « traditionnel », dans cette étude. Les carences nutritionnelles étaient davantage associées au schéma alimentaire « traditionnel », alors que les FRCM se retrouvaient dans les deux schémas alimentaires. Le schéma « urbain » regroupait significativement plus d’hommes et de personnes de niveau socioéconomique élevé, alors que les personnes de niveau socioéconomique bas et les femmes étaient proportionnellement plus nombreuses dans le schéma « traditionnel ». Le temps dévolu aux activités sédentaires était significativement plus important que celui consacré aux activités d’intensité modérée à vigoureuse. L’activité physique était inversement associée à l’indice de masse corporelle (IMC), au tour de taille (TT), à la masse grasse corporelle, à la tension artérielle systolique (TAS) et diastolique (TAD), à la triglycéridémie et au taux de lipoprotéine de faible densité (LDL-C). L’IMC et le TT augmentaient en outre avec le temps de sédentarité. Ainsi, le double fardeau de malnutrition était associé au statut socioéconomique bas, au sexe féminin et à la sédentarité. Nous avons aussi trouvé que 39,4 % des personnes avaient une inflammation subclinique qui était associée de façon indépendante et positive à la ferritinémie, à l’IMC, au TT et à la masse grasse corporelle, et négativement au HDL-C. L’exploration du stress psychosocial et de l’image corporelle a révélé une association entre le stress psychosocial, l’HTA et une perception positive de l’embonpoint. Les personnes ayant peut-être accusé un retard de croissance à l’enfance (d’après l’indice de Cormic) étaient significativement plus touchées par le surpoids/obésité, l’obésité abdominale et la résistance à l’insuline. Ces résultats nous ont permis d’atteindre nos objectifs, mais aussi de vérifier nos hypothèses de recherche. Comme on peut le constater, les FRCM sont une réalité à Ouagadougou, qui se compliquent par leur coexistence avec des carences en micronutriments dont la prévalence est tout aussi importante. Une transition nutritionnelle est en cours dans cette ville et contribue au bouleversement des comportements alimentaires et du style de vie favorisant l’émergence de ce double fardeau, dans un contexte où le passé nutritionnel de la population offre des conditions idéales pour un niveau de risque particulièrement élevé pour ces FRCM. Cependant, l’évolution de cette prévalence pourrait être inversée ou tout au moins ralentie si des actions étaient entreprises dès maintenant. / This study is a part of a project on the double burden of malnutrition in sub-Saharan Africa, developed and implemented by TRANSNUT, a WHO collaborating centre on nutrition changes and development, of the Department of Nutrition, Université de Montréal, in collaboration with its partners in Burkina Faso (Institut de Recherche en Sciences de la Santé and Institut Supérieur des Sciences de la Population). The study is among the first to focus on the double burden of malnutrition in French speaking Africa and aimed to describe the occurrence of the double burden among adults living in Ouagadougou, Burkina Faso, by determining its prevalence and to what extent it was related to life style factors. More specifically, the study aimed to: 1) describe nutrition deficiencies, cardio-metabolic risk factors (CMRF) and double burden phenotypes, to 2) examine the relationship between lifestyle characteristics and the double burden of malnutrition, and finally, 3) to examine the relationship between subclinical inflammation and both CMRF and nutrition deficiencies. We hypothesised that: ‘among the adults of Ouagadougou, the more frequent phenotype of double burden of malnutrition is the association of overweight/obesity with at least one micronutrient deficiency, which is more prevalent in women’; ‘an inadequate quality of the diet related to poor socioeconomic and living conditions is associated to both CMRF and micronutrients deficiencies’ and finally, that ‘subclinical inflammation is a mediator variable between lifestyle and both CMRF and nutrition deficiencies’. We carried out a population based cross-sectional study, descriptive and analytical, with a random sample of 330 adults aged 25-60y, selected from the population observatory of Ouagadougou located in the northern district. This sample was stratified in three income groups using household assets as a proxy of socioeconomic status, with 110 subjects in the following three income strata: low, middle and high. Each subject provided sociodemographic, anthropometric, clinical and lifestyle data and a blood sample for the assessment of the following study variables: age, and socioeconomic conditions (food insecurity, education and income); lifestyle factors (dietary intake and diet quality, physical activity, alcohol and tobacco consumption, body image perception, and psychosocial stress); subclinical inflammation; CMRF (overweight/obesity, high blood pressure or hypertension, hyperglycaemia, dyslipidemia, insulin resistance); nutritional deficiency markers ( underweight, anaemia, iron and vitamin A deficiencies); the double burden of malnutrition phenotypes featured by combining CMRF with nutrition deficiencies factors. We reported a high prevalence of overweight/obesity, abdominal obesity, hypertension, hyperglycaemia, insulin resistance and low concentration of high density lipoprotein cholesterol (HDL-C), which was 24.2%, 12.5%, 21.9%, 22.3%, 25.1%, and 30.0% respectively. When using International Diabetes Federation (IDF) cut-offs for abdominal obesity, high blood pressure, and hyperglycaemia, their prevalence were 23.5%, 36.1%, and 34.5% respectively. Anaemia, iron and vitamin A deficiencies and underweight were found in 25.5%, 15.4%, 12.7%, and 9.7% of subjects, respectively. Women were more affected by both CMRF and deficiencies than men. When combining CMRF and deficiencies within the same individual, the double burden of malnutrition was reported in 23.5% of subjects and even in 25.8% of them when IDF cut-offs for abdominal obesity, high blood pressure, and hyperglycaemia were used. Two main phenotypes were reported: the co-occurrence of ‘overweight/obesity with at least one micronutrient deficiency’, with a prevalence rate of 7.8% (11.8 % ♀ vs. 3.4 % ♂); and the co-occurrence of ‘CMRF other than overweight/obesity with at least one micronutrient deficiency’, with a prevalence rate of 9.0% (12.4 % ♀ vs. 5.4 % ♂). This prevalences was higher when using IDF cut-offs instead of WHO cut-offs. Finally, 72.9% of the subjects exhibited at least one CMRF and even 81.2% of the subjects when using IDF cut-offs. We also identified in this study population two dietary patterns: “urban” and “traditional”. Nutritional deficiencies were associated with ‘traditional’ dietary pattern, whereas CMRF were found in both patterns without statistical difference. The “urban” dietary pattern was significantly more common in men, high income subjects, whereas low income subjects and women were significantly more numerous in the ‘traditional’ one. Time devoted to sedentary activities was significantly higher than time spent in moderate to vigorous activities. Time in moderate to vigorous activities was significantly and negatively associated with body mass index (BMI), waist circumference (WC), and body fat mass, systolic blood pressure (SBP), diastolic blood pressure (DBP), triglyceridemia, and low density lipoprotein cholesterol (LDL-C), while BMI and WC were associated to sedentary time. The double burden of malnutrition was associated to low income status, women, and sedentary time. We reported that 39.4% of the subjects exhibited subclinical inflammation, which was independently and positively associated with serum ferritin, BMI, WC, body fat mass, and negatively to HDL-C. Body image evaluation revealed that overweight was perceived as desirable body image among the study subjects. Psychosocial stress was associated with hypertension and subjects who probably faced stunting during infancy (using Cormic Index) exhibited significantly higher prevalence of overweight/obesity, abdominal obesity and insulin resistance. The results allowed us to achieve the study objectives and confirm our hypotheses. CMRF represents an overwhelming issue in adults of Ouagadougou complicated with their coexistence with nutritional deficiencies, also highly prevalent. A nutrition transition is at play in the city, contributing to lifestyle changes favorable to the double burden of malnutrition in such a context where the early life nutritional conditions of the subjects may put them at further enhancement of CMRF. The progression of this prevalence can still be averted or at least be slowed if suitable actions were taken from now.

Cette étude s’inscrit dans le cadre du projet « Pôle francophone africain sur le Double Fardeau Nutritionnel » (DFN) du laboratoire TRANSNUT, centre collaborateur OMS sur la transition nutritionnelle du Département de Nutrition de l’Université de Montréal, en collaboration avec ses partenaires au Burkina Faso, à savoir l’Institut de Recherche en Sciences de la Santé (IRSS) et l’Institut Supérieur des Sciences de la Population (ISSP). Elle est l’une des premières à s’intéresser au double fardeau de la malnutrition en Afrique francophone. Cette étude avait pour objectif de démontrer l’existence du double fardeau de la malnutrition parmi les adultes de Ouagadougou au Burkina Faso, d’en donner l’ampleur et d’identifier ses liens avec les facteurs du mode de vie. Plus spécifiquement, elle visait à décrire les carences nutritionnelles, les facteurs de risque cardiométabolique (FRCM), et la typologie du double fardeau de la malnutrition; examiner les caractéristiques du mode de vie des adultes et leurs liens avec le double fardeau de la malnutrition selon les conditions économique, et enfin d’examiner l’association entre inflammation subclinique, les carences nutritionnelles et les FRCM selon les facteurs du mode de vie. Ces objectifs faisaient suite à nos principales hypothèses qui stipulaient que : parmi les adultes de Ouagadougou, le phénotype de double fardeau de la malnutrition le plus fréquemment observé est l’association de surpoids/obésité avec une ou plusieurs carences nutritionnelles, surtout chez les femmes, puis qu’une alimentation de piètre qualité, en lien avec de mauvaises conditions socioéconomiques et de vie est associée tant aux FRCM qu’aux carences nutritionnelles, contribuant ainsi au double fardeau de malnutrition, et enfin qu’un état d’inflammation subclinique joue un rôle de médiateur entre le mode de vie et aussi bien les carences nutritionnelles que les FRCM. Afin de répondre à ces objectifs, une étude transversale descriptive et analytique a été conduite auprès d’un échantillon aléatoire de 330 adultes âgés de 25 à 60 ans recrutés au sein de l’Observatoire de Population de Ouagadougou, situé à la partie nord de la ville. Cet échantillon a été subdivisé en terciles du score de possessions matérielles, proxy du statut socioéconomique, avec 110 personnes respectivement dans chaque strate de niveau socioéconomique bas, moyen et élevé. Chaque participant a fourni des données sociodémographiques, anthropométriques, cliniques et comportementales; il a aussi fourni un échantillon de sang. Les principales variables de l’étude étaient les suivantes : l’âge, les conditions socioéconomiques (insécurité alimentaire, éducation et proxy du revenu), le mode de vie (les apports alimentaires et la qualité de l’alimentation, l’activité physique, la consommation d’alcool et de tabac, la perception de l’image corporelle, le stress psychosocial); l’inflammation subclinique; les FRCM [surpoids/obésité, tension artérielle élevée (TAE) ou hypertension artérielle (HTA), hyperglycémie, dyslipidémie et insulino-résistance]; les carences nutritionnelles (maigreur, anémie, carence en fer et en vitamine A). Des phénotypes de double fardeau de la malnutrition ont été identifiés en combinant FRCM et carences nutritionnelles. Les résultats ont montré une prévalence élevée de surpoids/obésité, d’obésité abdominale, d’hypertension artérielle, d’hyperglycémie, de résistance à l’insuline et du taux de lipoprotéine de haute densité (HDL-C) bas, respectivement de 24,2 %, 12,5 %, 21,9 %, 22,3 %, 25,1 % et 30,0 %. En utilisant les seuils plus sensibles de la Fédération Internationale du Diabète (FID), l’obésité abdominale, la tension artérielle élevée (TAE), l’hyperglycémie était respectivement de 23,5 %; 36,1 % et 34,5 %. Des carences nutritionnelles étaient également présentes, l’anémie, la carence en fer et en vitamine A, ainsi que la maigreur atteignant respectivement 25,5 %, 15,4 %, 12,7 % et 9,7 % de la population étudiée. Les femmes étaient significativement plus touchées que les hommes autant par les FRCM que par les carences nutritionnelles. Le double fardeau de la malnutrition touchait 23,5 % des personnes et même 25,8 % avec les seuils de la FID pour l’obésité abdominale, la TAE, et l’hyperglycémie. Les deux principaux phénotypes observés étaient : l’association de « surpoids/obésité avec au moins une carence en micronutriment », touchant 7,8 % (11,8 % ♀ vs. 3,4 % ♂) des personnes et l’association d’au moins un FRCM autre que le surpoids/obésité avec au moins une carence en micronutriment, qui touchait 9.0 % (12,4 % ♀ vs. 5,4 % ♂) des personnes. La prévalence de ces phénotypes était plus élevée en utilisant les seuils de la FID plutôt que les seuils de l’OMS. Près de 72,9 % des personnes ou 81,2 % (seuils de la FID) avaient au moins un FRCM. Nous avons identifié à partir de l’analyse typologique, deux schémas alimentaires; « urbain » et « traditionnel », dans cette étude. Les carences nutritionnelles étaient davantage associées au schéma alimentaire « traditionnel », alors que les FRCM se retrouvaient dans les deux schémas alimentaires. Le schéma « urbain » regroupait significativement plus d’hommes et de personnes de niveau socioéconomique élevé, alors que les personnes de niveau socioéconomique bas et les femmes étaient proportionnellement plus nombreuses dans le schéma « traditionnel ». Le temps dévolu aux activités sédentaires était significativement plus important que celui consacré aux activités d’intensité modérée à vigoureuse. L’activité physique était inversement associée à l’indice de masse corporelle (IMC), au tour de taille (TT), à la masse grasse corporelle, à la tension artérielle systolique (TAS) et diastolique (TAD), à la triglycéridémie et au taux de lipoprotéine de faible densité (LDL-C). L’IMC et le TT augmentaient en outre avec le temps de sédentarité. Ainsi, le double fardeau de malnutrition était associé au statut socioéconomique bas, au sexe féminin et à la sédentarité. Nous avons aussi trouvé que 39,4 % des personnes avaient une inflammation subclinique qui était associée de façon indépendante et positive à la ferritinémie, à l’IMC, au TT et à la masse grasse corporelle, et négativement au HDL-C. L’exploration du stress psychosocial et de l’image corporelle a révélé une association entre le stress psychosocial, l’HTA et une perception positive de l’embonpoint. Les personnes ayant peut-être accusé un retard de croissance à l’enfance (d’après l’indice de Cormic) étaient significativement plus touchées par le surpoids/obésité, l’obésité abdominale et la résistance à l’insuline. Ces résultats nous ont permis d’atteindre nos objectifs, mais aussi de vérifier nos hypothèses de recherche. Comme on peut le constater, les FRCM sont une réalité à Ouagadougou, qui se compliquent par leur coexistence avec des carences en micronutriments dont la prévalence est tout aussi importante. Une transition nutritionnelle est en cours dans cette ville et contribue au bouleversement des comportements alimentaires et du style de vie favorisant l’émergence de ce double fardeau, dans un contexte où le passé nutritionnel de la population offre des conditions idéales pour un niveau de risque particulièrement élevé pour ces FRCM. Cependant, l’évolution de cette prévalence pourrait être inversée ou tout au moins ralentie si des actions étaient entreprises dès maintenant. / This study is a part of a project on the double burden of malnutrition in sub-Saharan Africa, developed and implemented by TRANSNUT, a WHO collaborating centre on nutrition changes and development, of the Department of Nutrition, Université de Montréal, in collaboration with its partners in Burkina Faso (Institut de Recherche en Sciences de la Santé and Institut Supérieur des Sciences de la Population). The study is among the first to focus on the double burden of malnutrition in French speaking Africa and aimed to describe the occurrence of the double burden among adults living in Ouagadougou, Burkina Faso, by determining its prevalence and to what extent it was related to life style factors. More specifically, the study aimed to: 1) describe nutrition deficiencies, cardio-metabolic risk factors (CMRF) and double burden phenotypes, to 2) examine the relationship between lifestyle characteristics and the double burden of malnutrition, and finally, 3) to examine the relationship between subclinical inflammation and both CMRF and nutrition deficiencies. We hypothesised that: ‘among the adults of Ouagadougou, the more frequent phenotype of double burden of malnutrition is the association of overweight/obesity with at least one micronutrient deficiency, which is more prevalent in women’; ‘an inadequate quality of the diet related to poor socioeconomic and living conditions is associated to both CMRF and micronutrients deficiencies’ and finally, that ‘subclinical inflammation is a mediator variable between lifestyle and both CMRF and nutrition deficiencies’. We carried out a population based cross-sectional study, descriptive and analytical, with a random sample of 330 adults aged 25-60y, selected from the population observatory of Ouagadougou located in the northern district. This sample was stratified in three income groups using household assets as a proxy of socioeconomic status, with 110 subjects in the following three income strata: low, middle and high. Each subject provided sociodemographic, anthropometric, clinical and lifestyle data and a blood sample for the assessment of the following study variables: age, and socioeconomic conditions (food insecurity, education and income); lifestyle factors (dietary intake and diet quality, physical activity, alcohol and tobacco consumption, body image perception, and psychosocial stress); subclinical inflammation; CMRF (overweight/obesity, high blood pressure or hypertension, hyperglycaemia, dyslipidemia, insulin resistance); nutritional deficiency markers ( underweight, anaemia, iron and vitamin A deficiencies); the double burden of malnutrition phenotypes featured by combining CMRF with nutrition deficiencies factors. We reported a high prevalence of overweight/obesity, abdominal obesity, hypertension, hyperglycaemia, insulin resistance and low concentration of high density lipoprotein cholesterol (HDL-C), which was 24.2%, 12.5%, 21.9%, 22.3%, 25.1%, and 30.0% respectively. When using International Diabetes Federation (IDF) cut-offs for abdominal obesity, high blood pressure, and hyperglycaemia, their prevalence were 23.5%, 36.1%, and 34.5% respectively. Anaemia, iron and vitamin A deficiencies and underweight were found in 25.5%, 15.4%, 12.7%, and 9.7% of subjects, respectively. Women were more affected by both CMRF and deficiencies than men. When combining CMRF and deficiencies within the same individual, the double burden of malnutrition was reported in 23.5% of subjects and even in 25.8% of them when IDF cut-offs for abdominal obesity, high blood pressure, and hyperglycaemia were used. Two main phenotypes were reported: the co-occurrence of ‘overweight/obesity with at least one micronutrient deficiency’, with a prevalence rate of 7.8% (11.8 % ♀ vs. 3.4 % ♂); and the co-occurrence of ‘CMRF other than overweight/obesity with at least one micronutrient deficiency’, with a prevalence rate of 9.0% (12.4 % ♀ vs. 5.4 % ♂). This prevalences was higher when using IDF cut-offs instead of WHO cut-offs. Finally, 72.9% of the subjects exhibited at least one CMRF and even 81.2% of the subjects when using IDF cut-offs. We also identified in this study population two dietary patterns: “urban” and “traditional”. Nutritional deficiencies were associated with ‘traditional’ dietary pattern, whereas CMRF were found in both patterns without statistical difference. The “urban” dietary pattern was significantly more common in men, high income subjects, whereas low income subjects and women were significantly more numerous in the ‘traditional’ one. Time devoted to sedentary activities was significantly higher than time spent in moderate to vigorous activities. Time in moderate to vigorous activities was significantly and negatively associated with body mass index (BMI), waist circumference (WC), and body fat mass, systolic blood pressure (SBP), diastolic blood pressure (DBP), triglyceridemia, and low density lipoprotein cholesterol (LDL-C), while BMI and WC were associated to sedentary time. The double burden of malnutrition was associated to low income status, women, and sedentary time. We reported that 39.4% of the subjects exhibited subclinical inflammation, which was independently and positively associated with serum ferritin, BMI, WC, body fat mass, and negatively to HDL-C. Body image evaluation revealed that overweight was perceived as desirable body image among the study subjects. Psychosocial stress was associated with hypertension and subjects who probably faced stunting during infancy (using Cormic Index) exhibited significantly higher prevalence of overweight/obesity, abdominal obesity and insulin resistance. The results allowed us to achieve the study objectives and confirm our hypotheses. CMRF represents an overwhelming issue in adults of Ouagadougou complicated with their coexistence with nutritional deficiencies, also highly prevalent. A nutrition transition is at play in the city, contributing to lifestyle changes favorable to the double burden of malnutrition in such a context where the early life nutritional conditions of the subjects may put them at further enhancement of CMRF. The progression of this prevalence can still be averted or at least be slowed if suitable actions were taken from now.

The prevalence of Protein-Energy Malnutrition (PEM) in South Africa has been welldescribed in previous research studies and yet little is known about the nutritional status of toddlers in the Vosloorus Township. Using the research questions as the conceptual framework for the study, an exploratory descriptive survey was conducted to determine. • What factors give rise to malnutrition in the Vosloorus Township? • Why do toddlers on the PEM Programme fail to achieve their expected target weight? Data was collected by means of structured interviews from a sample of 50 mothers in the Vosloorus Township whose toddlers were on the PEM Programme. The fmdings indicated that the poor socio-economic conditions of the majority of households, especially unemployment, low levels of education and ignorance, contributed towards the development of malnutrition amongst toddlers and their failure to thrive on the PEM Programme. Recommendations to reduce levels of malnutrition and transform existing nutrition programmes were made. / Health Studies / M.A. (Nursing Science)

The prevalence of Protein-Energy Malnutrition (PEM) in South Africa has been welldescribed in previous research studies and yet little is known about the nutritional status of toddlers in the Vosloorus Township. Using the research questions as the conceptual framework for the study, an exploratory descriptive survey was conducted to determine. • What factors give rise to malnutrition in the Vosloorus Township? • Why do toddlers on the PEM Programme fail to achieve their expected target weight? Data was collected by means of structured interviews from a sample of 50 mothers in the Vosloorus Township whose toddlers were on the PEM Programme. The fmdings indicated that the poor socio-economic conditions of the majority of households, especially unemployment, low levels of education and ignorance, contributed towards the development of malnutrition amongst toddlers and their failure to thrive on the PEM Programme. Recommendations to reduce levels of malnutrition and transform existing nutrition programmes were made. / Health Studies / M.A. (Nursing Science)