Thesis (MNutr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Introduction Breastfeeding is a key child survival strategy. Mixed feeding (predominant and partial breastfeeding as defined by the World Health Organisation) during the first six months of life is associated with childhood morbidity and mortality, especially in resource-limited settings, and carries the highest risk of HIV transmission through breastfeeding. When compared to exclusive breastfeeding, predominant, partial or no breastfeeding increases the risk for pneumonia and diarrhoea-related mortality. National exclusive breastfeeding rates are poor and have not improved significantly over the past fourteen years, supporting investigation into the contextual factors that influence infant feeding practices. Aim The study aimed to determine the feeding practices of primary caregivers of infants (0-5.9 months) and the influencing factors in Avian Park and Zwelethemba in Worcester, in the Western Cape Province of South Africa, in order to make recommendations, where appropriate. Methods The study was conducted from April to August 2011. A cross-sectional community-based survey was performed using a structured questionnaire. Focus group discussions were held with mothers, fathers and maternal and paternal grandmothers of infants younger than six months, and health care workers (formally trained professionals and counsellors) working in child health. Results One hundred and forty primary caregivers were interviewed. All caregivers were the biological mother of the infant. Seventy-seven percent (n=108) had initiated breastfeeding. At the time of the study, 6% (n=8) breastfed exclusively. Ninety-four percent (n=132) applied suboptimal breastfeeding practices: 36% (n=51) breastfed predominantly, 27% (n=38) breastfed partially, and 31% (n=43) did not breastfeed. Ninety percent (n=126) of the mothers had introduced water, of whom 83% (n=104) had done so before their infants were one month old. Forty-four percent (n=61) of the mothers had introduced food or formula milk, of whom 75% (n=46) had done so before their infants were three months old. Knowledge of the health and economic benefits of breastfeeding supported initiation but several barriers to exclusive breastfeeding remained. The main barriers were 1) the widely-held perception that infants needed water and nonprescription medicines, 2) the concern that milk alone does not satisfy the infant, 3) inadequate infant feeding education and support by the health system, 4) the lack of community-based postnatal support, 5) convention and family influence, 6) mothers separated from their infants and 7) local beliefs about maternal behaviour and breastfeeding. HIV infection exerted a significant influence on infant feeding choice (p<0.001) and none of the HIV-infected mothers breastfed (n=19). Forty-five percent (n=19) of the formula feeding mothers over-diluted the milk, and early supplementation of formula milk with food was common. Health care workers and maternal grandmothers were the key role-players in infant feeding information and support. Conclusion Exclusive breastfeeding during the first six months of life was a rare practice in these communities. Water, formula milk and/or food were introduced at an early age. HIV-infection discouraged breastfeeding and formula feeding practices proved to be poor. Comprehensive education and support at antenatal, intrapartum and postnatal level seemed lacking and community perceptions and convention contributed to mixed feeding practices. Mothers seemed ill equipped to negotiate infant feeding practices with roleplayers at home. / AFRIKAANSE OPSOMMING: Inleiding Borsvoeding is ‘n sleutelstrategie ter ondersteuning van kinderoorlewing. Gemengde voeding (hoofsaaklike en gedeeltelike borsvoeding, soos omskryf deur die Wêreldgesondheidsorganisasie) gedurende die eerste ses maande van lewe, sowel as geen borsvoeding, word geassosieer met kindersiektes and -sterftes, veral in gebiede met beperkte hulpbronne waar babas vatbaar is vir wanvoeding, gastroënteritis en longontsteking. Gemengde voeding dra ook die hoogste risiko vir MIV-oordrag deur borsvoeding. Nasionale eksklusiewe borsvoedingskoerse is swak en het nie oor die laaste veertien jaar verbeter nie. Dit dien as motivering vir die ondersoek na kontekstuele faktore wat babavoedingspraktyke beïnvloed. Doelwit Die doelwit van die navorsingsstudie is om voedingspraktyke van primêre versorgers van babas (0-5.9 maande) en die invloedryke faktore te bepaal in Avian Park en Zwelethemba in Worcester in die Wes-Kaap Provinsie van Suid-Afrika, om sodoende aanbevelings te kan maak waar gepas. Metodes Die studie is uitgevoer van April tot Augustus 2011. ‘n Gemeenskapsgebaseerde deursnee-opname is uitgevoer deur gebruik te maak van ‘n gestruktureerde vraelys. Fokusgroepbesprekings is uitgevoer met moeders, vaders, en oumas (aan moeders- en vaderskant) van babas jonger as ses maande, en gesondheidswerkers (formeel opgeleide werkers en beraders) wat in kindersorg werk. Resultate ‘n Onderhoud is met eenhonderd-en-veertig primêre versorgers gevoer. Al die versorgers was die biologiese moeder van die baba. Sewe-en-sewentig persent (n=108) het borsvoeding begin. Ten tye van die studie het 6% (n=8) eksklusief geborsvoed. Vier-en-negentig persent (n=132) het suboptimale borsvoedingspraktyke beoefen: 36% (n=51) het hoofsaaklik geborsvoed, 27% (n=38) het gedeeltelik geborsvoed en 31% (n=43) het nie geborsvoed nie. Negentig persent (n=126) van die moeders het water gegee, van wie 83% (n=104) dit gedoen het voordat hul babas een maand oud was. Vier-en-veertig persent (n=61) van die moeders het voedsel of formulemelk gegee, van wie 75% (n=46) dit gedoen het voordat hul babas drie maande oud was. Kennis van die gesondheids- en ekonomiese voordele van borvoeding het moeders ondersteun om te begin borsvoed, maar daar was steeds verskeie faktore wat eksklusiewe borsvoeding belemmer het. Die belangrikste hindernisse was 1) die algemene siening dat babas water en nie-voorskrif medisynes benodig, 2) die kommer dat alleenlik melk nie die baba bevredig nie, 3) ontoereikende babavoedingsonderrig en ondersteuning deur die gesondheidstelsel, 4) die gebrek aan gemeenskapsgebaseerde nageboorte-ondersteuning, 5) gebruike en die invloed van gesinslede, 6) moeders geskei van hul babas en 7) plaaslike sienings rakende moeders se gedrag en borsvoeding. MIV-infeksie het ‘n wesenlike invloed op voedingskeuse gehad (p<0.001) en geen van die MIV-positiewe moeders het geborsvoed nie (n=19). Vyf-en-veertig persent (n=19) van die formule voedende moeders het die melk oorverdun en vroeë supplementasie van formulemelk met kos was algemeen. Gesondheidswerkers en oumas was die kernrolspelers ten opsigte van baba-voedingsinligting en ondersteuning. Gevolgtrekking Eksklusiewe borsvoeding gedurende die eerste ses maande van lewe was ‘n seldsame praktyk in hierdie gemeenskappe. Water, formulemelk en/of voedsel is op ‘n vroeë ouderdom bekendgestel. MIV infeksie het borsvoeding ontmoedig en formulevoedingspraktyke was swak. Omvattende opvoeding en ondersteuning op voorgeboorte-, intrapartum- en nageboortevlak het ontbreek, en sienings en gebruike het bygedra tot gemengde voedingspraktyke. Dit het geblyk dat moeders nie toegerus was om oor babavoedingspraktyke met ander belanghebbendes by die huis te onderhandel nie.

Thesis (MNutr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Background: Very little data exists regarding the nutritional status of adolescent soccer players and there is no national data regarding this population. Aim: The aim of this study was to investigate the dietary intake and anthropometric profile of N=39 male, high-performance, adolescent soccer players who are of mixed race (14 -18 years of age), during the competitive season. Methods: The study design was a descriptive, observational study with an analytical component. A quantified food frequency questionnaire (QFFQ), which has been validated for athletes, was used to characterise their nutritional intake in terms of energy (kCal), macronutrient as well as micronutrient intake. Interpretation of anthropometric data included plotting and interpreting growth indicators such as height-for-age, body mass index (BMI)-for-age, tricep skinfold-for-age, subscapular skinfold-for-age, sum of skinfolds-for-age, arm muscle area (AMA)–for-age, arm muscle circumference (AMC)-for-age, arm fat area (AFA)-for-age and percentage body fat. Results: The anthropometric data showed that most of the players had an adequate height-for-age (100%, N=39) and BMI-for-age (87.2%, N=34). The mean percentage body fat was 10.9±3.5%. The majority of players’ skinfold thickness measurements were above the 85th percentile for triceps (56.4%, N=22), subscapular (59.0%, N=23) as well as the sum of two skinfolds (triceps and subscapular), (72.0%, N=28), AMA (82.1%, N=32), AMC (56.4%, N=22) and AFA (56.4%, N=22). Daily minimum and maximum mean energy expenditure was between 3146.9±213.4 and 3686.4±250.0 kcal while daily mean energy intake was 4374.0±1462.4 kcal. Protein (156±53 g/day), carbohydrate (CHO) (557±172 g/day), total fat (149±67.8 g/day) and cholesterol (546±230 mg/day) intake were all above levels recommended for athletes. The mean micronutrient intake met the estimated average requirement (EAR) or adequate intake (AI) for all nutrients. Players who were more physically active displayed more favourable anthropometric indices which included body weight, BMI, body fat indices as well as muscle mass indices, despite having a greater total energy intake (TEI). This difference did however not reach statistical significance. Supper was the most regularly consumed meal (97.4%, N=38). The majority of players (61.5%, N=24) ate breakfast daily with only 5.1% (N=2) who never ate breakfast. However, 20.5% (N=8) of the players only ate breakfast 3 days a week. Conclusion: Although most of the players had a normal body weight and BMI, they were predominantly categorised as above average according to indices of body fat. Body muscle indices was categorised as above average for most players suggesting a beneficial finding in terms of sporting performance. The mean TEI, CHO, protein intake and fat intake were all above the recommended levels for athletes. The mean intake of all vitamins and minerals met the EAR/AI. Players who were more physically active displayed more favourable anthropometric indices, despite having a higher TEI. Although this study population exhibited no evidence of stunting, indicating that the players were well nourished (in terms of sufficient macronutrients and micronutrients), they are at risk of being over-nourished which may negatively impact sporting performance as well as overall health. / AFRIKAANSE OPSOMMING: Agtergrond: Daar is baie min studies wat die dieetinname van adolosent-sokkerspelers ondersoek het en daar is sover die navorser se kennis strek, geen nasionale data rakende dieetinname in hierdie studie populasie nie. Doel: Die doel van die studie was om die dieetinname en antropometriese profiel van N=39 manlike hoë-prestasie adolosent-sokkerspelers van gemengde ras (14-18 jaar) gedurende die kompeterende seisoen te bepaal. Metodes: ‘n Kwantitatiewe voedselfrekwensie vraelys was gebruik om die totale energie (kcal), makronutriënt- en mikronutrientinname te bepaal. Die antropometriese data was geïnterpreteer met behulp van die volgende groei indikatore; lengte-vir-ouderdom, liggaamsmassa indeks (LMI)-vir-ouderdom, trisep velvou-vir-ouderdom, subskapulêre velvou-vir-ouderdom, som van velvoue-vir-ouderdom, arm spier area (ASA)-vir-ouderdom, arm spier omtrek (ASO)-vir-ouderdom, arm vet area (AVA)-vir-ouderdom en persentasie liggaamsvet. Resultate: Die antropometriese data het getoon dat meeste van die spelers toepaslike lengte-vir ouderdom (100%, N=39) en LMI-vir-ouderdom (87.2%, N=34) het. Die gemiddelde persentasie liggaamsvet was 10.9±3.5%. Die meerderheid van die spelers se velvou metings was bo die 85ste persentiel vir die trisep (56.4%, N=22), subskapulêr (59.0%, N=23) sowel as die som van twee velvoue (trisep en subscapulêr), (72.0%, N=28), ASA (82.1%, N=32), ASO (56.4%, N=22) en AVA (56.4%, N=22). Die daaglikse maksimum en minimum gemiddelde energie verbruik was 3146.9±213.4 tot 3686.4±250.0 kcal en daaglikse energie inname was 4757.9±2121.2 kcal. Proteïen (155.6±53.3 g/day), koolhidraat (556.8±172.1 g/day), totale vet (148.8±67.8 g/day) en cholesterol (545.5±230.1 mg/day) inname was bo die aanbevelings. Die gemiddelde mikronutriënt inname was binne die geskatte gemiddelde aanbeveling of toereikende inname vir al die mikronutriënte. Die gemiddelde vloeistof inname gedurende ‘n sokker wedstryd en ‘n twee uur oefen sessie was 479.1±163 ml en 597.7±281 ml, onderskeidelik. Die meer aktief spelers het ‘n meer geskikte antropometriese profiel, soos laer gewig, LMI en liggaamsvet waardes en hoër spiermassa waardes beskik, ten spite van ‘n hoër energie inname. Die maal wat die mees gereeld geëet was is aandeete (97.4%, N=38). Meeste (61.5%, N=24) van die spelers het ontbyt daagliks geëet met net 5.1% (N=2) wat nooit ontbyt geëet. Alhoevel daar nogsteeds 20.5% (N=8) van spelers was wat net ontbyt 3 keer per week geëet het. Die maaltyd wat die minste ingeneem was, was ontbyt, met net 20.5% (N=8) wat onybyt 3 dae per week eet. Slot: Alhoewel meeste van die spelers ‘n normale gewig en LMI getoon het, is die meeste spelers gekatogoriseerd as bo gemiddeld in terme van liggaamlike vet waarde. Die meeste van die spelers kan ook gekatogoriseer word as bo gemiddeld in term van spiermassa, wat voordelig is vir sport prestasie. Die gemiddlede energie, koolhidraat, proteïen, en vet innames was bo die aanbevole reikwydtes. Die gemiddelde mikronutriënt inname was binne die geskatte gemiddelde aanbeveling of toereikende inname vir al die mikronutriënte. Meer aktief spelers het ‘n meer geskikte antropometriese profiel getoon, ten spite van ‘n hoër energie inname. Alhoewel hierdie populasie wel gevoed is, in terme van makronutriënt en micronutrient, draar hulle ‘n risiko om oor gevoed to wees. Dit mag hulle sport prestasie en algehele gesondheid negatief beïnvloed.

Thesis (PhD (Interdisciplinary Health Sciences. Human Nutrition))--Stellenbosch University, 2008. / Objectives: To determine the impact of facility-based semi-intensive and home-based intensive counseling strategies to improve exclusive breastfeeding rates and to identify factors associated with exclusive breastfeeding. Methods: This was a randomized trial in which villages in the Kibera slum, Nairobi Kenya were assigned to two intervention groups and a control group. Study participants from among 34-36 week pregnant, HIV-negative women, attending antenatal clinic at Lang’ata health centre, were assigned to study groups and followed up in their homes until 6 months postpartum. Experimental group 1, the Home-Based Intensive Counseling Group (HBICG)] received 7 counseling sessions; 1 prenatally and 6 postnatally. Experimental group 2, the Facility-Based Semi-Intensive Counseling Group (FBSICG) received 1 counseling session prenatally. The control group (Control Group) received irregularly provided health education by health personnel. Information on infant feeding practices, using a validated 24-hour recall questionnaire was collected monthly at participant homes; observations were conducted on a random 10% sub-sample to verify the reported information. Qualitative data from focus group discussions provided information on the rationale for feeding choices. Information on infant morbidity and weight measurements were taken on a monthly basis. Results: At six months, exclusive breastfeeding rate was 23.6% in HBICG; 9.2% in FBSICG; and 5.6% in CG. Mothers from HBICG had a 4.2 increased likelihood to exclusively breastfeed compared to those in the CG (RR=4.20; 95% CI; 1.66-10.64; p=0.002). Cumulative exclusive breastfeeding rate for 6 months was 3.2% in the CG; and 6.9% and 15.6% in the FBSICG and HBICG respectively (p<0.00001). Mothers from HBICG had a 3.4 increased likelihood to practice exclusive breastfeeding for 6 months compared to those in CG (RR=3.4; 95% CI: 1-34-8.80; p=0.010). Exclusive breastfeeding rates in FBSICG were insignificantly higher than those in the CG. The median duration of exclusive breastfeeding was one month in both the CG and FBSICG and three months in the HBICG. The predictors of exclusive breastfeeding were non-giving of post-lacteal feeds; planned long breastfeeding duration; living in smaller households; non-ownership of telephones and televisions; absence of breast health problems; and correct knowledge of breastfeeding duration. The major hindrances to exclusive breastfeeding were: inadequate knowledge of exclusive breastfeeding; cultural perceptions about infant feeding; and absence of mother from home for long periods. The prevalence of acute respiratory infections and diarrhoea were significantly lower among exclusively breastfed infants than those non-exclusively breastfed. The prevalence of underweight was significantly lower among the exclusively breastfed infants than those non-exclusively breastfed at one month (p=0.006) and three months (p=0.005). Conclusions: It is feasible to promote and sustain exclusive breastfeeding for six months in low socioeconomic conditions, using the home-based intensive counseling strategy. Breastfeeding promotion programmes should adopt strategies to allow for wider dissemination of information, targeting both mothers and the community at large, as this study showed family members were major decision-makers in the choice of infant feeding practices. Hospital-based breastfeeding education should offer detailed information on a consistent basis. Breastfeeding promotion messages should be re-packaged to address cultural perceptions in infant feeding practices.

Thesis (Phd)-- Stellenbosch University, 2012. / ENGLISH ABSTRACT: Introduction: Adolescents are recognised as a nutritionally at-risk group, as they have high nutritional demand for growth and development, poor eating behaviour as well as a propensity for unhealthy behaviours. Heavy alcohol use, particularly in the form of binge drinking, is typical for an alarming proportion of school-going adolescents and is a plausible contributor to the nutritional challenges in adolescents, but this has not yet been fully investigated. Aim: This study investigated the potential influences of alcohol use on the nutritional status of adolescents with alcohol use disorders (AUDs), specifically with regards to their eating behaviour and dietary intake, growth and weight status, iron status, as well as vitamin D and calcium status. Methods: Substance use, physical activity, eating behaviour, dietary intake, growth and weight status, iron status and vitamin D and calcium status were assessed and compared in heavy drinking adolescents (meeting DSM-IV criteria for AUDs) (n=81) and in light/non-drinking adolescents without AUDs (non-AUDs)(n=81), matched for age, gender, language, socio-economic status and education. Observed dietary intake distributions were adjusted statistically to obtain usual nutrient intake distributions. Regression-adjusted differences between the groups were assessed using multi-level mixed effects linear regression, adjusting for potential confounders. Results: Lifetime alcohol dose in standard drinks of alcohol was orders of magnitude higher in the AUDs group compared to the non-AUDs group. AUDs adolescents had a binge alcohol use pattern and a “weekends-only” style of alcohol consumption. Poor eating patterns (breakfast skipping and frequent snacking), poor food choices (energy-dense and nutrient-poor foods) and low fruit and vegetable intake (non-AUDs 90 [42.4-153.3]; AUDs 88.3 [30.0-153.0] grams per day) in both groups were reflected in the poor nutritional quality of the diet. More than half of adolescents in both groups were at risk of inadequate intakes of folate (non-AUDs 97.5%; AUDs 98.8%), vitamin C (non-AUDs 65%; AUDs 67.5%), vitamin A (non-AUDs 80%; AUDs 82.5%), vitamin E (non-AUDs 78.8%; AUDs 51.3%), magnesium (non-AUDs 98.8%; AUDs 97.5%), and phosphorus (non-AUDs 76.3%; AUDs 73.8%) and all participants were at risk of inadequate calcium and vitamin D intakes. AUDs adolescents had a greater intake of unhealthy foods (energy-dense nutrient-poor) and a significantly greater energy intake than non-AUDs adolescents (p<0.001) that exceeded energy requirements. AUDs adolescents consumed foods high in unhealthy fats significantly more frequently (p=0.037) than the non-AUDs adolescents and had ensuing greater total fat (p<0.001), saturated fat (p<0.001) and cholesterol (p=0.009) intakes. Frequency of intake of sodium-rich foods was significantly higher in AUDs adolescents (p=0.001) and prevalence of risk of excessive sodium intake was significantly greater in the AUDs adolescents (45%) compared to non-AUDs adolescents (18.8%) (p<0.001). Anthropometric indices of growth and weight status were comparable between the groups and in line with that of the South African adolescent population. Female AUDs adolescents had increased odds (OR 2.42) of being overweight/obese compared to non-AUDs females. Physical activity in both groups was well below the WHO global recommendation. Iron store depletion (serum ferritin < 20 μg/L) was evident in a quarter of adolescents in both groups (non-AUDs 23.5%; AUDs 24.7%), with biochemical iron status measures (serum iron and total iron binding capacity) indicating a greater risk of iron store depletion in the AUDs group. Biochemical vitamin D insufficiency/deficiency (serum 25-hydroxyvitamin D < 30 ng/mL) was prevalent in both groups (non-AUDs 70.4%; AUDs 88.8%), although this was significantly greater in the AUDs group (p=0.013), with significantly lower serum 25-hydroxyvitamin D levels in the AUDs group compared to the non-AUDs group (p=0.038). Conclusions: Heavy alcohol use in the form of binge drinking in adolescents may have the following nutrition-related influences: increased intake of energy; unhealthy fats and sodium, increased risk of overweight/obesity in females; increased risk of iron store depletion; and increased risk of vitamin D insufficiency/deficiency. Persistence of heavy alcohol use, poor food choices and dietary intake may increase the risk for adverse nutrition-related health outcomes in the AUDs adolescents. / AFRIKAANSE OPSOMMING: Inleiding: Adolessente het 'n verhoogde risko vir wanvoeding as gevolg van hul hoë voedingbehoeftes vir groei en ontwikkeling, swak eetgedrag, asook 'n geneigdheid tot verdere ongesonde gedrag. Swaar alkohol gebruik in die vorm van “binge” drinkery kom toenemend onder skoolgaande adolessente voor. Hierdie gedrag kan moontlik bydra tot die verhoogde voeding risiko in dié ouderdomsgroep. Hierdie moontlikheid is egter nog nie ten volle ondersoek nie. Doel: Hierdie studie het die potensiële invloed van alkohol gebruik op die voedingstatus van adolessente met alkohol gebruik versteurings (AGVs) ondersoek, spesifiek met betrekking tot hul eetgedrag en dieetinname, groei en gewigstatus asook yster-, vitamien D- en kalsiumstatus. Metodes: Swaar drinkende adolessente wat voldoen aan DSM-IV kriteria vir AGVs (n=81) en lig/nie-drinkende adolessente sonder AGVs (nie-AGVs) (n=81), wat afgepaar is vir ouderdom, geslag, taal, sosio-ekonomiese status en opvoedingsvlak is gewerf vir deelname aan die studie. Middel gebruik, fisiese aktiwiteit, eetgedrag, dieetinname, groei en gewigstatus, ysterstatus en vitamien D- en kalsiumstatus is tussen die twee groepe vergelyk. Waargenome dieetinname verspreidings is statisties aangepas om gewoontelike nutriëntinname te verkry. Regressie-aangepaste verskille tussen die groepe is met behulp van ’n meervoudige gemengde effekte liniêre regressie model getoets, waartydens daar vir moontlike gestrengelde faktore aangepas is. Resultate: Leeftyd alkohol dosis, gemeet in standaard alkohol drankies, was beduidend hoër in die AGVs groep in vergelyking met die nie-AGVs groep. Alkohol gebruik in die AGVs adolessente het ‘n “binge” patroon en ‘n “slegs naweke” styl getoon. Swak eetgewoontes (oorslaan van ontbyt en gereelde peuselgewoontes), swak voedsel keuses (energie-dig en laag in nutriënte) en lae groente en vrugte inname (nie-AGVs 90.0 [42.4-153.3]; AGVs 88.3 [30.0-153.0] gram per dag), in beide groepe, is gereflekteer in die swak voeding kwaliteit van die dieet. ‘n Risiko vir onvoldoende inname van folaat (nie-AGVs 97.5%; AGVs 98.8%), vitamien C (nie-AGVs 65%; AGVs 67.5%), vitamien A (nie-AGVs 80%; AGVs 82.5%), vitamien E (nie-AGVs 78.8%; AGVs 51.3%), magnesium (nie-AGVs 98.8%; AGVs 97.5%), en fosfor (nie-AGVs 76.3%; AGVs 73.8%) was teenwoordig in meer as helfte van adolessente in beide groepe, asook Inleiding: Adolessente het 'n verhoogde risko vir wanvoeding as gevolg van hul hoë voedingbehoeftes vir groei en ontwikkeling, swak eetgedrag, asook 'n geneigdheid tot verdere ongesonde gedrag. Swaar alkohol gebruik in die vorm van “binge” drinkery kom toenemend onder skoolgaande adolessente voor. Hierdie gedrag kan moontlik bydra tot die verhoogde voeding risiko in dié ouderdomsgroep. Hierdie moontlikheid is egter nog nie ten volle ondersoek nie. Doel: Hierdie studie het die potensiële invloed van alkohol gebruik op die voedingstatus van adolessente met alkohol gebruik versteurings (AGVs) ondersoek, spesifiek met betrekking tot hul eetgedrag en dieetinname, groei en gewigstatus asook yster-, vitamien D- en kalsiumstatus. Metodes: Swaar drinkende adolessente wat voldoen aan DSM-IV kriteria vir AGVs (n=81) en lig/nie-drinkende adolessente sonder AGVs (nie-AGVs) (n=81), wat afgepaar is vir ouderdom, geslag, taal, sosio-ekonomiese status en opvoedingsvlak is gewerf vir deelname aan die studie. Middel gebruik, fisiese aktiwiteit, eetgedrag, dieetinname, groei en gewigstatus, ysterstatus en vitamien D- en kalsiumstatus is tussen die twee groepe vergelyk. Waargenome dieetinname verspreidings is statisties aangepas om gewoontelike nutriëntinname te verkry. Regressie-aangepaste verskille tussen die groepe is met behulp van ’n meervoudige gemengde effekte liniêre regressie model getoets, waartydens daar vir moontlike gestrengelde faktore aangepas is. Resultate: Leeftyd alkohol dosis, gemeet in standaard alkohol drankies, was beduidend hoër in die AGVs groep in vergelyking met die nie-AGVs groep. Alkohol gebruik in die AGVs adolessente het ‘n “binge” patroon en ‘n “slegs naweke” styl getoon. Swak eetgewoontes (oorslaan van ontbyt en gereelde peuselgewoontes), swak voedsel keuses (energie-dig en laag in nutriënte) en lae groente en vrugte inname (nie-AGVs 90.0 [42.4-153.3]; AGVs 88.3 [30.0-153.0] gram per dag), in beide groepe, is gereflekteer in die swak voeding kwaliteit van die dieet. ‘n Risiko vir onvoldoende inname van folaat (nie-AGVs 97.5%; AGVs 98.8%), vitamien C (nie-AGVs 65%; AGVs 67.5%), vitamien A (nie-AGVs 80%; AGVs 82.5%), vitamien E (nie-AGVs 78.8%; AGVs 51.3%), magnesium (nie-AGVs 98.8%; AGVs 97.5%), en fosfor (nie-AGVs 76.3%; AGVs 73.8%) was teenwoordig in meer as helfte van adolessente in beide groepe, asook

Thesis (MNutr)--Stellenbosch University, 2011 / ENGLISH ABSTRACT: Introduction Rheumatoid Arthritis (RA) is a chronic, inflammatory, autoimmune disorder characterized by inflammation of the joints and surrounding tissue causing pain, swelling and stiffness. Studies suggest that aspects of the diet may alleviate symptoms and decrease the risk of complications. The scientific basis for a role of dietary therapy in RA has grown although there is still no consensus on the optimum diet. It has been shown that persons with RA tend to have a poor nutritional status; and rheumatoid cachexia, the loss of body cell mass, occurs in nearly two-thirds of all patients with RA. The study aimed to establish what RA patients are practicing and their perceptions regarding the effect of diet, nutritional supplements, medication and complementary and alternative medicines (CAM) and therapies on their symptoms as well as determining their body composition and the possible presence of rheumatoid cachexia. Methodology The study design was a cross-sectional study with an analytical component. The study population consisted of adult (18 years or older) RA patients in the Cape Metropole from the private and public sector. An interviewer-administered questionnaire was used followed by the measurement of weight, height, waist circumference and skinfold thickness. Information was also gathered from the medical records. Results The sample size comprised of 251 RA patients (n=201 public sector; n=50 private sector). The mean body mass index (BMI) was 30.3 kg/m2 for females and 26.6 kg/m2 for males. BMI was used to classify obesity (n=133; 45.9%), overweight (n=66; 26.8%), normal weight (n=63; 25.6%) and underweight (n=4; 1.6%). Waist circumference measurement classifications showed a substantially increased risk for metabolic complications in 51.8% of participants (n=127) and an increased risk in 21.2% of participants (n=52). Just over half of the participants (n=65; 55.6%) had an unhealthy high body fat percentage classification. Rheumatoid cachexia was seen in 10.3% participants (n=12). Low fat-free mass (Fat-free mass index <10th percentile) was seen in 21% participants (n=24) and obesity (Fat mass index >90th percentile) was seen in 27% of participants (n=31). Twenty nine percent of participants (n=73) believed that certain types of food could improve their symptoms of RA and 60% of participants (n=151) believed that certain foods worsened their symptoms. Sixty four percent of participants (n=161) thought that nutritional supplements or complementary and alternative medicines and therapies could improve their symptoms of RA and 98% (n=246) of participants used nutritional supplements. The most frequently used supplements included folic acid (n=218; 91.6%), calcium (n=182; 76.5%), vitamin D (n=185; 77.7%), omega-3 fatty acids (n=48; 64.9%) and multivitamin and mineral preparations (n=22; 29.7%). Conclusion The obesity and waist circumference figures were unacceptably elevated in this population and the body composition of these RA patients should be highlighted as a concern. The high prevalence of risk factors for cardiovascular disease (CVD) need to be urgently addressed since CVD is the leading cause of mortality in RA patients. This study highlights the important role of the intra-professional team, including the dietitian, in the management of RA patients. / AFRIKAANSE OPSOMMING: Inleiding Rumatoïede artritis (RA) is 'n chroniese, inflammatoriese, outo-immuun siekte wat gekenmerk word deur inflammasie van die gewrigte en omliggende weefsel en veroorsaak pyn, swelling en styfheid. Studies dui daarop dat aspekte van die dieet simptome kan verlig en die risiko van komplikasies kan verminder. Die wetenskaplike basis vir die rol van dieetterapie in RA het gegroei, hoewel daar nog geen konsensus aangaande die optimale dieet is nie. Dit is al bewys dat persone met RA geneig is om 'n swak voedingstatus te hê; en rumatoïede cachexia, die verlies van liggaam selmassa in byna twee-derdes van alle pasiënte met RA voorkom. Die doel van die studie was om te bepaal wat RA-pasiënte se praktyke en persepsies ten opsigte van die uitwerking van dieet, voedselaanvullings, medikasie en aanvullende of alternatiewe medisyne (CAM) en terapieë op hul simptome het, sowel as om hul liggaamsamestelling en die moontlike teenwoordigheid van rumatoïede cachexia te bepaal. Metodiek Die studie ontwerp was 'n dwarssnitstudie met 'n analitiese komponent. Die studiepopulasie het bestaan uit volwassene (18 jaar of ouer) RA pasiënte uit die privaat en openbare sektore in die Kaapse Metropool. Onderhoude was gevoer met behulp van vraelyste. Gewig, lengte, middelomtrek en velvoudikte was ook gemeet. Inligting was ook versamel uit mediese rekords. Resultate Die steekproefgrootte het uit 251 RA pasiënte (n=201 openbare sektor, n=50 privaat sektor) bestaan. Die gemiddelde liggaamsmassa-indeks (LMI) was 30.3 kg/m2 vir vroue en 26.6 kg/m2 vir mans. LMI was gebruik om vetsug te klassifiseer (n=133; 45.9%), asook oorgewig (n=66; 26.8%), normale gewig (n=63; 25.6%) en ondergewig (n=4; 1.6%). Klassifikasie van middelomtrek metings het 'n aansienlike verhoogde risiko vir metaboliese komplikasies in 51.8% van die deelnemers (n=127) en 'n verhoogde risiko in 21.2% van die deelnemers (n=52) getoon. Net meer as die helfte van die deelnemers (n=65; 55.6%) het 'n ongesonde hoë liggaamsvet persentasie klassifikasie getoon. Rumatoïede cachexia was by 10.3% van die deelnemers (n=12) gevind. Lae vetvrye massa (vetvrye massa indeks <10de persentiel) was by 21% deelnemers (n=24) en vetsug (vet massa indeks >90ste persentiel) in 27% van die deelnemers (n=31) teenwoordig. Nege-entwintig persent van die deelnemers (n=73) het geglo dat sekere voedselsoorte hul simptome van RA kon verbeter en 60% van die deelnemers (n=151) was van mening dat sekere kosse die simptome kon vererger. Vier-en-sestig persent van die deelnemers (n=161) het gedink dat voedingsaanvullings of aanvullende en alternatiewe medisyne en terapieë hulle simptome van RA kon verbeter en 98% (n=246) van die deelnemers het voedingsaanvullings gebruik. Die mees algemene gebruikte aanvullings was foliensuur (n=218; 91.6%), kalsium (n=182; 76.5%), vitamien D (n=185; 77.7%), omega-3 vetsure (n=48, 64,9%) en multi-vitamien en mineraal preparate (n=22; 29.7%). Gevolgtrekking Die vetsug en middelomtrek syfers was onaanvaarbaar verhoog in die studiepopulasie en die liggaamsamestelling van hierdie RA pasiënte is 'n bekommernis. Die hoë voorkoms van risikofaktore vir kardiovaskulêre siekte (KVS) moet dringend aangespreek word, aangesien die KVS die grootste oorsaak van sterfte in RA pasiënte is. Hierdie studie beklemtoon die belangrike rol van die intra-professionele span, met inbegrip van die dieetkundige, in die bestuur van RA pasiënte.

Thesis (MNutr)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: Introduction: The worldwide increase in the prevalence of childhood overweight and obesity has been identified as a major threat to children’s health and South Africa has not been spared. A child’s food environment is constrained and shaped by their parents/carers who provide food based on own food preferences and food selections, which in turn are determined by the larger cultural, social and economic context. Risk factors for childhood obesity are not well established. Existing prevention strategies, focusing on late childhood and adolescence, are largely unsuccessful. There is however an increasing body of evidence that the early life environment is an important determinant of risk of obesity in later life. Aim: To determine prevalence and socio-demographic risk factors associated with childhood overweight and obesity in the Stellenbosch area, Western Cape Province. Methods: Cross-sectional, comparison study. A representative group of 638 children (aged 6- 13 years) attending three randomly selected Stellenbosch primary schools were weighed and measured to calculate body mass index (BMI) using international obesity task force (IOTF) guidelines in the screening phase of the project to determine the prevalence of overweight and obesity. The comparison study phase identified 84 overweight and obese children and 84 children of normal weight (comparison group) to comprise a sample population of 168 children. Socio-demographic data were determined with a structured questionnaire and compared between the overweight/obese group and comparison group (normal weight) to identify associated risk factors and investigate the Ho. Results: The prevalence of overweight and obesity in the sample of primary school children was 13% (n=84) as determined by BMI, of which 9% (n=57) were classified as overweight and 4% (n=27) as obese. Socio-economic factors including maternal employment hours (p=0.0462), family characteristics e.g. number of children in the household (p=0.0231), eating behaviour like consuming brown rice (p=0.0371), pork (p=0.0143), canola/olive-based margarine (p=0.0398) or poly-unsaturated margarine (p=0.0481), doughnuts (p=0.0280) and time spent doing sport (p=0.0450) were significantly associated with overweight or obesity. Ho were thus rejected. Conclusion: The results suggest that maternal working hours, the number of children in the household, poor eating habits and time spent doing sport are important predictor variables for childhood overweight and obesity. Socio-economic status, infant feeding practices and family characteristics like marital circumstances, household number, and mother’s age did not appear to play a role in the development of childhood overweight and obesity in this population. In light of this evidence, preventative initiatives should pro-actively promote healthy eating behaviour and physical activity to children at an early age, in particular girls. Involving families and schools in these initiatives is recommended as well as a national childhood obesity monitoring system to identify children at risk and tracking trends of childhood obesity in guiding evidence-based interventions to tackle this major health problem. / AFRIKAANSE OPSOMMING: Inleiding: Die wêreldwye toename in die prevalensie van kinder-oorgewig en vetsugtigheid is geïdentifiseer as 'n groot bedreiging vir kinders se gesondheid en Suid-Afrika word nie gespaar nie. 'n Kind se voedingsomgewing is beperk en word gevorm deur ouers of versorgers wat voedsel voorsien gebaseer op hul eie kos voorkeure en voedsel keuses, wat op sy beurt deur die groter kulturele, sosiale en ekonomiese konteks bepaal word. Risiko faktore vir kinder-vetsugtigheid is nie goed gevestig nie. Bestaande voorkoming strategieë, wat fokus op die laat kinderjare en vroeë adolessensie, is grootliks onsuksesvol. Daar is egter voortdurende toename in bewyse dat die vroeë lewensomgewing ‘n belangrike bepalende risiko faktor is vir vetsugtigheid in latere lewe. Doelstellings: Bepaling van prevalensie en sosio-demografiese risiko faktore wat geassosieer word met kinder-oorgewig en vetsugtigheid in die Stellenbosch area, Wes-Kaap Provinsie. Metodes: Deursnit, vergelykende studie. ‘n Verteenwoordigende groep van 638 kinders (ouderdom 6-13 jaar) skoolgaande by drie ewekansig geselekteerde Stellenbosch primêre skole was geweeg en gemeet om Liggaamsmassa Indeks (LMI), volgens die internasionale obesiteit werkgroep (IOTF) riglyne te bereken in die siftingsfase van die projek ter bepaling van prevalensie van oorgewig en vetsugtigheid. Die vergelykende fase het 84 oorgewig en vetsugtige kinders geidentifiseer en 84 kinders met normale gewig (vergelykende groep) ter samestelling van ‘n steekproef populasie van 168 kinders. Sosio-demografiese data was verkry deur ‘n gestruktureerde vraelys en vergelykings was getref tussen oorgewig/vetsugtige groep en vergelykende groep (normale gewig) ter identifisering van geassosieerde risiko faktore en ondersoek van die Ho. Resultate: Prevalensie van oorgewig en vetsugtigheid in die steekproef van primêre skool kinders was 13%(n=84) waarvan 9%(n=57) geklassifiseer was as oorgewig en 4%(n=27) as vetsugtig. Sosio-ekonomiese faktore soos moeders se werksure (p=0.0462), familie kenmerke soos aantal kinders in ‘n huishouding (p=0.0231), eetgedrag nl. bruin rys (p=0.0371), varkvleis (p=0.0143), canola/olyf-gebaseerde margarien (p=0.0398) of polionversadigde margarien (p=0.0481), oliebolle (p=0.0280) en tyd gespandeer aan sport (p=0.0450) was beduidend geassosieer met oorgewig en obesiteit. Ho was dus verwerp. Gevolgtrekking: Die resultate dui daarop dat moeders se werksure, aantal kinders in ‘n huishouding, swak eetgewoontes en tyd gespandeer aan sport, belangrike voorspellers vir kinder-oorgewig en vetsugtigheid is. Sosio-ekonomiese status, baba-voedingspraktyke en familie kenmerke soos huwelikstatus, huishoudelike getal en moeders se ouderdom blyk nie ‘n rol te speel in die ontwikkeling van kinder-oorgewig en obesiteit in hierdie populasie nie. Na aanleiding van hierdie bevindinge moet voorkoming inisiatiewe pro-aktief gesonde eetgewoontes en fisiese aktiwiteit in kinders aanmoedig reeds op 'n vroeë ouderdom, veral in meisies. Die betrekking van gesinne en skole in hierdie inisiatiewe word aanbeveel asook 'n nasionale kinder vetsugtigheids-moniteringstelsel om risiko kinders te identifiseer en die tendense van kinder-vetsugtigheid te volg in die begeleiding van navorsings-gebaseerde intervensies om hierdie belangrike gesondheidsprobleem aan te spreek.

Thesis (MNutr (Human Nutrition))--University of Stellenbosch, 2008. / Objective: To determine the use of complementary and alternative medicine (CAM) among adult HIV positive patients in an outpatient setting. Design: A prospective, observational study performed on patients diagnosed with HIV. The study was conducted from July 2005 to November 2005. Setting: An Outpatient clinic at the Department of Sexual Health (DOSH), Whipps Cross University Hospital, London. Subjects: All patients diagnosed with HIV at the DOSH were approached to participate in the project. Data on patients not using CAM and incomplete questionnaires were not used in the data analysis process. Outcomes measures: The outcome measures include the prevalence of CAM use, reasons for using CAM therapies and monthly expenditure with CAM therapies, sources of information about CAM therapies, disclosure of CAM therapy use, knowledge regarding antiretroviral therapy and CAM therapy drug interactions.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2006. / INTRODUCTION: Postmenopausal osteoporosis is associated with significant morbidity, mortality, reduction in quality of life, and increasing health care costs OBJECTIVE: The study objective was to identify the risk factors associated with the occurrence of osteoporosis, in Kenyan Asian women seen at the Aga Khan University Hospital, Nairobi, Kenya since there is no literature on the prevalence of all these risk factors for osteoporosis in a similar middle aged population sample of Kenyan Asian women. METHOD: The study was of a retrospective design and used recall as a basis of data collection. A socio-demographic questionnaire was completed and anthropometric measurements, of height, weight, waist and hip circumference taken. Bone mineral density (BMD) had been measured previously using Quantitative Computed Tomography (QCT) at the lumbar spine, T11 to L4. Nutrient intake was assessed using a validated food frequency questionnaire (FFQ) and physical activity was determined using the Epic Physical Activity Questionnaire 2 (EPAQ2). BMD scans had been done on all study participants from January 2004 to December 2004 and the subjects were aware of their bone status. RESULTS: Risk factors that were identified by being associated with the development of osteoporosis in Asian women were age (p<0.001), waist size (p<0.001), hip size (p<0.001) and BMI (p<0.001), low physical activity (p=0.001) and use of prescription drugs. Seventy two percent of the study sample was using prescription drugs and the effect on bone mass was most likely detrimental. Anti-hypertensive (p=0.002), non steroidal anti inflammatory drugs (p=0.003) and anti-diabetic drugs (p=0.033) had a significant negative association with bone health. Energy, protein, fat and carbohydrate intake in all the groups was above the EAR and comparatively similar. The intake of all the micronutrients in the study group was above the DRI. There were no statistical significant differences in most of the trace element intake between the two groups, apart from iodine, biotin and manganese. No dietary risk factors were identified which impacted adversely on bone health in this group. The impact of gynaecologic history (parity, oral contraceptive use, age of menarche) on BMD was uncertain. The educational level of the study sample was high as 50% of the subjects were graduates and had a relatively better diet. CONCLUSION: As Kenyan Asian women age they experience the menopausal transition and the risk of developing osteoporosis increases. No nutritional factors were identified that were adversely associated with BMD. Low level of physical activity, prescription drugs for chronic diseases like hypertension, asthma, diabetes and arthritis, age, weight and body mass index were identified and found to be adversely associated with bone mineral density. Early detection, and implementation of patient education, physical activity, and a diet rich in all nutrients, will help to slow down the progression of osteoporosis.

Thesis (MNutr (Human Nutrition))--University of Stellenbosch, 2005. / Introduction: The objective of this study was to develop a regression equation to estimate weight of black male paraplegic South African subjects. Very few institutions in South Africa have wheel chair scales and very few paraplegic persons know what their weight is. People with spinal cord injury (SCI) are reported to have an increased risk to develop obesity and diseases of lifestyle. It is therefore important to monitor the nutritional status of these patients to prevent and treat the above diseases effectively. The aim was to develop an equation that incorporates variables or measurements that do not require a high level of skill and experience to be determined. The equipment needed for the determination of the measurements should also be easily accessible, for example a tape measure rather than a skin-fold caliper.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: The inclusion of nutrition in the national syllabus for health and skincare therapists indicates the realisation of its importance within this industry. Health and skincare therapists should be able to observe any adverse skin condition as a result of a dysfunctional homeostatic relationship between the skin and internal body systems. The aim of this study was to assess the nutritional knowledge, attitude and practices of health and skincare therapists working in accredited clinics in South Africa. This was a cross-sectional, descriptive study using both quantitative and qualitative data collection methods. Two hundred and forty-five questionnaires were sent to 54 SAAHSP accredited clinics around South Africa. Data analysis was performed using the 73 completed questionnaires, representing a response rate of 29.8%. A further 22 therapists participated in focus group discussions and 7 experts in the field of nutrition and skincare acted as the expert panel and participated in in-depth interviews. A self-administered questionnaire on knowledge, attitude and practices was developed, based on the national syllabus. The 56-item questionnaire consisted of 10 demographic questions, 30 nutrition knowledge questions (selected by the expert panel from a pool of 96 questions), 10 attitude statements and 6 practice questions. The questionnaires were analyzed using both descriptive and inferential statistics. The mean total knowledge score of the respondents was 64.4% (SD 0.11) indicating a level of knowledge above the required pass percentage of 60% for a SAAHSP qualification. Therapists with a CIDESCO qualification had a statistically significant higher total knowledge score. The mean score for the therapists’ nutritional knowledge related to skincare was 47.5%, but their attitudes and their ability to advise clients about nutrition were mostly positive, with at least 61% and 69% of the therapists respectively agreeing with the statements. Fifty-six therapists (77%) felt that more intense theoretical nutrition training was needed and 83.3% agreed that more intense practical application of nutritional knowledge is needed at health and skincare institutes. Consistent with the majority’s opinion (82%) that nutritional counseling should form part of treatment, 59% and 63% offer nutritional counseling during body and facial treatment respectively. Therapists gain their nutritional knowledge predominantly from newspapers and magazines. The themes highlighted during the focus group discussions included the influence of training institutions on nutritional knowledge, the importance of client consultation, but the lack of time to perform these and the need for educational opportunities in the professional industry. During the in-depth interviews, the experts highlighted the purpose of nutrition in the industry, nutritional responsibility, training and counseling of therapists as well as the SAAHSP syllabus. Therapists’ understanding of the scientific functioning of nutrients and their nutritional knowledge regarding skincare is a cause for concern. Their lack of confidence in providing clients with nutritional advice, especially regarding skincare; despite their perception that they have sufficient knowledge in this regard, reveals their inability to apply nutritional knowledge in practice. Recommendations to governing bodies and educators responsible for the development and implementation of the national syllabus are made. / AFRIKAANSE OPSOMMING: Die opname van voeding in die nasionale sillabus vir gesondheids- en velsorgterapeute dui op die bewuswording van waarde daarvan in die industrie. Gesondheids- en velsorgterapeute behoort enige ongunstige veltoestand as ‘n nagevolg van gebrekkige homeostatiese verhoudings tussen die vel en interne liggaamssisteme, te identifiseer. Die doel van hierdie studie was om die kennis van voeding, houdings en praktyke van gesondheids- en velsorgterapeute werksaam in geakkrediteerde klinieke in Suid Afrika, te assesseer. Hierdie was ‘n dwarsprofiel, beskrywende studie wat beide kwantitatiewe en kwalitatiewe data insamelingsmetodes gebruik het. Twee honderd vyf-en-veertig vraelyste is na 54 SAAHSP geakkrediteerde klinieke in Suid Afrika gestuur. Die 73 voltooide vraelyste, wat ‘n reaksiekoers van 29.8% verteenwoordig, is vir data- analise gebruik. ‘n Verdere 22 terapeute het aan fokusgroep besprekings deelgeneem en 7 kenners op die gebied van voeding en velsorg het as die spesialis paneel opgetree en aan ‘n in-diepte onderhoude deelgeneem. ‘n Self geadministreerde kennis, houding en praktyk vraelys is op grond van die nasionale sillabus ontwikkel. Die 56-item vraelys het uit 10 demografiese vrae, 30 voedingkennis vrae (wat deur die spesialis paneel vanuit ‘n poel van 96 vrae uitgekies is), 10 houdingstellings en 6 praktyk vrae bestaan. Beskrywende sowel as afleibare statistiek is vir die analise van vraelyste gebruik. Die gemiddelde totale kennistelling van die respondente was 64.4% (SD 0.11), wat ‘n kennisvlak bo die verwagte slaagpersentasie van 60% vir ‘n SAAHSP kwalifikasie aandui. Terapeute wat ‘n CIDESCO kwalifikasie verwerf het, het statisties ‘n beduidende hoër totale kennistelling verwerf. Die terapeute se gemiddelde kennistelling aangaande velsorg was 47.5%, maar hul houdings en vermoë om kliënte rakende voeding te adviseer was meestal positief met onderskeidelik 61% en 69% van terapeute wat met die stellings saamgestem het. Ses-envyftig terapeute (77%) was van mening dat meer intense teoretiese opleiding nodig is en 83.3% het saamgestem dat meer intense praktiese toepassing van voedingskennis by gesondheid- en velsorginstansies nodig is. Konsekwent met die meerderheid (82%) se opinie dat voedingsraadgewing deel van behandelings moet uitmaak, bied 59% en 63% voedingsraadgewing tydens liggaam- en gesigbehandelings aan. Terapeute bekom hul voedingkennis hoofsaaklik van koerante en tydskrifte. Temas wat tydens fokusgroepbesprekings beklemtoon is, het die invloed van opleidingsinstansies op die voedingkennis, die belangrikheid van kliënte konsultasies, maar die gebrek aan tyd om dit uit te voer én die behoefte aan opvoedkundige geleenthede in die professionele industrie, ingesluit. Tydens die in-diepte onderhoude het die spesialiste die doel van voeding in die industrie, terapeute se verantwoordelikheid, opleiding en raadgewing ten opsigte van voeding, sowel as die SAAHSP sillabus beklemtoon. Terapeute se begrip van die wetenskaplike funksionering van nutriënte en hul voedingkennis ten opsigte van velsorg is ‘n bron van kommer. Hul gebrek aan vertroue tydens die verskaffing van voedingsadvies, spesifiek aangaande velsorg; ondanks hul persepsie dat hul voldoende kennis in die verband het, openbaar hul onvermoë om voedingkennis in die praktyk aan te wend. Aanbevelings vir die beheerliggame en opvoeders veranwoordelik vir die ontwikkeling en implementering van die nasionale sillabus, word gemaak.