Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: See full text for abstract / AFRIKAANSE OPSOMMING: Sien volteks vir opsomming

Thesis (MNutr)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Problem definition: Malnutrition increases the incidence and exacerbates the clinical manifestations of TB. Hepatotoxicity is one of the most serious and most frequent side-effects of anti-tuberculosis drugs and may be three times higher in malnourished patients. Objective: The influence of nutritional and retroviral status on the bio-availability and toxicity of anti-tuberculosis agents was studied and a possible relationship between abdominal lymph node enlargement and the occurrence of malnutrition investigated. Subjects and setting: The study subjects were 53 children, 19 HIV-infected and 34 HIV-uninfected, aged 3 months to 13 years with probable or confirmed tuberculosis admitted to the paediatric ward of Brooklyn Hospital for Chest Diseases in Cape Town, South Africa. The nutritional status of the children was assessed over the first four months of tuberculosis treatment by nutrient intake, anthropometric status and biochemical parameters. The relationship between abdominal lymph node enlargement and the occurrence of malnutrition was also evaluated. Pharmacokinetic studies were performed to evaluate the bio-availability of anti-tuberculosis agents and drug hepato-toxicity was evaluated by liver function. Results: Stunting (46.27%) and underweight (34.51%) were the most common types of malnutrition in the children studied. HIV-infection did not have a significant effect on stunting or wasting, but had a significant effect (p=0.003) on underweight for age with 31.5% HIV-infected compared to 2.9% HIV-uninfected at enrolment, but the effect was not statistically significant at month 4. There was no change in the number of stunted, wasted or underweight children from enrolment after 1 month of treatment to month 4 of treatment. HIV-infection did not have a significant effect on abdominal TB involvement (p=0.43354), and nutritional status was not significantly affected by abdominal lymph-node involvement. At enrolment weight for age had a significant effect on AST and ALT with p-values of 0.02166 and 0.02765 respectively and wasting had a significant effect on GGT at enrolment (p=0.03014). However on enrolment only two HIV-infected and two HIV-uninfected children had ALT values increased >X2 normal. Similarly AST values >X3 normal were found in only one HIV-infected child and two HIV-uninfected children. Stunting did not significantly affect liver enzymes. Anthopometric status did not have a significant effect on liver enzymes at month 4. None of the parameters used to determine nutritional status had a statistically significant effect on INH-levels or RMP-levels. HIV-infection had a significant negatve effect on selenium (p=0.030 and 0.012) and ferritin (p=0.026 and 0.002) at enrolment and month 4 and on IBC (p=0.025) at enrolment. At month 4 HIV-infection had a significant negative effect on the mean vitamin C-levels (p=0.005). Conclusions: HIV co-infection did not affect the extent or distribution of body composition changes in this study. Stunting was the most prevalent form of malnutrition in the study group, indicating longstanding undernutrition, which may be due to factors other than the present TB infection. Appropriate treatment of tuberculosis did not appear to affect the nutritional status over the four month period of the study. / AFRIKAANSE OPSOMMING: Probleemstelling: Wanvoeding verhoog die insidensie en vererger die kliniese beeld van TB. Hepatotoksisiteit is een van die ernstigste en algemeenste newe-effekte van anti-tuberkulose middels en mag tot drie keer hoër wees in wangevoede pasiënte. Doelwit: Die invloed van die kinders se voedings- en retrovirale status op die bio-beskikbaarheid en toksisiteit van anti-tuberkulose middels was ondersoek en 'n moontlike verband tussen vergrote abdominale limfnodes en die voorkoms van wanvoeding was ondersoek. Deelnemers en omgewing: Die deelnemers aan die studie was 53 kinders, 19 HIV-positief en 34 HIV-negatief, tussen die ouderdomme van 3 maande en 13 jaar met moontlike of bevestigde tuberkulose toegelaat tot die pediatriese saal van Brooklyn Hospitaal vir Borskwale in Kaapstad, Suid Afrika. Die voedingstatus van die kinders was bepaal oor die eerste vier maande van tuberkulose behandeling ten opsigte van nutriëntinname, antropometriese status en biochemiese parameters. Die verhouding tussen vergrootte abdominale limfnodes en die voorkoms van wanvoeding was ook geëvalueer. Farmakokinetiese studies was uitgevoer om die bio-beskikbaarheid van anti-tuberkulose middels te evalueer en hepatotoksisiteit was deur lewerfunksie geëvalueer. Resultate: Dwerggroei (46.27%) en ondergewig (34.51%) was die algemeenste tipes wanvoeding teenwoordig by die kinders bestudeer. HIV-infeksie het nie 'n noemenswaardige effek op dwerggroei of uittering gehad nie, maar het wel 'n noemenswaardige effek (p=0.003) getoon op ondergewig vir ouderdom met 31.5% HIV-positief vergeleke met 2.9% HIV-negatief by inskrywing, wat nie statisties noemenswaardig was teen maand 4 nie. Daar was geen verandering in die hoeveelheid kinders met dwerggroei, uittering of ondergewig vanaf inskrywing na 1 maand van behandeling tot maand 4 van behandeling nie. HIV-infeksie het nie 'n noemenswaardige effek op abdominale TB gehad nie (p=0.43354), en vergrootte abdominale limfnodes het nie 'n noemenswaardige effek op voedingstatus gehad nie. By inskrywing het gewig vir ouderdom 'n noemenswaardige effek op AST en ALT gehad met p-waardes van 0.02166 en 0.02765 onderskeidelik en uittering het 'n noemenswaardige effek op GGT by inskrywing gehad (p=0.03014). Dwerggroei het nie die lewerensieme noemenswaardig beïnvloed nie. Antropometriese status het nie 'n noemenswaardige effek op lewerensieme teen maand 4 gehad nie. Geen van die parameters wat gebruik is om voedingstatus te bepaal het 'n noemenswaardige statistiese effek op INH-vlakke of RMP-vlakke gehad nie. HIV-infeksie het 'n noemenswaardige effek op selenium (p=0.030 en 0.012) en ferritien (p=0.026 en 0.002) by inskrywing en maand 4 gehad en op IBC (p=0.025) by inskrywing. HIV-infeksie het 'n statisties noemenswaardige effek op die gemiddelde vitamien C-vlakke (p=0.005). Gevolgtrekking: HIV ko-infeksie het nie die verspreiding of mate van liggaamsamestelling veranderinge in hierdie studie geaffekteer nie. Dwerggroei was die algemeenste vorm van wanvoeding in die studiegroep, wat langstaande wanvoeding aandui en toegeskryf mag word aan faktore buiten die huidige TB infeksie. Toepaslike tuberkulose behandeling het nie 'n wesenlike effek op voedingstatus gehad tydens die vier maande periode van die studie nie.

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: A comprehensive food frequency questionnaire (FFQ) was developed to assess the daily total flavonoid intake over the past fortnight within a 14-week intervention that consisted of four periods to determine the effect of rooibos consumption on oxidative stress in adults (n=40) at intermediate to high coronary heart disease (CHD) risk. Within the intervention the comprehensive FFQ validity (against six estimated dietary records and biomarkers), reproducibility (on administrations in the washout and control periods six weeks apart as these periods had similar flavonoid intake restrictions) and responsiveness (across the four intervention periods of changed dietary conditions) was evaluated. The baseline period dietary record and FFQ dietary sources found to contribute most to the participants’ daily total flavonoid intake, considering the percentage contribution, and the between-person variation in intake, considering the stepwise multiple regression analysis, formed the food list of the resultant abbreviated FFQ. The validity, reproducibility and responsiveness of the latter were also evaluated within the intervention and its validity (against dietary records) and reproducibility (on re-administration two weeks apart) in an additional group (n=90) being at low and intermediate CHD risk to evaluate its external strength. The validity and reproducibility evaluations of the comprehensive and abbreviated FFQs in the intervention and abbreviated FFQ within the additional group comprised paired difference tests (to establish the ability to estimate group intakes), correlation coefficients (to establish the ability to rank individual participants), category agreement and gross misclassification next to the weighted kappa statistic (to establish the ability to classify the participants into tertiles and quintiles of intake) and Bland-Altman plots (as representation of the limits of agreement between the two dietary assessment methods). Correlation coefficients were also used for biomarker validity evaluations in the baseline period. The repeated measures analysis of variance (ANOVA) (Bonferroni correction) was used for the responsiveness evaluations of the comprehensive and abbreviated FFQs across the intervention periods alongside that of the biomarkers as evidence for the changed dietary conditions. The study demonstrated that the comprehensive FFQ could be modified to a format with a brief food list as few items contributed appreciably to the total flavonoid intake and of which most also contributed to the between-person intake variability. The comprehensive and moreover the abbreviated FFQ in the validity evaluations provided sufficiently accurate daily total flavonoid intake estimates. They could determine the intake at group level in correspondence with that of the dietary records. The participant intakes could additionally be categorized and in particular ranked greatly alike to the dietary record intakes. The Bland-Altman plots revealed proportional bias regarding overestimation at the higher intake level. The reproducibility also appeared to be greatly satisfactory although seasonal fruit exclusions from the abbreviated FFQ food list may hamper its repeated administration. Both FFQs also confirmed the changed total flavonoid intakes across the intervention periods in relation to changes in the expected direction concerning the plasma total polyphenol, conjugated diene and thiobarbituric acid reactive substance concentrations. / AFRIKAANSE OPSOMMING: ‘n Omvattende voedsel frekwensie vraelys (VFV) is ontwikkel om die daaglikse totale flavonoïed inname oor twee agtereenvolgende weke te beraam te midde van ‘n 14-week intervensie. Die intervensie het uit vier periodes bestaan wat die effek van rooibosinname op oksidatiewe stres in volwassenes (n=40), met ‘n intermediêre tot hoë koronêre hartsiekte (KHS) risiko, bepaal het. Binne die intervensie is die geldigheid (teen ses geskatte dieetrekords en biochemiese merkers), herhaalbaarheid (op aanwending ses weke uitmekaar in die uitwas en kontrole intervensie periodes met dieselfde flavonoïed inname bepalings) en waarneembaarheid (oor vier intervensie periodes van veranderde dieet bepalings) van die omvattende VFV geëvalueer. Die dieetbronne in die basislyn periode dieetrekords en vraelyste wat die meeste tot die deelnemers se daaglikse totale flavonoïed inname (baseer op die persentasie bydrae) en die tussen-persoon variasie in inname (baseer op die stapsgewyse meervuldige regressie analise) bygedra het, het die voedsellys van die voortvloeiende verkorte VFV gevorm. Die geldigheid, herhaalbaarheid en waarneembaarheid van dié VFV is binne die intervensie geëvalueer en die geldigheid (teen dieetrekords) en herhaalbaarheid (heradministrasie twee weke later) daarvan in ‘n verdere groep (n=90) met lae en intermediêre KHS risiko as evaluasie van die eksterne vermoë van die VFV. Die geldigheid en herhaalbaarheid evaluasies van die omvattende en verkorte VFV in die intervensie en die verkorte VFV in die verdere groep het bestaan uit gepaarde verskil toetse (bepaling van die groepinname skattingsvermoë), korrelasie koëffisiënte (bepaling van individuele deelnemer rangorde skattingsvermoë), kategorie ooreenstemming en erge wanklassifikasie naas die aangepaste kappa statistiek (bepaling van die vermoë om die deelnemer innames in derdes en vyfdes te klassifiseer) en die Bland-Altman karterings (verteenwoordiging van ooreenstemmingslimiete tussen die twee dieetinname metodes). Korrelasie koëffisiënte is ook gebruik vir biochemiese merker geldigheid evaluasies in die basislyn periode. Die herhaalde metings analise van variansie (ANOVA) (Bonferroni regstelling) is gebruik om die waarneembaarheid evaluasies van die omvattende en verkorte VFV oor die intervensie periodes naas dit van die biochemiese merkers te evalueer as bewys van die veranderde dieet bepalings. Die studie het aangedui dat die omvattende VFV gewysig kon word tot ‘n formaat met ‘n verkorte voedsellys omdat slegs ‘n aantal items merkbaar tot die totale flavonoïed inname bygedra het en die meeste hiervan ook tot die tussen-persoon variasie in inname. Die omvattende en die verkorte VFV het in die geldigheid evaluasies daarvan voldoende akkurate daaglikse totale flavonoïed inname skattings opgelewer omdat groep innames bepaal kon word in ooreenstemming met dit verkry van die dieetrekords en die deelnemer innames bykomend kategoriseer en in besonder grootliks eenders rangeer kon word as met hul dieetrekord innames. ‘n Proporsionele oorskatting by die hoër inname vlakke is wel vir al twee getoon in die Bland-Altman karterings. Die herhaalbaarheid was ook grootliks aanvaarbaar, alhoewel seisoenale vrugte uitsluitings in die verkorte VFV voedsellys die heruitvoering kan bemoeilik. Al twee vraelyste kon ook die veranderinge in die daaglikse totale flavonoïed inname oor die intervensie periodes bevestig in ooreenstemming met veranderinge in die verwagte rigting van die plasma totale polifenool, konjugaat diëne en tiobarbituursuur reaktiewe stof konsentrasies.

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Background: Abundant evidence supporting the ergogenic effect of caffeine during endurance exercise exists. Single sporting events, laboratory based studies and inappropriate research design questions the applicability of these studies to triathlon performance. Objectives: The main aims of this study were to i) investigate the ergogenic effect of caffeine supplementation during a triathlon; ii) evaluate parameters that could in part explain why caffeine supplementation is ergogenic, iii) investigate possible factors influencing the ergogenicity of caffeine supplementation and iv) investigate possible confounding factors influencing triathlon performance. Methods: A double-blind, randomized, crossover, controlled, clinical field trial was conducted. Performance data (time to complete (TTC), rating of perceived exertion (RPE) and mood state), parameters explaining the mechanism of action (endocrine-stress response, oxidative stress and plasma lactate), factors influencing ergogenicity (lifestyle, gender and genetics) and triathlon performance (general health, energy- and nutrient intake, body composition, training regime, side-effects of caffeine withdrawal- and supplementation and hydration status) was collected during two Olympic-distance triathlons (T1 and T2). Results: Twenty six Caucasian triathletes (Nm=14, Nf=12) participated (age: 37.8±10.6 years, habitual caffeine intake: 412.7±504.8 mg/day, percentage body fat: 14.5±7.2 %, training/week: 12.8±4.5 hours). There was a 3.7% reduction in swim time (33.5±7.0 vs. 34.8±8.1 minutes) (p=0.05*) and a 1.3% reduction in the overall time to complete the triathlon (149.6±19.8 vs. 151.5±18.6 minutes) (p=0.02*) in the caffeine group. Caffeine did not statistically influence mood state (p=0.72) or RPE (p=0.87), however, a trend was observed for decreased RPE values in the caffeine group. Caffeine supplementation made no difference to markers of endocrine-stress, except for cortisol, which increased beyond the effect observed from exercise (p=0.00*). Oxidative stress was more pronounced in the caffeine group, as seen with elevated leukocyte (p=0.05*), lymphocyte (p=0.05*) and monocyte (p = 0.05*) counts. Caffeine facilitated greater blood lactate accumulation (p=0.04*). Lifestyle, menstrual cycle, menopause, oral contraceptive use and CYP1A2 gene polymorphisms did not statistically influence the effect of caffeine supplementation on triathlon performance. The mean energy- and nutrient intake two days before T1 and T2 was low for energy (36.5±17.6 and 38.9±18.2 kcal/kg BW), estimated energy availability (estEA) (27.9±28.0 and 28.8±25.6 kcal/kg fat free mass) and carbohydrate (CHO) intake (4.1±1.6 and 4.6±2.5 g/kg body weight (BW)) compared to recommendations. The pre-event meal was low in CHO (0.7±0.4 and 0.7±0.5 g/kg BW) and only 62% (N=16) ingested a carbohydrate-electrolyte solution during T1 (CHO: 1.6±2.3 g/kg BW) and T2 (CHO: 0.7±0.4 g/kg BW). Eighty-five percent (N=22) used supplements. Seventy-two percent of pre-menopausal (Nf pre-men=5) and 40% of post-menopausal (Nf post-men=2) females were osteopenic. Of the males, 18% (Nm<50 = 2) had low anterior-posterior spine BMD and 33% (Nm>50 = 1) were osteopenic. Caffeine withdrawal presented as headaches (46%, N=12) and flu-like symptoms (38%, N=10). Side effects of caffeine experienced included shakiness (42%, N=11), heart palpitations (38%, N=10) and gastrointestinal disturbances (38%, N=10). Plasma volume and hydration was not influenced (p=0.70). Conclusion: Caffeine enhanced triathlon performance, but the effect was not as pronounced as seen in previous laboratory trials and did not affect RPE or mood state. Caffeine supplementation augments the endocrine-stress response by further increasing cortisol levels beyond that resulting from endurance exercise and it induces leukocytosis, neutrophillia and lymphocytosis, suggesting the primary ergogenic effect of caffeine may result due to stimulation of both the central and autonomic nervous systems. Lifestyle, gender and genetics did not significantly influence caffeine’s effect on triathlon performance in this cohort. The subjects had low energy, estEA and carbohydrate intake and a high prevalence of osteopenia. / AFRIKAANSE OPSOMMING: Agtergrond: Voldoende bewyse rakende die ergogeniese effek van kaffeïen gedurende uithouvermoë oefening bestaan. Enkel sportsoorte, laboratorium studies en ongeskikte navorsingsontwerpe bevraagteken die toepaslikheid van hierdie studies op driekamp prestasie. Doelwitte: Die hoofdoelwitte van die studie was om i) die verbetering van prestasie of ergogeniese effek van kaffeïen supplementasie tydens ‘n driekamp kompetisie waar te neem; ii) om verskeie parameters wat die ergogeniese effek van kaffeïen supplementasie deels te verduidelik te ondersoek, iii) om moontlike faktore wat die ergogeniese effek van kaffeïen supplementasie kan beïnvloed te ondersoek en iv) om moontlike faktore wat Olimpiese-afstand driekamp prestasie kan beïnvloed te ondersoek. Metodes: ‘n Dubbel-blinde, lukrake, oorkruis, gekontroleerde, kliniese veldproef is uitgevoer. Prestasie data (tyd om die driekampe te voltooi, waargenome inspanning en gemoedstoestand), parameters wat moontlik die aksie van kaffeïen kan verduidelik (endokrien-stress respons, oksidatiewe stress en plasma laktaat), faktore wat die ergogeniese effek van kaffeïen kan beïnvloed (lewensstyl, geslag en genetika) en faktore wat moontlik driekamp prestasie kan beïnvloed (algemene gesondheid, energie- en nutriëntinname twee dae voor en op die dag van die driekampe, liggaamsamestelling en beendigtheid, oefening twee dae voord die driekampe, newe-effekte van kaffeïen ontrekking- en supplementasie en hidrasie status) is ingesamel tydens twee Olimpiese afstand driekampe (T1 en T2). Resultate: Ses-en-twintig Kaukasiese driekamp atlete (Nm=14, Nf=12) is ingesluit (ouderdom: 37.8±10.6, daaglikse kaffeïen inname: 412.7±504.8 mg/dag, % liggaamsvet: 14.5±7.2%, oefening/week: 12.8±4.5 uur). Daar was 'n 3.7% afname in swem tyd (33.5±7.0 teenoor 34.8±8.1) (p=0.05*) en 'n 1.3% afname in totale tyd om die driekampe te voltooi (149.6±19.8 teenoor 151.5±18.6) (p=0.02*) in die kaffeïen groep. Kaffeïen het nie ‘n statisties beduidende effek op die gemoedstoestand (p=0.72) of die waargenome inspanning (p=0.87) gehad nie, maar 'n tendens is waargeneem vir laer waargenome inspannings-waardes in die kaffeïen groep. Kaffeïen het geen verskil gemaak aan parameters van die stres respons nie, behalwe vir kortisol, wat verhoog het bo- en behalwe die effek van oefening (p=0.00*). Oksitdatiewe stres was meer uitgesproke in die kaffeïen groep, soos waargeneem deur verhoogde witbloedsel (p=0.05*), limfosiet (p=0.05*) en neutrofiel (p = 0.05*) tellings. Kaffeïen fasiliteer die verhoging in bloedlaktaat vlakke (p=0.04*). Lewensstyl, menstruele siklus, menopause, orale voorbehoedmiddel gebruik en CYP1A2 geen polimorfismes het geen beduidende effek op die vermoë van kaffeïen om driekamp prestasie te beïnvloed gehad nie. Die gemiddelde energie- en nutriëntinname twee dae voor T1 en T2 was laer as die aanbevelings vir energie (36.5±17.6 en 38.9±18.2 kcal/kg LG), geskatte energie beskikbaarheid (29.9±28.0 en 28.8±25.6 kcal/kg vetvrye massa) en koolhidraat (CHO) inname (4.1±1.6 en 4.6±2.5 g/kg LG). Die voor-driekamp ete was laag in CHO (0.7±0,4 en 0.7±0.5 g / kg LG) en slegs 62% (N=16) het ‘n koolhidraat-elektroliet oplossing tydens T1 (CHO: 1.6±2.3 g/kg LG) en T2 (CHO: 0.7±0.4 g/kg LG) ingeneem. Vyf-en-tagtig persent (N=22) gebruik dieetaanvullings. Twee-en-sewentig persent van die pre-menopausale (Nf pre-men=5) en 40% van die post-menopausale (Nf post-men=2) vroue het osteopenie volgens die totale liggaams been mineraal digtheid. Van die mans, het 18% (Nm<50 = 2) met lae beendigtheid van die anterior-posterior spina en 33% (Nm>50 = 1) met osteopenie gepresenteer. Waargenome ontrekkingsimptome van kaffeïen was hoofpyn (46%, N=12) en griepagtige simptome (38%, N=10) en newe-effekte was bewerigheid (42%, N=11), hartkloppings (38%, N=10) en spysverteringskanaal versteurings (38%, N=10). Plasma volume en hidrasie was nie beïnvloed nie (p=0.70). Gevolgtrekking: Kaffeïen verbeter driekamp prestasie, maar die effek is nie so uitgesproke soos waargeneem tydens laboratorium studies nie en het nie ‘n beduidende effek op waargenome inspanning of gemoedstoestand getoon nie. Kaffeïen verhoog die stres respons deur die verdere verhoging van kortisol vlakke, bo- en behalwe vlakke waargeneem tydens uithouvermoë oefening en verhoog witbloedsel, limfosiet en neutrofiel tellings. Dit dui daarop dat die primêre ergogeniese effek van kaffeïen supplementasie moontlik as gevolg van stimulasie van beide die sentrale en autonome senuweestelsel voorkom. Lewensstyl, geslag en genetika het nie ‘n beduidende effek op die ergogeniese vermoë van kaffeïen getoon in hierdie studiepopulasie nie. Die deelnemers het ‘n lae energie, geskatte energie beskikbaarheid en koolhidraatinname gehad. Die studiegroep het ‘n hoë prevalensie van osteopenie.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--Stellenbosch University, 2008. / Background and objectives: An understanding of the effect of HAART on different aspects of health, including nutritional status, of HIV-infected individuals in South Africa is needed to ensure that appropriate population-specific guidelines and policies can be developed. This study aimed to investigate the impact of HAART on nutritional status, focusing on changes in anthropometric measures, and to explore the relationship between these measures and immunological and virological response to HAART. Methods: A prospective study of 30 adult females was carried out at a clinic in Cato Manor, KwaZulu-Natal. Anthropometric measurements, including weight, mid-upper arm circumference (MUAC), waist circumference, hip circumference, body mass index (BMI) and waist-to-hip ratio (WHR), were performed at baseline and 12 and 24 weeks after commencing HAART. Laboratory values, including CD4 lymphocyte count, viral load, albumin and haemoglobin as well as bioelectrical impedance analysis data, including lean body mass (LBM), fat mass (FM) and body fat percentage (BF%), were collected at baseline and after 24 weeks on HAART. Results: Overall, there was a statistically significant increase in all anthropometric measures, except WHR and LBM. The mean weight change was 3.4±5.8kg (p=0.006). Fifty percent of the subjects had a BMI above normal at baseline and mean BMI increased from 25.6±5.7kg/m2 to 27.3±5.6kg/m2 (p=0.007). Seventy percent of subjects gained weight, 18.5% had a stable weight and 11.1% lost weight. The weight gain in most subjects was attributable to a gain in FM while in subjects who lost weight, the loss consisted mainly of LBM. Some patients with stable body weight experienced changes in the relative proportions of fat and lean mass. Six patients showed evidence of disproportionate gains and losses in body circumference measurements which may be indicative of fat redistribution. Subjects with lower CD4 lymphocyte counts experienced greater increases in weight, BMI, FM and BF%. The strongest correlation was observed with FM (rs=-0.53; p=0.00). Greater increases in weight, BMI, MUAC, waist circumference, hip circumference, FM and BF% were seen in those with lower baseline haemoglobin. Baseline viral load and albumin did not correlate significantly with changes in any anthropometric variables. Change in CD4 count was only significantly associated with baseline MUAC (rs=0.40; p=0.04). Change in viral load was significantly correlated with baseline weight, LBM, FM, BF% and MUAC with the strongest correlation being with weight (rs=0.44; p=0.01). No significant association was found between anthropometric changes and changes in CD4 count and viral load between baseline and the 24-week visit. Conclusion: Overall, subjects experienced a significant increase in most anthropometric measures. There appears to be a relationship between some anthropometric and laboratory measures but this needs clarification. The findings of this study demonstrate the value of including circumference measurements and body composition techniques as part of nutritional status assessment and demonstrate the need for studies to determine the prevalence and significance of overweight and obesity in the HIV-infected population. Research is needed to determine the best methods of bringing about the most favourable anthropometric changes to enhance the health of patients on HAART.

Thesis (MNutr (Human Nutrition))--University of Stellenbosch, 2006. / INTRODUCTION: Adequate nutrition is required for patients to improve and maintain their health. Nurses are in one of the best positions to ensure adequate nutrition because of their holistic caring role. The aim of the study was to determine aspects of the current nutritional knowledge, attitudes and practices of registered nurses towards nutritional management of patients. RESEARCH METHODS: This was a descriptive and observational study. One hundred and one out of 160 Kenyan registered nurses working at the surgical division at Kenyatta National Hospital in Nairobi, Kenya successfully completed the study representing a 63% response rate. The 47-item validated questionnaire consisted of 9 socio-demographic questions, 13 questions on nutrition knowledge, 13 questions on attitude and 12 questions on nurses’ practices. RESULTS: The general performance of the registered nurses on the selected aspects of knowledge, attitudes and practices was overall poor. They contradicted themselves on their beliefs in relation to their practices. They did not know their primary role in nutrition care, neither did they know the role played by dietitians/nutritionists and doctors. Twenty-six percent of the registered nurses strongly agreed that it was the nurses’ responsibility to assess the nutritional status of patients compared to 72% who strongly agreed it was the dietitians’/nutritionists’ responsibility and 24% who strongly agreed it was the doctors' responsibility. Eighty-two percent reported that they would refer patients to a dietitian/nutritionist, 18% that they would discuss diet options with the patients, while none of the registered nurses would consult the doctor if they felt that the patient was not receiving adequate nutrition. Seventy-five percent of them suggested that nutritional care of patients could be improved by adopting a multidisciplinary approach and 18% by catering staff feeding the patients. Only 28% reported that nutritional issues were included in ward rounds. Although 72% of the registered nurses reported that it was important to weigh patients on admission, only 43% reported actually weighing patients, of which 59% weighed patients for medication purposes and only 18% weighed patients for nutritional status assessment. The overall nutritional knowledge score was graded as average (57%). The poorest scores were noted for knowledge on clinical nutrition questions (14%) and the highest scores for knowledge on basic nutrition questions (91%). CONCLUSION: Although the nurses regarded nutritional care of patients as important, their practices seemed to contradict their attitudes. Considering the responsibility the nurses are entrusted with regarding patient nutritional care, their current knowledge, attitudes and practices towards nutritional care is a cause for concern. The results of this study provide a basis for continuous nutrition education, well-designed protocols for nutritional status assessment by registered nurses and efforts directed towards improved clinical practice.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--Stellenbosch University, 2008. / INTRODUCTION: The objective of this research study was to analyze previously collected dietary intake data using multiple 24-hour dietary recalls and semiquantitative food frequency questionnaires (FFQ’s) in a group of HIV-positive and HIV-negative breastfeeding women from a rural region in KwaZulu-Natal in order to compare the intake of selective micronutrients obtained with the two instruments. Identifying the pattern of food intake and the contribution of different foods to the micronutrient intake in this population group will contribute to possible recommendations aimed at dietary changes to improve dietary micronutrient intake. This study was designed as a sub-study of a longitudinal prospective cohort study and subjects (N=108) were lactating mothers enrolled in a cohort which investigated the combined effect of HIV-infection and breastfeeding on women’s nutritional status. METHOD: A locally constructed FFQ and 24h-recall were used to collect dietary intake data from 108 subjects on three occasions, (~6 weeks, 14- and 24-weeks post partum). Analysis was done using the Food Finder Program™2. Micronutrients under investigation were iron, zinc, copper, selenium, vitamin A, B6, C, D and E, thiamin, riboflavin and folic acid and were selected on their relevance in HIV (AIDS). Descriptive statistics was used to determine the consumption of food items as percentage of all food items consumed and to calculate mean, mode, median and range of serving sizes for the ten food items most frequently consumed (measured with the 24h and FFQ respectively). Data was not normally distributed (indicated by the paired t-test and confirmed with a RM ANOVA nonparametric test). The F-value was determined (using Wilcoxon matched pairs test) and the significance of the difference between the micronutrient intakes measured with the two instruments (p<0.05) calculated. To investigate the strength of the correlation between the two dietary intake measures, Spearman’s correlation coefficients were determined for the nutrients under investigation. The significance level for these measurements was 95% (p<0.05). RESULTS: Both methods identified maize meal and mahewu, bread, chicken, dried beans, cabbage, onion, bananas, oranges and green leaves as the foods most often consumed. Bread, dried beans, maas, pilchards, mango and green wild leaves were the foods that contributed the most to the micronutrients under investigation. Although maize meal (in the form of phutu or mahewu) was the food item most frequently consumed in large portions, it was not in the top ten food items for any micronutrient contribution, except for selenium. Correlation coefficients (unadjusted for energy) in this study were very poor, ranging from 0.038 for vitamin B12 up to 0.48 for iron. All correlations (except vitamin B12) were poor but significant (p<0.05). CONCLUSION: There was some agreement found in the type of foods most frequently consumed and their contribution to the micronutrient intake of this population group, when using three 24h-recalls and FFQ’s and therefore in describing the habitual food intake of the population group. There was however no agreement between the micronutrient intake measured with three 24h-recalls and three FFQ’s (p<0.05). Further analysis of the data and comparisons with the biochemical results reported in another study, is recommended.

Thesis (MVoeding)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: Introduction: Heavy alcohol consumption during pregnancy is teratogenic.49-51 A woman’s nutritional requirements increase during pregnancy.4 The dangers of heavy drinking in the presence of malnutrition may put the fetus at a further disadvantage to normal development and life. Objectives: To determine the nutritional status of pregnant women in relation to alcohol consumption during pregnancy, and pregnancy outcome. To relate the combined effect of maternal alcohol consumption and nutritional status to pregnancy outcome. Study design: Prospective, longitudinal and cohort. Study population: Pregnant women attending Hanover Park MOU for pre-natal care. They were classified as subjects (heavy drinkers) or controls (light drinkers or abstainers), and 15 pairs were matched according to race, parity and gestational age at the onset of their participation in the study. Methodology: A skilled FARR worker determined the alcohol consumption of the individuals through a validated questionnaire, whilst the investigator gathered the study data blinded to the participants’ alcohol consumption status. The investigator conducted three interviews with the pregnant individuals. Anthropometrical, clinical and biochemical investigations were done and questionnaires completed to determine dietary intake, sociodemographics, health and eating habits. An experienced FARR paediatrician examined the newborns, assessing their anthropometric status, health and the presence of any alcohol-related signs. Results: The nutritional status of the matched subjects and controls did not differ significantly in terms of dietary intake, anthropometric or clinical assessment. There were significant differences between the 2 groups’ serum vitamin A values (p<0.0097). Significant associations were found between the mother and newborn data; specifically energy intake and gestational age at birth (p<0.0083), MUAC and birth weight (p<0.04), and weight gain and weight for age (p<0.0056). The participants’ energy intake also had a significant correlation with their weight gain during pregnancy (r=0.0389, p<0.01). The prevalence of FAS in the total population was 6.67%; a finding that confirms previously reported data in nearby Wellington, Western Cape.49 Conclusion: Some mothers’ good nutritional status did not protect their offspring against alcohol’s teratogenic effects. Nutritional status did have a few statistical significant effects on pregnancy. However, the investigator is of the opinion that the few significant findings were not enough to accept or reject the hypothesis; therefore, making the results inconclusive. / AFRIKAANSE OPSOMMING: Inleiding: Swaar alkoholgebruik tydens swangerskap is teratogenies.49-51 Vroue se voedingsbehoeftes verhoog met swangerskap.4 Die gevare van swaar alkoholgebruik in die teenwoordigheid van wanvoeding mag die fetus verhoed om normal te ontwikkel en groei. Doelwitte: Om die voedingstatus van swanger vroue te bepaal in verhouding met alkoholgebruik tydens swangerskap, en die swangerskapsuitkoms. Asook om die gekombineerde effek van die moeder se voedingstatus en alkoholgebruik op haar swangerskapsuitkoms te bepaal. Studie-ontwerp: Prospektief, longitudinaal en kohort. Studiepopulasie: Swanger vroue wat Hanover Park MOU besoek vir voorgeboorte sorg. Hulle is of as toetslinge (swaar drinkers) of as kontroles (ligte drinkers of geheelonthouers) geklassifiseer, en 15 pare is gepaar na aanleiding van ras, pariteit en gestasionele ouderdom by die aanvang van deelname aan die studie. Metodologie: ‘n Ervare SAVN lid het die individue se alkoholgebruik bepaal deur middel van ‘n gevalideerde vraelys. Die navorser was geblind vir die individue se alkoholgebruik. Die navorser het drie onderhoude gevoer met elke individu. Antropometriese, kliniese en biochemiese ondersoeke is gedoen. Vraelyste is voltooi om dieetinname, gesondheid, sosiodemografiese en eetgewoonte- inligting te versamel. ‘n Ervare SAVN pediater het alle pasgeborenes ondersoek om hulle antropometriese status, gesondheid en die teenwoordigheid van enige alkohol-verwante tekens te bepaal. Resultate: Die voedingstatus van die gepaarde toets-en kontrolegroepe het nie beduidend verskil in terme van dieetinname, antropometriese of kliniese evaluering nie. Daar was ‘n beduidende verskil tussen die 2 groepe se serum vitamien A vlakke (p<0.0097). Beduidende assosiasies is gevind tussen die moeder en pasgebore se data; naamlike tussen energie-inname en gestasionele ouderdom by geboorte (p<0.0083), bo-armomtrek en geboortegewig (p<0.0056), en gewigstoename tydens swangerskap en die baba se gewig vir ouderdom (p<0.0056). Die deelnemers se energie-inname het ook ‘n beduidende positiewe korrelasie met hul gewigstoename tydens swangerskap gehad (r=0.0389, p<0.01). Die prevalensie van FAS in die totale populasie was 6.67%; wat ook gevind is onlangs in die nabygeleë Wellington, Weskaap.49 Gevolgtrekking: Sommige moeders se goeie voedingstatus het nie hul kinders teen alkohol se teratogeniese effekte beskerm nie. Voedingstatus se effek op swangerskapsuitkoms was statisties beduidend in ‘n paar gevalle. Tog is die navorser van mening dat daar nie genoeg beduidende bewyse is om die nulhipotese te aanvaar of verwerp nie; dus is die gevolgtrekking onopgelos.

Thesis (MVoeding)--University of Stellenbosch, 2003. / ENGLISH ABSTRACT: Objectives: To assess whether actual nutrient intake of hospitalized patients with tuberculosis differed from that served by the hospital and from that required according to current recommendations. Design: Descriptive, cross-sectional study. Setting: Brooklyn Chest Hospital in Brooklyn, Cape Town, the Western Cape, South Africa. Subjects: Thirty patients, 23 male, seven female, with pulmonary tuberculosis, from Brooklyn Chest Hospital were enrolled in the study. Outcome measures: Assessment included dietary intake in order to calculate energy and nutrient intake and requirements, and height and weight at the beginning of the study in order to calculate BMI. Results: Patients were receiving and consuming sufficient macronutrients with the exception of protein in all patients, and micronutrients with the exceptions of calcium, iodine, folate and vitamin E in all patients, betacarotene, vitamin C and vitamin D in male patients, and selenium and pantothenate in female patients. Actual intake consumed in the hospital did not differ from that served by the hospital in the case of male patients, with the exception of iodine, however, due to significant plate wastage by female patients, consumed intake was less than that served by the hospital, with the exceptions of vitamin C and vitamin K. A total of 52% of the male patients, and 71% of the female patients, were normally nourished, according to their BMI. The remainder of the patients were mildly to severely malnourished on the basis of their BMI. Conclusions: According to current recommendations, the patients institutionalized at Brooklyn Chest Hospital for tuberculosis were receiving inadequate protein and selected micronutrients (calcium, iodine, folate and vitamin E in all patients, beta-carotene, vitamin C and vitamin D in male patients, and selenium and pantothenate in female patients). Therefore intervention programs, which serve as an adjunct to anti-tuberculosis therapy, should be introduced in order to rectify inadequate nutrient intake and to target malnourished patients. / AFRIKAANSE OPSOMMING: Doelstellings: Om te bepaal of die werklike voedingstofinname van gehospitaliseerde pasiënte met tuberkulose verskil van dit wat deur die hospitaal voorgeskryf word, en dit wat huidiglik aanbeveel word. Ontwerp: ‘n Beskrywende, dwarssnit studie. Milieu: Brooklyn Chest Hospitaal, te Brooklyn, Kaapstad, Westelike Provinsie, Suid Afrika. Studie groep: Dertig pasiënte met pulmonale tuberkulose van Brooklyn Chest Hospitaal (23 manlik, en sewe vroulik) is ingesluit in die studie. Toets parameters: Ondersoeke het ingesluit dieëtinname met die doel om energie en voedingstofinname en behoeftes te bereken, asook lengte en gewig meetings aan die begin van die studie om liggaamsmassaindex (LMI) te bereken. Resultate: Pasiënte het genoegsame hoeveelhede makro-voedingstowwe ontvang en ingeneem, met die uitsondering van proteïene by alle pasiënte, asook mikro-voedingstowwe, met die uitsondering van kalsium, jodium, folaat, en vitamine E by alle pasiënte, beta-karoteen, vitamine C en vitamine D by manlike pasiënte en selenium en pantoteensuur by vroulike pasiënte. Die werklike inname van voedsel in die hospitaal het nie verskil van dit wat deur die hospitaal voorgeskryf is in die geval van manlike pasiënte nie, met die uitsondering van jodium. As gevolg van beduidende voedselvermorsing deur vroulike pasiënte was werklike inname egter minder as wat deur die hospitaal voorgeskryf is, met die uitsondering van vitamine C en vitamine K. ‘n Totaal van 52% van die manlike pasiënte en 71% van die vroulike pasiënte het ‘n normale voedingstatus gehad volgens hulle LMI. Die oorblywende pasiënte was gering tot ernstig wangevoed op grond van hul LMI. Gevolgtrekkings: Volgens huidige aanbevelings het pasiënte, wat by Brooklyn Chest Hospitaal gehospitaliseer is vir tuberkulose, nie genoegsame hoeveelhede proteïene of geselekteerde mikro-voedingstowwe ontvang nie (kalsium, jodium, folaat, en vitamine E by alle pasiënte, betakaroteen, vitamine C en vitamine D by manlike pasiënte, en selenium en pantoteensuur by vroulike pasiënte). Daarom word intervensie programme voorgestel om te dien as ‘n toevoeging tot anti-tuberkulose behandeling, met die doel om onvoldoende voedingstof innames reg te stel en om ondervoede pasiënte te teiken.

Thesis (MNutr)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: INTRODUCTION: Immigration, especially to countries with a higher prevalence of overweight and obesity, has been found to exacerbate these conditions in immigrants. This study investigated the change in dietary intake, physical activity and body mass index (BMI) of South African immigrants in Hobart, Australia. OBJECTIVES: The objectives were to determine the change in BMI, the current and usual dietary intakes and perceived dietary changes and the current physical activity levels and perceived changes in physical activity since immigration of South African immigrants residing in the Greater Hobart Area. DESIGN: This study had descriptive, cross-sectional as well as analytical components. SAMPLING: Forty seven participants were recruited by contacting known immigrants, postings in newspapers, contacting immigrant social groups, contacting the Department of Economic Development as well as using the social networking program, “Facebook”. All participants had to be between the ages of 20 and 50 and have lived in Australia for longer than six months, but shorter than five years. Thirty participants completed the study with a mean age of 37.17 years. METHODS: Participants were required to complete a self-administered sociodemographic questionnaire, a 3-day diet record, physical activity questionnaire and quantified food frequency questionnaire (QFFQ). The investigator administered a weight change questionnaire. Anthropometric measurements included weight, height and waist circumference measurements. RESULTS: There was no significant difference between the BMIs of participants preand post-immigration (p=0.06), but the percentage of overweight female participants increased from 24% (n=4) to 29% (n=5) and the percentage of overweight male participants increased from 46% (n=6) to 69% (n=9). The percentage of obese female participants increased from 6% (n=1) to 12% (n=2) post-immigration with the male participants showing no increased prevalence of obesity. Participants appeared aware of their weight classifications with 60% (n=18) reporting that they considered themselves overweight. Mean waist circumference values of male and female participants were classified as action level 1. Forty one percent (n=7) of female participants and 31% (n=4) of male participants had waist circumference values classified as action level 2. Carbohydrate intakes were below the Nutrient Reference Values (NRV) recommendations for 84% (n=25) and 62% (n=19) of participants as indicated by the QFFQ and diet records respectively and the mean carbohydrate intake values of male and female participants (QFFQ and diet records) were below the NRV recommendations as well. Fibre intakes were below the NRV recommendations for 76% (n=23) and 82% (n=25) of participants as indicated by the QFFQ and food records respectively. Saturated fat and sodium intakes were high. Folate, calcium and potassium were consumed in lower than recommended amounts by a large proportion of participants. Sixty seven percent (n=20) of participants reported an increase in physical activity post-immigration and 70% (n=21) of participants anticipated a future increase in physical activity levels. CONCLUSION: The study population experienced an increase in weight. A number of other risk factors for cardiovascular and other chronic diseases were also identified including high waist circumference values, high saturated fat and sodium intakes and low fibre, folate, calcium and potassium intakes. Interventions aimed at decreasing the risk of South African immigrants in Hobart becoming overweight/obese and developing chronic diseases should probably be aimed at lower saturated and total fat intake, higher carbohydrate and fibre intake and plenty of dietary variation and should further encourage physical activity, but this needs to be confirmed by larger prospective studies. / AFRIKAANSE OPSOMMING: INLEIDING: Daar is gevind dat immigrasie, veral na lande met ‘n hoër prevalensie van oorgewig en vetsugtigheid, hierdie toestande in immigrante kan vererger. Hierdie studie het die veranderinge in dieetinname, fisiese aktiwiteit en liggaamsmassa-indeks (LMI) van Suid-Afrikaanse immigrante in Hobart, Australië ondersoek. DOELWITTE: Die doelwitte was om die verandering in LMI na immigrasie, die huidige en gewoontelike dieetinname en gerapporteerde dieet veranderinge na immigrasie asook die huidige fisiese aktiwiteit en gerapporteerde fisiese aktiwiteit veranderinge van Suid-Afrikaanse immigrante, wat in die groter Hobart area woon, te ondersoek. ONTWERP: Die studie het beskrywende asook analitiese komponente gehad. STEEKPROEFTREKKING: Respondente is gewerf deur alle bekende immigrante te kontak, koerant boodskappe te plaas, sosiale groepe vir immigrante te kontak, die Department van Ekonomiese Ontwikkeling te kontak asook deur die sosiale netwerk program, “Facebook”, te gebruik. Alle respondente moes tussen die ouderdomme van 20 en 50 wees en moes langer as ses maande, maar korter as vyf jaar in Australië woon. METODES: Respondente het ‘n sosio-demografiese vraelys asook ‘n drie dag voedselrekord, ‘n voedselfrekwensie vraelys en ‘n fisiese aktiwiteit vraelys voltooi. Die navorser het ‘n gewigsverandering vraelys afgeneem. Antropometriese metings het gewig, lengte en middelomtrek ingesluit. RESULTATE: Daar was nie ‘n betekenisvolle verskil tussen die LMI waardes van respondente voor en na immigrasie nie (p=0.06), maar die persentasie oorgewig vroulike respondente het toegeneem van 24% (n=4) na 29% (n=5) en die persentasie oorgewig manlike respondente het toegeneem van 46% (n=6) na 69% (n=9). Die persentasie vetsugtige vroulike respondente het toegeneem van 6% (n=1) na 12% (n=2) na immigrasie en die manlike respondente het geen toename in vetsugtigheid getoon nie. Dit het voorgekom asof respondente bewus was van hulle gewigsklassifikasies met 60% (n=18) wat gerapporteer het dat hulle hulself as oorgewig beskou. Die gemiddelde middelomtrek waardes van die manlike en vroulike respondente was geklassifiseer as aksie vlak 1. Een en veertig persent (n=7) van die vroulike respondente en 31% (n=4) van die manlike respondente het middelomtrek waardes getoon wat as aksie vlak 2 geklassifiseer was. Koolhidraat inname was laer as the nutrient verwysingswaardes vir 84% (n=25) en 62% (n=19) van die respondente soos aangedui deur die voedselfrekwensie lys en 3-dag voedselrekord. Vesel inname was laer as the nutrient verwysingswaardes vir 76% (n=23) en 82% (n=25) van die respondente soos aangedui deur die voedselfrekwensie lys en 3-dag voedselrekord. Die gemiddelde waardes vir koolhidraat en vesel inname vir manlike en vroulike respondente (voedselfrekwensie lys en 3-dag voedselrekord) was laer as die nutrient verwysingswaardes. Versadigde vet en natrium innames was hoog. Folaat, kalsium en kalium innames van ‘n groot proporsie respondente was laer as die aanbevelings. Sewe en sestig persent (n=20) van die respondente het gerapporteer dat hulle fisiese aktiwiteitsvlakke toegeneem het na immigrasie en 70% (n=21) van die respondente het verwag dat hulle fisiese aktiwiteitsvlakke sou verhoog. AANBEVELINGS: Die studie populase het ‘n toename in gewig en LMI ondervind. ‘n Aantal verdere risikofaktore vir kroniese en kardiovaskulêre siektes was geïdentifiseer, byvoorbeeld hoë middelomtrek waardes, hoë versadigde vet en natrium innames en lae vesel, folaat, kalsium en kalium innames. Programme wat fokus op die voorkoming van oorgewig/vetsug in Suid-Afrikaanse immigrante in Hobart, Australië moet moontlik gemik wees op laer totale en versadigde vet inname, hoër vesel en koolhidraat inname asook variasie in diet en fisiese aktiwiteit moet ook verder aangemoedig word. Sodanige aanbevelings moet egter bevestig word deur groter prospektiewe studies.