Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Introduction Complications of severe infection or acute trauma include a cascade of immunological dysfunctions known as SIRS (Systemic Inflammatory Response Syndrome), that affect response to treatment, prolonging and complicating the course of illness and jeopardizing clinical outcome. Timing and the nature of nutritional support in the Intensive Care Unit (ICU) setting may influence this process. Against this background, and despite some trials demonstrating beneficial clinical outcomes for the use of immune-modulating diets (IMD), the findings of the US summit on immune-enhancing enteral therapy concluded that the currently available enteral immune-enhancing formulas are “first-generation products” which may not be appropriate in patients with SIRS or severe sepsis. This highlights a need for alternative nutritional products that target the specific needs of this patient population. As such, Intestamin® is designed for use in severely stressed patients as an immune-modulating enteral feed supplement which aims to improve maintenance of gut barrier integrity and immune response. Aim The aim of this pilot study was to investigate the effect of Intestamin® administration to critically ill patients, and in particular, to determine if administration would impact on nosocomial infections, ventilation days and the length of stay in the ICU. Methods The study design was an open label, retrospective case control, analytical study, of patients admitted to the ICU in The Bay Hospital, Richards Bay, between January 2002 and November 2003, who received Intestamin®. Patients were selected for the study from post-surgery and post-trauma patients at high risk of sepsis and SIRS, and critically ill patients with manifested SIRS or severe sepsis. Development of respiratory and urinary sepsis was used as surrogate markers for progression to severe sepsis and SIRS. Additionally, duration of ventilation and ICU stay were considered representative of the response to treatment and degree of clinical complications. Results The findings of the study demonstrated a significant difference in the rates of respiratory infection(p=0.05), positive sputum and tracheal aspirate cultures(p=0.03) and urinary catheter tip cultures(p=0.04). with statistically lower rates in the intervention group compared to the control group. There were no significant differences in the rates of urinary tract infection, septicaemia or in combined sepsis rates between the two groups. There were statistically significant higher rates of positive pus cell counts in the sputum(p=0.003) and urine(p=0.01) in the intervention group, compared to the control group. No corresponding reduction in ventilation days or ICU stay was observed. Conclusion In this patient population, early enteral nutrition with specially formulated IMD, (Intestamin®), did result in a significant reduction in respiratory infections, but not in other types of sepsis, ICU or ventilator days in critically ill ICU patients. This positive finding in some, but not all endpoints collected, may reflect confounding factors in the small patient population or the choice of clinical endpoints, rather than a genuine limitation in the benefit. IMD remains a tantalizing and scientifically plausible intervention in this patient population, with larger clinical trials necessary to confirm outcomes. The study supports the safe use of Intestamin by the nasojejenal route in this patient population. / AFRIKAANSE OPSOMMING:Inleiding Komplikasies van erge infeksie of akute trauma sluit ‘n kaskade van immunologiese disfunsie in, bekend as SIRS (Sistemiese Inflammatoriese Respons Sindroom), wat die respons op behandeling affekteer, die verloop van siekte verleng en kompliseer asook die kliniese uitkoms beïnvloed. Tydsberekening en die aard van die voedingsondersteuning in die Intensiewe Sorg Eenheid (ISE) mag hierdie proses beinvloed. Teen hierdie agtergrond, en ten spyte van sommige studies wat die voordelige kliniese uitkoms vir die gebruik van immuun-modulerende diete (IMD) toon, het die “US summit” oor immuunverbeterde enterale terapie tot die gevolgtrekking gekom dat die huidige beskikbare enterale immuun-verbeterde formules, “eerste-generasie” produkte is, wat moontlik nie toepaslik is vir pasiente met SIRS of erge sepsis nie. Dit beklemtoon ’n behoefte aan alternatiewe voedingsprodukte wat die spesifieke behoeftes van die genoemde pasient populasie teiken. Intestamin® is ontwerp vir gebruik in erge gestresde pasiente as ‘n immuun-modulerende enterale voedingssupplement doelgerig om spysverteringskanaal integriteit te onderhou en immuniteit te verbeter. Doel Hierdie loodsstudie se doel was om die effek van Intestamin® toediening aan kritiek siek pasiente te ondersoek, spesifiek om vas te stel of die toediening impakteer op nosokomiale infeksies, ventilasie dae en dae in ISE. .Metode Die studie ontwerp was ‘n oop, retrospektiewe, geval kontrole, analitiese studie van pasiente opgeneem in die ISE van The Bay Hospital, Richardsbaai, tussen Januarie 2002 en November 2003, wat Intestamin® ontvang het. Pasiënte is geselekteer vir die studie uit post-chirurgies en post-trauma pasiente wat hoë risiko was vir sepsis en SIRS, en kritiek siek pasiente wat reeds manifisteer het met SIRS of erge sepsis. Ontwikkeling van respiratoriese en urinêre sepsis is gebruik as surrogaat merkers vir die progressie na erge sepsis en SIRS. Addisioneel is duur van ventilasie en ISE verblyf beskou as verteenwoordigend vir die respons op behandeling en die graad van kliniese komplikasies. Resultate Die bevindinge van die studie het betekenisvolle verskille aangedui in die voorkoms van respiratoriese infeksies(p=0.05), positiewe sputum en trachiale aspiraatkulture(p=0.03) en urine kateterpunt-kulture(p=0.04) met statistiese laer voorkoms in die intervensie groep in vergelyking met kontroles. Geen statistiese verskille in die voorkoms van urineweg-infeksies, septisemia of in gekombineerde sepsis voorkoms tussen die twee groepe is gevind nie. Daar was statistiese betekenisvolle hoër voorkoms van etterselle hoeveelhede in die sputum(p=0.030 en uriene(p=0.01) van die intervensie groep in vergelyking met die kontrole groep. Geen ooreenkomstige vermindering in ventilasie dae of ISE verblyf is opgemerk nie. Gevolgtrekking In hierdie pasiënt populasie, het vroeë enterale voeding met spesifieke geformuleerde IMD (Intestamin®), ‘n beduidende vermindering in respiratoriese infeksies getoon, maar nie in ander tipes sepsis, ISE of ventilasie dae by kritiek siek pasiente nie. Hierdie positiewe bevindinge in sommige. maar nie al die versamelde eindpunte nie, reflekteer moontlike bydraende faktore in die klein pasiënt populasie of die keuse van kliniese eindpunte, eerder as a ware beperking in die voordele. IMD bly steeds ‘n uitdagende en wetenskapilik uitsonderlike intervensie in hierdie pasiënt populasie, wat groter kliniese studies benodig om die uitkoms te bevestig. Die studie ondersteun die veilige gebruik van Intestamin® via die nasojejenale roete in kritiek siek pasiënte.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Background: Poor body image perception and body dissatisfaction has been found to be a risk factor for eating disorders. Studies have found that signs of distorted body image perception and body dissatisfaction can be detected in children as young as 8 or 9 years old. Aim: The current study served to assess the extent of this problem in Northeastern Johannesburg, South Africa, in order to allow for the necessary intervention steps (e.g. development of school-based programmes) to deal with this problem to be put in place. Method: The study was a cross-sectional analytical study with a descriptive component. Two hundred and four girls (81.37% Black, 15.20% White and 3.43% Coloured or Indian) aged between 96 and 119 months in primary schools in Northeastern Johannesburg were selected for this study using systematic random sampling. They were required to complete a questionnaire about their body image perception and weight control behaviours, as well as undergo anthropometric measurements (i.e. weight and height). Results: This study found that the subjects placed much importance on being thin, with subjects stating that they thought if a girl was thin she would be more popular (63.96%), have better self esteem (69.63%), be more attractive (69.11%), be more feminine (73.80%) and be healthier (66.84%). When asked to identify the girl from a silhouette drawing that most resembled themselves, 45.00% of the subjects were able to accurately identify which girl’s size most resembled their own, whereas 48.50% saw themselves as thinner than they are and 6.50% saw themselves as fatter than they are. In addition, the majority of subjects (69.61%) said that they were very happy with their weight and the majority (74.88%) classified it as “just right.” However, despite these findings, there was still significant body dissatisfaction evident in the group with 50.25% of the subjects wanting to be thinner, 28.57% wanting to be fatter and only 21.18% not wanting to be thinner or fatter than they currently are. Of the subjects participating in the study, 50.98% had tried to lose weight in the past and 28.71% had tried to gain weight. Also, various factors (i.e. media, cultural, family and peer influences), were shown to have a significant influence on the subjects’ body image perception. Other factors such as socioeconomic status and physical activity level had no significant link with the subjects’ body image perception. Conclusion: There is a significant problem with poor body image perception and resultant weight control behaviours in this age group. Clearly, there is a need for body image improvement programmes to be put in place in primary schools so as to prevent preadolescent girls from moving towards a lifetime of suffering with body dissatisfaction or, even worse, developing a life-threatening eating disorder. / AFRIKAANSE OPSOMMING: Agtergrond: ’n Swak liggaamsbeeld en liggaamsontevredenheid is bekende risikofaktore vir die ontwikkeling van eetsteurnisse. Volgens studies kan tekens van ’n verwronge liggaamsbeeld en liggaamsontevredenheid reeds by jong kinders, van 8 of 9 jaar, bespeur word. Doel: Hierdie studie het gepoog om die omvang van dié probleem in die noordooste van Johannesburg, Suid-Afrika, te bepaal ten einde die nodige intervensiemaatreëls te tref (byvoorbeeld om skoolgebaseerde programme te ontwikkel) om die probleem die hoof te bied. Metode: Die studie is ’n dwarssnit analitiese studie met ’n beskrywende komponent. Met behulp van sistematiese, ewekansige steekproefneming is 204 laerskoolmeisies (81.37% Swart, 15.20% Wit en 3.43% Bruin of Indiër) van tussen 96 en 119 maande uit die noordooste van Johannesburg as proefpersone vir die studie gekies. Die meisies moes elk ’n vraelys oor hul liggaamsbeeld en gewigsbeheergedrag invul sowel as antropometriese meting van gewig en lengte ondergaan. Resultate: Die studie het gevind dat die proefpersone baie waarde daaraan heg om maer te wees. Hulle reken onder meer dat, indien ’n meisie maer is, sy waarskynlik gewilder sal wees (63.96%), ’n beter selfbeeld sal hê (69.63%), aantrekliker sal wees (69.11%), vrouliker (73.80%) en gesonder sal wees (66.84%). Toe hulle op ’n profielskets ’n meisie moes uitwys na wie hulle dink hulle die meeste lyk, kon 45.00% van die proefpersone akkuraat uitwys watter meisie se grootte die meeste met hulle s’n ooreenstem, terwyl 48.50% hulself as maerder en 6.50% hulself as vetter beskou het as wat hulle werklik is. Die meerderheid van die proefpersone (69.61%) was oënskynlik gelukkig met hul gewig en die meeste (74.88%) het hul gewig as “net reg” beskryf. Tog, ondanks dié bevindinge, was daar steeds beduidende liggaamsontevredenheid by die groep: 50.25% van die subjekte wil maerder wees, 28.57% vetter en slegs 21.18% nie maerder óf vetter as wat hulle tans is nie. Van die studiedeelnemers het 50.98% al voorheen probeer gewig verloor, terwyl 28.71% al probeer gewig aansit het. Verskeie faktore (soos media-, kulturele, gesins- en portuurinvloede) blyk ook ’n beduidende impak op die proefpersone se liggaamsbeeld te hê. Daarenteen toon ander faktore, soos sosio-ekonomiese status en vlak van fisieke aktiwiteit, geen wesenlike verband met die proefpersone se liggaamsbeeld nie. Gevolgtrekking: Hierdie ouderdomsgroep blyk ’n beduidende probleem met ’n gebrekkige liggaamsbeeld en gevolglike gewigsbeheergedrag te hê. Daar is duidelik ’n behoefte aan programme om laerskoolmeisies se liggaamsbeeld te verbeter ten einde te voorkom dat preadolessente meisies weens liggaamsontevredenheid ’n leeftyd van swaarkry tegemoetgaan of, selfs erger, ’n lewensgevaarlike eetsteurnis ontwikkel.

Thesis (MNutr)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Obesity has become one of the major conditions contributing towards chronic lifestyle diseases. The management of obesity, in order to prevent chronic lifestyle disease, requires a combination of treatment modalities. There is therefore a constant need to search for innovative behavioural and awareness programmes regarding the treatment of obesity, and to develop innovative strategies to improve compliance and ultimately to change lifestyles. The notion of utilizing short message services (SMS), during a weight reduction progamme to provide regular reminders and information to achieve the aforementioned goals, was therefore used as an intervention in the study. Furthermore a questionnaire validating the effectiveness of the short message service was devised and completed by the recipients of the intervention. The purpose of the questionnaire was to statistically quantify the effectiveness of the SMS as an intervention. Each question had four graded answers, with a score allocated to each - 1 being the least effective and 4 being the most. These values were converted to percentages and according to these percentages a rating of effectiveness was ascertained. Ultimately the study set out to determine whether the intervention had a statistically significant effect on weight reduction, compliance in attending appointments and on the attrition rate. This was a double blinded randomized, controlled study in which 75 participants were recruited at a general medical practice in Gauteng. The sample comprised of three groups. Group 1 (N = 25) had no intervention; Group 2 (N = 25) received a SMS weekly and Group 3 (N = 25) received a SMS three times per week. The weight reduction programme, which included dietary modifications and lifestyle advice was standardized and remained the same for each group. The programme extended over a 12 week period and the questionnaire was completed at the end of the programme. Upon analysis of the results there was a decrease in the mean BMI and waist circumference for all the three groups, with no statistically significant difference (p-value > 0.05) between them. The percentages of the participants completing the programme in each group were – Group 1: 44%, Group 2: 60% and Group 3: 68%. The effectiveness of the intervention was manifested by the compliance of attendance at each visit and the reduced attrition rate in the intervention groups, although this was not found to be statistically significant. The analysis of the scores allocated to the responses of the questionnaire, equated to an outcome of above 75% and was assessed as being very successful in both the intervention groups. In conclusion the use of short message servicing in this weight reduction programme improved the compliance and reduced the attrition rate although not statistically and was perceived by the participants as a successful intervention. / AFRIKAANSE OPSOMMING: Vetsug (obesiteit) het een van die primêre kondisies geword wat bydrae tot chroniese leefstyl siektes. Die hantering van obesiteit vereis 'n kombinasie van behandelingsmodaliteite, ten einde hierdie siektes te voorkom, Daar is dus 'n konstante soeke na innoverende gedrags- en bewustheidsprogramme rakende die behandeling van obesiteit, asook 'n behoefte om innoverende strategieë te ontwikkel om inskiklikheid te verbeter en uiteindelik leefstyle te verander. Die idee om kortboodskapdienste (SMS) gedurende 'n gewigsverliesprogramme te gebruik om gereelde aanmanings en inligting te kommunikeer ten einde die genoemde doelwitte te bereik, is aangewend as intervensie in hierdie studie. 'n Vraelys is ontwikkel wat die effektiwiteit van die kortboodskapdiens valideer, en is voltooi deur die ontvangers van die intervensie. Die doel van die vraelys was om die effektiwiteit van die SMS as 'n intervensie te kwantifiseer. Elke vraag het vier gegradeerde antwoorde gehad, met 'n telling wat aan elk toegeken is – 1 wat aandui minste effektief en 4 wat aandui die meeste. Hierdie waardes was omgeskakel tot persentasies en na aanleiding van die persentasies is 'n waarde van effektiwiteit bepaal. Uiteindelik was die doel van die studie dus om vas te stel of die intervensie ʼn statisties beduidende effek op gewigsverlies, die nakom van afsprake en uitvalskoerse het. Hierdie was 'n dubbelblind, ewekansige gekontroleerde studie waarin 75 deelnemers gewerf was by 'n algemene mediese praktyk in Gauteng. Die steekproef het bestaan uit 3 groepe. Groep 1 (N = 25) het geen intervensie gehad nie; Groep 2 (N = 25) het 'n weeklikse SMS ontvang en Groep 3 (N = 25) het 'n SMS ontvang drie keer per week. Die gewigsverliesprogramme, wat dieetaanpassings en leefstyl advies ingesluit het, was gestandardiseer en het dieselfde gebly vir elke groep. Die programme het gestrek oor 'n 12 weke periode en die vraelys was voltooi aan die einde van die programme. Analise van die resultate het 'n afname getoon in die gemiddelde LMI (Liggaamsmassa indeks) en middelomtrek vir al drie groepe, met geen statisties beduidende verskil (p-waarde > 0.05) tussen groepe nie. Die persentasies van die deelnemers wat die programme voltooi het in elke groep was Groep 1: 44%, Groep 2: 60% en Groep 3: 68%. Die effektiwiteit van die intervensie was gemanifesteer deur die inskiklikheid van bywoning tydens elke besoek en die verlaagde uitvalkoers in die intervensie groepe, alhoewel dit nie statisties beduidend was nie. 'n Analise van die tellings geallokeer aan die response tot die vraeslys, dui 'n uitkoms aan van bo 75% en was beskou as baie suksesvol in albei die intervensie groepe. Die gebruik van kortboodskapdienste (SMS) in hierdie gewigsverliesprogramme het inskiklikheid verbeter en uitvalskoerse verlaag, alhoewel nie statisties beduidend nie, en was deur die deelnemers beskou as 'n suksesvolle intervensie.

Thesis (MNutr)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Background: Eating disorders are an important cause of morbidity and mortality in adolescent and young adult women. There is some evidence that Eating disorders may be more common in Jewish females than in their non-Jewish counterparts. Individuals with abnormal attitudes as defined by the Eating Attitudes Test (26-Item version) (EAT-26) are at increased risk of developing an eating disorder. School teachers are required to take an active role in the currently favoured ecological approach to the prevention of eating disorders. Objectives: The current study sought to determine the prevalence of abnormal eating attitudes and weight loss behaviours in a Jewish female adolescent sample and to investigate school teachers’ awareness of these factors and their attitudes towards a school programme to address these. Methods: A cross-sectional study of girls in grades 8 to 11 and teachers of both genders was undertaken at a “traditional” Jewish high school in Johannesburg, South Africa. A questionnaire consisting of the EAT-26 and a modified section of the United States Youth Risk Behaviour Survey (YRBS) was completed by pupils. A questionnaire developed by the researcher for the study was completed by teachers. Results: Two hundred and twenty pupils (response rate 84.3%) and 38 teachers (52.1%) participated. Twenty percent of pupils (n=43) had EAT-26 scores greater than or equal to 20 and 30.2% were found to require clinical evaluation for a potential eating disorder Thirty two point seven percent (n=72) of girls considered themselves to be overweight. Sixty four percent (n=139) were trying to lose weight at the time of the study and 19.1% (n=42) had engaged in one or more extreme methods of weight loss (fasting, purging or non-prescribed medication) in the past 12 months. Most teachers (81.6%, n=29) underestimated the proportion of girls requiring clinical evaluation and 71.1% (n=27) underestimated the extent of current weight loss attempts. Almost all (97.3%, n=37) the teachers recognised the need to address disordered eating attitudes and patterns in the school but only 34.2% (n=13) viewed the school as the appropriate place, would be prepared to participate and would give up class time. Conclusions: This is the first study to document the presence of abnormal eating attitudes among Jewish adolescent females in South Africa. The prevalence fell within the upper end of the range of rates reported in studies of adolescent girls in South Africa and abroad. Dieting and attempts at weight loss are common in this population and are also in keeping with the findings from international studies. This is the first study to measure teachers’ awareness of the eating attitudes and weight loss behaviours of girls attending the school at which they teach. The teachers participating in this study were not fully aware of the extent to which eating-related issues affect female pupils. Over and above this, there appears to be a resistance to facilitating and participating in a school programme addressing these issues. A qualitative exploration of this could yield valuable insights. / AFRIKAANSE OPSOMMING: Agtergrond: Eetstoornisse is 'n belangrike oorsaak van morbiditeit en mortaliteit in adolessente en jong volwasse vroue. Daar is bewyse dat Eetstoornisse meer algemeen mag voorkom in Joodse vroue vergeleke met hul nie-Joodse eweknieë. Individue met 'n abnormale houding soos gedefinieer deur die Eet-Houding-Toets (“Eating Attitudes Test”) (26-punt weergawe) (EAT-26) het 'n verhoogde risiko om 'n eetstoornis te ontwikkel. Daar word van onderwysers verwag om 'n aktiewe rol te speel in die ekologiese benadering om eetstoornisse te voorkom, wat tans voorkeur geniet. Doelstellings: Die huidige studie het gepoog om die voorkoms van abnormale houding en gedrag ten opsigte van eet en gewigsverlies in 'n steekproef van Joodse vroulike adolessente te bepaal, asook om ondersoek in te stel of onderwysers bewus is van hierdie faktore en hul houding teenoor 'n skoolprogram wat dit aanspreek. Metodes: 'n Dwarssnit studie van meisies in graad 8 tot 11 en onderwysers van beide geslagte was uitgevoer by 'n "tradisionele" Joodse hoërskool in Johannesburg, Suid-Afrika. 'n Vraelys bestaande uit die EAT-26 en 'n aangepasde afdeling van die “United States Youth Risk Behaviour Survey (YRBS)” is voltooi deur studente. Onderwysers het 'n vraelys voltooi wat vir die studie ontwikkel is deur die navorser. Resultate: Tweehonderd-en-twintig leerlinge (responskoers 84.3%) en 38 onderwysers (52.1%) het deelgeneem. Twintig persent van leerlinge (n=43) het EAT-26 tellings groter as of gelyk aan 20 gehad en daar was bevind dat 30.2% kliniese evaluering vir 'n potensiële eetstoornis benodig. Twee-en-dertig punt sewe persent (n=72) van meisies het hulself as oorgewig beskou. Vier-ensestig persent (n=139) het probeer om gewig te verloor ten tye van die studie en 19.1% (n=42) het betrokke geraak by een of meer ekstreme metodes van gewigsverlies (vas, purgasie of nievoorskrif medikasie) in die afgelope 12 maande. Meeste onderwysers (81.6%, n=29) onderskat die proporsie van meisies wat kliniese evaluasie benodig en 71.1% (n=27) onderskat die omvang van huidige gewigsverlies-pogings. Byna alle (97.3%, n=37) onderwysers het die behoefte erken dat versteurde houdings en eetpatrone aangespreek moet word, maar slegs 34,2% (n=13) beskou die skool as die geskikte plek daarvoor en sal bereid wees om deel te neem en klastyd af te staan. Gevolgtrekkings: Die teenwoordigheid van abnormale houding teenoor eet onder Joodse vroulike adolessente in Suid-Afrika word vir die eerste keer in hierdie studie gedokumenteer. Die prevalensie val binne die boonste deel van die reikwydte van koerse wat gerapporteer is in studies oor adolessente meisies in Suid-Afrika en die buiteland. Dieet en pogings tot gewigsverlies is algemeen in hierdie populasie en stem ook ooreen met die bevindinge van internasionale studies. Dit is die eerste studie wat onderwysers se bewustheid meet ten opsigte van die eethoudings en gewigsverlies-gedrag van meisies wat skool bywoon waar hul onderrig gee. Die onderwysers wat deelgeneem het aan hierdie studie was nie ten volle bewus van die mate waartoe eet-verwante kwessies vroulike leerlinge affekteer nie. Boonop blyk daar weerstand te wees teenoor die fasilitering van, en deelname aan 'n skoolprogram wat hierdie kwessies aanspreek. Verdere kwalitatiewe ondersoeke hiervan kan moontlik waardevolle insig bied.

Thesis (M Nutr)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Background Adverse reactions to food are frequently suspected in daily clinical practice yet the knowledge of health care workers regarding correct diagnosis and management remains limited. This is compounded by few allergy consultants and may contribute to patient dissatisfaction and self‐diagnoses. The primary treatment modality for food hypersensitivity remains strict but nutritionally adequate elimination of offending food allergens based on accurate diagnosis. Nutritional misconceptions and incorrect diagnosis may lead to inappropriate dietary restriction resulting in nutritional deficiencies, malnutrition, growth retardation, and feeding difficulties in children. Elimination diets thus require supervision and monitoring similar to drug treatments, being reviewed regularly for possible food re‐challenges. There is limited research to assess knowledge and management approaches of food allergies by medical doctors and no research of this nature exists for Dietitians. There is also limited information as to whether current approaches conform to the most recent evidence‐based recommendations, particularly with regard to dietary intervention and allergy prevention strategies. Aim The aim of this survey was to determine aspects of food allergy related knowledge and practices of Medical Doctors and Dietitians. Methodology This was an analytical cross sectional study with participants randomly selected from the three largest provinces in South Africa, Gauteng, Western Cape and Kwazulu Natal (N=660). A quantitative questionnaire was compiled to explore aspects of food allergy diagnosis and management. Participants were currently working in South Africa and were selected according to three categories, General Practitioners, Dietitians and Medical Specialists. Ethics approval was obtained from the University of Stellenbosch, Faculty of Health Sciences Committee of Human Research. Results Even though valuable insights were obtained, poor response from all three groups (N=82) compromised the strength of significant findings. There was limited knowledge regarding appropriate diagnosis, dietary intervention and allergy prevention strategies. 98% of respondents believed they needed more education and training in management of allergies. Approximately 50% reported use of complementary therapy by patients prior to and while using conventional medicine. Dietitians weren't consulted for nutritional management by 72% General Practitioners and 45% Specialists. For allergy prevention, over 50% of health professionals advised extensive food avoidance for the first year in high risk infants. Dietitians recommended multiple food avoidance for the longest period of time per food in infants, pregnant and lactating women to prevent allergy. Advice for infant feeding and introduction of solid foods was not evidence‐based. Goat's milk, soya formula and breast milk with maternal dietary avoidance were advised for allergy prevention. 54% of medical doctors and 31% of Dietitians provided no guidance for implementing an elimination diet. Only 15% of respondents did growth assessment of allergic patients. 99% of all participants recognised a need for South African specific 'best practice' guidelines. Conclusion The study highlighted a need in South Africa, at undergraduate and post graduate levels, for better education and training of food allergy, in particular diagnosis, dietary management and prevention strategies. This will create a platform for the achievement of minimum levels of competency in allergy care. It should also provide motivation for the establishment of South African specific guidelines, allergy support networks and better public awareness. / AFRIKAANSE OPSOMMING: Agtergrond Afwykende reaksies tot voedsel word dikwels by gesondheidsorg instellings verdag. Nieteenstaande, bestaan daar steeds beperkte kennis oor allergië. Die tekort aan allergie konsultante vererger sake en het dikwels ontevrede pasiënte en self‐diagnose tot gevolg. Die primêre modaliteit van behandeling van voedsel hipersensitiwiteit behels doelmatige verwydering van die oorsaaklike voedsel allergene deur middel van 'n streng dog voedingswaardige dieet. Ontoepaslike bestuur van, en die verkeerde implementering van die uitskakelings dieet mag egter lei tot komplikasies by kinders soos hongersnood, groei vertraging en voedings probleme. Daar is tans beperkte navorsing om die peil van kennis van voedsel allergië en die bestuur van die probleem te meet. Geen sodanige navorsing ten opsigte van dieëtkundiges is al gedoen nie. Slegs beperkte inligting is beskikbaar tot welke mate huidige behandelings praktyk konformeer met die mees onlangse bewys‐gebaseerde aanbevelings, veral met betrekking tot allergie voorkomende strategië. Doelstelling Die doelstelling van hierdie opname was om die kundigheid en bestuur van voedsel verwante allergië deur medici en dieëtkundiges te bepaal. Metodologie Dwarsprofiel analiese was gedoen met respondente wat onwillekeurig gekies was uit profesionele mediese en dieëtkundige praktisyns uit die drie grootste provinsies in Suid Afrika, Gauteng, Wes‐Kaap en Kwazulu Natal (N=660). Deelnemers was versoek om vraelyste met 'n samestelling van aspekte van voedsel allergie diagnose en bestuur te voltooi. Deelnemers is huidiglik werksaam in Suid Afrika en was verteenwoordigend van drie kategorië, naamlik Algemene Praktisyns, Dieetkundiges en Mediese Spesialiste. Etiese goedkeuring was bekom van die Universiteit Stellenbosch se Fakulteit Gesondheidswetenskappe Navorsingsetiek komitee. Bevindinge Desnieteenstaande insiggewende inligting is die bevindinge gekompromitteer deur beperkte respons (N=82). Kennis met betrekking tot diagnose, dieëtkundige intervensie en allergie voorkomings strategië, is beperk. 88% van respondente versoek meer opleiding in die bestuur van allergië. 53% beweer dat pasiënte komplementêre terapie aanwend voor en gelyktydig met die gebruik van konvensionele medikasie. Interdisiplinêre konsultasie is beperk. Dieëtkundiges word nie geraadpleeg deur 72% van algemene praktisyns en 54% mediese spesialiste nie. Meer as 50% gesondheidsorg praktisyns beveel algemene voedsel ontwyking aan by hoë risiko kleuters gedurende die eerste lewensjaar. Dieëtkundiges se allergie voorkomings aanbevelings aan kleuters, swanger en lakterende vrouens was vir die langste periode. Advies vir kleuter voeding was nie bewys‐gebaseerd nie. Bokmelk, soya formule en borsmelk van moeders met dieëtkundige beperkinge word aanbeveel vir die voorkoming van allergië by kleuters. 54% mediese en 31% dieëtkundiges voorsien geen voorkomings dieët riglyne nie. Slegs 15% respondente takseer kleuter groei van allergie pasiënte. 99% van al die respondente ondersteun die vestiging van spesifieke 'beste praktyk' riglyne vir Suid Afrika. Gevolgtrekking Die bevindinge van die studie beklemtoon die behoefte in Suid Afrika vir verbeterde en doelgerigte voedsel allergie onderrig en opleiding, vir voorgraadse en nagraadse onderrig. Meer doeltreffende diagnose, dieëtkundige bestuur en allergie voorkomings strategië word aanbeveel. Daar word 'n doelwit geskep vir die bereiking van minimum vaardigheids vlakke vir allergie versorging. Die inligting motiveer ook die vestiging van doelgerigte Suid‐Afrikaanse riglyne, allergie ondersteunings bronne en beter, openbare bewuswording van allergië.

Thesis (MNutr)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Introduction: Nutritional genomics is a new and emerging field aimed at investigating the complex interactions between genetics and diet and the joint influence this has on disease prevention and health promotion. Research is accelerating at a rapid pace and although still in its infancy, it is important for registered dietitians (RDs) to be knowledgeable and keep abreast of these developments as it promises to revolutionize dietetic practice. International studies have demonstrated low confidence and involvement as well as poor knowledge of both genetics and nutritional genomics amongst RDs. To date no similar studies have been conducted amongst South African (SA) RDs. Methods: A cross-sectional descriptive study was conducted using a national survey of 1881 dietitians registered with the Health Professions Council of South Africa (HPCSA). Data was collected using an existing and validated questionnaire as developed for use in a similar study amongst RDs in the United Kingdom (UK). The self-administered questionnaire consisted of 4 sections to assess the following aspects: i) involvement and confidence in activities relating to genetics and nutritional genomics ii) knowledge of genetics and nutritional genomics iii) factors associated with knowledge and iv) demographic information. The main method of questionnaire distribution was via email (70%) using the Association of Dietetics in South Africa (ADSA) distribution service and questionnaires were posted to those RDs not registered with ADSA (30%). Results: The response rate was 15.2% (n = 279). Results showed low involvement in activities relating to genetics (n = 47, 17%) and nutritional genomics (n = 72, 25.8%). The majority of respondents indicated low confidence in performing activities relating to genetics (n = 161, 58.7%) and nutritional genomics (n = 148, 53.8%). However, a significant positive association was found between involvement and confidence for all activities (p < 0.001). The mean total knowledge score was 48.5 (±19%) and considered as low, with the mean genetics score of 58.5 (± 24%) being significantly higher than the nutritional genomics score of 31.9 (±23%), p < 0.001. Those respondents who reported involvement in discussing the genetic basis of a disease (p = 0.02); providing guidance to patients with genetic disorders (p = 0.01); providing training or education on human genetics (p = 0.01) and discussing with patients how diet may interact with genes to influence risk (p = 0.03) also had higher total knowledge scores. Factors associated with knowledge were greater genetics content in university studies (p < 0.001); higher qualification (p = 0.01); participating in related continuous professional development (CPD) activities (p <0.001) and considering genetics of greater importance to dietetic practice (p = 0.03). Conclusions: The results of this study indicate that there is overall low involvement, confidence and knowledge of genetics and nutritional genomics amongst SA RDs and this compares well with international studies. Recommendations therefore include the development of a competency framework for genetics and nutritional genomics for undergraduate dietetic education as well as CPD activities in order to provide the driving force for the development of this field in SA. / AFRIKAANSE OPSOMMING: Inleiding: Voeding genomika is 'n nuwe en ontwikkelende veld wat die komplekse interaksies tussen dieet en genetika bestudeer, asook die gesamentlike invloed wat dit op gesondheids- bevordering en siekte voorkoming het. Navorsing is vinnig besig om uit te brei en alhoewel dit nog in die begin fase is, is dit belangrik vir geregistreerde dieetkundiges (GDs) om op hoogte te bly van die nuutste ontwikkelinge, aangesien dit die potensiaal het om 'n merkwaardige invloed op die dieetkunde praktyk te hê. Internasionale studies het lae selfvertroue en betrokkenheid, asook lae kennis van genetika en voeding genomika onder GDs bevind. Daar is tans geen studies beskikbaar onder Suid Afrikaanse (SA) GDs nie. Methodes: 'n Dwarssit studie is onderneem deur gebruik te maak van 'n nasionale opname van al 1881 dieetkundiges wat by die Health Professions Council of South Africa (HPCSA) geregistreer is. Data is ingesamel deur 'n gevalideerde self-geadministreerde vraelys wat ook begruik is vir 'n eenderse studie onder dieetkundiges in die Vereenigde Koninkryk (VK). Dit het bestaan uit vier afdelings om die volgende aspekte te evalueer: i) betrokkenheid en selfvertroue in aktiwiteite te make met genetika en voeding genomika ii) kennis van genetika en voeding genomika iii) faktore wat met kennis geassosieer word asook iv) demografiese inligting. Die hoof metode van data insameling was deur middel van epos (70%) met behulp van die Association for Dietetics in South Africa (ADSA) se epos databasis. Vraelyste is aan diegene gepos wat nie geregistreer was by ADSA nie (30%). Resultate: Vyftien persent (n = 279, 15.2%) van GDs het op die vraellys gereaggeer. Resultate het lae betrokkenheid in aktiwitiete met betrekking tot genetika (n = 47, 17%) en voeding genomika (n = 72, 25.8%) gewys. Die meerderheid van die deelnemers het lae selfvertroue gerapporteer in die uitvoering van aktiwiteite wat genetika (n = 161, 58.7%), asook voeding genomika (n = 148, 53.8%) behels. Daar was 'n statistiese beduidende positiewe assosiasie tussen betrokkenheid en selfvertroue vir alle aktiwiteite (p < 0.001). Die gemiddelde kennis telling was 48.5 (±19%) wat as laag beskou kan word. Die gemiddelde kennis vir genetika van 58.5 (± 24%) was statisties beduidend meer as die vir voeding genomika 31.9 (±23%), p < 0.001. Deelnemers wat betrokkenheid aangedui het in die bespreking van die genetiese basis van 'n siekte (p = 0.02); raadgewing aan pasiënte met genetiese siektes (p = 0.01); lewering van opleiding met betrekking tot genetika (p = 0.01) asook die bespreking van die interaksie van dieet en genetika met pasiënte en die invloed hiervan op risiko (p = 0.03), het ook beduidende hoër totale kennis gehad. Faktore wat met kennis geassosieer word is die genetika inhoud in voorgraadse studies (p < 0.001), hoër kwalifikasies (p = 0.01), voorgesette professionele onderrig (VPO) (p <0.001) asook diegene wat genetika as belangrik beskou vir dieetkunde praktyk (p = 0.03). Gevolgtrekking: Die resultate van hierdie studie wys dat daar oor die algemeen lae betrokkenheid, selfvertroue en kennis is van genetika en voeding genomika onder SA GDs. Dit vergelyk goed met international bevindinge. Aanbevelings is dat 'n raamwerk vir die kennis van genetika asook voeding genomika ontwikkel word vir voorgraadse dieetkunde studies, asook die ontwikkeling van VPO aktiwiteite wat die dryfkrag sal voorsien vir die ontwikkeling van hierdie veld in SA.

Thesis (MNutr)-- Stellenbosch University, 2011. / ENGLISH ABSTRACT: Background: Oxidative stress has been implicated in the development of a number of conditions including amongst others cancer, arthritic disorders and cardiovascular disease. Pycnogenol is a herbal dietary supplement derived from French maritime pine bark extract. Pycnogenol is standardised to contain 70 ± 5% procyanidin which is a powerful antioxidant. Pycnogenol is marketed as a supplement for preventing or treating a wide range of chronic conditions. Although several randomised controlled trials of Pycnogenol have been conducted to date, this evidence has not yet been systematically reviewed. Objectives: The aim was to carry out a systematic review in order to assess the efficacy and safety of Pycnogenol for the treatment of chronic disorders. Search methods The electronic databases CENTRAL (until 18 September 2010), MEDLINE (until 18 September 2010) and EMBASE (until 13 October 2010) were searched, as well as three trial registries. Furthermore the manufacturer of Pycnogenol was contacted and bibliographies of included studies were hand-searched. Selection criteria: Randomised controlled trials (RCTs) evaluating the effectiveness of Pycnogenol in adults or children with any chronic disorder were included. The primary outcomes were any clinical outcomes directly related to the disorder (stratified as participant- and investigator-reported) as well as all-cause mortality. Adverse events and biomarkers of oxidative stress were also assessed. Data collection and analysis: Two authors independently assessed trial eligibility, extracted all data and judged methodological quality. A third author additionally extracted information on outcomes and results. With two exceptions, results for outcomes across studies could not be pooled mainly due to poor quality reporting. Study authors were contacted for additional information. Results: This review includes 15 RCTs with a total of 791 participants that have evaluated Pycnogenol for the treatment of seven different chronic disorders. The disorders included asthma (2 studies; N = 86), attention deficit hyperactivity disorder (1 study; N = 61), chronic venous insufficiency (2 studies; N = 60), diabetes mellitus (4 studies; N = 201), erectile dysfunction (1 study; N = 21), hypertension (2 studies; N = 69) and osteoarthritis of the knee (3 studies; N = 293). Two of the studies were conducted exclusively in children; the others involved adults. Due to small sample size, limited numbers of trials per condition, variation in selected outcomes and outcomes measures and the risk of bias no definitive conclusions regarding the efficacy or safety of Pycnogenol are possible. Authors’ conclusions: Current evidence is insufficient to support Pycnogenol use for the treatment of any chronic disorder. Well designed, adequately powered trials are recommended to establish the value of this treatment. / AFRIKAANSE OPSOMMING: Inleiding: Oksidatiewe stres blyk ’n rol te speel in die ontwikkeling van ’n verskeidenheid siektes onder andere kanker, artritis en kardiovaskulêre siektes. Pycnogenol, ‘n kruie-bevattende dieetaanvulling wat uit Franse denneboombas vervaardig word, is gestandaardiseer om 70 ± 5% prosianidien – ’n kragtige anti-oksidant – te bevat. Die produk word bemark om ‘n wye reeks chroniese siektes te voorkom of te behandel. Alhoewel daar tot op hede verskeie kliniese proewe op Pycnogenol uitgevoer is, is die uitkomstes nog nie met behulp van ‘n stelselmatiese oorsig geëvalueer nie. Doelwitte: Die doel van hierdie studie was om met behulp van ‘n stelselmatiese oorsig die doeltreffendheid en veiligheid van Pycnogenol ten opsigte van die behandeling van chroniese siektes te evalueer. Soektogstrategie: Die elektroniese databasisse CENTRAL (tot 18 September 2010), MEDLINE (tot 18 September 2010) en EMBASE (tot 13 Oktober 2010) is deursoek, asook drie registers met kliniese proewe. Verder is die vervaardiger van Pycnogenol gekontak en is daar met die hand deur bibliografieë van ingeslote studies gesif. Keuringskriteria: Ewekansige gekontroleerde proewe (RCT’s) is ingesluit waarin die effektiwiteit van Pycnogenol in volwassenes of kinders met enige chroniese siekte geëvalueer is. Enige kliniese uitkomste wat direk aan die chroniese siekte verwant is (gesorteer as deelnemer- of ondersoeker-gerapporteerde uitkomstes) asook mortaliteit (enige oorsake) is as die primêre uitkomstes ondersoek. Dataversameling en -ontleding: Twee navorsers het onafhanklik van mekaar proewe gekeur, alle relevante data onttrek en gehalte van die metodiek beoordeel. ‘n Derde navorser het die resultate van die uitkomstes bykomend onttrek. Met twee uitsonderings, kon resultate van uitkomstes van die verskillende ingeslote studies kon nie statisties saamgevoeg word nie, hoofsaaklik as gevolg van swak rapportering. Skrywers van die ingeslote studies is in verband met die verlangde inligting gekontak. Resultate: Vyftien RCT’s met ‘n totaal van 791 deelnemers is ingesluit. In hierdie studies is Pycnogenol vir die behandeling van sewe verskillende chroniese siektes geëvalueer: asma (2 studies; N = 86), aandagafleibaarheid-hiperaktiwiteitsgebreksindroom (1 studie; N = 61), chroniese veneuse ontoereikendheid (2 studies; N = 60), diabetes mellitus (4 studies; N = 201), erektiele disfunksie (1 studie; N = 21), hipertensie (2 studies; N = 69) en osteo-artritis van die knie (3 studies; N = 293). Twee van hierdie studies is uitsluitlik met kinders gedoen; die res was volwassenes. As gevolg van klein steekproewe, ‘n beperkte aantal studies per siekte, wisseling in uitkomstes en die risiko vir sydigheid kan geen definitiewe gevolgtrekking oor die doeltreffendheid en veiligheid van Pycnogenol gemaak word nie. Skrywers se gevolgtrekking: Tans is daar nie voldoende wetenskaplike bewyse om Pycnogenol-gebruik vir die behandeling van enige chroniese siekte aan te beveel nie. Goed ontwerpte proewe met ‘n voldoende aantal deelnemers word aanbeveel om die waarde van hierdie behandeling onomwonde vas te stel.

Thesis (MNutr)--Stellenbosch University, 2012. / Please refer to full text for abstract.

Thesis (MNutr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Introduction: Malnutrition, as defined by the Malnutrition Universal Screening Tool (MUST), Mini-Nutritional Assessment-Short Form (MNA-SF), Subjective Global Assessment (SGA), Nutritional Risk Screening Tool-2002 (NRS-2002), Short Nutritional Assessment Questionnaire (SNAQ), Nutritional Risk Indicator (NRI) and Malnutrition Screening Tool (MST), has been associated with adverse outcomes in hospitalised patients. Therefore nutritional risk screening is recommended for all hospitalised patients to improve the recognition and treatment of malnutrition. However, little is known about the use of screening tools in an intensive care unit (ICU) setting. The aim of this study was to assess which of these screening tools could best predict clinical outcomes in ICU patients and to comment on their feasibility, in order to make suggestions on their applicability for this patient population. Methods: Over an eight month study period all patients (>18years) with a surgical ICU stay of >48 hours were included. Patients were screened within 48 hours of admission using each of the seven screening tools. Clinical outcomes (mortality, APACHE II score, length of stay (LOS), length of ventilation (LOV), complications, serum-albumin, white cell count (WCC) and C-reactive protein) were recorded until discharge or death. Feasibility and applicability of the screening tools were also assessed. Results: A total of 206 patients (62.6% males) were included. The average age was 49.5 ±17.4 years and average LOS was 5.7 ± 5.5 days. Screening was not feasible in 18.3% of patients. The MUST classified 18.9% of patients as at risk of malnutrition and 30.1% as malnourished, but was not predictive of any clinical outcomes. According to the MNA-SF, 52.2% of patients were at risk of malnutrition and 16.5% were malnourished. This was associated with progressively decreasing serum-albumin levels (p<0.01) and WCC (p=0.01). The SGA classified 30.6% of patients as moderately and 18.4% of patients as severely malnourished and was significantly associated with LOS (p=0.03), LOV (p=0.01), mild complications (p=0.04) and serum-albumin (p=0.01). However, except for serum-albumin which progressively declined with a poorer nutritional status, the moderately malnourished patients showed the worst outcomes and the severely malnourished patients the best. According to the NRS-2002, 72.8% of patients were malnourished; and this correlated significantly with LOV (p=0.02) and the development of moderate (p=0.04) and total (p=0.01) complications. A non-significant but consistent trend for worse results in the malnourished group was also seen for the other outcomes studied. The SNAQ classified 35.9% of patients as malnourished or at risk thereof. This was associated with lower serum-albumin levels (p=0.04), but also with decreased LOV (p<0.01). The NRI classified 2.3% of patients as mildly malnourished, 21.0% as moderately malnourished and 75.0% as severely malnourished and only effectively predicted serum-albumin (p<0.01). The MST classified 78.2% of patients as malnourished and this was predictive of developing more complications (p<0.01). Almost all of the other variables also showed worse outcomes for the malnourished group, but this was not significant. Conclusion: Screening in an ICU seems to have only moderate feasibility and applicability and limited value. Only the NRS-2002 and MST showed potential for predicting clinical outcomes in ICU patients. / AFRIKAANSE OPSOMMING: Inleiding: Wanvoeding, soos gedefinineer deur die “Malnutrition Universal Screening Tool” (MUST), “Mini-Nutritional Assessment-Short Form” (MNA-SF), “Subjective Global Assessment” (SGA), “Nutritional Risk Screening Tool-2002” (NRS-2002), “Short Nutritional Assessment Questionnaire” (SNAQ), “Nutritional Risk Indicator” (NRI) en die “Malnutrition Screening Tool” (MST), is al met nadelige uitkomste in hospitaal pasiënte geassosieer. Daarom word voedings-risiko-sifting vir alle gehospitaliseerde pasiënte aanbeveel om die herkenning en behandeling van wanvoeding te verbeter. Daar is egter min bekend oor die gebruik van siftingshulpmiddele in ‘n intensiewe sorg eenheid (ISE) omgewing. Die doel van die studie was om te assesseer watter van hierdie siftingshulpmiddele kliniese uitkomste in ISE pasiënte die beste kon voorspel en om kommentaar te lewer op die uitvoerbaarheid daarvan, om sodoende voorstelle te maak oor die toepaslikheid daarvan vir hierdie pasiënt populasie. Metodes: Alle pasiënte (>18 jaar) met ‘n chirurgiese ISE verblyf van >48 uur gedurende ‘n ag maande studieperiode is ingesluit. Pasiënte is binne 48 uur na toelating gesif m.b.v. al sewe siftingshulpmiddele. Kliniese uitkomste (mortaliteit, APACHE II telling, lengte van verblyf (LVVer), lengte van ventilasie (LVVen), komplikasies, serum-albumien, witseltelling (WST) en C-reaktiewe proteïen) is genoteer tot en met ontslag of dood. Uitvoerbaarheid en toepaslikheid van die siftingshulpmiddele is ook geassesseer. Resultate: ‘n Totaal van 206 pasiënte (62.6% manlik) is ingesluit. Die gemiddelde ouderdom was 49.5 ±17.4 jare en die gemiddelde LVVer was 5.7 ± 5.5 dae. Siftings was onuitvoerbaar in 18.3% van die pasiënte. Die MUST het 18.9% van die pasiënte as wanvoeding-risikogevalle geklassifiseer en 30.1% as wangevoed, maar kon nie enige kliniese uitkomste voorspel nie. Volgens die MNA-SF was 52.2% van die pasiënte wanvoeding-risikogevalle en 16.5% was wangevoed. Dit was geassosieer met progressief dalende serum-albumienvlakke (p<0.01) sowel as WST (p=0.01). Die SGA het 30.6% van pasiënte as matig en 18.4% as erg wangevoed geklassifiseer en het ‘n beduidende assosiasie met LVVer (p=0.03), LVVen (p=0.01), ligte komplikasies (p=0.04) en serum-albumien (p=0.01) getoon. Behalwe vir serum-albumien wat progressief verlaag het met ‘n swakker voedingstatus, het die matig wangevoede pasiënte egter die swakste uitkomste getoon en die erg wangevoede pasiënte die beste. Volgens die NRS-2002 was 72.8% van die pasiënte wangevoed en dit het ‘n beduidende korrelasie met LVVen (p=0.02) en die ontwikkeling van matige (p=0.04) en totale (p=0.01) komplikasies gehad. ‘n Nie-beduidende, maar konsekwente neiging vir swakker resultate in die wangevoede groep is ook vir die ander studie-uitkomste gesien. Die SNAQ het 35.9% van pasiënte as wangevoed of as risikogevalle daarvoor geklassifiseer. Dit was geassosieer met laer serum-albumienvlakke (p=0.04), maar ook met ‘n korter LVVen (p<0.01). Die NRI het 2.3% van pasiënte as lig, 21.0% as matig en 75.0% as erg wangevoed geklassifiseer en het slegs serum-albumien effektief voorspel (p<0.01). Die MST het 78.2% van pasiënte as wangevoed geklassifiseer en dit het die ontwikkeling van meer komplikasies (p<0.01) voorspel. Amper al die ander veranderlikes het ook swakker uitkomste getoon in die wangevoede groep, maar dit was nie-beduidend. Gevolgtrekking: Dit blyk of sifting in ‘n ISE slegs matige uitvoerbaarheid en toepaslikheid en beperkte waarde het. Slegs die NRS-2002 en die MST het potensiaal gewys om kliniese uitkomste in ISE pasiënte te voorspel.

Thesis (MNutrition (ITE))--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Background Statins are drugs of known efficacy in the treatment of hypercholesterolaemia. However, statin-induced myopathy, an adverse effect of statins in up to 15% of its users, has warranted a reduction in the prescription dose or discontinuation of the drug. The exact mechanism of statin-induced myopathy is unknown, but the potential of Coenzyme Q10 (CoQ10) as treatment has been recognized due to decreased human plasma CoQ10 levels found after statin use and the concomitant role of CoQ10 in muscle function. Objectives This systematic review assessed the effect of CoQ10 supplementation on: the severity of statin-induced myopathic symptoms, levels of plasma creatine kinase, intramuscular and plasma CoQ10, as well as whether any adverse effects of CoQ10 supplementation such as abdominal pain, nausea and vomiting or headaches were experienced. Search methods Two searches for studies were conducted in The Cochrane Central Register of Controlled Trials (inception to March 2011 and inception to November 2011), MEDLINE (inception to March 2011 and inception to November 2011), Web of Science (inception to March 2011 and inception to November 2011), Science Direct (inception to March 2011 and inception to February 2012), Wiley Online Library (inception to March 2011 and inception to February 2012), Springerlink (inception to April 2011 and inception to February 2012), EBSCOhost [Academic Search Premier and CAB abstracts (inception to March 2011 and inception to February 2012), CINAHL (inception to March 2011 and inception to November 2011)], Scopus (inception to March 2011 and inception to November 2011) and Google Scholar (inception to March 2011 and inception to February 2012). Reference lists of articles were hand searched for relevant clinical trials. Only trials with a full text were included in the review. Selection criteria Randomised controlled trials (RCTs) were included with adult participants (mean of 18-64.99 years) of all race/ethnic groups and gender on statin therapy with reported myopathic symptoms from an unknown cause. The intervention was in the form of a pure oral supplement of CoQ10 irrespective of dose, duration and frequency, and the control in the form of a placebo, a similar antioxidant, or no intervention. Outcomes included the severity of myopathic symptoms, levels of plasma creatine kinase (U/L), intramuscular CoQ10 (μmol/kg) and plasma CoQ10 (μmol/L), as well as adverse effects of CoQ10. Data collection and analysis The principle investigator and one independent reviewer selected the studies, extracted data and assessed for risk of bias using the Cochrane Collaboration‘s tool for assessing risk of bias. Authors of relevant clinical trials were contacted for additional information. Results Two RCTs were included in the review, totaling 76 participants. A meta-analysis could not be performed, thus the review is narrative. There were an insufficient number of RCTs to confirm whether routine supplementation of CoQ10 improves statin-induced myopathic symptoms. Conclusions More and larger RCTs are required to determine the efficacy of CoQ10 supplementation in statin-induced myopathy. Consensus needs to be reached regarding the definition and measurement instrument/s of myopathy so that results of future studies can easily be compared and synthesized. / AFRIKAANSE OPSOMMING: Agtergrond Statiene is medikasie bekend vir die effektiewe behandeling van hipercholesterolemie. Statien-geïnduseerde miopatie is egter 'n newe-effek wat voorkom in tot 15% van gebruikers, wat 'n vermindering in die voorgeskrewe dosis of staking van die medikasie tot gevolg het. Die presiese meganisme van statien-geïnduseerde miopatie is onbekend, maar die potensiaal van Koënsiem Q10 (CoQ10) is geïdentifiseer as 'n moontlike behandeling aangesien menslike plasma CoQ10 vlakke verlaag na die gebruik van statiene en as gevolg van die rol van CoQ10 in spierfunksie. Doelwitte Hierdie sistematiese literatuuroorsig het die effek van CoQ10 supplementasie bepaal op: die graad van statien-geïnduseerde miopatiese simptome, plasma kreatien kinase vlakke, intra-muskulêre en plasma CoQ10 vlakke, asook die teenwoordigheid van enige newe-effekte van CoQ10 supplementasie soos abdominale pyn, naarheid en braking of hoofpyne. Soektogstrategie Twee soektogte vir studies is uitgevoer in The Cochrane Central Register of Controlled Trials (ontstaan tot Maart 2011 en ontstaan tot November 2011), MEDLINE (ontstaan tot Maart 2011 en ontstaan tot November 2011), Web of Science (ontstaan tot Maart 2011 en ontstaan tot November 2011), Science Direct (ontstaan tot Maart 2011 en ontstaan tot Februarie 2012), Wiley Online Library (ontstaan tot Maart 2011 en ontstaan tot Februarie 2012), Springerlink (ontstaan tot April 2011 en ontstaan tot Februarie 2012), EBSCOhost [Academic Search Premier en CAB abstracts (ontstaan tot Maart 2011 en ontstaan tot Februarie 2012), CINAHL (ontstaan tot Maart 2011 en ontstaan tot November 2011)], Scopus (ontstaan tot Maart 2011 en ontstaan tot November 2011) en Google Scholar (ontstaan tot Maart 2011 en ontstaan tot Februarie 2012). Verwysingslyste van artikels is ook met die hand nagegaan vir relevante kliniese proewe. Slegs kliniese proewe waarvan die volteks beskikbaar was, is ingesluit in die oorsig. Seleksiekriteria Ewekansige gekontroleerde proewe (EGP) is ingesluit met volwasse deelnemers (gemiddeld 18-64.99 jaar) van alle rasse/etniese groepe en geslag op statien-terapie met gerapporteerde miopatie simptome van onbekende oorsaak. Die intervensie was 'n suiwer orale supplement van CoQ10 ongeag die dosis, duurte en frekwensie, en die kontrole 'n plasebo, soortgelyke antioksidant, of geen intervensie. Uitkomste het ingesluit: die graad van miopatie simptome, vlakke van plasma kreatien kinase (U/L), intra-muskulêre CoQ10 (μmol/kg) en plasma CoQ10 (μmol/L), sowel as newe-effekte van CoQ10. Dataversameling en -analise Die hoof ondersoeker en een onafhanklike hersiener het die seleksie van studies en data-ekstraksie onderneem en die risiko vir sydigheid geassesseer deur gebruik te maak van die Cochrane Collaboration’s tool for assessing risk of bias. Outeurs van relevante kliniese proewe is geraadpleeg vir addisionele inligting Resultate Twee EGP is ingesluit in die oorsig met 'n totaal van 76 deelnemers. 'n Meta-analise kon nie uitgevoer word nie, dus is die oorsig beskrywend. Daar was te min EGP om te bewys dat roetine supplementasie van CoQ10 statien-geïnduseerde miopatiese simptome verbeter. Gevolgtrekkings Meer en groter EGP is nodig om die effektiwiteit van CoQ10 supplementasie in statien-geïnduseerde miopatie te bepaal. Konsensus moet bereik word ten opsigte van die definisie en metingsinstrument/e van miopatie sodat die resultate van toekomstige studies makliker vergelyk en verwerk kan word.