Background: Cardiovascular disease (CVD) is becoming one of the leading causes of death in middle and low income countries, with ischaemic heart disease specifically being predicted to be the 4th and 5th causes respectively. The numerous risk factors for the development of CVD have been extensively researched; however, the same wealth of data is not available for the black South African population as there is for Caucasians. Although the same risk factors that are present in Caucasians have been seen to be present in the black South Africans, there are questions regarding the contributory roles of the individual risk factors, particularly within the context of urbanisation. The role of diet in CVD has been widely studied and it is known that with urbanisation there are dietary changes which are thought to add the development of CVD. With urbanisation, however, there are numerous other lifestyle changes taking place within a population, making it difficult to isolate and make conclusions of the individual role of diet. Added to this is the complex issue of assessing dietary intake. Assessing only nutrient or food intake does not give a holistic picture of dietary habits. The main aim of this study was to determine the association between dietary intake and CVD risk in black South Africans in the context of urbanisation. Methods: The first study that forms part of this thesis was a case-control study aimed at exploring the risk factor profile and clinical presentation of black South African patients with coronary artery disease (CAD). In this study clinical, biochemical and nutrient intakes were compared with a black South African control group that were matched for age and body composition. The second study to form part of this thesis aimed to relate the dietary intakes of the Prospective Urban and Rural Epidemiological (PURE) study population to CVD risk associated with urbanisation, by using both nutrient intake and predefined diet quality scores (DQS). The Healthy Diet Indicator (HDI) and the Deficiency and Excess Score were carefully selected from the large number of available scores and adapted as best as possible for the black South African population. The third study aimed to investigate the role of dietary intake by using nutrients as well as food group consumption patterns as a risk factor in urbanised black South African CAD patients. The dietary habits of the coronary artery disease (CAD) patients were compared to that of an apparently healthy reference group of volunteers selected from the PURE study population. This urbanised reference group was from a similar socio- demographic background and was selected according to their risk for CVD. The Reynolds Risk score which includes C-reactive protein as factor was used to stratify the PURE population into CVD risk categories, in order to select the reference group, which had a low risk (<5%) of developing CVD within the next 10 years. Dietary intake was assessed by comparing nutrient and food group intake (including the ultra-processed food group category). Results and discussion: Black South African CAD patients had increased levels of the same risk factors that are seen in Caucasians with insulin resistance and LDL size being particularly significant in their contribution. Apart from a lower vitamin C intake, no differences in dietary intake and physical activity were observed between the CAD and control group. When comparing the dietary intake of the rural and urban group, the urban group, who had an increased CVD risk, had higher intakes of macro- and micronutrients as well as higher DQS. The DQS must however be interpreted with caution, as when looking at the absolute intakes of individual components of the scores, the urban group was still deficient in a numerous vital micronutrients. A similar picture was seen in the third study, in that the CAD patients also consumed more saturated fatty acids and ultra-processed foods than the reference group, as well as more of the “protective” foods such as fruit and vegetables. However, although their dietary habits could be considered prudent, they were still inadequate in numerous important micronutrients. Conclusion and recommendation: This thesis therefore shows that there are two sides of the story regarding the role of diet in CVD in black South Africans. Although it is important to follow prudent dietary guidelines so as to control the intake of nutrients and foods known to play a role in the development of CVD, it is just as important to ensure adequate intake of the foods rich in micronutrients known to protect against CVD. Dietary advice and prevention programs should also focus on the adequacy aspect of the diet, such as increasing fruit and vegetable and low fat dairy intake, not only on the prudent diet aspect. Additionally, nutrient intake alone does not adequately explain the link between diet and CVD and additional analyses such food consumption patterns are required. / Thesis (PhD (Dietetics))--North-West University, Potchefstroom Campus, 2013

Background: Cardiovascular disease (CVD) is becoming one of the leading causes of death in middle and low income countries, with ischaemic heart disease specifically being predicted to be the 4th and 5th causes respectively. The numerous risk factors for the development of CVD have been extensively researched; however, the same wealth of data is not available for the black South African population as there is for Caucasians. Although the same risk factors that are present in Caucasians have been seen to be present in the black South Africans, there are questions regarding the contributory roles of the individual risk factors, particularly within the context of urbanisation. The role of diet in CVD has been widely studied and it is known that with urbanisation there are dietary changes which are thought to add the development of CVD. With urbanisation, however, there are numerous other lifestyle changes taking place within a population, making it difficult to isolate and make conclusions of the individual role of diet. Added to this is the complex issue of assessing dietary intake. Assessing only nutrient or food intake does not give a holistic picture of dietary habits. The main aim of this study was to determine the association between dietary intake and CVD risk in black South Africans in the context of urbanisation. Methods: The first study that forms part of this thesis was a case-control study aimed at exploring the risk factor profile and clinical presentation of black South African patients with coronary artery disease (CAD). In this study clinical, biochemical and nutrient intakes were compared with a black South African control group that were matched for age and body composition. The second study to form part of this thesis aimed to relate the dietary intakes of the Prospective Urban and Rural Epidemiological (PURE) study population to CVD risk associated with urbanisation, by using both nutrient intake and predefined diet quality scores (DQS). The Healthy Diet Indicator (HDI) and the Deficiency and Excess Score were carefully selected from the large number of available scores and adapted as best as possible for the black South African population. The third study aimed to investigate the role of dietary intake by using nutrients as well as food group consumption patterns as a risk factor in urbanised black South African CAD patients. The dietary habits of the coronary artery disease (CAD) patients were compared to that of an apparently healthy reference group of volunteers selected from the PURE study population. This urbanised reference group was from a similar socio- demographic background and was selected according to their risk for CVD. The Reynolds Risk score which includes C-reactive protein as factor was used to stratify the PURE population into CVD risk categories, in order to select the reference group, which had a low risk (<5%) of developing CVD within the next 10 years. Dietary intake was assessed by comparing nutrient and food group intake (including the ultra-processed food group category). Results and discussion: Black South African CAD patients had increased levels of the same risk factors that are seen in Caucasians with insulin resistance and LDL size being particularly significant in their contribution. Apart from a lower vitamin C intake, no differences in dietary intake and physical activity were observed between the CAD and control group. When comparing the dietary intake of the rural and urban group, the urban group, who had an increased CVD risk, had higher intakes of macro- and micronutrients as well as higher DQS. The DQS must however be interpreted with caution, as when looking at the absolute intakes of individual components of the scores, the urban group was still deficient in a numerous vital micronutrients. A similar picture was seen in the third study, in that the CAD patients also consumed more saturated fatty acids and ultra-processed foods than the reference group, as well as more of the “protective” foods such as fruit and vegetables. However, although their dietary habits could be considered prudent, they were still inadequate in numerous important micronutrients. Conclusion and recommendation: This thesis therefore shows that there are two sides of the story regarding the role of diet in CVD in black South Africans. Although it is important to follow prudent dietary guidelines so as to control the intake of nutrients and foods known to play a role in the development of CVD, it is just as important to ensure adequate intake of the foods rich in micronutrients known to protect against CVD. Dietary advice and prevention programs should also focus on the adequacy aspect of the diet, such as increasing fruit and vegetable and low fat dairy intake, not only on the prudent diet aspect. Additionally, nutrient intake alone does not adequately explain the link between diet and CVD and additional analyses such food consumption patterns are required. / Thesis (PhD (Dietetics))--North-West University, Potchefstroom Campus, 2013

abstract: Diet quality is closely intertwined with overall health status and deserves close examination. Healthcare providers are stretched thin in the current stressed system and would benefit from a validated tool for rapid assessment of diet quality. The Rapid Eating and Activity Assessment for Participants Short Version (REAP-S) represents one such option. The objective of the current study was to evaluate the effectiveness of the REAP-S and Healthy Eating Index 2010 (HEI-2010) for scoring the diet quality of omnivorous, vegetarian and vegan diets. Eighty-one healthy male and female subjects with an average age of 30.9 years completed the REAP-S as well as a 24-hour dietary recall. REAP-S and HEI-2010 scores were calculated for each subject and evaluated against each other using Spearman correlations and Chi Square. Further analysis was completed to compare diet quality scores of the HEI-2010 and REAP-S by tertiles to examine how closely these two tools score diet quality. The mean HEI-2010 score was 47.4/100 and the mean REAP-S score was 33.5/39. The correlation coefficient comparing the REAP-S to the HEI-2010 was 0.309 (p=0.005), and the REAP-S exhibited a precision of 44.4% to the HEI-2010 for diet quality. The REAP-S significantly correlated with the HEI-2010 for whole fruit (r=0.247, p=0.026), greens and beans (r=0.276, p=0.013), seafood proteins (r=0.298, p=0.007), and fatty acids (r=0.400, p<0.001). When evaluated by diet type, the REAP-S proved to have increased precision in plant-based diets, 50% for vegetarian and 52% for vegan, over omnivorous diets (32%). The REAP-S is a desirable tool to rapidly assess diet quality in the community setting as it is significantly correlated to the HEI-2010 and requires less time, labor and money to score and assess than the HEI-2010. More studies are needed to evaluate the precision and validity of REAP-S in a broader, more diverse population. / Dissertation/Thesis / Masters Thesis Nutrition 2015

Range cattle grazing in semi-arid regions are commonly limited by lack of nutrients from low-quality forage. Due to this, ranchers are faced with the challenge of monitoring diet quality in order to address nutrient limitations. Near infrared spectroscopy (NIRS) of fecal samples is a method used to determine diet quality values like crude protein (CP) and digestible organic matter (DOM) in grazing animals. When combined with a nutritional balance analyzer such as the NUTBAL system, fecal NIRS can be used to monitor diet quality and project animal performance. Our research aimed to test the ability of NUTBAL to project animal performance as represented by body condition score (BCS) in cattle (n=82 Animal Units) grazing on the Santa Rita Experimental Range (SRER) in southern Arizona. Previous work conducted on other Arizona rangelands led to the hypothesis that fecal NIRS coupled with NUTBAL can be used to monitor diet quality and project BCS in a southern Arizona commercial grazing operation. Data collection occurred between June 2016 and June 2017. Standing biomass and botanical composition were measured before each grazing period, and relative utilization was measured following each grazing period. During the midpoint of grazing in each pasture, 30 body condition scores and a fecal composite of 15 samples were collected. Fecal derived diet quality varied between a maximum of 10.75% CP and 61.25% DOM in early August 2016, to a minimum value of 4.00 % CP and 58.40 % DOM in March 2017. This study confirmed the ability of fecal NIRS paired with NUTBAL to project future BCS within 0.5 a score point more than 80% of the time in cattle grazing on the SRER. With this information, cattle managers in southern Arizona can better address animal performance needs and nutrient deficiencies.

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abstract: Food insecurity and childhood obesity are both major public health concerns in the United States of America. Research has not found a definite relationship between childhood obesity and food insecurity to date, with conflicting results being found due to differences in sample sizes and protocol for measuring key variables. Preschoolers (children aged 2-5 years) are a population of particular interest as there tends to be improved health behaviors and greater adaptability to change at this period of growth and development. This study aims to evaluate if there is a relationship between food insecurity and childhood obesity with diet quality as a mediator among preschoolers in the Phoenix area. A secondary data analysis from participants (n=154) from the SAGE (Sustainability via Active Garden Education) research project was used to evaluate food insecurity status, diet quality components (kcal, saturated fat, added sugars, and servings of juice, fruits, and vegetables), and anthropometrics (waist circumference and BMI percentile). No significant associations between food insecurity status, diet quality components, and anthropometric data were found. There was an increased rate of food insecurity and childhood overweight/obesity in this sample compared to state and national averages. Further research of high quality is necessary to determine whether a relationship exists between childhood obesity and food insecurity exists and in what context. Additionally, practice and policy will need to be implemented to decrease rates of food insecurity and childhood obesity among Phoenix preschoolers. / Dissertation/Thesis / Masters Thesis Nutrition 2020

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