Thesis (M.S.)--University of Texas Health Science Center at Houston, School of Public Health, 2007. / Source: Masters Abstracts International, Volume: 46-05, page: 2643. Adviser: Craig L. Hanis. Includes bibliographical references.

Thesis ( Mnutr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Background: The rising prevalence of non-communicable diseases (NCD) is cause for concern. Improving dietary quality is a key health promotion strategy aimed at reducing NCD morbidity and mortality. Assessments that quantify “risky” dietary behaviours are worthwhile, and may help to identify high risk individuals, that would benefit from targeted interventions. Purpose: Discovery Vitality is a wellness incentive business associated with Discovery Health medical aid in South Africa. This study developed a Dietary Behaviour Score (DBSPHR) that measured degrees of compliance of Discovery Vitality members with the “spirit of dietary guidance”. It further categorized scores and identified members who may be at risk for developing NCDs due to poor dietary compliance. Methods: The DBSPHR included proportionally weighted components related to the consumption of fruit, vegetables, low fat dairy, whole-grain foods, lean meat, chicken and discretionary fat. The study population included adult South African members of Discovery Vitality, who had completed the programme’s on-line health risk assessment (PHR) between the 1st February 2010 and 31st January 2011. Stratified random sampling was used (n=1600). Half the sample included members who participated in Vitality’s HealthyFoodTM benefit (HFB) programme. The different Vitality Status groups were equally represented, and reflect degrees of engagement with the programme. Genders were equally represented. DBSPHR data were categorized as: Poor (Score 0-18), Inadequate (18.5-22.5), Fair (23-26), Good (26.5-29), Excellent (29.5-36). DBSPHR data was analyzed for variables: Vitality status, HFB participation, smoking, physical activity, alcohol consumption, body mass index (BMI), age and gender. The relationships between continuous response variables and nominal input variables were analysed using analysis of variance (ANOVA). When ordinal response variables were compared versus a nominal input variable, non-parametric ANOVA methods were used. Further, the Mann-Whitney test or the Kruskal-Wallis test was used. A p-value of p < 0.05 was considered to represent statistical significance, and 95% confidence intervals were used to describe the estimation of unknown parameters. Results: Of the sample, 67.13% of members had DBSPHRs that were considered “poor” or “inadequate”. The mean DBSPHR of the sample was 20.47 points. Women achieved better DBSPHRs than men (p<0.01). Greater engagement with the Vitality programme was associated with better DBSPHRs (p<0.01). There was no significant difference between the mean DBSPHR of members participating in the HFB and Non-HFB members, however the HFB was not assessed as an intervention. Members with “risky” lifestyle behaviours such as; inactivity, smoking and consuming alcohol excessively, demonstrated lower DBSPHR than members without these risks. Obese members achieved significantly lower DBSPHRs than normal weight and overweight members (p<0.01). Conclusions: It is concerning that Discovery Vitality members did not perform better than the general global standard of inadequate compliance with the “spirit of dietary guidance”. Engagement with the Vitality programme seems to positively impact on dietary compliance. Members at an increased risk for NCD morbidity and mortality due to; aging, obesity, smoking, inactivity or non-compliance with alcohol consumption guidelines, demonstrated lower DBSPHRs compared to members without these risks. Targeted interventions aimed at addressing “risky” dietary and lifestyle behaviours may benefit these members. / AFRIKAANSE OPSOMMING: Agtergrond: Die styging in voorkoms van nie-oordraagbare siektes (NOS) is rede tot kommer. Verbetering van dieetkwaliteit is ‘n sleutel gesondheidsbevordering strategie gemik daarop om NOS morbiditeit en mortaliteit te verminder. Assesserings wat “riskante” dieetgedrag kwantifiseer is waardevol en mag help om hoë risiko individue te identifiseer wat sal baatvind by geteikende intervensies. Doel: Discovery Vitality is ‘n welwees motiveringsbesigheid wat geassosieer is met Discovery Health mediese fonds in Suid-Afrika. Hierdie studie het ‘n dieet-gedragstelling (“Dietary Behaviour Score - DBSPHR”) ontwikkel wat die graad van nakoming van Discovery Vitality lede gemeet het aan die “gees van leiding oor dieet”. Dit het verder tellings gekategoriseer en lede geïdentifiseer wat ‘n verhoogde risiko vir die ontwikkeling van NOS mag hê as gevolg van swak nakoming van dieet. Metodes: Die DBSPHR het proporsioneel geweegde komponente bevat, verwant aan die inname van vrugte en groente, laevet suiwelprodukte, volgraan voedsels, maer vleis, hoender en diskresionêre vet. Die studiepopulasie het volwasse Suid-Afrikaners ingesluit wat lede van die Discovery Vitality program was en wat die program se aanlyn gesondheidsrisiko assessering tussen 1 Februarie 2010 en 31 Januarie 2011 voltooi het. Gestratifiseerde, ewekansige steekproeftrekking was gebruik (n=1600). Helfte van die steekproef het lede ingesluit wat aan Vitality se HealthyFoodTM voordeel program deelgeneem het. Die verskillende Vitality Status groepe was gelyk verteenwoordig en reflekteer verskillende grade van interaksie met die program. Geslagte was gelyk verteenwoordig. DBSPHRs data was gekategoriseer as: Swak (Telling 0-18), Onvoldoende (18.5-22.5), Matig (23-26), Goed (26.5-29), Uitstekend (29.5-36). DBSPHR data was vir die volgende veranderlikes geanaliseer: Vitality status, deelname aan die HealthyFoodTM voordeel, rook, fisiese aktiwiteit, alkohol inname, liggaamsmassa indeks (LMI), ouderdom en geslag. Die verhouding tussen aaneenlopende reaksie veranderlikes en nominale inset veranderlikes was geanaliseer deur die gebruik van analise van variansies (ANOVA). Wanneer ordinale reaksie veranderlikes vergelyk was teenoor ‘n nominale inset variansie, was nie-parametriese ANOVA metodes gebruik. Verder was die Mann-Whitney toets of die Kruskal-Wallis toets gebruik. ‘n P-waarde van p < 0.05 was gesien as verteenwoordigend van statistiese beduidendheid en 95% sekerheidsintervalle was gebruik om die skatting van onbekende parameters te beskryf.Resultate: Van die studie monster het 67.13% van die lede DBSPHRs getoon wat gereken was as “swak” of “onvoldoende”. Die gemiddelde DBSPHR van die steekfproef was 20.47 punte. Vroue het beter DBSPHR as mans behaal (p<0.01). Meer interaksie met die Vitality program was geassosieer met beter DBSPHRs (p<0.01). Daar was geen beduidende verskille tussen die gemiddelde DBSPHR van lede wat aan die HealthyFoodTM voordeel program deelneem en die lede wat nie aan die program deelneem nie, alhoewel die HealthyFoodTM voordeel nie geëvalueer was as ‘n intervensie nie. Lede met “riskante” lewenstyl gedrag soos onaktiwiteit, rook en hewige alkoholinname het laer DBSPHR getoon as lede sonder hierdie risiko’s. Vetsugtige lede het laer DBSPHR behaal as normale gewig en oorgewig lede (p<0.01). Gevolgtrekking: Dit is ‘n bron van kommer dat Discovery Vitality lede nie beter vertoon het as wat blyk ‘n algemene globale standaard van gebrekkige nakoming van die “gees van leiding oor dieet” te wees nie. Interaksie met die Vitality program blyk ‘n positiewe impak te hê op dieet nakoming. Lede wat ‘n verhoogde risiko gehad het vir NOS morbiditeit en mortaliteit as gevolg van veroudering, vetsugtigheid, rook, onaktiwiteit of verontagsaming van alkohol inname riglyne het ook laer DBSPHRs getoon in vergelyking met lede sonder hierdie risiko’s. Geteikende intervensies gemik op die aanspreek van riskante dieet en lewenstyl gedrag mag tot voordeel van hierdie lede wees.

Thesis (MNutr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Objectives: To measure the impact on nutrition knowledge; to ascertain the opinions and practices related to nutrition and physical activity, tuck shop visits, and dietary quality of Grade 4 learners; as well as the perceptions on and acceptability of the ‗Fun Food Game‘ (FFG) as nutrition education tool as evaluated in selected Grade 4 learners and educators. Design: A before-after, experimental study with analytical components. Setting: A purposive sample of four schools in the City of Cape Town district of the Western Cape province. Schools A and B in a higher socio-economic area served as intervention school (HIS) and control school (HCS), whereas schools C and D were in a lower socio-economic area and served as intervention school (LIS) and control school (LCS). Subjects: Grade 4 English-speaking boys (n=85), girls (n=90) and Life Orientation educators (n=10). Methods: Pre-tested questionnaires were used to determine change in nutrition knowledge, opinions and practices, both related to nutrition and physical activities in a pre-and post-setting, as well as the perceptions on and acceptability of FFG as a nutrition education (NE) tool for Grade 4 learners and educators. A ‗Dietary Diversity Questionnaire‘ was used to establish the ‗Dietary Diversity Score‘ (DDS), and to note tuck shop visits. Questionnaires were pre-tested in a pilot study. Results: Increased nutrition knowledge and improved opinion on nutrition and physical activities were measured in all schools, but practices related to nutrition and physical activities as well as visits to the tuck shop showed mixed results. In the pre- and post-setting, a DDS of 5 was measured in the HIS and HCS, with a DDS of 5 in the pre- and 6 in the post-setting in the LIS and LCS. Fewer learners had a DDS<4 in the post-setting. Consumption of most food groups and eating breakfast were higher in the post-setting. Bringing lunch boxes to school scored lower in the intervention schools. More tuck shop visits were reported in the LIS and LCS. Most (80% n=8) educators indicated a strong need for NE for themselves. All educators indicated self-learning as a means of familiarising themselves with the content of NE. Sources of nutrition advice included magazines (90% n=9), the Internet (80% n=8) and textbooks (70% n=7). A strong need for NE was expressed by all educators; however, they stated that it should not increase their work load. Educators ‗strongly agreed‘ that the educational nutrition board game FFG can be classified as ‗Health Promotion‘. Overall, learners indicated that playing FFG was a positive experience. Conclusion: Playing FFG and/or having an increased awareness regarding nutrition and physical activities at schools could have had a positive impact on nutrition knowledge and behaviour that could have resulted in positive behaviour, but no definite conclusion can be made in this regard. Nutrition behaviour was more positively influenced in the lower socio-economic schools. Implementing the Health Promoting Schools concept, where Nutrition Education Programmes form part of a multi-component strategy, is recommended. / AFRIKAANSE OPSOMMING: Doel: Om die impak van voedingskennis, opinies en praktyke verwant aan voeding en fisiese aktiwiteite, snoepiebesoeke asook dieetkwaliteit van Graad 4 leerders te bepaal, sowel as die persepsie en aanvaarbaarheid van ‗Fun Food Game‘ (FFG) as hulpmiddel in voedingsopleiding soos geëvalueer deur geselekteerde Graad 4 leerders en -onderwysers. Ontwerp: ‗n Voor-na, eksperimentele studie met analitiese komponente Omgewing: ‗n Doelbewuste groepskeuse van vier skole. Skole A en B in ‗n meer gegoede area het as intervensie skool (HIS) en kontrole skool (HCS) gedien, terwyl skole C en D in ‗n minder gegoede area as intervensie skool (LIS) en kontrole skool (LCS) gedien het in die Stad Kaapstad distrik van die Westelike Provinsie. Deelnemers: Graad 4 Engelssprekende seuns (n=85), dogters (n=95) en Lewensoriënteringsonderwysers (n=10) Metodes: Voorafgetoetsde vraelyste is gebruik om te bepaal of voedingskennis, opinies en praktyke beide verwant aan voeding en fisiese aktiwiteite, voor en na die studie verander het, asook die persepsie en aanvaarbaarheid van FFG as ‗n hulpmiddel in voedingsopleiding vir geselekteerde Graad 4 leerders en onderwysers. ‗n Dieetdiversiteit Vraelys (‗Dietary Diversity Questionnaire‘ – DDQ) is gebruik om ‗n Dieetdiversiteit Telling (‗Dietary Diversity Score‘ – DDS), sowel as snoepiebesoeke te bepaal. ‗n Loodsstudie is uitgevoer om die vraelyste te toets. Resultate: ‗n Toename in voedingkennis en verbeterde opinies oor voeding en fisiese aktiwiteite is in alle skole gevind, maar praktyke oor voeding en fisiese aktiwiteite, asook snoepiebesoeke het gemengde resultate getoon. In die voor- en na-toetsing is ‗n DDS van 5 in HIS en HCS bepaal, met ‗n DDS van 5 in die voor- en 6 in die na-toetsing in LIS en LCS. Minder leerders het ‗n DDS<4 in die na-toetsing gehad. Inname van die meeste voedselgroepe sowel as ontbyt het in die skole toegeneem. Die bring van kosblikke het in die intervensie skole verminder. Die hoogste frekwensie snoepiebesoeke kom voor by die LIS en LCS. Meeste (80% n=8) onderwysers het ‗n sterk behoefte aan voedingsopleiding vir hulself aangedui. Alle onderwysers dui aan dat die inhoud van voedingskennis deur selfleer verhoog word. Tydskrifte (90%, n=9), Internet (80%, n=8) en handboeke (70%, n=7) word as bronne van voedingsadvies beskryf. ‗n Sterk behoefte vir opvoedkundige voedingsopleiding is deur al die onderwysers aangedui, maar sonder dat dit hul werkslading moet verhoog. Die onderwysers is ―sterk oortuig‖ daarvan dat die opvoedkundige voedingsbordspeletjie FFG, as ―Gesondheidsbevordering‖ geklassifiseer kan word. In die algemeen het leerders dit baie positief ervaar om FFG te speel. Samevatting: Die speel van FFG en/of ‗n groter bewusmaking van voeding en fisiese aktiwiteit wat by die skole plaasgevind het, kon ‗n positiewe impak op voedingskennis en -gedrag gehad het, wat kon lei tot positiewe gedrag, maar geen definitiewe gevolgtrekking kan gemaak word in die verband nie. Voedingsgedrag in die mindergegoede skole is meer positief beïnvloed. Implimentering van die Gesondheidsbevorderende Skole konsep, waar Voedingsopleidingsprogramme deel vorm van ‗n multi-komponent strategie, word aanbeveel.

No description available.

Submitted in fulfillment of the requirements of the degree of Doctor of Technology: Health Sciences, Durban University of Technology, Durban, South Africa, 2015. / Background: In a vulnerable low-income group with a confirmed high risk of cardiovascular disease, like the elderly in the Sharpeville care centre, an acute intervention is needed in order to improve their health profile. Previous studies suggested homocysteine lowering by vitamin B12, B6 and folate supplementation. The effect of vitamin B12, B6 and folate supplementation on the inflammatory response, thrombotic risk, lipid profile, hypertension, risk of metabolic syndrome and homocysteine metabolism in an elderly, black South African population has never been reported. Objectives: The main aim of this interventional study was to assess the effect of vitamins B12, B6 and folate supplementation at 200% RDA for six months on cardiovascular risk markers of an elderly semi-urbanised black South African community. Design: This study was an experimental intervention non-equivalent control group study design in 104 purposively selected samples of all the elderly attending the day-care centre. Setting and participants: A homogeneous group of respondents was included in the study. All subjects were equivalent in age (>60 years), race (black), unemployed/pensioners (socio-demographic) and 60 years and older attending a day care centre in Sharpeville, situated in the Vaal region, Gauteng, SA. Measurements: The distinctiveness of this study lies in the broad panel of parameters evaluating the CVR in correlation with the increased nutritional intake of vitamin B6, B12 and folate. These included: weight, height, waist, serum cholesterol, high density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, blood pressure, fibrinogen, high-sensitivity C-reactive protein (HS–CRP), homocysteine, vitamin B12, folate, glucose, insulin, adiponectin and fibronectin. Results: A very high incidence (66.36%) of hyperhomocysteinaemia is present in the sample. The mean serum homocysteine level in hyperhomocysteinaemic individuals decreased statistically significantly from 25.00±8.00 umol/l to 18.80±12.00 umol/l after the intervention. The number of respondents with an increased homocysteine level decreased from 100% (baseline) to 67% (follow-up). The supplementation was beneficial (statistically significant changes) to the glucose levels, fibrinolytic status, vitamin B6 serum levels, fibronectin levels and haemopoeiesis (decreased macrocytosis) of all the individuals (regardless of their homocysteine status). Conclusion: It is concluded that supplementation of vitamins B6, B12 and folate at 200% RDA for six months is an effective homocysteine-lowering approach as a strategy to reduce hyperhomocysteinaemia in an elderly population and thereby reduce cardiovascular risk (CVR). The supplementation intervention mentioned is not an effective multifactorial strategy to decrease CVR although beneficial effects were found with other CVR markers independent of homocysteine status.

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Research aim The study aimed to explore the associations between agricultural biodiversity, household food security and dietary diversity in households with children aged 24 to 59 months in two rural areas of Kenya, of which one had higher rainfall and agricultural biodiversity than the other. Methods Study sample and location The study adopted a cross-sectional analytical approach to investigate the associations in resource in poor households in two rural areas; Akithii and Uringu of Kenya. Of the 525 households randomly selected, 261 were from Uringu division and 264 from Akithii division. Two independent cross-sectional surveys were conducted; Phase one in September to October 2011 (during the dry season) while Phase 2 took place in March 2012 (during the rainy season). A questionnaire was developed to gather information on the socio-demographics of the household, breastfeeding and infant feeding practices, immunization and childhood illnesses. Dietary intake was measured during each season by conducting a repeated 24-hour recall (24-hr recall) with the mother/care giver of the household. A nutrient adequacy ratio (NAR) was calculated for each nutrient as the percent of the nutrient meeting the recommended dietary intake (RDI) value for that nutrient. A mean adequacy ratio (MAR) was calculated for 11 nutrients as the mean of the NARs of these nutrients. Dietary diversity was measured using data from the 24-hour recalls and classifying it into nine food groups. A dietary diversity score (DDS) was calculated based on each different food group which was consumed during the period of recall up to a maximum of nine if the food had been consumed from each of the nine groups. Household food security (HFS) was measured using the Household Food Insecurity Access Scale (HFIAS). The agricultural biodiversity was calculated by counting the number of different crops and animals eaten either from domestic sources or from the wild. Weight and height measurements of children and their mothers/care givers were taken. Weight for age (WAZ), height for age (HAZ) and weight for height z (WHZ) scores were determined for children, while body mass index (BMI) measurements were calculated for the adult women. The relationships between continuous response variables and nominal input variables were analyzed using appropriate analysis of variance (ANOVA) or pooled, paired and independent mean T-tests when only two groups were involved. Results Dietary intake was low with the majority of households not meeting the RDIs for most nutrients. The MAR was 61.3%; 61.8% for Phase 1 and 2 respectively. The DDS was low at 3.3 ±1.2 for both Phases. The majority of households were food insecure with a HFIAS mean of 12.8 ± 6.19 and 10.9 ± 7.49 for Phase 1 and 2 respectively. Agricultural biodiversity was low with a total of 26 items; 23 domesticated and 3 from the natural habitat. Two food items from the natural habitat originated from plants and one from animals. Exclusive breastfeeding up to the recommended six months was practiced at low rates of 23.4% while 39.3% of mothers in both divisions introduced complementary foods before 6 months of age. Stunted growth among the children was high at a mean of 30.5% (n=291). Boys had higher stunted growth rates in both divisions compared to the girls. A significant positive relationship was established between the number of contributors to household income with height for age z-scores (HAZ) scores of the children (Spearman r=-0.15, p=0.02). The number of household assets also significantly influenced HAZ scores (Spearman r=-0.17, p=0.01), the higher the number of household assets, the lower HAZ scores were. During Phase 1 (dry season) (pooled t-test, p<0.001), levels of food insecurity were higher compared to Phase 2 (wet season) (pooled t-test, p<0.001); showing the influence of season on food security. Phases 1 & 2 showed that Akithii had a significantly higher level of food insecurity (Mann-Whitney U; p<0.01), and a lower DDS (chi-square test, p<0.001) compared to Uringu. Children in Akithii consumed a less diversified diet than those in Uringu. Agricultural biodiversity was positively and significantly related to: HFIAS (Spearman r=-0.10, p=0.02); DDS (ANOVA, p<0.001); all NARs (Spearman, p<0.05) and MAR (Spearman, p<0.001).This implies that households with higher agricultural biodiversity were more likely to be food secure, have higher dietary diversity levels and a diet comprising a higher nutritional value. DDS was significantly correlated to MAR and NARs of all the nutrients studied in this study. Findings showed that DDS was also consistently significantly inversely correlated to Household Food Insecurity Access Prevalence (HFIAP) (R =-0.185, t (N-2)-3.889), p=0.0001). This correlation showed that an increase in dietary diversity inversely affected HFIAS. A significant relationship was found between HFIAP and MAR (ANOVA, p=0.00268); indicating that households with a higher MAR were more likely to be food secure. There was a significant correlation between the BMI of the mother/care giver and the WAZ scores of the children (r=0.1410, p<0.001); indicating that higher HAZ scores were found in mothers with higher mean BMI values. There was a significant difference between households with and without children with stunted growth in DDS (ANOVA; p=0.047) and HFIAS (ANOVA; p=0.009) but not with agricultural biodiversity score (ANOVA; p=0.486). The agricultural biodiversity mean score for households with children presenting with stunted growth were, however, lower at 6.8, compared to 7.0 for those with normal growth however the p value was not significant. This indicates that households with children with stunted growth and those without are significantly different in DDS and HFIAS but not regarding agricultural biodiversity. This further implies that the potential of DDS and HFIAS to be used as proxy measures for stunting be further explored. Conclusion Agricultural biodiversity has a positive impact on household food security, dietary diversity, dietary adequacy and child growth. Food security is closely linked to dietary diversity and dietary adequacy; therefore improving one is likely to improve the other two and impact positively on child growth status. Interventions to improve child health and food security in resource poor rural households should aim at increasing dietary diversity through agricultural biodiversity. / AFRIKAANSE OPSOMMING: Navorsingsdoel Die studie is daarop gemik om die assosiasies tussen die landbou-biodiversiteit, huishoudelike voedselsekerheid en dieetdiversiteit in huishoudings met kinders tussen die ouderdomme van 24 tot 59 maande in twee landelike gebiede van Kenia, waarvan een 'n hoër reënval en landbou-biodiversiteit as die ander gehad het, te verken. Metodes Studie steekproef en plek Die studie het 'n deursnit-analitiese benadering aangeneem om die assosiasies te ondersoek in hulpbron-arm huishoudings in twee landelike gebiede; Akithii en Uringu van Kenia. Van die 525 huishoudings wat ewekansig gekies is, was 261 van Uringu afdeling en 264 van Akithii afdeling. Twee onafhanklike deursnit-opnames is uitgevoer; fase een in September tot Oktober 2011 (tydens die droë seisoen), terwyl Fase 2 in Maart 2012 (gedurende die reënseisoen) plaasgevind het. 'n Vraelys is ontwikkel om inligting oor die sosio-demografie van die huishouding, borsvoeding en babavoeding praktyke, immunisering en kindersiektes in te samel. Dieetinname is gemeet tydens elke seisoen deur die uitvoer van 'n herhaalde 24-uur herroep met die moeder / versorger van die huishouding. 'n Voedingstof toereikendheidsverhouding (VTR) is bereken vir elke voedingstof, uitgedruk as die persentasie van die voedingstof wat voldoen aan die aanbevole dieetinname (ADI) waarde vir daardie voedingstof. 'n Gemiddelde toereikendheidsverhouding (GTR) is bereken vir 11 voedingstowwe uitgedruk as die gemiddelde van die VTR‘s van hierdie voedingstowwe. Dieetdiversiteit is gemeet deur data vanuit die 24-uur herroepe, geklassifiseer in nege voedselgroepe. 'n Dieetdiversiteit telling (DDT) is bereken op grond van elke verskillende voedselgroep wat gedurende die tydperk van herroep ingeneem is tot 'n maksimum van nege, indien die voedsel verbruik is uit elk van die nege groepe. Huishoudelike voedselsekerheid (HVS) is gemeet deur die huishoudelike voedselonsekerheid toegangskaal (HVOTS) te gebruik. Die landbou-biodiversiteit is bereken deur die som te bereken van die aantal verskillende gewasse en diere geëet óf van huishoudelike bronne óf uit die natuur. Gewig en lengte metings is geneem van die kinders en hul moeders / versorgers. Gewig vir ouderdom (GVO), lengte vir ouderdom (LVO) en gewig vir lengte (GVL) Z-tellings is bepaal vir die kinders, terwyl die liggaamsmassa-indeks (LMI) metings bereken is vir die volwasse vroue. Die verhoudings tussen aaneenlopende reaksie veranderlikes en nominale inset veranderlikes is ontleed met behulp van toepaslike analise van variansie (ANOVA) of saamgevoegde, gepaarde en onafhanklike gemiddelde T-toetse, indien slegs twee groepe betrokke was. Resultate Dieetinname was laag en die meerderheid van huishoudings het nie aan die ADIs vir die meeste voedingstowwe voldoen nie. Die GTR is 61,3% en 61,8% vir onderskeidelik fase 1 en 2. Die DDT is laag; 3,3 ±1,2 vir beide fases. Die meerderheid van huishoudings was voedselonseker met 'n gemiddelde HVOST van 12,8 ±6,19 en 10,9 ±7,49 vir onderskeidelik fase 1 en 2. Landbou-biodiversiteit was laag met 'n totaal van 26 items, 23 huishoudelike en 3 vanuit die natuurlike habitat. Twee voedselitems uit die natuurlike habitat was afkomstig van plante en een vanaf diere. Eksklusiewe borsvoeding, tot die aanbevole ses maande, was laag en beoefen deur 23,4%, terwyl 39,3% van die moeders, in beide streke, komplimentêre voedsel voor 6 maande ouderdom bekendgestel het. Vertraagde groei onder die kinders was hoog met 'n gemiddeld van 30,5% (n=291). Seuns het hoër vertraagde groei in beide streke in vergelyking met dogters getoon. ʼn Beduidende positiewe verhouding is gevind tussen die aantal bydraers tot huishoudelike inkomste en lengte vir ouderdom z-tellings (LOZ) van die kinders (Spearman r=-0,15, P=0,02). Die aantal huishoudelike bates het ook LOZ tellings (Spearman r=-0,17, P=0,01) aansienlik beïnvloed; hoe hoër die aantal huishoudelike bates, hoe laer die LOZ tellings. Tydens fase 1 (droë seisoen) (saamgevoegde t-toets, p<0.001), was vlakke van voedselonsekerheid hoër in vergelyking met fase 2 (nat seisoen) (saamgevoegde t-toets, p <0.001), wat die invloed van die seisoenaliteit op voedeselsekerheid uitwys. Fase 1 en 2 het gewys dat Akithii ʼn beduidende hoër vlak van voedselonsekerheid gehad het (Mann-Whitney U; p<0.01) en ʼn laer DDT (chi-square toets, p<0.001) in vergelyking met Uringu. Kinders in Akithii het ʼn dieet laer in diversiteit ingeneem as die in Uringu. Landbou-biodiversiteit is positief en beduidend verwant aan: HVOTS (Spearman r = -0,10, P = 0,02); DDT (ANOVA, p<0.001), alle VTR‘s (Spearman, p <0.05) en GTR (Spearman, p <0.001). Dit impliseer dat huishoudings met 'n hoër landbou-biodiversiteit, meer geneig is om voedselseker te wees, hoër dieetdiversiteit vlakke en ʼn hoër voedingswaarde het. DDT is beduidend gekorreleer aan GTR en VTT‘s van al die voedingstowwe wat bestudeer is in hierdie studie. Bevindinge het getoon dat DDT konsekwent en beduidend omgekeerd gekorreleer is met huishoudelike voedselonsekerheid toegang prevalensie (HVOTP) (R=-0,185, t(N-2)-3,889), p=0,0001). Hierdie korrelasie toon dat 'n toename in dieetdiversiteit HVOTS omgekeerd beïnvloed het. ʼn Betekenisvolle verhouding is gevind tussen HVOTP en GTR (ANOVA, p=0,00268); wat aandui dat huishoudings met 'n hoër GTR meer geneig is om voedselsekerheid te toon. Daar is 'n beduidende korrelasie tussen die LMI van die moeder / versorger en die GOZ tellings van die kinders (r=0,1410, p<0.001), wat aandui dat hoër LOZ tellings gevind is in moeders met hoër gemiddelde LMI waardes. Daar is 'n beduidende verskil tussen huishoudings met en sonder kinders met dwerggroei se DDT (ANOVA; p=0.047) en HVOTS (ANOVA; p=0.009) maar nie die landbou-diversiteit telling nie (ANOVA; p=0.486). Die gemiddelde landbou-diversiteit telling vir huishoudings met en sonder kinders met dwerggroei is egter laer met 6.8 in vergelyking met 7.0 vir die met normale groei. Die p-waarde is egter nie beduidend nie. Dit dui aan dat huishoudings met kinders met dwerggroei en daarsonder beduidend verskillend is ten opsigte van DDT en HVOTS, maar nie met landbou-diversiteit in die studie nie. Dit impliseer verder dat die potensiaal van DDT en HVOTS om gebruik te word as alternatiewe metings vir dwerggroei verder ondersoek moet word. Gevolgtrekking Landbou-biodiversiteit het 'n positiewe impak op huishoudelike voedselsekerheid, dieetdiversiteit, dieettoereikendheid en groei van kinders. Voedselsekerheid is nou gekoppel aan dieetdiversiteit en dieettoereikendheid, daarom sal die verbetering van die een waarskynlik die ander twee positief beïnvloed asook ʼn positiewe impak hê op die groei van kinders. Intervensies vir die verbetering van kindergesondheid en voedselsekerheid in hulpbron-arm landelike huishoudings moet poog om dieetdiversiteit te verhoog deur landbou-biodiversiteit.

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Introduction: An association between maternal human immunodeficiency virus (HIV) infection and Necrotizing Enterocolitis (NEC) in preterm infants has been reported. The impact of probiotics in an HIV-exposed very low birth weight (VLBW) infant on the occurrence of NEC is uncertain at present; however it is known that probiotics have protective effects against inflammation and prevent NEC. Postnatal growth restriction is a major issue in preterm, especially extremely-low-birth-weight (ELBW) infants and probiotics have been found to improve feeding tolerance in preterm infants. Human milk oligosaccharides (HMO) also known as the prebiotics of human milk, are known to have bifidogenic and anti-adhesive effects. Infants that receive human milk show a reduced incidence of NEC compared to those who receive infant formula. Very little is known about the composition of breast milk in the HIV-infected mother. Objective: The primary objective of the study was to assess the effect of probiotics on the incidence and severity of NEC in high-risk infants born to HIV-positive and HIV-negative women. The secondary objectives were to assess the effect of probiotic administration on feeding tolerance and growth outcomes of HIV-exposed but uninfected preterm infants, to describe the HMO composition of HIV-infected mothers breast milk and lastly to determine if HMO composition affects the incidence of NEC in HIV-exposed preterm very low birth weight infants. Patients and Methods: A randomized, double blind, placebo controlled trial was conducted for the period July 2011 to August 2012. HIV-exposed and HIV-unexposed premature (<34 weeks gestation) infants with a birth weight of ≥500g and ≤1250g were randomized to receive either a probiotic or a placebo. The probiotic consisted of 1x109 CFU, L. rhamnosus GG and B. infantis per day and was administered for 28 days. NEC was graded according to Bell’s criteria. Anthropometrical parameters and daily intakes were monitored. Breats milk samples were analysed for oligosaccharide content. Results: 74 HIV-exposed and 110 HIV-unexposed infants were enrolled and randomized (mean birth-weight, 987g; mean gestational 28.7 weeks). The incidence of death and NEC did not differ significantly between the HIV-exposed and unexposed groups but a significantly higher NEC incidence was found in the control group. There was no difference in the average daily weight gain for treatment groups or HIV exposure. The HIV-exposed group achieved significantly higher z-scores for length and head circumference at day 28 than the unexposed group (p<0.01 and p=0.03, respectively). There were no differences in the incidence of any signs of feeding intolerance and abdominal distension between the groups. Our results show significantly higher absolute concentrations of 2’-fucosyllactose, laco-N-tetraose and lacto-N-fucopentaose 1 and higher relative abundance of 3’-sialyllactose, difucosyl-lacto-N-tetraose and fucosyl-disialyllacto-N-hexaose in HIV-infected compared to -uninfected Secretor women. DSLNT concentrations were significantly lower in the breast milk of mothers whose infants developed NEC compared to infants without NEC. Conclusion: Probiotic supplementation reduced the incidence of NEC in the premature infants; however results failed to show a lower incidence of NEC in HIV-exposed premature infants. Probiotic supplementation did not affect growth outcomes or the incidence of any signs of feeding intolerance in HIV-exposure. The data confirms previous reports that HIV-infected mothers have higher 3’sialyllactose milk concentrations. Most intriguing though, the data also indicates that low levels of DSLNT in the mother’s milk increase the infant’s risk for NEC, which is in accordance with results from previously published animal studies and warrants further investigation. / AFRIKAANSE OPSOMMING: Inleiding: ʼn Verwantskap tussen moederlike menslike immuniteitsgebreksvirus (MIV) en nekrotiserende enterokolitis (NEK) in premature babas is aangemeld. Die impak van probiotika in ʼn MIV-blootgestelde baie lae geboortemassa (BLGM) baba op die voorkoms van NEK is tans nog onseker, maar dit is wel bekend dat probiotika ʼn beskermende effek het teen inflammasie en die voorkoms van NEK. Nageboortelike groei beperkings is ʼn groot probleem in premature, veral ekstreme lae geboortemassa (ELGM) babas. Daar is gevind dat probiotika voeding toleransie in premature babas kan verbeter. Menslike melk oligosakkariede (MMO), ook bekend as die prebiotika van menslike melk, is bekend om bifidogeniese en anti-kleef effekte te hê. Babas wat moedersmelk ontvang toon ʼn verlaagde voorkoms van NEK in vergelyking met diegene wat baba formule melk ontvang. Baie min inligting is bekend oor die samestelling van borsmelk in die MIV-positiewe moeder. Doel: Die primêre doel van die studie was om die effek van probiotika op die voorkoms en die graad van NEK in hoë risiko babas van MIV-positiewe en MIV-negatiewe vroue te bepaal. Die sekondêre doelwitte was om die effek van probiotika op voeding verdraagsaamheid en groei uitkomste van MIV-blootgestelde, maar nie- geinfekteerde premature babas te evalueer sowel as die MMO samestelling van MIV-positiewe moeders se borsmelk te beskryf en laastens om die invloed van die MMO samestelling op die voorkoms van NEK in baie lae geboortegewig MIV-blootgestelde premature babas te beskryf. Pasiënte en Metodes: ʼn Gerandomiseerde, dubbelblinde, plasebo-beheerde studie is vir die tydperk Julie 2011 tot Augustus 2012 onderneem. MIV-blootgestelde en nie-blootgestelde premature (<34 weke) babas met 'n geboorte gewig van ≥500g en ≤1250g was ewekansig verdeel om probiotika of plasebo te ontvang. Die probiotika het bestaan uit 1x109 kolonie vormende eenhede, L. rhamnosus GG en B. infantis per dag en is toegedien vir 28 dae. NEK is gegradeer volgens Bell se kriteria. Antropometriese parameters en daaglikse inname is gemonitor. Borsmelk monsters is geanaliseer vir oligosakkaried inhoud. Resultate: 74 MIV-blootgestelde en 110 MIV-nie-blootgestelde babas is ingesluit en ewekansig ingedeel (gemiddelde geboorte gewig, 987g, gemiddelde gestasie 28,7 weke). Die voorkoms van die sterftes en NEK het nie beduidend verskil tussen die MIV-blootgestelde en nie-blootgestelde groepe nie, maar 'n beduidende verskil is gevind vir NEK voorkoms tussen die studie en die kontrole groep. Daar was geen verskil in die gemiddelde daaglikse gewigstoename tussen die behandelings groepe of MIV-blootstelling nie. Die MIV-blootgestelde groep het beduidend hoër z-tellings vir lengte en kopomtrek op dag 28 getoon teenoor die nie-blootgestelde groep (p <0.01 en p = 0,03, onderskeidelik). Daar was geen verskille in die voorkoms van voeding onverdraagsaamheid en abdominale distensie tussen die twee groepe nie. Ons resultate dui op aansienlik hoër absolute konsentrasies van 2'-fucosyllactose, laco-N-tetraose en lakto-N-fucopentaose 1 en hoër relatiewe voorkoms van 3'-sialyllactose, difucosyl-lakto-N-tetraose en fucosyl-disialyllacto-N-hexaose in MIV-positiewe vroue in vergelyking met-negatiewe Sekretor vroue. DSLNT konsentrasies was aansienlik laer in die melk van moeders wie se babas NEK ontwikkel het in vergelyking met babas sonder NEK. Gevolgtrekking: Probiotika aanvullings verminder die voorkoms van NEK in premature babas, maar die resultate kon nie ʼn laer voorkoms van NEK in MIV-blootgestelde premature babas bewys nie. Probiotiese aanvulling het geen invloed op groei uitkomste of die voorkoms van voeding onverdraagsaamheid in MIV-blootstelling getoon nie. Die data bevestig vorige verslae wat aandui dat MIV-besmette moeders hoër 3'sialyllactose borsmelk konsentrasies het. ʼn Interessante aspek is dat lae vlakke van DSLNT in die moeder se melk beduidend is van ʼn verhoogde risiko vir NEK, wat in ooreenstemming is met die resultate uit voorheen gepubliseerde dier studies en regverdig verdere ondersoeke.

Thesis (MTech (Food Technology))--Cape Peninsula University of Technology, 2016. / In South Africa malnutrition exists due to inadequate dietary intake of micronutrients which is one of the major causes of vitamin deficiencies leading to disease. The treatment of malnutrition over the past years has been a considerable burden on the South African economy. Therefore, food fortification is one of the current strategies used to minimize malnutrition by increasing the nutritional value of staple foods. Commercial dairy products and pharmaceutical nutritional products (food supplements) in South Africa have been developed and produced for affluent consumers. Hence the need to develop an affordable fortified dairy product for the majority of South Africans prompted this study aimed at using a “naturally” fortified kefir beverage with vitamin B12 and folate to increase B-vitamins levels. Since Propionibacterium freudenreichii and Streptococcus thermophilus are known to be good producers of vitamin B12 and folate, respectively, and propionibacteria has the ability to grow symbiotically in the presence of lactic acid bacteria, the inclusion of these organisms with the kefir grains was an achievable objective. In order to conduct the analysis of vitamin B12 and folate in the samples, sample extraction and HPLC assay techniques were developed. The extraction of vitamin B12 and folate were achieved by using KCN extraction buffer and the trienzymatic method, respectively. The samples were also subjected to purification and concentration using solid phase extraction for optimum results. All standards and samples were flushed with nitrogen gas and stored for a maximum of 2 weeks at –20°C to prevent B-vitamin deterioration. The HPLC assembly for the vitamin B12 analysis included a Luna C18 column and a diode array detector (DAD) for the detection and quantification. For the folate analysis it included a Zorbax SB-C18 and Luna C18 columns in tandem and the fluorescence detector (FLD) was used for the detection and quantification of THF, 5-CH3-THF and 5-CHO-THF, while the DAD was used for PGA and pteroyltri-γ-L-glutamic acid concentration in the samples.

Vitamin A deficiency (VAD) is a major public health problem in developing countries, including South Africa. The potential of provitamin A-biofortified maize for use as a complementary strategy to alleviate vitamin A deficiency in developing countries, where maize is the dominant staple food, is currently a subject of research. Although the nutritional composition of white maize is thought to be similar to that of biofortified maize, apart from the differences in provitamin A carotenoid content, the comparative nutritional composition of the two maize types seems not to have been subjected to a comprehensive scientific study. When setting the target level of provitamin A in the provitamin A-biofortified maize, it is important to consider the potential effect of processing on the final provitamin A carotenoid content of the biofortified food products, as the provitamin A carotenoids levels may decrease on processing. Furthermore, the yellow/orange provitamin A-biofortified maize may not be widely accepted by African consumers who are vulnerable to VAD, and are traditional consumers of white maize. This study firstly aimed to evaluate the nutritional composition, including provitamin A composition, and grain quality of provitamin A-biofortified maize varieties, compared to white maize. The second aim was to assess the effect of processing (milling and cooking) on the retention of provitamin A carotenoids and other nutrients in popular South African maize food products prepared with provitamin A-biofortified maize. Thirdly, the study aimed to assess the acceptability of maize food products prepared with provitamin A-biofortified maize by consumers of different age and gender in rural KwaZulu-Natal, South Africa. The grains of the provitamin A-biofortified maize varieties and grain of a white maize variety (control) were analysed for their nutritional composition using standard or referenced methods. The carotenoid content of the grains was analysed by High-Performance Liquid Chromatography (HPLC) and mass spectroscopy. The provitamin A carotenoids β-cryptoxanthin, and trans and cis isomers of β-carotene, and other unidentified cis isomers of β-carotene were detected in varying levels in the provitamin A-biofortified maize varieties. The total provitamin A content in the biofortified maize varieties ranged from 7.3-8.3 μg/g dry weight (DW), with total β-carotene ranging from 3.5-3.6 μg/g DW, and β-cryptoxanthin from 3.7-4.8 μg/g DW, whilst no carotenoids were detected in the white maize variety. Results of the evaluation of the content of other nutrients showed that, when compared with the white maize variety, the provitamin A-biofortified maize varieties had higher levels of starch, fat and protein but were lower in iron. The zinc and phosphorus levels in the white maize and the biofortified maize were comparable. The biofortified maize varieties were better sources of most of the essential amino acids relative to the white maize, but, similar to the white maize, they were deficient in histidine and lysine, indicating that further improvement is required. Selected quality attributes (grain density, susceptibility of kernels to cracking, milling quality and resistance of the kernels to fungal infection) of grains of 32 provitamin A-biofortified maize varieties and a white variety (control) were assessed. Overall, the quality of the grains of the provitamin A-biofortified maize varieties were found to be superior to that of the white maize grain, although the biofortified maize grains showed less resistance to fungi, including mycotoxin-producing types. This indicates that the trait of grain resistance to infection by fungi should also be incorporated in the provitamin A-biofortified maize varieties during breeding. To assess the retention of provitamin A carotenoids and other nutrients in maize food products, three selected provitamin A-biofortified maize varieties and the control (white maize variety) were milled into mealie meal and samp. The milled products were cooked into three products: phutu and thin porridge (from the mealie meal) and cooked samp. Nutrient retention during processing was determined. Milling resulted in either an increase or slight decrease in the provitamin A carotenoid levels, but there was no major decrease in the total provitamin A level. Most of the other nutrients were well retained during milling, but there were substantial losses of fibre, fat and minerals. Provitamin A carotenoid levels decreased on cooking. In phutu 96.6 ± 20.3% β-cryptoxanthin and 95.5 ± 13.6% of the β-carotene was retained after cooking. In thin porridge 65.8 ± 4.6% β-cryptoxanthin and 74.7 ± 3.0% β-carotene; and in samp 91.9 ± 12.0% β-cryptoxanthin and 100.1 ± 8.8% of the β-carotene was retained after cooking, respectively. Provitamin A retention seemed to be influenced by both maize variety and food form, indicating that suitable varieties and food forms should be found. There was generally a high retention of the other nutrients in all the three cooked products, except for the substantial losses of fat in thin porridge and iron and phosphorus in cooked samp. These findings indicate that an optimal delivery of provitamin A to the consumer can be achieved by processing provitamin A-biofortified maize into foods that have a good retention of provitamin A carotenoids, such as phutu and samp. These food products would be recommended in areas where VAD is prevalent. In order to assess consumer acceptability of provitamin A-biofortified maize, a total of 212 subjects aged 3-55 years from Mkhambathini Municipality, in KwaZulu-Natal province, South Africa, participated in the sensory evaluation of phutu, thin porridge and cooked samp prepared with provitamin A-biofortified maize varieties and a white variety (control). Preference for yellow maize food products was negatively associated with an increase in the age of the subjects. Overall, preschool children preferred yellow maize to white maize food products: phutu (81% vs. 19%), thin porridge (75% vs. 25%) and samp (73% vs. 27%). In contrast, primary school children preferred white maize to yellow maize food products: phutu (55% vs. 45%), thin porridge (63% vs. 38%) and samp (52% vs. 48%). Similarly, secondary school children and adults also displayed a similar preference for white maize food products. There was no association between gender and preference for maize variety. Focus group discussions revealed that participants had a negative attitude towards biofortified maize due to its colour, taste, smell and texture. However, the participants expressed a willingness to consume biofortified maize if it was cheaper than white maize and was readily available in local grocery stores. These findings indicate that there is a potential to promote the consumption of provitamin A-biofortified maize and its food products in this part of South Africa, thereby contributing to a reduction in the incidence of VAD. This study has shown that provitamin A-biofortified maize has a good potential to be used as an additional strategy to alleviate VAD in poor communities of South Africa, including similar environments in sub-Saharan Africa. However, the study has revealed that there are still challenges to be overcome in order to achieve the target provitamin A content of 15 μg/g in provitamin A-biofortified maize, set by HarvestPlus, an international challenge program. This may also explain why provitamin A-biofortified maize varieties with this level of provitamin A have been scarcely reported in the literature. Thus, more research is required to achieve the target provitamin A level in maize by conventional breeding. The results of this study indicate that besides provitamin A, the biofortified maize is also a good source of other nutrients including starch, fat, protein and zinc. However, improving the consumer acceptability of the provitamin A-biofortified maize remains a challenge, due to the negative attitudes towards the yellow/orange maize by African consumers. On the other hand, the results of this study indicate that there is an opportunity to promote the consumption of provitamin A-biofortified maize food products by preschool children, a finding which has not been previously reported in the literature. Nutrition education on the benefits of provitamin A-biofortified maize, as well as improved marketing are recommended, in this part of South Africa and also in similar environments in other sub-Saharan countries. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2011.

Adolescent athletes of this era are more pressurized than adolescents of previous generations to perform at an optimum level (Micheli & Jenkins 2001, p49). The importance of winning can result in adolescent athletes developing inappropriate nutritional practices such as neglecting hydration and consuming insufficient carbohydrate (Micheli & Jenkins 2001, p57). Consuming insufficient fluid leads to dehydration which reduces a soccer player’s ability to continue training. Consuming inadequate carbohydrate reduces performance and blood glucose levels during training. This study aimed to determine the hydration status, fluid and carbohydrate intake of male, adolescent soccer players during training. A cross-sectional study was conducted among 122 amateur male, adolescent soccer players (mean age = 15.8 ± 0.8 years; mean BMI = 20.4 ± 2.0 kg/m2). The players’ hydration status before and after training, was measured using urine specific gravity and percent loss of body weight. Their carbohydrate intake, as well as the type and amount of fluid consumed, were assessed before, during and after training. A questionnaire was administered to determine the players’ knowledge regarding the importance of fluid and carbohydrate for soccer training. The study had an 87.1% response rate. The mean environmental conditions did not predispose players to heat illness. However, the players were at risk of developing heat illness during six of the 14 training sessions. Although the mean urine specific gravity indicated that players were slightly dehydrated before and after training, 43.8% of players were very or extremely dehydrated before training and 53.6% after training. A few (3.3%) were extremely hyperhydrated before training and after training (7.0%). On average players lost less than 1% of body weight during training and less than 3% of players dehydrated more than 2%. Players consumed mainly water before (289.17 ± 206.37 ml), during (183.20 ± 158.35 ml) and after (259.09 ± 192.29 ml) training. More than 90% stated that water was the most important fluid to consume before, during and after training. Very few (4.7%) correctly stated that carbohydrate should be consumed before, during and after training. Players were found to be slightly dehydrated before and after training and therefore were not consuming enough fluids during training. Players consumed inadequate amounts and types of fluid and carbohydrate. This not only compromises their performance but also health. Players were not aware of the importance of fluid and carbohydrate for soccer training. This study is unique in that it focused on the carbohydrate and hydration practices of socioeconomically disadvantaged adolescent soccer players during training. The study sample therefore represents a high risk group about which there is limited published data both locally and internationally. This study generated important baseline information which was lacking before on the hydration status, fluid and carbohydrate intake of adolescent soccer players in South Africa. / Thesis (M.Sc.Agric.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.