The micronutrient intake of the average South African is not optimal. National fortification of staple foods does not solve all micronutrient deficiencies. Furthermore, urbanisation causes a shift in food intake, increasing the availability of cheaper and more energy dense food and drinks that are often lacking in micronutrients. It is unclear whether the current literature provides sufficient evidence of nutrient dilution by the moderate consumption of alcohol and/or added sugar. The aim of the present study was to evaluate the dietary intakes of a population in nutrition transition and determine the effect of intake of alcohol and added sugars on intakes of micronutrients and food groups to provide information for the development of preventive strategies in public health. A number of countries, including South Africa, suggest limited alcohol and sugar intakes in the Food Based Dietary Guidelines but do not quantify this recommendation. Data from the "Transition and Health during Urbanisation in South Africa" survey (THUSA) were analysed for dietary intakes (as determined by a validated quantified food frequency questionnaire), age and body mass index (BMI). The THUSA study was conducted during 1996 and 1998 in the North West Province and included 1854 "apparently healthy". Respondents aged 15 years and older from 37 randomly selected sites from rural and urban areas. Alcohol intake (absolute intake and percentage of energy) was the highest for men living in middle class urban areas. With increased urbanisation, the type of beer shifted from sorghum based to commercial beer. Sixty-one percent of men and 25% of women reported that they consumed alcohol at the time of the survey. Eighteen percent of men and 11.7% of women consumed more than 30g and 15g alcohol per day, respectively (intakes which are regarded as moderate). Men and women consuming the most alcohol had significantly higher mean intakes of most macro and micronutrients. However, the intake of vitamin Bi2, B6, folate, vitamin E and vitamin C did not meet the recommended dietary intake (RDA) across all levels of alcohol intake. Although the total energy intake increased with increased alcohol intake, there was no significant difference between the mean BMI of men or women with different levels of intake. One third of the population consumed more than a 100g of added sugar daily. Intake of sugar was the highest in the farm dwellers but the intake of sweets, cakes, cookies and cold drinks was the highest in the urban areas. As sugar intake increased so did energy, carbohydrates and most micronutrients. However, the intake of vitamin B12, folate, vitamin C and calcium did not meet the RDA across all levels of sugar intake. BMI did not differ between respondents with the highest and lowest sugar intake and no association was found between BMI and sugar intake. The THUSA study was conducted before fortification of staple food became law in October 2003. Maize meal and wheat flour are nowadays fortified with certain vitamins and minerals which may alleviate some micronutrient deficiencies. For future research it is imperative to establish the reasons for low intake of certain micronutrients rather than to look at a single food item in the diets of the South African adult population. Proper education on the intake of cheaper food sources of micronutrients needs to be highlighted at all levels of the health sector. / Thesis (M.Sc. (Dietetics)--North-West University, Potchefstroom Campus, 2009.

The micronutrient intake of the average South African is not optimal. National fortification of staple foods does not solve all micronutrient deficiencies. Furthermore, urbanisation causes a shift in food intake, increasing the availability of cheaper and more energy dense food and drinks that are often lacking in micronutrients. It is unclear whether the current literature provides sufficient evidence of nutrient dilution by the moderate consumption of alcohol and/or added sugar. The aim of the present study was to evaluate the dietary intakes of a population in nutrition transition and determine the effect of intake of alcohol and added sugars on intakes of micronutrients and food groups to provide information for the development of preventive strategies in public health. A number of countries, including South Africa, suggest limited alcohol and sugar intakes in the Food Based Dietary Guidelines but do not quantify this recommendation. Data from the "Transition and Health during Urbanisation in South Africa" survey (THUSA) were analysed for dietary intakes (as determined by a validated quantified food frequency questionnaire), age and body mass index (BMI). The THUSA study was conducted during 1996 and 1998 in the North West Province and included 1854 "apparently healthy". Respondents aged 15 years and older from 37 randomly selected sites from rural and urban areas. Alcohol intake (absolute intake and percentage of energy) was the highest for men living in middle class urban areas. With increased urbanisation, the type of beer shifted from sorghum based to commercial beer. Sixty-one percent of men and 25% of women reported that they consumed alcohol at the time of the survey. Eighteen percent of men and 11.7% of women consumed more than 30g and 15g alcohol per day, respectively (intakes which are regarded as moderate). Men and women consuming the most alcohol had significantly higher mean intakes of most macro and micronutrients. However, the intake of vitamin Bi2, B6, folate, vitamin E and vitamin C did not meet the recommended dietary intake (RDA) across all levels of alcohol intake. Although the total energy intake increased with increased alcohol intake, there was no significant difference between the mean BMI of men or women with different levels of intake. One third of the population consumed more than a 100g of added sugar daily. Intake of sugar was the highest in the farm dwellers but the intake of sweets, cakes, cookies and cold drinks was the highest in the urban areas. As sugar intake increased so did energy, carbohydrates and most micronutrients. However, the intake of vitamin B12, folate, vitamin C and calcium did not meet the RDA across all levels of sugar intake. BMI did not differ between respondents with the highest and lowest sugar intake and no association was found between BMI and sugar intake. The THUSA study was conducted before fortification of staple food became law in October 2003. Maize meal and wheat flour are nowadays fortified with certain vitamins and minerals which may alleviate some micronutrient deficiencies. For future research it is imperative to establish the reasons for low intake of certain micronutrients rather than to look at a single food item in the diets of the South African adult population. Proper education on the intake of cheaper food sources of micronutrients needs to be highlighted at all levels of the health sector. / Thesis (M.Sc. (Dietetics)--North-West University, Potchefstroom Campus, 2009.

Childhood micronutrient deficiencies have negative effects on cognition. Little is known about the effects of combined consumption of micronutrients and sugar on growth and cognitive function. The aim of this thesis was to 1) investigate the effects of micronutrients and sugar, alone and in combination, in a beverage, on growth and cognition in South African children and 2) review recent evidence on iron status and anaemia prevalence in South African children since the National Food Consumption Survey-Fortification Baseline-2005 (NFCS-FB-2005). Children (n = 408, 6−11 years) were randomly allocated to a beverage containing 1) micronutrients with sugar, 2) micronutrients with non-nutritive sweetener, 3) no micronutrients with sugar, or 4) no micronutrients with non-nutritive sweetener for 8.5 months. Cognition was assessed using sub-tests from the Kaufman Assessment Battery for Children-II. Growth was assessed as weight-for-age (WAZ), height-for-age and body-mass-index-for-age z-scores. Relevant internet search engines identified studies reporting iron status of South African children after 2005. Secondary analysis was conducted on NFCS-FB-2005 provincial data for children 7−9 years old. Positive intervention effects were observed for micronutrients (0.76; 95% CI: 0.10, 1.42) and sugar (0.71; 95% CI: 0.05, 1.37) on Atlantis (measure learning ability), and sugar on Rover (measure simultaneous processing) (0.72; 96% CI: 0.08, 1.35) test scores. Attenuating micronutrient x sugar interactions were observed on Atlantis, Number Recall (measure sequential processing) and Rover test performance. Micronutrients or sugar alone lowered WAZ. In combination, this effect was attenuated (significant micronutrient x sugar interaction). Four studies from four different provinces were identified. All reported lower anaemia prevalence than the NFCS-FB-2005 (KwaZulu-Natal (11.5% vs 14.4%), North West (6.9% vs 27%) Western Cape (17.2% vs 18.8%) and Northern Cape (5.4% vs 22.2%). A beverage fortified with micronutrients or added sugar had beneficial effects on cognition, but a lowering effect on WAZ in the children. Unexpectedly, the combination of micronutrients and sugar attenuated these effects. In the identified studies, anaemia prevalence in school-aged children was lower than reported in the NFCS-FB-2005. / Thesis (PhD (Nutrition))--North-West University, Potchefstroom Campus, 2013.

Childhood micronutrient deficiencies have negative effects on cognition. Little is known about the effects of combined consumption of micronutrients and sugar on growth and cognitive function. The aim of this thesis was to 1) investigate the effects of micronutrients and sugar, alone and in combination, in a beverage, on growth and cognition in South African children and 2) review recent evidence on iron status and anaemia prevalence in South African children since the National Food Consumption Survey-Fortification Baseline-2005 (NFCS-FB-2005). Children (n = 408, 6−11 years) were randomly allocated to a beverage containing 1) micronutrients with sugar, 2) micronutrients with non-nutritive sweetener, 3) no micronutrients with sugar, or 4) no micronutrients with non-nutritive sweetener for 8.5 months. Cognition was assessed using sub-tests from the Kaufman Assessment Battery for Children-II. Growth was assessed as weight-for-age (WAZ), height-for-age and body-mass-index-for-age z-scores. Relevant internet search engines identified studies reporting iron status of South African children after 2005. Secondary analysis was conducted on NFCS-FB-2005 provincial data for children 7−9 years old. Positive intervention effects were observed for micronutrients (0.76; 95% CI: 0.10, 1.42) and sugar (0.71; 95% CI: 0.05, 1.37) on Atlantis (measure learning ability), and sugar on Rover (measure simultaneous processing) (0.72; 96% CI: 0.08, 1.35) test scores. Attenuating micronutrient x sugar interactions were observed on Atlantis, Number Recall (measure sequential processing) and Rover test performance. Micronutrients or sugar alone lowered WAZ. In combination, this effect was attenuated (significant micronutrient x sugar interaction). Four studies from four different provinces were identified. All reported lower anaemia prevalence than the NFCS-FB-2005 (KwaZulu-Natal (11.5% vs 14.4%), North West (6.9% vs 27%) Western Cape (17.2% vs 18.8%) and Northern Cape (5.4% vs 22.2%). A beverage fortified with micronutrients or added sugar had beneficial effects on cognition, but a lowering effect on WAZ in the children. Unexpectedly, the combination of micronutrients and sugar attenuated these effects. In the identified studies, anaemia prevalence in school-aged children was lower than reported in the NFCS-FB-2005. / Thesis (PhD (Nutrition))--North-West University, Potchefstroom Campus, 2013.

Introduction A group of 317 HIV-1 infected pregnant women and 53 postpartum HIV-negative women were recruited for a two-year prospective descriptive study of psychosocial and other determinants of antenatally planned and actual postnatal feeding, associations between maternal status and infant feeding practices, and health outcomes. Methods The subjects were interviewed periodically for 2 years using structured research instruments. Anthropometric measurements, biomarkers of nutritional status and measurements of pysychosocial wellbeing were obtained from the mothers. Data was collected on infant feeding and outcomes for the babies. Results At recruitment, 74% of mothers planned to formula-feed. Significant differences between these women and those who planned to breastfeed emerged. After delivery, 25% of the women who antenatally planned to formula-feed changed their minds and actually breastfed. Conversely, half of the women who antenatally planned to breastfeed actually formula-fed. Some significant reasons emerged for these feeding changes. Most mothers were well-nourished or overweight. Breastfeeding mothers lost little weight between six weeks and six months after delivery. At the end of follow-up, 65% were obese. While there were differences between HIV-infected and uninfected women in respect of micronutrients, no deficiencies were observed. Vitamin A and selenium concentrations were higher in the HIV-infected women than uninfected women at six weeks. There were no significant micronutrient changes over time. Most mothers maintained an adequate immune status with only slow deterioration of CD4 counts. At two years postpartum, 60% had a CD4 cell count greater than 500cells/mm³, and only about 8% less than 200/mm3. HIV transmission was 15% by 24 months of follow-up. Among the 65 ever breastfed children, 16 (24.6%) were HIV-infected compared to 12.8% of never breastfed children. Most children were growing normally, suggesting that, overall, maternal HIV status did not interfere with feeding ability. Eight mothers (3%) and 33 children (11%) died. Only 12 of 33 children who had died had a positive HIV-PCR. By 2 years, 78% surviving HIV-infected children had been initiated onto ARV therapy. Maternal adherence to HAART was poor. Conclusion HIV and infant feeding counselling is inadequate in the routine PMTCT programme, with stigma and lack of disclosure continuing as major barriers to appropriate care. Whilst maternal obesity was common, most children were growing normally. Weaknesses in routine PMTCT services were identified, and compliance with HAART was poor. / Thesis (PhD)--University of Pretoria, 2010. / Paediatrics and Child Health / unrestricted