Typescript / 420 leaves : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Agronomy, 1965

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

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

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

Thesis (MNutr)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: Introduction A paucity of data exists regarding growth patterns and nutrition-related problems in infants (<12 months) on antiretroviral treatment (ART) and the infant feeding knowledge, beliefs, attitude and practices of their caregivers. Aim To describe the growth and nutrition-related problems of infants (<12 months) attending the Antiretroviral (ARV) clinic at Red Cross Children’s Hospital, as well as the knowledge, attitudes, beliefs and practices of their caregivers concerning infant feeding. Methods A cross-sectional, descriptive study was conducted with census sampling. Thirty infants and 31 caregivers were included in the sample. Anthropometric measurements were performed and interviewer-administered questionnaires were utilised to obtain the knowledge, attitude, beliefs and practices of the caregivers. The mean Z-score of each measurement as well as the weight-for-age, length-for-age, weight-forlength and bodymass index-for-age for each infant were determined, analysed, interpreted and described according to the World Health Organisation (WHO) growth standards for children. Results Thirty-nine percent (n=11) of the mothers (n=28) did not receive infant feeding counselling prior to delivery, while only 9 (32%) received the minimum number of at least 4 sessions, as prescribed by the Department of Health. It was not assessed whether the counselling occurred before delivery. The mean age of the infants was 6.9 (SD 3.3) months. Eighty-three percent (n=25) had an opportunistic infection prior to data collection. Twenty-three percent (n=7) were underweight-forage and 40% (n=12) of the infants were stunted. Vomiting and diarrhoea were the most common nutrition-related problems experienced. A statistical significant positive correlation (p=0.003) was found between an infant’s duration on ART and W/A z-score. Only two caregivers were breastfeeding at the time of data collection, but 34% (n=10) of the other caregivers had at some stage breastfed their infant. Formula feeding practices were poor. Sixty-two percent (n=18) were not preparing the feeds correctly and only six (21%) were correctly cleaning and sterilising the bottles. Thirty-nine percent (n=11) of the infants were not receiving an adequate amount of milk per day. Sixty-five percent (n=11) of the infants (>six months) did not receive a diet the previous day which met the minimum WHO dietary diversity indicator and only 18% (n=3) received a minimum acceptable diet. Caregivers had an average knowledge concerning infant feeding. Thirteen percent (n=4) knew the correct definition of exclusive breast- or formula feeding. Sixty-eight percent (n=21) did not know what mixed feeding meant, or the dangers associated with it. Most caregivers (n=25, 81%) knew that oral rehydration solution had to be given when infants developed diarrhoea, but only 48% (n=15) knew how to prepare it and only 6% (n=2) knew how to administer it. Seventy-five percent (n=9) of caregivers did not know what should be done when experiencing breast problems. Sixty-four percent (n=19) of the caregivers believed that if a HIV-positive woman breastfeeds she would definitely transmit HIV to her infant. Conclusion The infant sample showed a variety of erratic growth patterns with a high prevalence of underweight and stunting. Infant feeding knowledge of caregivers was average, but not deemed sufficient to translate into appropriate, safe and optimal infant feeding practices. The breastfeeding prevalence was low. Formula preparation, feeding and hygiene practices were poor and dietary intake of infants was not optimal. The quality and quantity of HIV infant feeding counselling sessions received at antenatal clinic visits were poor and need to be addressed. / AFRIKAANSE OPSOMMING: Inleiding Daar is 'n tekort aan data oor groeipatrone en voedingsverwante probleme by babas (<12 maande) op antiretrovirale behandeling asook die babavoedingkennis, -oortuigings, -houdings en -praktyke van hul versorgers. Doelwit Om ondersoek in te stel na die groei- en voedingsverwante probleme by babas (<12 maande) in die antiretrovirale kliniek by Rooikruis-kinderhospitaal, sowel as die babavoedingkennis, - oortuigings, -houdings en -praktyke van hul versorgers. Metodes 'n Beskrywende dwarssnitstudie is met sensussteekproefneming onderneem. Dertig babas en 31 versorgers is by die steekproef ingesluit. Antropometriese metings was gedoen en onderhoude was met behulp van vraelyste gevoer ten einde inligting oor die versorgers se kennis, houdings, oortuigings en praktyke te bekom. Elke baba se gemiddelde z-telling per meting sowel as die gewig-vir-ouderdom, lengte-vir-ouderdom en liggaamsmassa-indeks-vir-ouderdom was volgens die Wêreldgesondheidsorganisasie (WGO) se groeistandaarde vir kindersbepaal, ontleed, vertolk en beskryf. Resultate Altesaam 39% (n=11) van die moeders (n=28) het nie voor die bevalling voorligting oor babavoeding ontvang nie, terwyl slegs 9 (32%) die Departement van Gesondheid se voorgeskrewe minimum 4 sessies, deurloop het. Dit was nie bepaal of hierdie sessies voor die bevalling ontvang was nie. Die gemiddelde ouderdom van die babas was 6,9 (standaardafwyking 3,3) maande. 'n Totaal van 83% (n=25) het voor data-insameling 'n opportunistiese infeksie gehad, 23% (n=7) was ondergewig-vir-ouderdom, en 40% (n=12) van die babas se lengtegroei was ingekort. Die algemeenste voedingsverwante probleme was braking en diarree. Daar blyk 'n statisties beduidende positiewe korrelasie (p=0.003) te wees tussen die duur van die baba se antiretrovirale behandeling en sy/haar gewig-vir-ouderdom-z-telling. Slegs twee versorgers het hul babas ten tyde van die studie geborsvoed, hoewel 34% (n=10) van die versorgers in 'n stadium geborsvoed het. Voedingspraktyke met die gee van melkformule was swak. Altesaam 62% (n=18) het die melkformule verkeerd aangemaak en slegs ses (21%) het die bottels behoorlik skoongemaak en gesteriliseer. Nege-en-dertig persent (n=11) van die babas het te min melk per dag ontvang. Vyf-en-sestig persent (n=11) van die babas (>6 maande) se melkinname die vorige dag het nie aan die minimum WGO aanbevole dieetdiversiteitsaanwyser voldoen nie, en slegs 18% (n=3) het 'n minimum aanvaarbare dieet gevolg. Versorgers se kennis ten opsigte van babavoeding was gemiddeld, met net 13% (n=4) wat die korrekte omskrywing van eksklusiewe bors- of formulevoeding geken het. 'n Totaal van 68% (n=21) het nie geweet wat gemengde voeding beteken of watter gevare dit inhou nie. Die meeste versorgers (n=25, 81%) het geweet dat orale rehidrasie oplossing toegedien moet word wanneer babas aan diarree ly, maar slegs 48% (n=15) het geweet hoe om dit aan te maak en 'n skrale 6% (n=2) hoe om dit toe te dien. Vyf-en-sewentig persent (n=9) van die versorgers het nie geweet wat om te doen as hulle probleme met hul borste ervaar nie. Altesaam 64% (n=19) van die versorgers het geglo dat 'n MIV-positiewe vrou definitief haar baba MIV sal gee indien sy hom/haar sou borsvoed. Samevatting Die steekproef babas het 'n verskeidenheid onreëlmatige groeipatrone getoon en baie was ondergewig of het ook dwerggroei getoon. Versorgers se kennis van babavoeding was gemiddeld, maar nie voldoende om tot toepaslike, veilige en optimale babavoedingspraktyke aanleiding te gee nie. Die voorkoms van borsvoeding was laag. Melkformulevoorbereiding, - voeding en -higiëne was swak, en babas se voedinginname was nie ideaal nie. Die gehalte van en hoeveelheid voorligting oor MIV-babavoeding met besoeke aan voorgeboorteklinieke was swak en moet aangespreek word.

Thesis (MNutr (Human Nutrition))--University of Stellenbosch, 2007. / OBJECTIVE: The objectives of this study were to determine the nutritional practices used in burns units in South Africa and to compare them with the latest available literature in order to make appropriate recommendations for possible implementation. METHODS: Validated questionnaires were sent out to surgeons, dietitians and professional nurses working in burns units that complied with the inclusion criteria. Information on the units was obtained from an advertisement placed via email through ADSA. Non-random sampling was done and all the burns units were included in the study. Descriptive cross-sectional statistics were used to analyze the data. RESULTS: Twelve burns units were identified. Ten of the burns units’ health professionals (surgeons, dietitians and professional nurses) participated in the study. All the health professionals had experience in burned patients’ management judging by the average number of year’s experience. The average number of adult burned patients treated was 188 (58-350) and the mortality per year was 16% [Standard Deviation (SD) 6.4%] About half of the professionals indicated they used a protocol for the implementation of nutrition support. A degree of miscommunication was noted between the health professionals working in the units. Very few units (n=2) were able to perform wound excisions within 72 hours post-burn. All the dietitians used predictive equations when estimating energy requirements and the most popular formula remained the Curreri formula. Various different predictive equations were used. Even though most institutions indicated that micronutrient supplementation was routine practice, no standard regimen existed and supplementation varied significantly between units. The oral route, enteral route or a combination were used to feed patients with different degrees of burns, and the majority (60%) of the health professionals stated that they waited until oral diets were tolerated before enteral nutrition was stopped. The nasogastric enteral route remained the most popular route. Very few units used other feeding routes, and they would rather opt for TPN if nasogastric feeding should fail. The estimated nutritional requirements were met in 90% of patients in whom the feeding tube was successfully placed. From the results it appeared that dietitians were less confident regarding the use of immunonutrition in burned patients, in spite of the available literature. Anabolic agents were not very commonly used in South Africa, probably due to the high cost. Patients were not followed-up regularly by dietitians. CONCLUSION The results of this study indicated that despite the use of correct recommendations in certain instances there remained a definite degree of variation and uncertainty amongst health professionals. There also appeared to be poor communication between health professionals. The burns units in South Africa should use set standards for nutritional managements, obtain and implement strict feeding protocols and improve communication amongst the health professionals.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Introduction : The health status of women in peri-urban areas has been influence by the South African political transition. Despite some progress, maternal and child mortality rates are still unacceptably high. A mother’s nutritional status is one of the most important determinants of maternal and birth outcomes. The Institute of Medicine’s pre-pregnancy Body Mass Index (BMI) method is not always appropriate to use in a peri-urban setting as many women attend their first antenatal clinic later on in their pregnancy. Two alternative methods, the gestational BMI (GBMI) and the gestational risk score (GRS), have been used elsewhere to screen for at risk pregnancies, but have not been used in a South African peri-urban setting. Furthermore, examining socio-economic variables (SEV) aids in the explanation of the impact of social structures on an individual. Risk factors can then be established and pregnant women in these higher risk groups can be identified and given additional antenatal clinic appointments and priority during labour. Aim: The first aim was to investigate the strength of the GBMI and GRS methods for predicting birth outcomes and maternal morbidities. The second aim was to investigate the relationships between SEV, GBMI and maternal morbidities. Methods: This was a sub-study of the Philani Mentor Mothers Study. A sample of 103 and 205 were selected for investigating the prediction methods and SEV respectively. Maternal anthropometry, gestational weeks and SEV were obtained during interviews before birth. Information obtained was used to calculate GBMI and GRS and to assess the SEV. Birth outcomes were obtained from the infant’s clinic cards and maternal morbidities were obtained from interviews two days after the birth. Results No significant association was found between GBMI and birth outcomes and maternal morbidities. A significant positive association was found between GRS and birth head circumference percentile (r=0.22, p<0.05). The higher the GRS, the higher the risk of an infant spending longer time in the hospital (Kruskal Wallis X2 = 4, p<0.05). A significant positive association was found between GBMI and the following SEV factors; age (r=0.33, p<0.05), height (r=0.15, p<0.05), parity (r=0.23, p<0.05), income (r=0.2, p<0.05), marital status (X2 = 9.35, p<0.05), employment (U=2.9, p<0.05) and HIV status (U=2.54, p<0.05). No statistically significant relationships were found between gestational hypertension and gestational diabetes mellitus and SEV. Conclusion: From the findings of this sub-study there were some promising results, however it is still unclear as to which method is the most appropriate to predict adverse birth outcomes and maternal morbidity. It is recommended that the GBMI and GRS once-off methods be repeated in a larger population to see if there are more parameters that could be predicted. Women who were older, shorter, married, had more pregnancies, HIV negative and had a higher socioeconomic status tended to have a greater GBMI. This can lead to adverse birth outcomes and increases the risk of women developing maternal morbidities and other chronic diseases later in their life. Optimal nutrition and health promotion strategies targeting women before conception should be implemented. / AFRIKAANSE OPSOMMING: Inleiding: Die gesondheidstatus van vroue in semi-stedelike areas is beïnvloed deur die Suid-Afrikaanse politiese oorgang. Ten spyte van ’n mate van vooruitgang is die sterftesyfers vir moeders en kinders steeds onaanvaarbaar hoog. ‘n Moeder se voedingstatus is een van die mees belangrike bepalende faktore van moeder- en geboorteuitkomste. Die Instituut van Geneeskunde se voorswangerskap Liggaamsmassa Indeks (LMI) metode is nie altyd toepaslik om te gebruik in ‘n semi-stedelike opset nie aangesien baie vroue hul eerste voorgeboorte-kliniek eers later in hul swangerskap bywoon. Twee alternatiewe metodes, die swangerskap LMI (SLMI) en die swangerskap risiko telling (SRT) is al elders gebruik as sifting vir hoë risiko swangerskappe, maar is nog nie gebruik in ‘n Suid-Afrikaanse semi-stedelike opset nie. Vervolgens kan ‘n ondersoek na sosio-ekonomiese veranderlikes (SEV) help om die impak van maatskaplike strukture op ‘n individu te verduidelik. Risiko faktore kan dan vasgestel word en swanger vroue wat in hierdie hoër risiko groepe val kan geïdentifiseer word. Dié vroue kan addisionele voorgeboorte-kliniek afsprake ontvang asook voorkeurbehandeling tydens die geboorteproses. Doelstellings: Die eerste doelstelling was om die sterkte van die SLMI en SRT metodes te ondersoek as voorspellers van geboorte uitkomste en moeder-morbiditeite. Die tweede doelstelling was om die verhoudings tussen SEV, SLMI en moeder-morbiditeite te ondersoek. Metodes: Hierdie projek was ‘n sub-studie van die Philani Mentor Moeders Studie. ‘n Steekproefgrootte van 103 en 205 was geselekteer om onderskeidelik die voorspeller metodes en SEV te ondersoek. Die moeder se antropometrie, swangerskap weke en SEV was verkry gedurende onderhoude voor geboorte. Informasie ingewin was gebruik om die SLMI en SRT te bereken en om die SEV te ondersoek. Geboorteuitkomste was verkry vanaf die babas se kliniekkaarte en moeder-morbiditeite was verkry tydens onderhoude twee dae na die geboorte. Resultate: Geen betekenisvolle assosiasie was gevind tussen SLMI, geboorteuitkomste en moeder-morbiditeite nie. ‘n Betekenisvolle positiewe assosiasie was gevind tussen SRT en die geboorte kopomtrek persentiel (r=0.22, p<0.05). Hoe hoër die SRT, hoe hoër die risiko dat ‘n baba langer in die hospitaal sou bly (Kruskal Wallis X2=4, p<0.05). ‘n Betekenisvolle positiewe assosiasie was gevind tussen SLMI en die volgende SEV faktore: ouderdom (r=0.33, p<0.05), lengte (r=0.15, p<0.05), pariteit (r=0.23, p<0.05), inkomste (r=0.2, p<0.05), huwelikstatus (X2=9.35, p<0.05), besit van ‘n identiteitsdokument (U=1.75, p<0.05), werkstatus (U=2.9, p<0.05) en MIV status (U=2.54, p<0.05). Geen statisties beduidende verhoudings was gevind tussen swangerskap hipertensie, swangerskap diabetes mellitus en SEV nie. Gevolgtrekking Sommige bevindinge van hierdie sub-studie dui op belowende resultate, alhoewel dit steeds nie duidelik is watter metode die mees toepaslike is om ongewenste geboorteuitkomste en moeder-morbiditeit te voorspel nie. Dit word aanbeveel dat die SLMI en SRT eenmalige metodes herhaal word in ‘n groter populasie om te sien of daar meer parameters is wat voorspel kan word. Vroue wat ouer, korter, getroud, meer swangerskappe, MIV negatief en ‘n hoër sosio-ekonomiese status gehad het was geneig om ‘n hoër SLMI te hê. Dit kan lei tot ongewenste geboorteuitkomste en verhoogde risiko om moeder-morbiditeite en ander chroniese siektes later in hul lewe te ontwikkel. Optimale voeding en gesondheidsbevordering strategieë wat vroue teiken voor bevrugting behoort geïmplementeer te word.

Thesis (MNutr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The possible advantages of vitamin D supplementation on various cardiometabolic conditions have been examined over the past few years. Vitamin D supplementation has possibly shown effects on each of the individual components of the metabolic syndrome i.e.: obesity, hypertension, dyslipidaemia and glucose intolerance. The aim of this systematic review was to ascertain whether or not vitamin D supplementation has any effect on any of the components of the metabolic syndrome. We searched the (Cochrane Central Register of Controlled Trails (Central), Medline, Science direct, ISI Web of knowledge and Scopus during 2010 (repeated search in 2012). We found four randomized controlled trials that met our inclusion and exclusion criteria. Three hundred and seventy three patients were included in these four randomized controlled trails comparing vitamin D supplementation with placebo. Duration of treatment was a minimum of 4 weeks, through to a maximum of on-year. The different trials looked at various components of the metabolic syndrome as outcomes. The results were not consistent amongst the trials and the results could not be combined in a meta-analysis due to heterogeneity in study design and outcomes measured. The current systematic review highlights the shortcomings in the published data and we recommend further trials be undertaken before vitamin D supplementation can be recommended as beneficial for patients with the metabolic syndrome. / AFRIKAANSE OPSOMMING: Die moontlike voordele van vitamien D-aanvullings op verskillende kardiometaboliese toestande is oor die afgelope paar jaar ondersoek. Daar is aangetoon dat vitamien Daanvullings uitwerkings het op elk van die individuele komponente van die metaboliese sindroom naamlik vetsug, hipertensie, dislipidemie en glukose-intoleransie. Die doel van hierdie sistematiese oorsig was om vas te stel of vitamien D-aanvullings enige uitwerking het op enige van die komponente van die metaboliese sindroom of nie. Ons het gedurende 2010 soektogte uitgevoer op die Cochrane Sentrale register van gekontroleerde proewe (Central), Medline, Science Direct, ISI Web of Knowledge en Scopus (soektog is in 2012 herhaal). Ons het vier verewekansigde gekontroleerde proewe wat aan ons insluiting- en uitsluitingskriteria voldoen het, opgespoor. Driehonderd drie en sewentig pasiënte is by die vier proewe ingesluit. Al vier proewe het vitamien D-aanvullings met plasebo vergelyk. Die duur van behandeling het van 4 weke tot een jaar gestrek. Die verskillende proewe het gekyk na verskillende komponente van die metaboliese sindroom as uitkomste. Die resultate van die onderskeie proewe was nie konsekwent nie. Die huidige sistematiese oorsig belig die tekortkominge in die gepubliseerde data en ons beveel aan dat verdere proewe onderneem word om vas te stel of dit nuttig is om vitamien D aanvullings vir pasiënte met die metaboliese sindroom aan te beveel, en of dit dalk skadelik kan wees.

Thesis (MNutr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Introduction and purpose The aim of the study was to determine the renal handling of a once-off bolus dietary protein load in patients treated for nephroblastoma. Patients who have been managed for nephroblastoma always have suboptimal amounts of kidney tissue as a result of their medical management which includes nephrectomies, chemotherapy and or radiotherapy. Little data are available indicating the extent of renal impairment expected in such patients as a result of their disease and management. The study was to determine whether the use of regular screening tests such as serum urea, creatinine and urine microalbumin, in conjunction with a dietary protein load could help detect early progressive deterioration of kidney function in nephroblastoma patients. Methodology The study was a quantitative non-randomised intervention study in which patients served as their own control before and after a protein load. Thirty-four participants were included in the study. Each participant was provided with a supplemental protein drink providing 2 g/kg body weight of protein. Serum creatinine, urea and urine microalbumin were assessed at baseline and four hours after the intervention. These pre- and post intervention biochemical values were then analysed together with descriptive data relating to the participants, such as age, stage of nephroblastoma, aspects of medical management and the period of time since they had been treated for nephroblastoma, and statistical relationships were assessed. Data were collected from May 2010 to November 2010. Results Descriptive statistics indicated that the mean [± Standard deviation (SD)] age of the population was 92 (± 55) months, the mean age at diagnosis was 41 (± 27) months and the mean age from the diagnosis to the time of the study was 51 (± 53) months. There was a statistically significant increase (p = 0.00) in serum urea post intervention; however, no significant difference was noted between pre- and post intervention serum creatinine and urine microalbumin values. The stages of nephroblastoma failed to show a statistical correlation with the response to the dietary protein bolus load in terms of the difference in pre- and post intervention biochemical data. No statistical correlation was found between post-pubescence and response to the protein load. Similiarly, no statistical correlation could be demonstrated for a longer period between the diagnosis and the time of this study, on the one hand, and the prevalence of high values in the biochemical data, on the other. Conclusion The study was unable to demonstrate statistically that participants managed for nephroblastoma had poor renal handling of a once-off dietary protein load in terms of the objectives specified. The study had limitations including a small population with even smaller subgroups of participants, therefore results of the study need to be interpreted in context to the size of the population. / AFRIKAANSE OPSOMMING: Doel Die doel van die studie was om die renale hantering van ’n eenmalige bolus dieetproteïenlading by pasiënte wat vir nefroblastoom behandel word, te bepaal. Pasiënte wat vir nefroblastoom behandel word, het altyd ‘n subopitmale hoeveelheid nierweefsel as gevolg van hulle mediese behandeling wat nefrektomies, chemoterapie en / of radioterapie insluit. Min data is beskikbaar omtrent die omvang van die nierbelemmering wat in sulke pasiënte verwag word as gevolg van hulle siekte en behandeling. Die studie is uitgevoer om te bepaal of die gebruik van gereelde siftingstoetse soos serum-ureum, kreatinien en mikroalbuminurie, in samewerking met ‘n dieetproteïenlading, kan help om vroeë progressiewe agteruitgang van nierfunksie in nefroblastoom pasiënte, op te spoor. Metodologie Die studie was ‘n kwantitatiewe nie-ewekansige intervensie studie waar pasiënte as hul eie kontrole gedien het voor en na ‘n proteïenlading. Altesaam 34 deelnemers is by die studie betrek. Elke deelnemer het ’n proteïenaanvullingsdrankie ontvang wat 2 gram proteïen per kilogram liggaamsgewig voorsien het. Serumkreatinien, serum-ureum en mikro-albuminurie is op die basislyn sowel as vier uur na die intervensie gemeet. Hierdie biochemiese waardes voor en na die intervensie is daarna saam met beskrywende data van die deelnemers – soos ouderdom, stadium van nefroblastoom, aspekte van mediese behandeling en tydsverloop sedert behandeling vir nefroblastoom – ontleed. Statistiese verwantskappe is vervolgens beoordeel. Data is vanaf Mei 2010 tot November 2010 ingesamel. Resultate Beskrywende statistieke het op ’n gemiddelde [± Standaard afwyking (SA)] populasie-ouderdom van 92 (± 55) maande, ’n gemiddelde diagnose-ouderdom van 41(± 27) maande en ’n gemiddelde ouderdom van 51(± 53) maande vanaf diagnose tot en met die studie gedui. Ná die intervensie is ’n statisties beduidende toename (p = 0.00) in serum-ureum opgemerk, hoewel daar geen beduidende verskil in serumkreatinien en mikro-albuminurie waardes, voor en na behandeling, was nie. Biochemiese data voor en na die intervensie het geen statistiese verwantskap tussen die stadium van nefroblastoom en die reaksie op die dieetproteïenlading getoon nie. Boonop is geen statistiese verwantskap opgemerk tussen post-pubesensie en die reaksie op die proteïenlading, of tussen ’n langer tydsverloop tussen die diagnose en die studie en die voorkoms van hoë waardes in die biochemiese data nie. Gevolgtrekking Wat die studie-doelwitte betref, kon die navorsing nie statisties bewys dat deelnemers wat vir nefroblastoom behandel word, swak renale hantering van ’n eenmalige dieetproteïenlading toon nie. Die beperkinge van die studie sluit ‘n klein populasie met selfs kleiner subgroepe in; die resultate van die studie moet derhalwe in die konteks van die grootte van die populasie, geÏnterpreteer word.

Made available in DSpace on 2015-06-17T19:33:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-03-25. Added 1 bitstream(s) on 2015-06-18T12:47:54Z : No. of bitstreams: 1 000825588_20160425.pdf: 531180 bytes, checksum: bcff3ca8530ed3298e5cefa9d3c35184 (MD5) Bitstreams deleted on 2016-04-25T15:55:56Z: 000825588_20160425.pdf,. Added 1 bitstream(s) on 2016-04-25T15:56:53Z : No. of bitstreams: 1 000825588.pdf: 1146710 bytes, checksum: a7cb967f34f08fb92600baccf707e15b (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / As pesquisas relacionadas ao envelhecimento são crescentes em todo mundo em decorrência do aumento da população idosa, fato este que traz consequências para a sociedade, necessitando, para o enfrentamento deste desafio, da identificação das causas determinantes das condições de vida dos idosos. Assim, o objetivo do presente trabalho foi avaliar a associação entre o estado nutricional, consumo alimentar e a capacidade funcional de idosos. Para isso foram avaliados 365 idosos do município de Botucatu-SP. Para a avaliação da capacidade funcional foi aplicado o Índice de Katz e a Escala de Lawton, que avaliam as Atividades de Vida Diária (AVD) e Atividades Instrumentais da Vida Diária (AIVD) respectivamente. A avaliação do estado nutricional foi realizada pela obtenção de variáveis antropométricas e a avaliação do consumo alimentar, pela aplicação de três recordatórios de 24 horas. Os dados de consumo foram calculados por meio do programa Nutrition Data System - Research e para a análise da adequação foi utilizado o método National Cancer Institute. Os idosos foram caracterizados ainda quanto aos dados sociodemográficos. Foi encontrado que 62,6% dos idosos eram do sexo feminino, com média de idade de 72,11 anos (DP= 7,35), casados, com ensino fundamental e aposentados. As enfermidades mais referidas foram hipertensão arterial, diabetes mellitus, hipercolesterolemia, oesteoporose, problemas cardiovasculares e distúrbios da tireóide. Quanto à capacidade funcional, foi observado que 89,9% e 67,6% dos idosos eram totalmente independentes para AVD e AIVD, respectivamente. Grande parte (45,71%) dos idosos foi classificada com excesso de peso. Foram encontradas associações negativas significantes entre Índice de Massa Corporal, circunferência do braço, circunferência abdominal e atividades instrumentais de vida diária. Os dados revelaram que os idosos com baixo peso têm maior risco de declínio ...