Thesis (Mnutr)--University of Stellenbosch, 2003. / ENGLISH ABSTRACT: Problem Definition: In the context of HIV/AIDS malnutrition is almost universal among children, and of the adverse effects of Protein Energy Malnutrition, the most frequent seems to be the occurrence of opportunistic infections with micro-organisms such as oral Candida. Objective: The aim of this study was to determine the nutritional status of children with oral complications in relation to HIV/AIDS as well as the effects of the oral lesions on nutritional status. Subjects/setting: The subjects of study were 24 children co-infected with TB and HIV who were admitted consecutively to the paediatric ward of Brooklyn Chest Hospital in Cape Town, South Africa. The nutritional status of the children was assessed over a maximum period of six months by nutrient intake, anthropometric status, and by biochemical parameters and clinical and oral examination on admission and at discharge from hospital. Results: Children with HIVand TB infection presenting with or without oral lesions were similarly malnourished throughout the period of hospitalization. There was no improvement in the nutritional status as indicated by height and weight measurements. Throughout the time of hospitalization, 7% of the children had a combination of stunting, underweight and wasting. Average nutrient intake was not found to be higher than the Recommended Dietary Allowance (RDA) in any of the children. At the time of admission to hospital and at discharge, carbohydrate intake provided most of the daily energy (36% and 42%, the difference not being statistically significant). There was a significant increase in the intake of energy (p=O.04) and a decrease in total fat intake (p=O.03) at discharge. Although not significant, mean protein intake at admission was higher than at time of discharge. Selected sub-optimal biochemical values were prevalent among the children studied, with 45% and 41% showing low serum albumin values «2.9g/dL) at the time of admission and at discharge respectively. Both on admission and at discharge, 38% of the children had Haemoglobin levels below normal values. Serum ferritin levels below normal values were present in almost all the children and the trend was similar for the prevalence of low zinc values. Sub-normal plasma retinol was present in 79% of the children at time of admission, while only 21% had deficient values at time of discharge (p=O.03). On admission, 29% of the children had vitamin evalues below the normal range whereas at time of discharge 17% of the children had values below normal (p=O.04). A total of 29% children presented with oral complications on admission. These included oral herpes, oral thrush, reflux, bleeding gums and stomatitis/angular cheilosis. Two children were asymptomatically colonized with Candida of the oral cavity. Mean total protein intake was higher (p=O.057) among the children who were not diagnosed with oral complications. Conclusions: This study confirmed that malnutrition is not only a common and serious problem associated with HIVand AIDS, but also that nutritional problems cannot be dealt with in isolation where Opportunistic Infections are present. The severity of malnutrition depends on various factors including oral complications. Additionally, appropriate management and treatment of tuberculosis did not appear to affect the nutritional status significantly. Recommendations: On the basis of these findings, and because of the increased risk of growth failure and developmental delays, children should be referred for full nutritional evaluation as soon as possible after diagnosis of HIV -infection. In addition, there is a need for intervention programmes to identify the immediate underlying causes of malnutrition and the ways in which such causes interact, in order to ensure that such interventions increase the resistance of HIV infected infants and children to the disease. / AFRIKAANSE OPSOMMING: Probleemdefiniëring: Binne die konteks van MIVNIGS is wanvoeding bykans universeelonder kinders en van die nadelige effekte van proteïen energie wanvoeding is die voorkoms van opportunistiese infeksies (Ol) met mikro-organismes soos orale candida die algemeenste. Doelwit: Die doel van dié studie was om die voedingstatus van kinders met orale komplikasies in verhouding tot MIVNIGS en die effek van orale letsels op voedingstatus, te bepaal. Proefpersone/omgewing: 'n Groep van 24 kinders, met beide tuberkulose en MIVNIGSinfeksie, wat agtereenvolgend in die kindersaal van Brooklyn Bors-Hospitaal in Kaapstad, Suid- Afrika opgeneem is, is bestudeer. Vir 'n periode van ses maande is die kinders se voedingstatus geassesseer deur middel van voedingstofinname, antropometriese status en biochemiese parameters met opname in en ontslag uit die hospitaal. Kliniese en orale ondersoeke was op elke kind uitgevoer met opname sowel as ontslag. Resultate: Kindres met HIV en tuberkulose, met of sonder orale letsels, het soortgelyke wanvoeding tydens hospitalisering ervaar het. Volgens antropometriese metings was daar geen verbetering in die voedingstatus nie. 'n Kombinasie van belemmerde groei, ondergewig en uittering het in 7% van die kinders tydens hospitalisering voorgekom. Nie een van die gemiddeldes van die voedingstowwe was hoër as die Aanbevole daaglikse toelatings (ADT) in enige van die kinders wat bestudeer is nie. Met opname sowel as ontslag, was koolhidraatinname die grootste energieverskaffer met onderskeidelik 36% en 42% (alhoewel die verskil nie statisties beduidend was nie). Daar was 'n beduidende toename in energie-inname (p=O.04) en 'n afname in totale vetinname (p=O.03) met ontslag. Alhoewel nie beduidend nie, was die gemiddelde proteïeninname hoër met ontslag. Die voorkoms van geselekteerde sub-optimale biochemiese waardes met toelating en ontslag wys dat onderskeidelik 45% en 41% van die kinders lae serum albumienwaardes «2.9g/dL) getoon het. Subnormale plasma retinol het in 79% van die kinders met toelating voorgekom, terwyl slegs 21% gebrekkige waardes (p=O.03) met ontslag getoon het. Tydens opname, sowel as met ontslag, was 38% van die kinders se hemoglobienvlakke laer as die normale. Serum ferritienvlakke was amper by al die kinders laer as die normale vlakke te bespeur, met sinkvlakke wat op soortgelyke lae vlakke voorkom. Met toelating was 29% van die kinders se Vitamien C-waardes laer as normaal en met ontslag was sowat 17% se waardes steeds laer as die normaal (p=O.04). Met toelating het 29% van die kinders orale komplikasies getoon. Ingeslote hierby was orale herpes, orale sproei, refluks, bloeiende tandvleise en stomatis/ angulêre cheilose. Slegs twee kinders was asimptomaties met orale Candida van die mondholte gediagnoseer. Die gemiddelde proteïeninname was hoër (p=O.057) onder die kindres wat nie orale komplikasies getoon het nie. Gevolgtrekking: Hierdie studie bevestig dat wanvoeding me net 'n algemene en ernstige probleem is wat met MIV en VIGS geassosieer word nie, maar ook in die teenwoordigheid van opportunistiese infeksies, die voedingsprobleem nie in isolasie gehanteer kan word nie. Die graad van wanvoeding hang af van ander faktore, insluitende orale komplikasies. Voldoende behandeling van TB het ook nie 'n beduidende effek op voedingstatus gehad nie. Aanbevelings: Op hierdie bevindings gebaseer, en as gevolg van die verhoogde risiko VIr belemmerde groei en vertraagde ontwikkeling wat al die liggaamstelsels van MIV -positiewe kinders affekteer, moet kinders so gou as moontlik nadat die MIV-infeksie gediagnoseer is, vir volle voedingsevaluasies verwys word. Daarmee gepaardgaande is daar 'n behoefte aan programme wat die onmiddellike onderliggende oorsake van wanvoeding identifiseer, asook om interaksie van hierdie oorsake met HIV vas te stel, ten einde intervensies wat weerstand van HIVkinders en-babas verbeter, positieftoe te pas.

MSCPNT / Department of Nutrition / Objectives: The study objectives were to determine demographic and environmental factors that can affect nutritional status of children receiving CSG, to assess the nutritional knowledge of caregivers, to determine the proportion of CSG spent on food and to determine the nutritional quality of food bought from CSG. Design: Cross-sectional descriptive with an analytical component Subjects: PCG of children under the age of 5 receiving CSG in Mogalakwena Municipality. 189 caregiver-child pairs were interviewed, in their households. Methods: Data collected by the interviewer included demographic data, Use of CSG, nutritional knowledge and the HHFI and anthropometric measurements were done by a 3rd year Nutrition student. Results: About 36.5% of participants were in the age 26-35 years, 75.7% were unmarried, 84.1% were unemployed and 72% had no matric. Mean age for children studied was 2.84±1.33, 77.8% of participants stayed in a household of more than 5 people. In terms of types of housing, 56% had formal houses, 55% had access to pit latrines and 52.9% used communal taps to access water, 41.3% used electricity for energy while 23.3% used wood to stretch the availability of electricity. Mean CSG received was R386.22 ±R208.75. Majority of participants (56.1%) indicated that CSG supports the whole family and 64.6% of the families depended solely on CSG for survival, while 27% of families had elderly people receiving pension grant which was supplementing the CSG. The CSG was used for different items, majority of families used 94.2% of the money for food at a mean of R171.55±159.25, followed by toiletry (71.6%) at a mean R61.89±69.24, then clothing (68.9%) at a mean of R70.77±97.14. Stokvel was also mentioned as one of the items contributed for by CSG, 32.3% of participants used more than R50.00 for stokvel. Different food items were purchased using CSG, 80.5 % of the money was used to purchase starchy food, mealie meal being the highest commodity at 43.7%. Offal (35.8%) was the highest protein source purchased followed by poultry at 26.4% and soya soup at 20%. Potatoes (19.6%) were mentioned as the most purchased vegetable, followed by cabbage (14.8%). There was a 53.5% of prevalence of stunting, of this 19.6% of children were severely xiii stunted, 5.3% underweight, and 32.3% of wasting. There were 22.1 % of PCG who were overweight and 12.1% were obese. The PCG BMI was negatively associated with WAZ (r= -0.48, p=0.515). There was a positive association between PCG BMI and HAZ (r=0.103, p=0.158), however when caregivers BMI was correlated to BAZ the association was strongly negatively significant (r=0.206, p=0.004). Most PCG received nutrition education from relatives, 71.1% were never educated on nutrition, 57.9% of children were fed 3X/ day. Conclusion: It is apparent from the study that malnutrition, precisely stunting is still a problem in South Africa, however this does not disregard the impact that CSG has on the lives of the poor. It affords the families to access basic needs in the household such as food, toiletry, electricity and even stokvel. The role of nutritionists/ dieticians is paramount in helping mothers to choose healthier economic food for the children in order to curb the burden of malnutrition. / NRF

Text in English / Potato is an important source of energy to most micronutrient malnourished affected population in South Africa. Improvements through bio-fortification can therefore enhance access to essential micronutrients. The study was aimed at determining the level of variability of iron and zinc concentration among 20 potato genotypes as a preliminary step for future breeding program. The materials were evaluated using inductively coupled plasma optical emission spectrometry. Statistical analysis indicated significant (P<0.001) variation of Fe and Zn among the genotypes. The average concentration ranges from 34.67 to 76.67 mg kg-1 and 12.88 to 66.1 mg kg-1 for iron and zinc respectively. The best performing genotypes were cultivar Mnandi, Hertha, Buffelspoort and breeding lines-N105-1, 00-S100-33 and 03-627-50. Iron concentration was positively correlated with Zinc concentration. The study showed that enough variability of Fe and Zn concentration exist among the evaluated genotypes, which can be exploited for use in potato bio-fortification breeding programme. / Agriculture, Animal Health and Human Ecology / M.Sc. (Agriculture)

<p>Many of the known risk factors associated with low birth weight, such as socio-economic status, ethnicity, genetic makeup, and obstetric history, are not within a women's immediate control. However, there are many things that a woman can do to improve her chances of having a normal healthy child. Lifestyle behaviours, such as cigarette smoking, nutrition and the use of alcohol, play an important role in determining the growth of the fetus. The aim of this study was to establish the knowledge, attitudes and practices related to lifestyle factors such as alcohol use, smoking and nutrition among childbearing women and health care workers on the farms in Stellenbosch and Vredendal.</p>

by Choi Ka Yan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2000. / Includes bibliographical references (leaves 113-128). / Abstract and appendix in English and Chinese. / Acknowledgements --- p.i / Abstract --- p.ii / Abstract (Chinese version) --- p.iv / Table of Contents --- p.vi / List of Tables --- p.xi / List of Figures --- p.xiv / List of Abbreviations --- p.xv / Chapter CHAPTER ONE: --- BACKGROUND AND LITERATURE REVIEW / Chapter 1.1 --- Coronary Heart Disease: a global health problem --- p.1 / Chapter 1.2 --- Risk Factors of Coronary Heart Disease --- p.3 / Chapter 1.2.1 --- Age --- p.3 / Chapter 1.2.2 --- Gender --- p.4 / Chapter 1.2.3 --- Family History of Cardiovascular Disease --- p.5 / Chapter 1.2.4 --- Hypercholesterolemia --- p.7 / Chapter 1.2.5 --- Unhealthy Dietary Habits --- p.11 / Chapter 1.2.6 --- Obesity --- p.14 / Chapter 1.2.7 --- Physical Inactivity --- p.20 / Chapter 1.3 --- Clustering of Risk Factors --- p.24 / Chapter 1.4 --- Risk Factors in Children: Atherosclerosis Begins Early in Life --- p.26 / Chapter CHAPTER TWO: --- RESEARCH IN HONG KONG AND PURPOSES OF THIS STUDY / Chapter 2.1 --- Nutrition Transition --- p.27 / Chapter 2.2 --- CHD Mortality Trends in Hong Kong --- p.28 / Chapter 2.3 --- Serum Total Cholesterol and Obesity in Hong Kong Adults --- p.29 / Chapter 2.4 --- "Obesity, Serum Total Cholesterol, Dietary Habits and Physical Activity of Hong Kong Children and Adolescents" --- p.31 / Chapter 2.5 --- Study Purpose and Objectives --- p.35 / Chapter CHAPTER THREE: --- SURVEY DESIGN / Chapter 3.1 --- Sample Selection --- p.39 / Chapter 3.2 --- "Blood Total Blood Cholesterol, Triglyceride and Anthropometric Measurements" --- p.40 / Chapter 3.2.1 --- Total Blood Cholesterol and Triglyceride --- p.40 / Chapter 3.2.2 --- Anthropometry Measures --- p.42 / Chapter 3.3 --- Questionnaire --- p.45 / Chapter 3.3.1 --- Questionnaire Design and Pre-testing --- p.45 / Chapter 3.3.2 --- General Health and Socio-demographic Questionnaire --- p.47 / Chapter 3.3.3 --- Physical Activity Questionnaire --- p.47 / Chapter 3.3.4 --- Dietary Questionnaire --- p.48 / Chapter 3.4 --- Data Management --- p.49 / Chapter 3.5 --- Statistics --- p.49 / Chapter 3.6 --- Data Analysis --- p.50 / Chapter 3.6.1 --- Blood Total Cholesterol and Triglyceride --- p.50 / Chapter 3.6.2 --- Obesity and Fat Distribution --- p.50 / Chapter 3.6.3 --- Diet --- p.51 / Chapter 3.6.4 --- Physical Activity Patterns --- p.51 / Chapter 3.6.5 --- Body Mass Index of Parent and Family History of Diseases --- p.52 / Chapter CHAPTER FOUR: --- RESULTS / Chapter 4.1 --- Sample Size and the Characteristics of the Students in the Two Schools --- p.54 / Chapter 4.2 --- Gender and Age Distribution --- p.55 / Chapter 4.3 --- Blood Total Cholesterol and Triglyceride --- p.56 / Chapter 4.4 --- Anthropometry Measures --- p.58 / Chapter 4.5 --- Dietary Habits --- p.60 / Chapter 4.5.1 --- Dietary Composition of 3-day Dietary Record --- p.60 / Chapter 4.5.2 --- Eating Behaviors --- p.65 / Chapter 4.6 --- Physical Activity --- p.68 / Chapter 4.7 --- Family History of Diseases --- p.70 / Chapter 4.8 --- Parents' Anthropometry --- p.71 / Chapter 4.9 --- Demographic Data --- p.71 / Chapter 4.10 --- Inter-relationships --- p.75 / Chapter 4.10.1 --- Blood Total Cholesterol and Triglyceride --- p.75 / Chapter a. --- "Blood Total Cholesterol, Triglyceride and Body Fatness" --- p.75 / Chapter b. --- "Blood Total Cholesterol, Triglyceride and Diet" --- p.75 / Chapter c. --- "Blood Total Cholesterol, Triglyceride and Physical Activity Patterns" --- p.77 / Chapter d. --- Blood Total Cholesterol，Triglyceride and Family History of Hypercholesterolemia --- p.78 / Chapter e. --- Relative Importance of the Key Factors in Predicting Blood Total Cholesterol levels --- p.79 / Chapter 4.10.2 --- Obesity and Body Fatness --- p.79 / Chapter a. --- "Obesity, Body Fatness and Physical Activity Patterns" --- p.79 / Chapter b. --- "Obesity, Body Fatness and Diets" --- p.82 / Chapter c. --- Body Fatness and Genetics --- p.84 / Chapter 4.10.3 --- Diet and Physical Activity --- p.86 / Chapter 4.10.4 --- "Blood Total Cholesterol, Triglyceride, Obesity and Other Demographic or Economic Characteristics" --- p.87 / Chapter 4.11 --- Clustering of Risk Factors among Obese children --- p.87 / Chapter CHAPTER FIVE: --- DISCUSSION / Chapter 5.1 --- Implication of Research Findings --- p.89 / Chapter 5.2 --- Limitations --- p.108 / Chapter CHAPTER SIX: --- CONCLUSIONS AND RECOMMENDATIONS --- p.111 / References --- p.113 / Appendices / Chapter I --- Questionnaire (English version) --- p.129 / Chapter II --- Questionnaire (Chinese version) --- p.139 / Chapter III --- Introductory letter (English version) --- p.152 / Chapter V --- Introductory letter (Chinese version) --- p.153 / Chapter V --- Consent form (English version) --- p.154 / Chapter VI --- Consent form (Chinese version) --- p.155 / Chapter VII --- Photos of the standard household measures given to children for estimation of portion size (English version) --- p.156 / Chapter VIII --- Photos of the standard household measures given to children for estimation of portion size (Chinese version) --- p.157 / Chapter IX --- Responses from the children to the food frequency questionnaire --- p.158 / Chapter X --- The frequency of the reported food items liked or disliked by the children --- p.160

by Kwan Kwok Yiu. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1997. / Includes bibliographical references (leaves 145-155). / Acknowledgment --- p.i / Abstract --- p.ii / List of Tables --- p.vii / List of Figures --- p.x / List of Abbreviations --- p.xii / Chapter Chapter 1 --- Literature review / Chapter 1.1 --- Historical background --- p.1 / Chapter 1.2 --- Chemistry of trans and cis fatty acids --- p.3 / Chapter 1.3 --- Dietary source of trans fatty acids --- p.6 / Chapter 1.4 --- Consumption of trans fatty acids among Western countries --- p.9 / Chapter 1.5 --- Current health concern for excessive intake of trans fatty acids --- p.10 / Chapter 1.6 --- Metabolism of trans fatty acids --- p.13 / Chapter 1.6.1 --- Absorption --- p.15 / Chapter 1.6.2 --- Oxidation --- p.15 / Chapter 1.6.3 --- Incorporation --- p.16 / Chapter 1.6.4 --- Selectivity --- p.17 / Chapter 1.7 --- Impact of trans fatty acids on essential fatty acid metabolism --- p.19 / Chapter 1.8 --- Desaturation and elongation of trans fatty acids --- p.21 / Chapter 1.9 --- Trans fatty acids and neonatal growth --- p.23 / Chapter Chapter 2 --- Amount of trans fatty acids in Hong Kong fast foods / Chapter 2.1 --- Introduction --- p.25 / Chapter 2.2 --- Objective --- p.25 / Chapter 2.3 --- Materials and methods --- p.26 / Chapter 2.4 --- Results --- p.27 / Chapter 2.5 --- Discussion --- p.31 / Chapter Chapter 3 --- Cross-cultural study of trans fatty acids in human milk / Chapter 3.1 --- Introduction --- p.35 / Chapter 3.2 --- Objective --- p.35 / Chapter 3.3 --- Materials and methods --- p.36 / Chapter 3.4 --- Results / Chapter 3.4.1 --- Dietary information --- p.38 / Chapter 3.4.2 --- Fatty acid composition of Chinese and Canadian human milk --- p.40 / Chapter 3.4.3 --- Difference between Chinese and Canadian human milk --- p.40 / Chapter 3.4.4 --- Difference between Hong Kong and Chongqing Chinese human milk --- p.43 / Chapter 3.4.5 --- The change in milk fat and LCPUFA as lactation progresses --- p.43 / Chapter 3.5 --- Discussion / Chapter 3.5.1 --- Trans fatty acids in human milk --- p.46 / Chapter 3.5.2 --- Content of LCPUFA in human milk --- p.47 / Chapter 3.5.3 --- Content of 18:2n-6 in human milk --- p.48 / Chapter 3.5.4 --- Fat content in Hong Kong and Chongqing Chinese human milk --- p.49 / Chapter 3.6 --- Conclusion --- p.50 / Chapter Chapter 4 --- Trans fatty acids and maternal and neonatal essential fatty acid metabolism / Chapter 4.1 --- Introduction --- p.51 / Chapter 4.2 --- Objectives --- p.53 / Chapter 4.3 --- Materials and methods --- p.53 / Chapter 4.4 --- Results / Chapter 4.4.1 --- Experiment1 / Chapter 4.4.1.1 --- Relationship between the trans fatty acids in maternal diet and those in milk --- p.64 / Chapter 4.4.1.2 --- Relationship between the trans fatty acids in maternal diet and those in neonatal liver --- p.64 / Chapter 4.4.1.3 --- Content of 20:4n-6 in milk and in neonatal liver relative to that in maternal diet --- p.72 / Chapter 4.4.2 --- Experiment2 / Chapter 4.4.2.1 --- Amount of trans fatty acids in rat milk --- p.75 / Chapter 4.4.2.2 --- Trans fatty acids in rat liver phospholipids --- p.75 / Chapter 4.4.2.3 --- Linoleic acid (18:2n-6) content in rat and its relation to maternal diets --- p.86 / Chapter 4.4.2.4 --- Content of 20:4n-6 in rat milk --- p.86 / Chapter 4.4.2.5 --- Content of20:4n-6 in rat liver --- p.89 / Chapter 4.4.2.6 --- Suppression of the synthesis of 20:4t isomers in maternal and neonatal liver --- p.89 / Chapter 4.5 --- Discussion / Chapter 4.5.1 --- Relationship between fatty acid composition of diet and that of milk --- p.93 / Chapter 4.5.2 --- 20:4n-6 in rat milk --- p.95 / Chapter 4.5.3 --- Transfer of trans fatty acids from maternal diet to neonatal liver phospholipids --- p.98 / Chapter 4.5.4 --- The inhibitory effect of trans fatty acids on synthesis of 20:4n-6 in neonatal liver --- p.99 / Chapter 4.5.5 --- Effect of 18:2n-6 supplement on 20:4n-6 level of neonatal liver --- p.101 / Chapter 4.5.6 --- Suppression of 18:2n-6 supplement on synthesis of 20:4t isomers --- p.101 / Chapter 4.6 --- Conclusion --- p.104 / Chapter Chapter 5 --- Accumulation and turnover of trans fatty acids / Chapter 5.1 --- Introduction --- p.105 / Chapter 5.2 --- Objective --- p.105 / Chapter 5.3 --- Materials and methods --- p.106 / Chapter 5.4 --- Results / Chapter 5.4.1 --- Accumulation of trans fatty acids in liver and adipose tissue --- p.108 / Chapter 5.4.2 --- Selectivity of individual 18:2 trans isomersin liver and adipose tissue --- p.112 / Chapter 5.4.3 --- Turnover of trans fatty acids --- p.112 / Chapter 5.4.4 --- Accumulation and turnover of 18:lt in brain --- p.115 / Chapter 5.5 --- Discussion / Chapter 5.5.1 --- Accumulation of trans fatty acids in liver and adipose tissue --- p.120 / Chapter 5.5.2 --- Turnover of trans fatty acids --- p.122 / Chapter 5.5.3 --- Accumulation and turnover of trans fatty acidsin brain --- p.124 / Chapter 5.6 --- Conclusion --- p.125 / Chapter Chapter 6 --- In vivo Oxidation of trans fatty acids in rat / Chapter 6.1 --- Introduction --- p.126 / Chapter 6.2 --- Objective --- p.127 / Chapter 6.3 --- Materials and methods --- p.127 / Chapter 6.4 --- Results --- p.129 / Chapter 6.4.1 --- Apparent oxidation of saturated fatty acids --- p.136 / Chapter 6.4.2 --- Apparent oxidation of 18:lt relative to 18:ln-9 --- p.136 / Chapter 6.4.3 --- Oxidation of 18:2t isomers relative to 18:2n-6 --- p.137 / Chapter 6.4.4 --- Effect of 18:2n-6 supplement in PHCO diet on oxidation per se --- p.137 / Chapter 6.5 --- Discussion --- p.138 / Chapter 6.5.1 --- Oxidation of 18:lt and 18:2t isomers --- p.139 / Chapter 6.5.2 --- Effect of 18:2n-6 supplement on oxidation per se --- p.140 / Chapter 6.6 --- Conclusion --- p.141 / General conclusion --- p.142 / References --- p.145

This parallel randomized control trial study assessed the effect of food-based strategies in improving the haemoglobin level; decreasing anaemia and thus the iron status of pregnant women. The study randomized 195 anaemic women enrolled from four randomly selected health centres in Dire Dawa while attending ANC into two intervention groups and control; and followed for 12weeks. The study intervened diet-based supplementation of 90mg/day vitamin C divided and consumed in three doses; combined with nutrition education intervention in intervention group 1; while only nutrition education intervention in group 2. Dietary diversity was assessed using past 24-hours and 7-days dietary recall approaches and haemoglobin levels were determined at baseline and end-line and compared to analyse treatment effects. By end of the study, intervention group 1 and 2 had significantly increased mean haemoglobin by 0.77 ± 0.11gm/dl and 0.398 ± 0.073gm/dl respectively; however, the control had significant decrease by -0.193 ± 0.05gm/dl. Anaemia prevalence also significantly decreased by 29% and 19.7% in intervention group 1 and 2 respectively. However, all women in the control were anaemic. Intervention group 1 and 2 also had significantly higher dietary diversity, consumption of vitamin C-rich fruits and vegetables, nutritional knowledge and modification practices. The researcher thus concludes that diet-based vitamin C supplementation integrated with nutrition education has a significant effect in improving haemoglobin, decreasing anaemia and thus improving the iron status of pregnant women in Dire Dawa. Based on the findings, the researcher developed a framework for an integrated food-based strategy for improving the iron status of pregnant women in Ethiopia. / Health Studies / D. Litt. et Phil. (Health Studies)

Acute lymphoblastic leukemia (ALL) encompasses a spectrum of lymphoid progenitors that have undergone malignant transformation and clonal proliferation at various stages of differentiation. Some cases of ALL have been documented to have prenatal origins and in particular neonatal exposure to various environmental pollutants is associated with increased disease risk, including childhood lymphoma and leukemia. Dibenzo[def,p]chrysene (DBC) is a polycyclic aromatic hydrocarbon (PAH) and in our laboratory has been established as a transplacental carcinogen in mice, producing aggressive T-cell lymphoblastic lymphomas, lung, liver, uterine, ovarian, and testicular lesions, depending on timing and dose of exposure. Investigation of the transplacental and translactational transfer of DBC was warranted following a cross-foster experiment demonstrating the greatest tumorigenic response occurred in offspring both gestating in and nursed by an exposed female. [¹⁴C]-DBC (GD17) dosing was utilized to examine time-dependent alterations of [¹⁴C] in maternal and fetal tissues, excreta, and residual levels at weaning. Fetal tissue levels of [¹⁴C]-DBC equivalents were 10-fold lower than maternal tissue, and after weaning the residual body burden was roughly equivalent in offspring exposed only in utero or only via lactation. Certain bioactive food components, including indole-3-carbinol (I3C), 3,3'-diindolylmethane (DIM), and sulforaphane (SFN) from cruciferous vegetables have been shown to target cellular pathways regulating carcinogenesis. In the above mentioned DBC initiated model of carcinogenesis, I3C is an effective transplacental chemopreventive agent. We sought to extend our chemoprevention studies in mice to a human neoplasm in cell culture, analogous to the observed murine T-cell lymphomas. Treatment of the human T-ALL cell line CCRF-CEM (CEM) with I3C reduced cell proliferation and viability only at supraphysiologic concentrations whereas DIM, the primary acid condensation product of I3C, had a marked effect at low micromolar concentrations in vitro and reduced growth of CEM xenografts in vivo. Additional T-ALL lines, selected to represent the heterogeneity of the disease, (CCRF-HSB2, Jurkat, and SUP-T1) responded similarly in vitro, demonstrating a potential therapeutic value of DIM in T-ALL. Given that epigenetic reprograming is especially active during fetal development and that DNA hypermethylation contributes to the etiology of T-ALL we examined genome-wide DNA methylation in CEM. Differential methylation analysis revealed that DIM and I3C alter CpG methylation in unique, yet overlapping, gene targets. DIM treated cells exhibited a dose-dependent decrease in hypermethylation, an observation consistent with an epigenetic mechanism of cancer suppression. Pyroseqencing and RTPCR technologies were utilized to validate changes in DNA methylation and to compare these patterns with a transcriptional response in both novel targets and candidate genes selected from the literature. Collectively, these studies merited returning to the murine transplacental model for further investigation of genetic and epigenetic changes upon maternal dietary intervention with I3C. More importantly we incorporated whole cruciferous vegetable diets (10% broccoli sprouts or 10% Brussels sprouts), SFN diet, or the combination of SFN and I3C, in order to examine matrix and mixture effects. Preliminary analysis suggests a worse prognosis for those animals exposed in utero to SFN or the whole foods, especially males. As this is the first study to administer SFN or whole cruciferous vegetables in a transplacental model of carcinogenesis, our results warrant further study on the concentration dependent influence of these potent phytochemicals during the perinatal window. / Graduation date: 2012

Background: Prenatal alcohol consumption is one of the leading preventable causes of birth defects, including fetal alcohol syndrome and learning disabilities. Although there is strong evidence of the benefits of screening and alcohol brief interventions (ABIs) in reducing hazardous and harmful drinking among the primary care population, evidence of its effectiveness with the antenatal care population is limited. Nevertheless, the Scottish Government is incorporating an alcohol screening and ABI programme as part of the routine antenatal care provided to women in a bid to protect the health and safety of the unborn child and improve subsequent health and developmental outcomes. This research therefore seeks to increase understanding of the factors that are likely to influence the effectiveness of this recently implemented programme. It also aims to explore the extent to which contemporary issues such as change in guidelines regarding alcohol consumption during pregnancy influences perceptions and attitudes, and the possible implications of these on the screening and ABI delivery. Methods: The study described in this thesis employed a realistic evaluation methodology. Realistic evaluation is a theory-driven approach to investigating social programmes. It is concerned with hypothesising, testing and refining programme theories by exploring the interaction of contexts, mechanisms and outcomes. To identify the relevant screening and ABI programme theories, two separate systematic reviews, a critical review and four face-to-face interviews were undertaken with health policy implementers. The findings were used to construct context, mechanism and outcomes propositions. The propositions were then tested by conducting individual interviews with seventeen pregnant women and fifteen midwives, a further six midwifery team leaders were involved in a focus group discussion. A thematic approach using a hybrid of inductive and deductive coding and theme development informed the qualitative analysis. Results: In the context of uncertainties regarding the threshold of drinking that causes fetal harm, pregnant women reported that screening assessment helped them to reflect on their drinking behaviour and facilitate behaviour change. For women who drank at hazardous and harmful levels before attending the booking appointment, screening and ABI may be helpful in terms of eliciting behaviour change. However, they may not be very beneficial in terms of reducing harm to the fetus as it has been found that drinking during the first trimester poses the most risk to the fetus. Training and resources provided to midwives as part of the screening and ABI programme were found to be facilitating mechanisms that midwives indicated improved their skills and confidence. However, most of the midwives had not subsequently employed the motivational interviewing skills required for the ABI delivery, as many of the pregnant women reported that they reduced or abstained from alcohol consumption once pregnancy was confirmed. The outcome noted was that midwives confidence decreased leading to missed opportunities to appropriately deliver the ABI to eligible women. The small numbers of women being identified for ABI meant midwives rarely delivered the ABI. This negatively influenced midwives attitudes as they then accorded ABI low priority in their workload. Other disenabling mechanisms noted to be hampering the implementation of the screening and ABI initiative included midwives contending with competing priorities at the booking appointments, and the lack of adequate rapport between midwives and pregnant women at the booking appointment to discuss alcohol issues appropriately, leading to women providing socially desirable responses to screening questions. Conclusions: The findings of this study has generated greater explanations of the working of the screening and ABI programme in antenatal care setting and has provided transferable lessons that can be used by others intending to implement similar programmes in other settings.

Aim: To determine whether the tuck shop purchasing habits of Grade 4 learners were contributing towards the development of childhood overweight and obesity. Objectives: To assess the nutritional quality of the food and beverages available for learners to purchase; items regularly purchased from the tuck shop as well as factors influencing the learner’s decision to purchase these items; the anthropometric and socio-demographic characteristics of grade 4 learners as well as their nutrition knowledge related to the tuck shop items purchased. Method: A survey administered to 11 tuck shop managers, a questionnaire administered to 311 Grade 4 learners and two single-sex focus groups of 5 learners each were conducted. Results: Fifty six percent of the sample were female (n=173) and 44% were male (n=138). Twenty seven percent of the study sample was overweight (n = 83) and 27% were obese (n = 85). Eighty six percent of learners (n = 266) claimed to buy from their school tuck shop. Twenty two percent of learners purchased from their tuck shop at least three times per week (n =58). Learners who purchased from the tuck shop had a significantly higher BMI than those who did not (p = 0.020). Learners who purchased from the tuck shop spent on average R8,38 per day with a minimum of R1 and a maximum of R40 (standard deviation R5.39). The most popular reasons for visiting the tuck shop included “this is my favourite thing to eat or drink” (66.5%, n = 177) and “I only have enough money to buy this item” (47.0%, n = 125). Savoury pies were the most popular "lunch" item for all learners for both food breaks (45%, n = 5 schools and 27.3%, n = 3 schools) selling the most number of units (43) per day at eight of the eleven schools (72.7%). Iced popsicles were sold at almost every school, ranked as the cheapest beverage and also sold the most number of units (40.7). Healthy beverages sold included canned fruit juice and water, while healthy snacks consisted of dried fruit, fruit salad, bananas, yoghurt and health muffins. The average healthy snack contained almost half the kilojoules of its unhealthy counterpart (465kJ vs 806kJ). Nutritional analyses of the healthy lunch options revealed total fat contents that exceeded the DRI and South African recommended limit. Perceived barriers to stocking healthy items included cost and refrigeration restrictions. The average score for the food groups was only 33% indicating that learners were not familiar with the Food Based Dietary Guidelines (FBDG). Further analyses showed that the total knowledge scores of those learners that reported to buy from the tuck shop frequently, was significantly lower when compared to the total knowledge scores of those learners who bought from the tuck shop less frequently (13.0 ± 3.9 and 11.6 ± 3.1, respectively; p < 0.05). Logistic regression analysis confirmed that the total knowledge of a learner could be used to predict whether he or she is more likely to make purchases from the tuck shop (significance = 0.017). Focus group results revealed that learners are aware of “healthy” and “unhealthy” tuck shop items. Most learners stated that they would continue to purchase items from their tuck shop if all “unhealthy” items were removed. Conclusion: Primary school tuck shops of well resourced schools in Pietermaritzburg are contributing to childhood overweight and obesity through a combination of factors. These include the poor nutritional quality of the items stocked at the tuck shop as well as the poor tuck shop purchasing practices. Much consultation is required amongst dieticians, school principals and privatised tuck shop managers to overcome barriers to stocking healthy items. School management and government have an important role to play in imposing restrictions on the sale of unhealthy items; along with improving the quality of the nutrition education curriculum to ensure that learners are able to translate their knowledge into healthier purchasing practices. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2011.