Consumer Testing of the Preliminary Paediatric Food-Based Dietary Guidelines (PFBDG) Among Mothers with Infants Younger Than 6 Months in Selected Urban and Rural Areas in the Western Cape

Aim: To determine the comprehensibility of the preliminary paediatric food-based dietary guidelines (PFBDG) for infants younger than 6 months in South Africa.Methods: This qualitative study used focus group discussions held in the Western Cape to evaluate the comprehensibility and the understandability of the preliminary PFBDG. Groups were convened according to area of residence (rural; urban formal and urban informal) and ethnicity (white; coloured and black) to reflect the Western Cape population. Focus group discussions were conducted in the participant's home language; namely Afrikaans; eng or Xhosa. The purposive sample included 89 women with infants younger than 6 months divided in 20 groups.Results: In general; mothers understood the guidelines and could reportedly implement them; but constraints such as having to go back to work; being tired and not having enough breast-milk were volunteered. There were very few problems regarding the PFBDG terminology except with the word 'regularly' in the context of the oral hygiene guideline. With regard to the breast-feeding guideline there was some confusion over whether other foods could be included while breast-feeding. Suggestions were made to include 'only' in the breast-feeding guideline. Some of the participants did not know anything about cleaning the infant's mouth; and suggested it be changed to the overall hygiene of the infant. Conclusion: The findings from this study indicate that it may be possible to use one set of dietary guidelines for infants younger than 6 months for all ethnic groups living in the Western Cape; provided that these guidelines are accompanied by supportive documentation citing examples and reasons for the implementation of the guidelines. ecommendations were made for the PFBDG Work Group to revise the preliminary PFBDG for infants younger than 6 months for implementation and further action

Development of the South African renal exchange lists

Objective: The objective of this developmental study was the development of renal exchange lists for the South African population with renal failure.Subjects and design: A questionnaire was circulated to South African renal dietitians to establish the format and composition of the proposed exchange lists. Foodfinder 3 was used for assessment of nutrient composition of foods; and the NRIND Food Quantities Manual was used for assessment of portion sizes. Results from the Food Consumption Study were used to identify food items frequently consumed by the South African population; and dietitians with knowledge of the eating habits of Moslem; Indian; white; black and coloured groups were consulted regarding the inclusion of cultural foods. Portion sizes were determined by protein content of foods. The preliminary exchange lists were circulated for comment and tested for a period of 1 year. Results: Many new food items were added during revision of the exchange lists. Portion sizes were adapted to be more realistic; and in some cases additional sub-groups were added. Foodfinder 3 and renal exchange list values for all food items included in the exchange lists were then compared; and this showed highly significant correlations for all nutrients concerned. There was no significant difference between mean nutrient values for the two methods; with the exception of protein; the content of which was consistently and significantly underestimated by a mean of 0.1 g per food item. This underestimation is not considered to be of clinical importance. Conclusion: In this study renal exchange lists were developed for use in South African persons with renal failure. Despite the small but significant underestimation of protein content; the lists appear to be of sufficient precision for use in clinical practice

Nutritional management of chronic renal failure by dietitians - the South African experience

Objective: The objective of this descriptive study was to assess the practices of South African dietitians regarding the dietary treatment of patients with chronic renal failure. Subjects and design: A questionnaire was mailed to 600 randomly selected dietitians registered with the Health Professions Council of South Africa. Practices were compared to international standards for pre-dialysis; haemodialysis (HD) and peritoneal dialysis (PD) patients. Results: A 26 response rate was obtained; with only 28 of these dietitians indicating that they counsel renal patients. The majority of dietitians met the international dietary recommendations; but a substantial number deviated from them. This was especially evident in PD patients; where the deviation ranged from 20 (4 dietitians) in the case of energy and phosphate; to 55 (11 dietitians) in the case of calcium. Parameters used for the assessment of nutritional status included body mass index (45of dietitians); serum albumin (44); clinical examinations (43); bioelectrical impedance (37) and diet history (36). Methods used to monitor dietary compliance included biochemistry; dietary history; anthropometric measurements and clinical investigation. The most frequently used approaches in the management of protein-energy malnutrition included supplemental drinks (86) and dietary enrichment at household level (76). Conclusion: Although the majority of dietitians met international standards for most nutrients; there was some variation and uncertainty. Ongoing education will enable South African dietitians to treat renal patients competently and with confidence