Prevalence of Diabetes Mellitus in Rural Southern Free State

Background: A worldwide increase in the prevalence of diabetes mellitus (DM) has been reported and an even further increase is expected as a result of lifestyle changes. The objectives of this study were to determine the prevalence of DM in the rural southern Free State and to investigate the contribution of risk factors such as age; physical activity; body mass index (BMI); waist-to-hip ratio and waist circumference to the development of impaired fasting glucose (IFG) or DM. Methods: Fasting venous plasma glucose (FVPG) levels were obtained from a total of 552 participants from Springfontein (n = 195); Trompsburg (n = 162) and Philippolis (n = 180). Participants were between 25 and 64 years of age; with 28.1male (mean age 47.3 years) and 71.9female (mean age 46 years). Anthropometric status was determined using standardised techniques. Levels of physical activity were determined using a 24-hour recall of physical activity as well as frequency of performing certain activities. Relative risks (RR) as well as 95confidence intervals (95CI) were used to distinguish significant risk factors for having IFG or DM. Results: In the study population the prevalence of DM was 7.6(5.2in men and 8.6in women) and that of IFG was 6.3(4.5in men and 7.1in women). The majority of nondiabetic (34); IFG (55) and DM (61) participants were between the ages of 51 and 60 years. Age was found to be a statistically significant risk factor for having IFG or DM in participants older than 40 years of age (RR 2.3; 95CI [1.22; 4.34]). Crude measurements (not age- and gender-adjusted) of waist circumference (RR 3.23; 95CI [1.82; 5.74]); BMI (RR 2.32; 95CI [1.43; 3.78]) and waist-to-hip ratio (RR 2.51; 95CI [1.55; 4.07]) were statistically significant risk factors for having IFG or DM. Physical inactivity in men . 40 years was also a statistically significant risk factor (RR 3.23; 95CI [1.15; 9.05]) for having IFG or DM. Conclusions: In this study; 37.5of diabetics were newly discovered. A high waist circumference; BMI and waist-to-hip-ratio were associated with an increased risk for developing IFG or DM; with a high waist circumference being the most significant general risk factor. Physically inactive men (. 40 years) were also at a higher risk of having IFG or DM. Follow-up FVPG and glucose tolerance tests should be performed on participants in the IFG group. A need for intervention regarding the identification and treatment of DM in these rural areas has been identified

Metabolic Profile of HIV-Infected Women in Mangaung; Free State

Objective: To determine the biochemical nutritional status of HIV-infected women in Mangaung. Design: Cross-sectional. Setting: The community of Mangaung; Free State; South Africa. Subjects: A representative group of 500 black women (25-44 years) was selected randomly to participate. Outcome measures: Biochemical analyses were performed for total lymphocytes; serum protein; serum albumin; plasma fibrinogen; serum insulin; serum glucose; serum triglycerides and serum cholesterol using standard methodology. Values were compared to standard references; and between HIV-infected and HIV-uninfected women. Results: After screening for eligibility; 488 women qualified. Sixty-one per cent of the younger women (25-34 years) and 38of the older women (35-44 years) were HIV-infected. HIV-infected women had significantly lower median blood values for total lymphocytes (p = 0.0001 and p = 0.02 for younger and older group respectively) and serum albumin (p = 0.0001 for both age groups); but significantly higher median concentrations of serum protein (p = 0.0001 for both age groups) than uninfected women. Plasma fibrinogen and serum insulin concentrations were significantly lower in HIV-infected younger women than in their uninfected counterparts (p = 0.002 for both parameters). Older HIV-infected women had significantly lower total serum cholesterol values (p = 0.01) than older HIV-uninfected women. Serum glucose and serum triglycerides did not differ significantly between HIV-infected and HIV-uninfected women. Conclusions: The results indicate a possible impact of HIV infection on serum protein and serum albumin; which may adversely affect biochemical nutritional status and the course of HIV progression. Future research into the causes and possible treatment of metabolic changes in women in this community should be prioritised

Nutritional Status of Disabled Schoolchildren in Bloemfontein (2002 - 2003)

Objectives. To assess the nutritional status of disabled schoolchildren using anthropometric measures and dietary intake; and to compare estimated energy expenditure with energy intake and body weight.Design. A descriptive; cross-sectional survey was undertaken.Setting. The study was conducted at three Bloemfontein schools for disabled children (Tswellang: physically disabled; Pholoho: mentally disabled; Martie du Plessis: both mentally and physically disabled).Subjects. Subjects included a random selection of 145 boys and girls aged 8 - 15 years.Outcome measures. Standard methods were used to determine height; demi-span; knee-height; weight; midupper arm circumference and triceps skinfolds. A 24-hour recall combined with a food frequency questionnaire and 7-day weighed food record were used to determine usual dietary intake of day scholars and hostel scholars respectively. Resting energy expenditure (REE) was calculated for each child using Shofield equations. Total energy expenditure (TEE) was calculated by multiplying the appropriate physical activity level (PAL) factor by REE. Results. The high prevalence of stunting (weight-for-height -2 standard deviations (SD)) (Tswellang 47.7; Pholoho 37.3); and underweight (weight-for-age -2 SD) (Tswellang 29.8; Pholoho 18.7) was a matter of concern. Although median energy intake was slightly lower than the recommended intakes; median protein intake tended to be adequate; while micronutrient intake was low. Median energy intake determined by the 24-hour recall tended to be lower (Pholoho -769 kJ) or nearly the same (Tswellang 327 kJ) as the calculated TEE (PAL1.2 - 1.8).Conclusion. Nutrient density and texture of the children's diet should be monitored to improve nutritional status. In future studies more accurate methods should be used to determine energy intake and expenditure

Micronutrient Intake of HIV-Infected Women in Mangaung; Free State

Background. Poor nutritional status in HIV/AIDS patients can affect immune function profoundly; leading to faster disease progression and earlier death.Objective. To determine the micronutrient intake of HIV-infected women in Mangaung.Design and setting. A cross-sectional study was undertaken in Mangaung; Bloemfontein; Free State.Subjects and methods. A representative group of 500 pre-menopausal women (25 - 44 years) was randomlyselected to participate in the study. Micronutrient intake was determined using a Quantitative Food FrequencyQuestionnaire (QFFQ). Median micronutrient intakes were compared with the Recommended Dietary Allowance(RDA) or Adequate Intake (AI) values. The prevalence of women with intakes 67of the RDA or AI was calculated. Median micronutrient intakes were compared between HIV-infected and uninfected women using non-parametric 95confidence intervals (CIs) and the Mann-Whitney test.Results. Sixty-one per cent of women in the younger age group (25 - 34 years) and 38of older women (35 - 44 years) were HIV-infected. Between 46.6and 70.7of all women consumed 67of the RDA or AI for calcium;total iron; selenium; folate and vitamin C. At least 25of HIV-infected women did not meet either the RDA or the AI for vitamins A; D and E. Younger HIV-infected women had significantly higher intakes of calcium (p = 0.046);phosphorus (p = 0.04); potassium (p = 0.04); vitamin B12 (p = 0.01); vitamin D (p = 0.03) and vitamin E (p = 0.04)than their HIV-uninfected counterparts. Older HIV-infected women had significantly lower intakes of haem iron (p = 0.03); non-haem iron (p = 0.04) and selenium (p = 0.04) than their HIV-uninfected counterparts.Conclusions. Insufficient micronutrient intakes are common in both HIV-infected and uninfected women. A well-balanced diet and micronutrient supplementation seem warranted to ensure optimal health and survival; particularly in HIV-infected women