A Structural Equation Modelling Approach to Examine the Relationship between Socioeconomic Status, Diet Quality and Dyslipidaemia in South African Children and Adolescents, 6-18 Years.

This study utilised a structural equation model to examine the relationship between diet quality, socioeconomic status, and cardiovascular disease (CVD) risk in South African learners. Confirmatory factor analysis was used to test the indirect effects model for diet, socioeconomic status, diet quality and cardiovascular risk using pre-existing cross-sectional data. The structural equation model was fit using Lavaan version 0.6-5 in R version 3.6.1. Data were analysed from 178 children and adolescents, aged 6-18 years, from five rural schools in Cofimvaba, South Africa. Latent variables were created for dietary quality, dyslipidaemia and the socioeconomic status of participants. A negative association was observed between socioeconomic status and dyslipidaemia in school-aged children (p = 0.029).

Is food insecurity a problem among the elderly in Sharpeville, South Africa?

The objective of this study was to determine the prevalence of food and nutrition insecurity and assess the socio-demographic factors associated with food and nutrition insecurity among 146 free-living elderly persons attending a care centre in Sharpeville, South Africa. Measurement instruments included socio-demographic-, 24-hour-recall and dietary diversity questionnaires and the validated household food insecurity access scale/score (HFIAS). Data were analysed with IBM SPSS Software, version 25.0. The prevalence of food insecurity from HFIAS was 60% (n = 87), with a variety of balanced responses being employed. Significant relationships were observed between HFIAS and age (r = 0.301; p = 0.000) and with household income (r = -0.258; p = 0.007). An association was observed between HFIAS and marital status (p = 0.005). Regression analysis showed that age and being single were predictors of food and nutrition insecurity. This study indicated a problem of household food insecurity with poor dietary intakes among these elderly people, mostly due to poverty and being single. More research on associations between food security and socio-economic variables is needed to plan and implement appropriate strategies to address food and nutrition insecurity in South Africa.

Hemoglobin and ferritin concentrations are positively associated with blood pressure and hypertension risk in older adults: a retrospective cross-sectional study, Sharpeville, South Africa.

BACKGROUND AND OBJECTIVES: We aimed to determine the association between Hemoglobin (Hb) and ferritin with blood pressure (BP) and risk of hypertension (HTN) among elderly South African adults in four time points over a period of 10 years. METHODS AND STUDY DESIGN: We used the data source from the Sharpeville Project conducted among the elderly in Sharpeville, South Africa (SA). A total of 275 subjects from the 2004 data source were included. Among these, data were available for 251, 114, and 81 subjects in 2007, 2012, and 2014 respectively. Confounding factors included age, BMI, sodium intake, high-sensitivity C-reactive protein (hs-CRP), and serum total cholesterol. Linear and logistic regressions were used to investigate the Hb and ferritin associations with BP and HTN risk. RESULTS: Mean age in 2004, 2007, 2012, and 2014 was 72.8±8.66, 75.8±7.28, 80.2±9.54, and 83.2±8.98 respectively. In the unadjusted model, systolic BP (SBP) and diastolic BP (DBP), after 132.2 and 83.6 mmHg, increased by 0.57 and 0.72 mmHg respectively for each increment increase in Hb. In the adjusted model, slope coefficients remained statistically significant. Adjusted OR (95% CI) for the highest quartile of Hb (Q4) compared to the first quartile (Q1) in 2004 (p<0.001) and 2007 (p=0.017) were 2.81(2.12-4.83) and 2.58 (1.18-5.65) respectively. Those in Q4 of ferritin had OR (95% CI) of 1.85(1.32-3.73) in 2004 (p<0.001) and 2.20 (1.24-4.04) in 2007 (p<0.001) compared to Q1. CONCLUSIONS: Consistencies between the results from both variables suggest that some part of these positive associations could be iron dependent. Caution should be taken about unmonitored iron supplements consumption among older adults particularly those with elevated BP or on antihypertensive medications.

Comparative analysis of the factors contributing to sustainability of a food and nutrition intervention programme: Two case studies from South Africa.

Sustainability of health interventions is a consistent and ongoing issue in Africa. Understanding key aspects of sustainable interventions provides the necessary methods for success. This research evaluates a nutrition intervention implemented in two peri-urban communities in the Free State and Gauteng province in South Africa (SA) respectively. A case study approach was employed using cross-case study analyses, including triangular data collection (empirical research through surveys of respondents; qualitative data collection through researcher journals, diaries, communications and photographs; and research team reflections). The information from these case studies is organized according to a framework from the United States (US) Office of Organizational Health (OAH) to evaluate the sustainability of intervention programmes. All eight of the OAH criteria were met in the Free State community and supported the importance of these key factors for sustainability compared to only three in the Gauteng community. The OAH framework provided a compelling rationale for the relative success of the intervention and clearly showed the Free State project was sustainable. The Gauteng project was not sustainable. Planned interventions should devote significant effort and time towards ensuring sustainability. The OAH guidelines provide key steps that the research shows is relevant to the South African context.

Nutrition knowledge and dietary intake of adolescents in Cofimvaba, Eastern Cape, South Africa.

The aim of the study was to assess the nutrition knowledge, nutrient intakes, and association between nutrition knowledge and dietary intakes of 98 adolescents attending five schools in rural Cofimvaba, South Africa. Measures included a socioeconomic questionnaire, two 24-hour-recall questionnaires, and food-frequency and nutrition knowledge questionnaires. The overall score for the multiple-choice section on general nutrition and the South African Food-Based Dietary Guidelines was 72.9%; 75.4% for correct identification of food groups; and 41.3% for correct identification of food portions/serving sizes. Median nutrient intakes, measured by 24-hour recall, failed to meet average requirements, with the exception of protein, carbohydrates, chromium, riboflavin, pantothenate, and vitamin K among girls. A similar trend was observed for boys. Lower total carbohydrate and fat and higher protein intakes were associated with a higher quartile score for nutrition knowledge. The study provided a valuable understanding of the association between nutrition knowledge and dietary intakes of adolescents.

Is obesity associated with iron status in the elderly? A case study from Sharpeville, South Africa.

OBJECTIVE: To investigate the relationship between poor Fe status and overweight or obesity in elderly respondents in South Africa. DESIGN: Cross-sectional, observational baseline survey. SETTING: Sharpeville, South Africa. SUBJECTS: A sample size calculation determined a representative sample of 104 randomly selected elderly (≥60 years) respondents. Measurements included weight, height, biochemical and haematological parameters. Measured BMI was used to categorise the respondents into normal weight, overweight and obese groups. RESULTS: The majority of the women were overweight (28·4%) or obese (54·6%); 58% of the respondents had normal Fe status, 15% were classified as Fe depleted, 9% as Fe deficient and 13% as Fe-deficient anaemic. Ten per cent of the respondents had low Hb levels with no other low Fe status parameters, and were thus anaemic due to other causes. A significant correlation (r = 0·318, P < 0·001) existed between BMI and high-sensitivity C-reactive protein (hs-CRP). hs-CRP was negatively correlated to serum Fe levels (r = -0·319, P < 0·001). No significant relationships existed between BMI and Fe status parameters. CONCLUSIONS: A coexistence of obesity and poor Fe status were observed in these elderly respondents. The positive relationship between hs-CRP and BMI indicated chronic inflammation in the higher BMI groups. The negative relationship between hs-CRP and serum Fe indicated that lower serum Fe levels were related to the inflammation linked with higher BMI. A relationship between obesity-related chronic, low-grade inflammation and poor Fe status has been found in adults, but the significance of the current study is that this relationship was also confirmed for elderly persons.

Socio-Economic Variables and Nutrient Adequacy of Women in the Vaal Region of South Africa.

The aim of this cross-sectional, observational baseline survey was to examine the association between nutrient intakes and selected socio-economic variables in 722 women, aged 19 to 90 years living in peri-urban settlements. Measurements included socio-demographic data and 24-hour recall dietary intake data. The results showed poor nutrient intakes with the Estimated Average Requirement (EAR) not met for the mean intakes of all nutrients except carbohydrates, phosphorus, and vitamin B12. The inadequate energy intakes were significantly higher among the women who had lower education (p = .015), lower income (p = .028), and were unemployed (p = .015). The epidemiological value of the study findings is in the contribution to the rationale of appropriate interventions such as income-generating projects as well as household agricultural projects to improve food and nutrient intakes.

The effect of consumption of soy foods on the blood lipid profile of women: a pilot study from Qwa-Qwa.

The objective of this study was to compare the long-term effect of 40-g daily whole bean soy consumption for a period of 18 mo on blood lipid levels of women. A single-system design was used and 90 women randomly selected in peri-urban Qwa-Qwa, South Africa. Measurements included dietary intake (24-h recall), anthropometric (weight and height) and biochemical lipid parameters with venous blood samples. The respondents were divided into a hypercholesterolemic and normo-cholesterolemic (NC) group and data analyses included descriptive statistics and t-tests on SPSS, version 21.0. The results showed that a large percentage (40%) of the women was hypercholesterolemic. The hypercholesterolemic group showed abnormal mean values for all the lipid parameters at baseline whereas the NC group showed total cholesterol (TC) and LDL-cholesterol (LDL-C) values in the normal range, but abnormally low mean HDL-cholesterol (HDL-C) (0.9±0.6) and high mean triglyceride (TG) (2.3±0.8) levels. At follow-up, the hypercholesterolemic group had significantly improved HDL-C (p=0.000), LDL-C (p=0.032) and TG (p=0.000) levels, but with significantly increased TC (p=0.01). A similar trend was observed in the NC group; however, no significantly improved HDL-C or TG values were observed. It can be concluded that dyslipidemia and obesity were prevalent amongst this group of women. The daily consumption of 40 g of whole soybean, had no significant positive effect on TC, but had a beneficial effect on LDL-C in the women in Qwa-Qwa. The HDL:LDL ratio was also improved in the in the hypercholesterolemic group, thus reducing the risk for CVD. The consumption of whole soybean thus had a beneficial effect on the lipid profile of the women in Qwa-Qwa.

Breakfast, midday meals and academic achievement in rural primary schools in Uganda: implications for education and school health policy.

BACKGROUND: Underachievement in schools is a global problem and is especially prevalent in developing countries. Indicators of educational performance show that Uganda has done remarkably well on education access-related targets since the introduction of universal primary education in 1997. However, educational outcomes remain disappointing. The absence of school feeding schemes, one of the leading causes of scholastic underachievement, has not been given attention by the Ugandan authorities. Instead, as a national policy, parents are expected to provide meals even though many, especially in the rural areas, cannot afford to provide even the minimal daily bowl of maize porridge. OBJECTIVE: To assess and demonstrate the effect of breakfast and midday meal consumption on academic achievement of schoolchildren. DESIGN, MATERIALS AND METHODS: We assessed household characteristics, feeding patterns and academic achievement of 645 schoolchildren (aged 9-15 years) in Kumi district, eastern Uganda, in 2006-2007, using a modified cluster sampling design which involved only grade 1 schools (34 in total) and pupils of grade four. Household questionnaires and school records were used to collect information on socio-demographic factors, feeding patterns and school attendance. Academic achievement was assessed using unstandardized techniques, specifically designed for this study. RESULTS: Underachievement (the proportion below a score of 120.0 points) was high (68.4%); in addition, significantly higher achievement and better feeding patterns were observed among children from the less poor households (p<0.05). Achievement was significantly associated with consumption of breakfast and a midday meal, particularly for boys (p<0.05), and a greater likelihood of scoring well was observed for better nourished children (all OR values>1.0). CONCLUSION: We observed that underachievement was relatively high; inadequate patterns of meal consumption, particularly for the most poor, significantly higher scores among children from 'less poor' households and a significant association between academic achievement and breakfast and midday meal consumption.