Nutrition transition and double burden of malnutrition in Africa: A case study of four selected countries with different social economic development.

BACKGROUND: Disease and lifestyle patterns have been changing rapidly especially in Africa due to transformation in economic development and urbanization. Research on the magnitude and consequences of these transformations in Africa is limited. This study investigates the shifts in nutritional status in children and adults in four selected low-, middle- and high-income countries in Africa, identifies factors associated with the shifts, and provides recommendations for future studies. METHODS: Malawi, Kenya, Ghana, and South Africa were selected based on their Gross Domestic Product (GDP). Nationally representative data were obtained from the 2017 Global Nutrition Report, Demographic Health Surveys (DHSs), and the World Health Organization (WHO) database. Prevalence of underweight, overweight, and obesity were assessed and compared across the countries, gender, residence, and over time. Results: South Africa had the highest GDP and largest prevalence of overweight and obesity rates in children < 5 years old and adults > 18 (13.3% and 51.9%, respectively). Malawi, with the lowest GDP, had the highest stunting rate (37.0%). In all 4 countries, but most notably in South Africa, trends indicated that the increasing prevalence of overweight and obesity was much greater than the declining rate of underweight. Malawi, Kenya, and Ghana had a slight decline in overweight prevalence in children under 5 years. CONCLUSIONS: Nutritional shifts are occurring in Africa and seem to be heavily influenced by economic development. The double-burden of malnutrition presents prioritization challenges for policymakers. Attention needs to be shifted towards prevention of obesity, at least in the higher income countries in Africa.

Interdisciplinary Discrepancies Between Parenteral Nutrition Macronutrient Prescribing and Recommendations: Is Body Mass Index a Factor?

BACKGROUND: Formal nutrition training in medical schools and residencies is lacking and needed. Registered dietitians (RDs) are formally trained in nutrition support and considered experts in the nutrition field. Our purpose was to examine prescribing and recommending discrepancies of parenteral nutrition macronutrients between medical residents (MRs) and RDs and compare results with the ASPEN clinical care guidelines. We also looked at discrepancies among obese patients, due to their increased risk of mortality. MATERIALS AND METHODS: The primary end point of this retrospective review was discrepancies in nonprotein calories (NPCs) and grams of protein (PRO) between MRs and RDs. The secondary end point was discrepancies in NPCs and PRO between MRs and RDs among patients stratified by body mass index category. RESULTS: MRs prescribed 300 NPCs more versus RDs ( P < .001). When compared with RDs, MRs prescribed fewer NPCs for underweight patients and more for obese patients ( P < .001). The same analysis found that the PRO discrepancies significantly varied by body mass index classification as well ( P = .022). When these results were compared with the ASPEN clinical care guidelines, RDs adhered closer to the guidelines than did MRs in terms of permissive underfeeding of obese patients. CONCLUSION: It is widely accepted that MRs are in need of increased formal training, and the results of our study confirm this need and suggest a short-term solution of increasing order-writing privileges for the RD. RDs with this privilege may adhere more closely to clinical care guidelines and therefore increase patient safety.

A pilot study to assess students' perceptions, familiarity, and knowledge in the use of complementary and alternative herbal supplements in health promotion.

CONTEXT: According to the National Center for Complementary and Alternative Medicine (NCCAM), use of herbal supplements is increasing and will continue to rise. With parents administering medicinal herbs to children as a preventive alternative to traditional drugs, the research team thought it would be interesting to assess the use of these products during the transition into adulthood through college life. OBJECTIVE: This study examined participants' perceptions of, familiarity with, and knowledge of herbal supplements for health promotion. DESIGN: The research team invited participants to complete a 13-item Perception, Familiarity, and Knowledge Survey (PFKS). This online survey included questions regarding demographics, perceptions of complementary and alternative medicine, and familiarity with and knowledge of gingko, ginseng, St. John's wort, garlic, echinacea, and cinnamon. SETTING: The study occurred at a Midwestern university. PARTICIPANTS: Two-hundred and eighty-six college students participated. OUTCOME MEASURES: The research team used the Chi-square test of association to examine the class rank (freshmen/sophomores, juniors/seniors, and graduate students) of students (frequency) and their gender in relation to their perceptions of, familiarity with, and knowledge of herbal supplements. RESULTS: Chi-square analysis showed that 80.8% of participants were familiar with complementary and alternative medicine (CAM) (P = .000). Of participants who were aware of the six herbs, a majority was familiar with ginkgo (82.4%), ginseng (96.1%), St. John's wort (78.4%), garlic (98.4%), echinacea (65.6%), and cinnamon (96.8%). Despite students' familiarity with the herbs, 45.1% to 74.1% of the participants were unsure of their effectiveness in preventing disease or promoting good health. Participants perceived the barriers to their CAM awareness as (1) insufficient education (26.0%), (2) a lack of scientific evidence (25.9%), and (3) a lack of trained professionals (17.5%). Many students (85.8%) desired educational courses on CAM therapies, with nutrition professors being ranked highest as the providers of this education by 88.0%. Over 60.0% of participants thought that conventional medicine could benefit from integration with CAM and that medical professionals should integrate CAM into health-care practices. CONCLUSION: College students appear to be highly familiar with CAM and herbal supplements but currently have little experience with and knowledge of herbal supplements.

Visual plate waste in hospitalized patients: length of stay and diet order.

The purpose of this pilot research was to investigate the effect of diet order, sex, diagnosis, and length of stay on visual lunch plate waste in hospitalized patients. Information on 346 patients was collected using the computer program CBORD Diet Office. Visual plate waste during lunch was measured and analyzed for 4 consecutive days. Neither sex nor diagnosis at admittance was associated with visual plate waste. However, the odds of visual plate waste increased by 14.1% for every day a patient was admitted. In patients receiving a diabetic diet order, odds of visual plate waste decreased by 61.2%, indicating there was reduction in plate waste. Conversely, in patients receiving altered consistency diet orders, odds of visual plate waste increased by 344%, signifying a rise in plate waste. Due to an increase of visual plate waste associated with long length of stay and altered consistency diet orders, registered dietitians working in acute-care facilities need to develop strategies to create cost-effective, nutritionally balanced, altered consistency diets that would enhance patient acceptance and consumption of food.

Impact of tofu or tofu + orange juice on hematological indices of lacto-ovo vegetarian females.

The purpose of this study was to investigate iron status of premenopausal vegetarian women consuming tofu or tofu plus orange juice. Following a three day pre-period, 14 lacto-ovo vegetarians were randomly divided into two experimental periods of 30 days each. For the first 30 days, one half of the subjects (n = 7) received 6 oz (173 grams) of tofu/day (T) while the other half of the subjects (n = 7) received 6 oz of tofu/day along with 303 mg of vitamin C/d (TO). After 30 days, there was a crossover of the diets. Iron status was assessed by measuring serum ferritin and hemoglobin concentrations on the first day of the study and at the end of each experimental period. The Mann Whitney-U test was significant during the first (W = 17.5; Z = -2.095; p = 0.0361) and over the second (W = 40.0; Z = -2.611; p = 0.009) experimental periods which indicated the change in hemoglobin levels for the T and TO groups were different. Mean ranks showed a greater increase in hemoglobin levels for the TO group. There was no significant difference in the change in serum ferritin levels between the T and TO groups over the first and second experimental periods. In conclusion, bioavailability of iron from tofu is enhanced by supplementation with ascorbic acid.