The use of the South African Food Composition Database System (SAFOODS) and its Products in Assessing Dietary Intake Data. Part II

Objectives: This study set out to determine the following in relation to the nutrition information on the food labels of selected fat spreads: the demographic profile of female consumers using the food label; reasons for food label use and whether the use of the food label leads to the purchase of the selected fat spreads. Methods: One hundred and fifty women aged 25 to 45 years were chosen using an accidental; non-probability sample of consumers shopping at selected supermarkets in Pietermaritzburg. Consenting subjects were presented with a questionnaire to determine their demographic characteristics as well as their reasons for purchasing the selected fat spreads. Descriptive statistics and principal component analyses were used to analyse the results of this study. Results: Fifty-five per cent (n = 82) of this study sample reported using the nutrition information label to assist with their purchases and 68(n = 102) found the nutrition information important when purchasing a new product. Conclusions: The female consumer most likely to use the nutrition information on the food label had a tertiary education; was a primary food purchaser; lived with other people; had more money per month to spend on food; and was conscious of choosing the healthier option. Principal component analysis revealed that the purchase of a selected fat spread was influenced by a number of variables reflecting health awareness; the selected fat spread's marketing; presentation and popularity; and familiarity with and cost awareness of the selected fat spread

Iron status of South African women working in a fruit-packing factory.

OBJECTIVE: The aim of this study was to determine the iron status, and the risk factors for iron deficiency (ID) and iron-deficiency anaemia (IDA), of non-pregnant adult women working in a fruit-packing factory. DESIGN: A cross-sectional analytical study was done on 338 women, 18 to 55 years of age. Information on demographic data, risk factors for ID, smoking, and the consumption of red meat, chicken and fish was collected by questionnaire. Height and weight were measured and the body mass index (BMI) calculated. A non-fasting venous blood sample was analysed for haemoglobin (Hb), serum ferritin (SF), serum iron, serum transferrin and C-reactive protein; transferrin saturation (TFS) was calculated. SETTING: Fruit-packing factory in the Western Cape, South Africa. RESULTS: The mean value for Hb was 13.06 (standard deviation (SD) 1.16) g dl-1 and for SF 48.0 (SD 47.8) microg l-1 (geometric mean 26.44 microg l-1). Women were categorised on the basis of iron status: 60% had a normal iron status (NIS); 12.6% had low TFS (<16%) but normal Hb (>or=12 g dl-1) and SF (>or=12 microg l-1) concentrations (LTS); and 27.4% had low iron status (LIS), defined as combinations of low SF (<12 microg l-1 or <20 microg l-1), low TFS (<16%) and low Hb (<12 g dl-1). More than 30% of the women were obese The risk ratio for LIS (LIS vs. NIS) was 3.8 (95% confidence interval (CI) 1.9-7.6) if women were still menstruating or 3.2 (95% CI 1.6-6.2) if they were pregnant during the past 12 months. Women with LIS consumed significantly smaller portions of red meat, chicken and fish than did women in the other two groups. CONCLUSIONS: IDA (low Hb, SF and TFS) and ID (low SF and TFS) did not seem to be a major problem. Women who were still menstruating or were pregnant during the past 12 months were at greater risk for ID. The consumption of smaller portions of red meat, chicken and fish was related to LIS. A high prevalence of obesity, which demonstrated the coexistence of both under- and overnutrition, was observed.

Dietary intake of Indians living in the metropolitan area of Durban.

OBJECTIVE: To report on energy and nutrient intakes, as a risk factor for coronary heart disease in Indian South Africans. DESIGN: Cross-sectional dietary study as part of a coronary heart disease survey. SETTING: Metropolitan area of Durban, South Africa. SUBJECTS: Free-living Indian men (n = 406) and women (n = 370) 15-69 years of age. METHODOLOGY: Dietary data were collected by three interviewers using a 24-h dietary recall and expressed as median intakes of macronutrients. RESULTS: Results reported a low energy intake and the percentage of energy derived from total fat varied between 32.3 and 34.9% in men and between 33.1 and 36.1% in women. The energy intake to basal metabolic rate (EI:BMR) ratios were low for all age groups suggesting potential under-reporting. Intake of polyunsaturated fatty acids was high, more than 10% of energy, with a median polyunsaturated to saturated fatty acid ratio (P:S ratio) that varied between 1.38 and 1.96 for the various age and sex groups. Dietary cholesterol varied between 66 and 117 mg per 4.2 MJ in men and between 76 and 109 mg per 4.2 MJ in women. Dietary fibre intakes were low and varied between 8.0 and 11.0 g per 4.2 MJ in men and between 7.6 and 9.6 g per 4.2 MJ in women. CONCLUSIONS: The dietary P: S ratios were high and the effect of such a high P:S ratio on the oxidation of low density lipoprotein in this population, with a high prevalence of coronary heart disease (CHD), should be investigated as a possible risk factor for CHD.

Effects of a prudent diet containing either lean beef and mutton or fish and skinless chicken on the plasma lipoproteins and fatty acid composition of triacylglycerol and cholesteryl ester of hypercholesterolemic subjects.

In this two-phase crossover study, 39 hypercholesterolemic subjects followed a prudent diet with either lean red meat or fish and skinless chicken (treatment groups), and 13 subjects (reference group) followed their habitual diet. Fasting blood samples were analyzed for plasma total cholesterol, triacylglycerol (TAG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein one- and two-cholesterol, apolipoprotein-B, very low density lipoprotein cholesterol, and very low density lipoprotein TAG, and fatty acid composition of plasma TAG and cholesteryl ester (CE). Body mass and blood pressure were determined. Seven-day dietary records were kept once at baseline and twice during the treatment periods. Significant differences were observed in dietary intake between the baseline and treatment diets and between the two treatment diets. HDL-C (P < 0.05) and diastolic blood pressure (P < 0.01) were higher in patients on the red meat diet than in those on the chicken-fish diet. No other significant differences in lipoproteins were observed between the effects of the two treatment diets. The linoleic acid (%), eicosapentaenoic acid (%), and the eicosapentaenoic acid/arachidonic acid ratios in TAG and CE were higher (P < 0.01) in subjects on the chicken-fish diet than in those on the red meat diet. In conclusion, this study showed that the effect of two lipid-lowering diets containing either lean red meat or skinless chicken and fish on the atherogenic lipoproteins did not differ significantly. A prudent diet with skinless chicken and fish, however, had a more favorable effect on the fatty acid composition of the plasma TAG and the CE than did the lean red meat diet.

Macronutrient intake and cardiovascular risk factors in older coloured South Africans.

A cross-sectional analytical study was undertaken to investigate the macronutrient intake and cardiovascular risk factor profile of community-dwelling older coloured (mixed descent) South Africans. A sample of 200 subjects aged 65 years and above in Cape Town was randomly drawn using a two-stage cluster design. Trained field workers interviewed subjects to obtain demographic, dietary and life-style data, to draw fasting blood samples for the analysis of plasma lipids, and to take anthropometric measurements. Nutrient intake was assessed using a validated quantified food frequency questionnaire. Blood pressure was measured according to the guidelines of the American Heart Association. The mean daily energy intake was 7984 (3245) kJ and 6979 (2219) kJ for men and women, respectively. Twenty-nine per cent of the subjects had energy intakes less than two-thirds of the RDA. Dietary fat intake comprised 32.4% of total energy intake, which is in line with the prudent dietary guidelines. The inadequate fibre intake (mean = 17(8) g/day) was attributed to the low consumption of fruit and vegetables. Anthropometric assessment indicated that the women tended towards overnutrition, while the men appeared to be undernourished. Lipid profiles fell within the lower end of the moderate risk band for cardiovascular disease and a high prevalence of hypertension (71.7%) was identified. The survey findings indicate a need for health promotion activities to encourage increased physical activity levels and an increased consumption of vegetables, fruit, wholegrain cereals and low fat dairy products in this population.

Iron, folate and vitamin B12 status of an elderly South African population.

OBJECTIVES: To determine the prevalence of anaemia and the haemopoietic nutrient status of older mixed ancestry (coloured) South Africans. DESIGN: A cross-sectional analytic study. SUBJECTS: A random sample of 200 non-institutionalized subjects aged > or = 65 y of age, resident in urban Cape Town, was drawn using a two-stage cluster design. METHODS: Trained fieldworkers interviewed subjects to obtain demographic and lifestyle data. Dietary intake was assessed using a validated food frequency questionnaire. Fasting blood samples were drawn for the determination of haematological parameters, serum vitamin B12, serum folate, RBC folate and a full blood count. RESULTS: The prevalence of anaemia was 13.9. Eight of the 26 cases of anaemia (31) were associated with suboptimal haemopoietic nutrient status; 2(25) and 3(38) cases of these 8 anaemic subjects had suboptimal vitamin B12 and folate status, respectively. Iron deficiency anaemia accounted for 5(63) of the subjects with nutrition-related anaemia. Ten men and two women (6.5 of subjects) had raised serum ferritin concentrations, half of whom had abnormal biochemical parameters indicative of alcohol abuse. CONCLUSIONS: Older coloured South Africans, particularly women, should be encouraged to eat diets with a high nutrient density and to consume adequate amounts of foods high in iron, folate and vitamin B12. Further investigation regarding the high prevalence of hyperferritinaemia found in the men in this population is indicated.

Apolipoprotein B levels and related factors in a rural white South African community--the CORIS study. Coronary Risk Factor Study.

OBJECTIVE: In a survey of the Coronary Risk Factor Study (CORIS), apolipoprotein B (apoB) levels were determined to ascertain their impact on coronary heart disease (CHD) risk. Other CHD risk factors associated with apoB were also identified. DESIGN: Cross-sectional analytical study, which included CHD risk factor and dietary questionnaires, electrocardiography, anthropometric and blood pressure measurements, and a blood sample for a lipid profile. SETTING AND PARTICIPANTS: The three districts of Riversdale, Robertson and Swellendam in the south-western Cape; a 25% random sample of 1,528 white respondents aged 15-68 years. RESULTS: Men tended to have higher mean apoB levels than women. Classification of CHD risk by apoB levels and total cholesterol (TC) levels did not correspond, as only 61% of men and 58.5% of women were classified in the same risk categories. Respondents in the highest apoB risk category reported a medical history of hypercholesterolaemia and hypertension more frequently than those in lower categories. There was a significant increase from the low to the high apoB risk category of TC, low-density lipoprotein (LDL) cholesterol, triglyceride levels, body mass index and percentage body fat. Using stepwise multiple regression, 84.9% of the variation in apoB of men and 85.8% in apoB of women were accounted for by significantly associated variables. CONCLUSION: Although apoB may be a better predictor of CHD than TC or LDL cholesterol concentrations, its easy approximation with the formula (TC-HDLC)/2 + 20, high cost, measurement variability and an approach in management similar to that for raised TC discourage its routine use in the screening of patients for CHD.

The influence of consuming fatty fish instead of red meat on plasma levels of vitamins A, C and E.

The effect of fatty fish consumption on the plasma levels of vitamins A, C and E and the intake of these vitamins were studied in 12 males and 16 females with a mean age of 32.4 years. This cross-over study had a 3 week baseline, 6 week experimental and 6 week post-experimental period with a washout period of approximately 3 months in between. Four 7 day dietary records were used to collect dietary information. Blood samples were drawn after an overnight fast at baseline and every third week thereafter. Plasma total cholesterol, high density lipoprotein cholesterol, triacylglycerol, vitamin A, C and E levels were determined. During the experimental periods red meat was consumed by half of the volunteers while fatty fish was consumed by the other half. Diets were crossed-over after the washout period. Plasma levels of vitamins A, C and E remained within normal limits in the experimental periods. The intake of polyunsaturated fatty acids (PUFA) was significantly higher in the experimental fatty fish period than in the experimental red meat period. The dietary ratio of vitamin E: PUFA and the plasma vitamin E level were lower (P < 0.01) in the experimental fatty fish period than in the experimental red meat period but the ratio of plasma vitamin E: total cholesterol plus triacylglycerol did not differ between the experimental periods. In this study none of the experimental groups were at risk in terms of their intake of the antioxidant vitamins.

Dietary patterns and nutritional status in free-living older white men with established vascular disease.

Thirty-nine white men aged 51-84 years with established vascular disease were studied to investigate the effect of fish oil capsules on the regression of these lesions. This article deals with the baseline data of the study. The subjects completed a 7-day dietary record, weight and height were measured and a fasting blood sample was analysed for proteins, haematological values and certain vitamins. Dietary analysis indicated that the mean energy intake was 8,552 kJ (SD = 2,095). The energy distribution was 15.5% protein, 33.6% fat and 46.4% carbohydrate. In the light of the recommended dietary allowances the diet was lacking in zinc, vitamin B6 and folic acid, which suggests that the subjects might be deficient in these micronutrients. Although the diets were lacking in these nutrients, no clinical stigmata were observed. The subjects averaged a body mass index of 26.1 and could therefore be classified as overweight. The mean haematological values as well as the plasma vitamins were within the normal range. In conclusion it can be said that the men consumed a diet that was too high in fat and that the diet lacked certain micronutrients.

The first 6 years of the Tygerberg Hospital lipid clinic.

The Tygerberg Hospital Lipid Clinic was established in July 1983. The demographic characteristics, lipid abnormalities, coronary risk factor profile, treatment status and 6-month follow-up lipid changes of patients seen during its first 6 years are summarised. During this period 329 patients were seen and complete lipograms were available for 312 of them. This patient population, consisting of 87.2% whites and 12.8% coloureds, represented a wide age range (2-69 years), various occupations and the whole spectrum of educational qualifications. The plasma cholesterol levels of 78.8% of the patients could be described as high risk, according to the cholesterol action limits of the Heart Foundation of Southern Africa, and 33.2% had low high-density lipoprotein cholesterol (less than 1 mmol/l) levels. Approximately 20% of the patients had familial hypercholesterolaemia and 31.1% were already on lipid-lowering medication before registration. The Lipid Clinic succeeded in improving the mean overall plasma cholesterol levels by 8% during the 6 months after registration and provided essential information for the planning of treatment strategies for patients with hypercholesterolaemia.

Plasma lipoprotein response to substituting fish for red meat in the diet.

The effect of 6 wk of either red meat (RM) or fatty fish (FF) intake on plasma lipid concentrations in 28 free-living volunteers (12 males, 16 females) aged 22-45 y was investigated in this clinical crossover trial. Dietary intake was estimated by 7-d dietary records, and fasting blood samples were analyzed for plasma lipid concentrations. Although energy intake did not differ, protein intake was higher (P less than 0.01) in the FF period than in the RM period. There was also a difference (P less than 0.001) in the ratio of dietary polyunsaturated to saturated fatty acids in the RM (0.45) and FF (0.93) periods. Mean plasma total cholesterol, low-density-lipoprotein cholesterol, very-low-density-lipoprotein (VLDL) cholesterol VLDL-triacylglycerol, and plasma triacylglycerol concentrations were lower (P less than 0.001) in the FF than in the RM period. Positive correlations between animal-protein intake and plasma lipoproteins were observed. Atherogenic plasma lipoprotein concentrations were lower when FF was substituted for RM.

The contribution of different food groups to the energy, fat and fibre intake of the Coronary Risk Factor Study (CORIS) population.

A dietary survey done in 1979 on a randomly selected 15% subsample (454 males and 659 females, 15-64 years old) of the 1979 Coronary Risk Factor Study (CORIS) population showed that this population consumed a typical Western diet. In order to identify specific weaknesses in the dietary habits of the population, additional analyses were performed on the data. Foods consumed by the respondents were grouped into 8 groups and the percentage contribution of each of these food groups to total energy intake, total macronutrients, dietary cholesterol and dietary fibre intake was determined. A reference, an 8.4 MJ diet, calculated according to the prudent diet guidelines, was also analysed as described above. The results showed that the CORIS respondents' dietary intake compared unfavourably with the values of the reference diet. The meat group was the main source of total fat, saturated fat and dietary cholesterol. The fat group was the second most important source of total fat in the diet, while the milk group was the second most important source of saturated fat. The study population preferred refined cereals and had a low fruit and vegetable intake. These results revealed specific shortcomings in the dietary habits of the CORIS population and emphasised the need for changes necessary to meet the requirements for a prudent diet.

Intake of macronutrients and their relationship with total cholesterol and high-density lipoprotein cholesterol. The Coronary Risk Factor Study, 1979.

In a dietary study on a subsample (1,113 males and females, 15-64 years of age) of the Coronary Risk Factor Study (CORIS) population, dietitians used the 24-hour recall method by interview to quantify nutrient intake and energy distribution and to investigate the relationship between dietary variables and blood lipid values. Mean total fat intakes varied from 35% to 37% of daily energy intake for different age groups. Dietary polyunsaturated/saturated fatty acid ratios varied from 0.48 to 0.59. Cholesterol intakes ranged from 243 mg/d to 500 mg/d and when expressed per 4.2 MJ (1,000 kcal) were similar for males and females. The results of this intrapopulation cross-sectional study showed no significant relationship between dietary variables and total serum cholesterol and high-density lipoprotein cholesterol. However, the low percentage of respondents who met the prudent dietary guidelines add dietary risk factors to the already high prevalence of other major risk factors in this population.