Prevalence of iron and zinc deficiencies among preschool children ages 3 to 5 y in Vhembe district, Limpopo province, South Africa.

OBJECTIVES: Children under the age of 5 y constitute the most vulnerable group for iron and zinc deficiencies and their nutritional status is a sensitive indicator of community health and nutrition. The aim of this study was to determine the prevalence of zinc and iron deficiency among preschool children aged 3 to 5 y in Vhembe district, Limpopo province, South Africa. METHODS: This study included 349 preschool children recruited from two municipalities of Vhembe district, Limpopo province, South Africa. Municipalities were purposively selected and simple random sampling was used to choose children. Body weight and height were measured using standard techniques. Serum zinc, iron, ferritin, transferrin saturation, transferrin and C-reactive protein levels were also assessed, as were hemoglobin levels. RESULTS: The prevalence of wasting, stunting, and underweight was 1.4%, 18.6%, and 0.3%, respectively; whereas 20.9% of the children were overweight and 9.7% were obese. The prevalence of zinc deficiency was 42.6% and anemia was 28%; both were higher in girls than in boys. When using serum ferritin and transferrin saturation 7 (2%) of the children had iron-deficiency anemia. Combined iron and zinc deficiencies using ferritin was found in 8 (2.3%) of the children; when using transferrin saturation these deficiencies were found in 42 (12%) of the children. CONCLUSIONS: Iron and zinc deficiencies as well as anemia, accompanied by high prevalence of stunting; and overweight and obesity, were common in preschool children. The results observed here call for interventions to combat the escalating problem of child malnutrition in the form of nutritional education for mothers and food handlers at preschools to ensure food diversification in these children.

Prevalence of anaemia and its associated factors in African children at one and three years residing in the Capricorn District of Limpopo Province, South Africa.

OBJECTIVE: The present study evaluated the prevalence of anaemia and its determinants in one- and three-year-old children from the Capricorn District of Limpopo Province, South Africa. METHODS: A prospective cohort study conducted in rural villages in the Capricorn District of Limpopo Province, South Africa. At birth, a cohort of 219 children was followed until they were one and three years of age. Data collected included the children's anthropometric measurements, blood for biochemical analysis (full blood count, ferritin, folate and vitamin B12) and socio-demographic status. RESULTS: At one year, anaemia (Hb < 11 g/dL) was present in 52% of the children, decreasing to 22% by the third year. Iron deficiency (ferritin < 12 µg/mL) was common in these children (39% and 33% at one year and three years, respectively) particularly in the presence of anaemia. Folate and vitamin B12 deficiencies (< 5 ng/mL and < 145 pg/mL, respectively) were common at one year, with the children accumulating enough vitamin B12 by three years; however, folate deficiency levels remained fairly constant between the two time points. CONCLUSION: There was a high prevalence of anaemia in the study participants at one year and three years of age. Factors that increased the risk of anaemia at three years were: a mother with only a primary school education, anaemia at one year, male gender, overweight, and combined overweight and stunting. Protective factors against anaemia were having a younger mother who served as the main caregiver.

The association between dyslipidemia and anthropometric indicators in black and white adolescents residing in Tlokwe Municipality, North-West Province, South Africa: the PAHL study.

BACKGROUND: The dyslipidemia associated with excess weight is a risk for cardiovascular disease. Worldwide and in South Africa adolescent obesity has been reported. OBJECTIVES: To determine the association between dyslipidemia and anthropometric indices in black and white adolescents. METHODS: The study involved 129 black and 69 white adolescents aged 12 to 16 years. Data collected included height, weight, waist circumference (WC) and skinfolds, blood pressure and blood for glucose, insulin, total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), triglycerides (Trig) and C - reactive protein (CRP). RESULTS: WC correlated negatively with HDL in both blacks (p=0.042) and whites (p=0.008) and in whites it correlated positively with LDL (p=0.006); TC/HDL (p=<0.001) and LDL/HDL ratio (p<0.0001). WC/Hgt correlated negatively with HDL (p=0.028) and positively with LDL/HDL (p=0.026 and p<0.0001) in both races. In whites positive correlations were between WC/Hgt and TC (p=0.049); LDL (p=0.003) and TC/HDL (p<0.0001). BAZ correlated positively with TC/HDL ratio (p=0.004) and LDL/HDL ratio (p=0.002). The most common abnormalities were HDL and LDL. CONCLUSION: Whites exhibited more associations between dyslipidemia and anthropometric indicators as compared to Blacks, suggesting that there might be differences in the lipid metabolism or even susceptibility to risk factors in adolescents.

Association between insulin-like growth factor-1, measures of overnutrition and undernutrition and insulin resistance in black adolescents living in the North-West Province, South Africa.

OBJECTIVE: To determine if insulin-like growth factor-1 (IGF-1) is a significant predictor of body fat percentage (%BF), lean body mass, and insulin resistance (IR) in black adolescents presenting with overnutrition and undernutrition. METHODS: A cross-sectional study was undertaken in 181 adolescents (111 girls, 70 boys, 13-20 years old) from a low socio-economic population in the North-West Province, South Africa. Anthropometric measurements were performed, and %BF and lean mass were assessed by air displacement plethysmography. Serum glucose, leptin, insulin, IGF-1 and IGF-binding protein-3 (IGFBP-3) were measured and homeostasis model assessment of IR (HOMA-IR) was calculated. Predictors of body composition and HOMA-IR were determined in multivariate linear regressions. RESULTS: Of the boys, 31% had a %BF >20%, whereas 42% of girls had a %BF >30%. Furthermore, 17.1% male and 18.9% female adolescents were stunted, indicating overnutrition and undernutrition in the same group. IGF-1 showed a negative association with %BF in both sexes, and a positive correlation with height-for-age z-score (HAZ) and lean mass, respectively, in the boys. IGF-1 correlated positively and physical activity correlated negatively with fasting insulin and HOMA-IR in the girls. In both sexes, leptin had the strongest association with %BF in multiple regressions. Leptin and Tanner stage were significant predictors of HOMA-IR in girls, but not in boys. CONCLUSIONS: IGF-1 was positively associated with lean mass and HAZ in boys, indicating a beneficial relationship with linear growth, but with IR in the girls, indicating possible adverse metabolic effects in the presence of high %BF and physical inactivity.

Association between iron status and white blood cell counts in African schoolchildren of the North-West Province, South Africa.

Iron deficiency with or without anemia is associated with increased susceptibility to infection owing to impaired immune function; this study aimed to examine the associations between markers of iron status and white blood cell counts in African schoolchildren. This cross-sectional study is part of the larger BeForMi study done in the North-West province of South Africa. A total of 556 African schoolchildren (aged 7-10 years) were recruited from the three schools participating in the BeForMi multiple micronutrient intervention study. Demographic information of the children was obtained from their parents/caregivers/guardians in the language of choice using validated questionnaires. Anthropometric indices (weight and height), iron status parameters, hematological parameters (hemoglobin (Hb), red blood cell count (RBC), total and differential white blood cell counts) were measured using standard procedures. No significant gender differences were observed in most of the iron markers and hematological parameters except in C-reactive protein (CRP) (p=0.004) and eosinophils (p=0.042) which were higher in boys while RBC (p=0.018) and Hb (p=0.023) levels were higher in girls. No relationships were observed between the different iron markers and differential white blood cell counts. A positive correlation was observed between serum ferritin (SF) and CRP in girls only (r=0.336, p<0.01), and a positive correlation between SF and mean cell volume (MCV) in boys only (r=0.197, p<0.01). In both genders, no correlations were observed between the different iron markers and the differential white blood cell counts. The study revealed no associations between iron status and differential white blood cell counts in children that participated in the BeForMi study calling for more studies to be done in the area of the significance of iron supplementation in healthy children.

Point-of-use micronutrient fortification: lessons learned in implementing a preschool-based pilot trial in South Africa.

This current pilot trial assessed the feasibility of implementing a point-of-use (PoU) micronutrient fortification in preschool settings. Preschool children (n = 151) aged 36-79 months were randomized into intervention (n = 76) and control (n = 75) groups, both receiving breakfast maize-porridge with added micronutrient or placebo powder for 52 school days. Process evaluation and early childhood development indicators were used to assess trial feasibility. Process evaluation results showed that the implementation components were feasible and could be delivered with high fidelity. The improvement in hemoglobin concentration in intervention and control groups were not significantly different (P = 0.250). There was medium likelihood for practical significance for the two global cognitive scores assessed: non-verbal index (intervention effects: 7.20; 95% confidence interval: 2.60, 11.81; P = 0.002, effect size: 0.55) and mental processing index (intervention effects: 2.73; 95% confidence interval: 0.25, 5.70; P = 0.072, effect size: 0.36) on the Kaufman Assessment Battery for Children, Second Edition. The lessons from this trial could help in planning/implementing future PoU micronutrient fortification trial among South African preschool children.

Iron status and cardiovascular disease risk in black South African women: the PURE study

Objective: To examine the associations between measures of iron status and cardiovascular disease (CVD) risk factors in South African women.Method: In a cross-sectional study; demographic information and health history were obtained during individual interviews using validated questionnaires in the North West Province; South Africa. Anthropometric indices; iron indices; blood pressure; blood glucose and lipid profiles were measured using standard procedures in 1 262 apparently healthy black South African women aged 35 years or older. Iron status was assessed using serum concentrations of ferritin; transferrin receptor (TfR) and TfR:ferritin ratio.Results: Associations between iron status parameters and CVD risk factors were generally weak (r 0.3; p 0.01) and were not retained when adjustment was made for age; body mass index; smoking; alcohol consumption and C-reactive protein in the analysis. Waist circumference (WC) and waist:hip ratio (WHR) were higher in the fourth quartile of serum ferritin than in the third quartile; and also in the third quartile compared to the second quartile (P 0.05). Based on WC and WHR respectively; 31 and 52of the women had excess abdominal obesity. The mean (95 confidence interval) serum TfR concentration was high; at 9.09 ?g/ml (8.77; 9.44); indicating risk of iron deficiency. The mean (95 confidence interval) concentrations of lipids [total cholesterol 4.78 mmol/l (4.64; 4.93); high-density lipoprotein cholesterol 1.45 mmol/l (1.39; 1.52); low-density lipoprotein cholesterol 1.65 mmol/l (1.53; 1.78); triglyceride 1.12 mmol/l (1.07; 1.18)] were within reference ranges.Conclusion: No significant association was found between iron status parameters and established CVD risk factors. However; excessive abdominal adiposity indicated by high WC and WHR contributes significantly to increased serum ferritin concentration in this population

Prevalence and determinants of stunting and overweight in 3-year-old black South African children residing in the Central Region of Limpopo Province, South Africa.

OBJECTIVES: To determine the prevalence of stunting, wasting and overweight and their determinants in 3-year-old children in the Central Region of Limpopo Province, South Africa. DESIGN: Prospective cohort study. SETTING: Rural villages in the Central Region of the Limpopo Province, South Africa. SUBJECTS: One hundred and sixty-two children who were followed from birth were included in the study. Anthropometric measurements and sociodemographic characteristics of the children were recorded. RESULTS: Height-for-age Z-scores were low, with a high prevalence of stunting (48%). The children also exhibited a high prevalence of overweight (22%) and obesity (24%). Thirty-one (19%) children were both stunted and overweight. Gaining more weight within the first year of life increased the risk of being overweight at 3 years by 2.39 times (95% confidence interval (CI) 1.96-4.18) while having a greater length at 1 year was protective against stunting (odds ratio (OR) 0.41; 95% CI 0.17-0.97). Having a mother as a student increased the risk for stunting at 3 years by 18.21 times (95% CI 9.46-34.74) while having a working mother increased the risk for overweight by 17.87 times (95% CI 8.24-38.78). All these factors also appeared as risks or as being protective in children who were both overweight and stunted, as did living in a household having nine or more persons (OR 5.72; 95% CI 2.7-12.10). CONCLUSION: The results of this study highlight the importance of evaluating anthropometric status in terms of both stunting and overweight. Furthermore, it is important to realise the importance of normal length and weight being attained at 1 year of age, since these in turn predict nutritional status at 3 years of age.

Feeding practices and growth of infants from birth to 12 months in the central region of the Limpopo Province of South Africa.

OBJECTIVE: We evaluated feeding practices and growth patterns of infants in the central region of the Limpopo Province over the first 12 mo of life. METHODS: A follow-up study on a cohort of term infants born to 276 mothers recruited during their third trimester of pregnancy was undertaken. The mothers were recruited by the nursing staff at nine randomly selected clinics. From this sample, 219 women gave birth at the local hospital and the infants were followed from birth to 12 mo. Data collected included infant feeding practices and anthropometry at regular intervals (1, 3, 6, 9 and 12 mo). The anthropometric measurements taken were body weight, length, and head circumference. RESULTS: At birth 8.8% of infants had a low birth weight, 9.6% were stunted, 48.9% were underweight, and 7.3% were wasted. Mothers in this study breastfed their infants for long periods with more than 80% still breastfeeding by the ninth month. However, exclusive breastfeeding during the first 3 mo was uncommon as mothers tended to introduce supplementary feeds at an early age, with 56% of the infants receiving some form of supplement by the end of the first month. The most common supplementary foods were maize meal porridge and mabella (sorghum). Stunting became increasingly apparent in the early months with 30% of infants being stunted (<-2 standard deviations [SD] of the National Center for Health Statistics [NCHS] reference curves) by the first month, and this percentage remained high for the 12-mo period, remaining at below - 1 SD NCHS height-for-age standard. Increased weight gain was seen during the first 3 mo and then declined until mean weight-for-age at 12 mo was below 0 SD NCHS. Twelve percent of infants were overweight (>2 SD NCHS) by the 12th month. Postnatally the infants showed a pattern of gradual stunting. Postnatal factors associated with this pattern were related to maternal socioeconomic status, and these included the mother's level of education, employment status, parity, and access to electricity. CONCLUSION: There was a high frequency of underweight infants at birth but stunting was less common. With respect to feeding practices, the mothers tended to introduce supplementary feeds at an early age.