Dietary intake of pregnant women and their infants in a poor black South African community.

The aims of this study were (i) to determine the dietary intake of women in a poor rural area during pregnancy and lactation, and (ii) to determine the nutritional status and dietary intake of their infants at age 6 months. We recruited 46 women, below 40 years old, in their 2nd trimester of pregnancy. The subjects were living in a rural area of Limpopo Province. Their heights and weights were recorded, as were their diets during pregnancy and for the first 6 months after delivery. We also recorded weights, lengths, and dietary intake of the infants at 3 and 6 months after birth. The subjects were living in severe poverty: none had running water and almost all did their cooking over an open fire. None of the subjects smoked and only one consumed alcohol. The diets of the subjects consisted mainly of maize, brown bread, sweetened beverages (cold drink and tea), and small amounts of vegetables and chicken. The diets were adequate in protein but were marginal in energy and in dietary fibre, and may be deficient in numerous micronutrients, particularly calcium, iron, zinc, niacin, folate, and vitamins A, C, E, and B6. This was seen during pregnancy and lactation. Blood analysis 6 months after birth revealed normal levels of vitamins A and E and an absence of anaemia. Body mass index (BMI) of the women was 23.9 +/- 5.3 kg/m2 (mean +/- SD) when measured 6 months after birth. Those above 25 years old had a higher BMI than did younger subjects (25.5 vs. 22.2; p = 0.028). Overall, 24% were overweight (BMI 25-30) while 9% were obese (BMI > 30). Most infants (93%) were breastfed for at least 6 months but exclusive breastfeeding was only done by 65% of mothers. One-third of breastfed infants also received formula. The use of formula while breastfeeding was twice as common among mothers aged above 25 years (46% vs. 23%). Early introduction of solid foods was very common in this group. Younger mothers introduced solids in the first month (51%) more often compared with older mothers who tended to introduce solids at 2-3 months (64%). The most common solid food given was maize meal porridge (by 78% of all mothers). Mean BMI was low at birth (< 15), but this reached a normal value by 6 months. A significant fraction of the infants was underweight or short (i.e., stunted), based on being below the 3rd percentile compared with NCHS standards. Underweight was short length in girls. This study found that pregnant and lactating women had diets low in energy and micronutrients as reflected by the high prevalence of underweight at birth. Most infants were exclusively breastfed, but the benefit of this was offset by the early introduction of solid foods having a low energy and nutrient density. By 6 months, the prevalence of stunting had more than doubled.

Diet, nutrition and the prevention of type 2 diabetes.

OBJECTIVES: The overall objective of this study was to evaluate and provide evidence and recommendations on current published literature about diet and lifestyle in the prevention of type 2 diabetes. DESIGN: Epidemiological and experimental studies, focusing on nutritional intervention in the prevention of type 2 diabetes are used to make disease-specific recommendations. Long-term cohort studies are given the most weight as to strength of evidence available. SETTING AND SUBJECTS: Numerous clinical trials and cohort studies in low, middle and high income countries are evaluated regarding recommendations for dietary prevention of type 2 diabetes. These include, among others, the Finnish Diabetes Prevention Study, US Diabetes Prevention Program, Da Qing Study; Pima Indian Study; Iowa Women's Health Study; and the study of the US Male Physicians. RESULTS: There is convincing evidence for a decreased risk of diabetes in adults who are physically active and maintain a normal body mass index (BMI) throughout adulthood, and in overweight adults with impaired glucose tolerance who lose weight voluntarily. An increased risk for developing type 2 diabetes is associated with overweight and obesity; abdominal obesity; physical inactivity; and maternal diabetes. It is probable that a high intake of saturated fats and intrauterine growth retardation also contribute to an increased risk, while non-starch polysaccharides are likely to be associated with a decreased risk. From existing evidence it is also possible that omega-3 fatty acids, low glycaemic index foods and exclusive breastfeeding may play a protective role, and that total fat intake and trans fatty acids may contribute to the risk. However, insufficient evidence is currently available to provide convincing proof. CONCLUSIONS: Based on the strength of available evidence regarding diet and lifestyle in the prevention of type 2 diabetes, it is recommended that a normal weight status in the lower BMI range (BMI 21-23) and regular physical activity be maintained throughout adulthood; abdominal obesity be prevented; and saturated fat intake be less than 7% of the total energy intake.

Waist circumference predicts clustering of cardiovascular risk factors in older South Africans.

OBJECTIVE AND DESIGN: A cross-sectional analytical study to determine the cardiovascular risk factor profile of older residents of fishing villages on the West Coast of South Africa, and to determine which anthropometric measures are associated with risk factors. SUBJECTS: A convenient community-based sample of 152 subjects of mixed ancestry aged 55 years and over was recruited door-to-door using an address list of age-eligible subjects provided by the local public health care clinics. METHODS: Cardiovascular relationships were investigated between (i) number of risk factors (hypertension, hypercholesterolaemia, diabetes) and body mass index (BMI), waist-to-hip ratio (WHR), and waist circumference; and (ii) continuous cardiovascular risk factor variables and physical activity, smoking, dietary intake, and 24-hour urinary sodium and potassium concentrations. RESULTS: The prevalence of hypertension ( > or =160/95 mmHg) was 74.3% (95% CI: 67.2 - 81.4%). Neither 24-hour urinary sodium nor potassium concentrations was associated with blood pressure (BP). Past, but not present, moderate-intensity physical activity, particularly that associated with occupation, was negatively associated with systolic BP (r = -0.24, P < 0.05). The prevalence of diabetes and hypercholesterolaemia (serum cholesterol > or = 6.5 mmol/l) was 24.6% (95% CI: 17.2 - 32%) and 40% (95% CI: 31.8 - 48.2%), respectively. The percentage of subjects with 0, 1, or 2 or more cardiovascular risk factors was 13.4%, 44.1% and 42.5%, respectively. Subjects with a waist circumference > or = 92 cm had a significantly higher number of cardiovascular risk factors than those with a waist circumference < 92 cm ( chi(2) = 9.29, P < 0.01), and this association remained significant even after controlling for age, sex and smoking (P < 0.05). Neither BMI tertiles according to sex, nor a BMI cut-point > or =30, was significantly associated with a clustering of risk factors. CONCLUSION: In a sample of older South Africans of mixed ancestry at high risk of cardiovascular disease, waist circumference measuring > or = 92 cm predicts clustering of risks factors, independently of BMI. This simple, population-specific reference value may provide a useful screening tool to identify at-risk individuals for targeted prevention for coronary heart disease and associated metabolic disorders.

The epidemic of obesity in South Africa: a study in a disadvantaged community.

OBJECTIVE: The objective of this study was: 1) to determine the anthropometric profile of adults in Mamre, a small town in South Africa, which has a population of mixed ancestry ("colored" people of Afro-Euro-Malay-Khoisan ancestry); and 2) to determine the change in this profile between 1989 and 1996. DESIGN: Cross-sectional surveys conducted in random samples of adults in 1989 and 1996. PARTICIPANTS: The subjects were 684 women and 529 men in 1989, and 546 women and 430 men in 1996, aged 15 and older. MAIN OUTCOME MEASURES: The following measurements were recorded: height, weight, and circumference of waist, hips, and mid-upper arm. RESULTS: Based on data from the 1996 survey, 32% of women are obese (body mass index [BMI] > or = 30) at ages 25-44 years, rising to 49% at ages 45-64 years. A much lower prevalence of obesity is seen in men: 14% at ages 35-64 years. Obesity levels significantly increased in women between the two surveys (P=.015): up from 44% in 1989 to 49% in 1996 at ages 45-64 years. There was an increase in the prevalence of overweight (BMI 25-29.9) in men, though not in obesity. Mean BMI increased by about 3% in women and 2% in men between 1989 and 1996. CONCLUSIONS: This study conducted among people of mixed ancestry living in a disadvantaged community in South Africa shows that half of middle-aged women are obese. A rising trend in BMI was seen in adults of both sexes between 1989 and 1996. This trend may be explained by factors associated with rural-urban transition, including electrification, reduced physical activity, and increasing availability of energy-dense food.

Survey of nutrition knowledge of Canadian physicians.

OBJECTIVES: Previous reports have indicated that physicians generally have little training in nutrition and a poor knowledge of the subject. A survey was carried out to determine the nutrition knowledge of physicians working in general practice. METHODS: A questionnaire with multiple-choice questions was mailed to 248 physicians working in Alberta, Canada, mainly in Edmonton and Calgary. Non-respondents received a second questionnaire and a phone call. RESULTS: Completed questionnaires were received from 36.1% (84 of 233 eligible physicians). The average correct response was 63.1%. The results indicate that physicians are generally aware of information which has been publicized in the medical press: which nutrients are antioxidants; the nutrient associated with the prevention of neural tube defects (folate); the preventive action of fruit and vegetables against cancer; the energy value of fat (9 kcals/g); and the recommended fat intake (under 30% of energy). By contrast they have a poor knowledge of other important topics in nutrition: the typical salt intake of Canadians; the association between excess protein intake and calcium loss; the type of dietary fiber helpful in lowering the blood cholesterol level (soluble fiber); and the nutrient which helps prevent thrombosis (omega-3 fat). CONCLUSIONS: These results support other data that physicians need more training in nutrition.

Interpretive group psychotherapy and dependent day hospital patients: a preliminary investigation.

A small group of highly dependent day hospital patients, together with a small number of 'potential' day hospital referrals sharing similar characteristics, were treated in twice weekly interpretive group psychotherapy for between seven and nine months. At the end of treatment three of four day hospital patients had made a successful separation from the day hospital, and at nine month follow-up outcome appeared improved. Only two of the six non-day hospital patients remained in the group, the reasons for which are discussed. The method of evaluation proved manageable, although it would be more appropriate to studies involving larger numbers and possibly control interventions. It is suggested that the role of interpretive group psychotherapy in rehabilitation deserves further investigation.

Reference values for young normal Sprague-Dawley rats: weight gain, hematology and clinical chemistry.

1. Arterial blood from 63 male (315-500 g) and 60 female (210-290 g) healthy Sprague-Dawley rats was analyzed for 16 hematological and 22 clinical chemistry parameters. 2. Nine of these parameters were associated with growth and developmental changes in males between 38-78 days and females 49 - 89 days of age. 3. Weight gain in both sexes followed patterns consistent with other studies using this strain, but interexperimental variation was as much as +/-22%. 4. Rectal temperatures of females averaged 37.28 degrees C, being statistically greater (P < 0.05) than the average male at 36.99 degrees C. 5. The data provide reference values for use in toxicological and other investigations.

Dietary fats and coronary heart disease.

The prevention and treatment of coronary heart disease (CHD) necessitates vigorous dietary intervention so as to lower the serum cholesterol level by at least 6%. Greater decreases in serum cholesterol can bring about reversal of atherosclerosis. The critical dietary change is the reduction in intake of saturated fat and cholesterol. Some of this fat may be replaced by unsaturated fats, especially monounsaturated fat (olive or canola oil). Fish and the omega-3 fats they contain may also be useful for the prevention of CHD. The benefits of omega-3 fats occur within a few months and probably involve an anti-thrombotic effect. There is evidence that the intake of trans-fatty acids formed by the hydrogenation of oils should be reduced as they are associated with CHD. Hypolipidaemic drugs may be useful for persons at very high risk of CHD but should generally be avoided for primary prevention.

Blood cholesterol and coronary heart disease: changing perspectives.

There has been much controversy concerning the value of efforts to reduce blood cholesterol levels. In this contribution, the risks and benefits of interventions are discussed. Lowering cholesterol level by drugs is not recommended except in a small minority of subjects at very high risk of coronary heart disease (CHD), since it causes an excess of non-CHD deaths. Dietary intervention, by contrast, is safe. However, for it to be effective it must be sufficiently vigorous to achieve a drop in blood cholesterol of at least 6%, though considerably more is preferable. This action should be part of a more general effort aimed at the prevention of all Western diseases based on changes in lifestyle.

Towards a new system of health: the challenge of Western disease.

Over the last three decades, the concept of Western disease has become well established. Medicine has approached this group of diseases by searching for new cures but has achieved relatively little success. We argue that medicine should now accept the failure of this strategy and place a major emphasis on prevention. The key objective is to change the climate of opinion so that prevention is taken seriously by the general population. The chief activity should be a wide ranging public education campaign so as to persuade people to live a healthier lifestyle. Medicine will require restructuring in order to carry out this work. Medical education needs to be reformed so that medical students receive the necessary training. This must be done as part of an integrated approach in which government, industry and medical research all play a major role. Governments should use taxation and subsidies in areas such as food and tobacco so as to shift consumption patterns towards healthier products. Governments must also tighten laws on tobacco sales and advertising, support health education, and improve food labelling. Industry must be made far more responsive to the health needs of the population. This should be done both by public education, so as to alter demand, and by government action. Medical research should change its emphasis from studying the detailed mechanisms of disease ("complex research") to studying the role of lifestyle factors ("simple research").

Evidence from immunoblotting studies on uncoupling protein that brown adipose tissue is not present in the domestic pig.

Adipose tissues and other tissues of the pig have been examined for the presence of the mitochondrial "uncoupling protein," characteristic of brown adipose tissue, in order to assess whether brown fat is present in this species. Mitochondria were prepared from various tissues and the proteins separated on the basis of molecular weight by sodium dodecyl sulphate--polyacrylamide gel electrophoresis. Immunoblotting procedures were then used to probe for uncoupling protein, employing a rabbit anti-(rat uncoupling protein) serum. Pigs were examined at 4 days, 4 weeks, and 8 weeks of age. No evidence for the presence of uncoupling protein was found at any of these ages. The protein was, however, readily detected in brown adipose tissue from rats, mice, golden hamsters, guinea pigs, Richardson's ground squirrel, and lambs. An additional group of pigs was acclimated to the cold (10 degrees C) for a period of 10 days prior to the examination of tissues, but again uncoupling protein was not detected in any tissue. These results indicate that uncoupling protein is either absent from adipose tissues of the pig or is present at such a low concentration that it is unlikely to support thermogenesis. It is concluded that the pig does not contain adipose tissue that is functionally "brown;" adipose tissues in this species appear to be exclusively "white."

Serum vitamins A and E, beta-carotene, and selenium in patients with breast cancer.

A total of 89 subjects including 30 breast cancer patients with distal metastases, 29 patients with benign breast disease, and 30 healthy subjects were studied. Serum samples from these subjects were obtained from the National Cancer Institute (NCI) Breast Cancer Serum Bank, Bethesda. Serum concentrations of vitamin A and its transport proteins (prealbumin and retinol-binding protein [RBP]), beta-carotene, vitamin E, and selenium were determined. For each of these parameters the mean for the breast cancer patients was lower than that of the healthy subjects. The differences between healthy subjects and patients with either breast cancer or benign breast disease were, however, statistically significant only in the case of RBP (p less than 0.05). In the case of vitamin A and its transport proteins these differences were reduced by comparing the cancer patients with the benign breast disease patients rather than with the healthy controls. This indicates that the low serum levels for those three parameters may be merely a consequence of disease in general rather than a feature of cancer per se.

Dietary fibre and the mouse colon: its influence on luminal pH, reducing activity and bile acid binding.

Female, Swiss mice were fed semi-synthetic diets for 33 days. The diets were fibre-free (FF) or supplemented with corn bran (CB) 12%, wheat bran (WB) 12%, alfalfa (AL) 12%, pectin (P) 6%, cellulose (CL) 6%, or lignin (LG) 6%. Fibre caused little hyperplasia of the colon mucosa. The number of cells per crypt was increased 9-13% and the crypt column length by 14-19% in the CL, AL and LG groups. CB caused rather less hyperplasia, WB less again and P caused none. The colon mucosal DNA content was approximately 5-10% lower in mice given supplemental fibre. The pH of the contents of the distal colon was apparently unaffected by fibre. Measurement of a non-specific, non-enzymic reducing activity indicated that activity was doubled by AL and LG, lowered 41% by CB but little changed by WB, CL and P. The deoxycholate binding capacity of the colon contents was increased 3--4-fold by LG, whereas the other fibre sources were without appreciable effect. This high binding capacity by LG was also seen in the material used for diet preparation. Analyses of the contents of the caecum and of the remaining colon indicated that as food residue passes from the caecum to the remaining colon little change in binding capacity occurs.