Masters Degrees (Nutrition and Dietetics)

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Open Access
Causes of malnutrition in Mangaung
(University of the Free State, 2005) Pienaar, Michelle; Walsh, C. M.; Dannhauser, A.
English: Malnutrition is often a silent and invisible problem and its persistence has profound and devastating implications for children, society and the future of humankind. While good nutrition is extremely important for a healthy lifestyle and quality of life, the effects of poor nutrition are devastating. Before interventions can be implemented however, it is essential to determine the specific causes of malnutrition in a community. The community of Mangaung is a rapidly urbanizing community where the double burden of malnutrition and diseases of lifestyle occur simultaneously. The causes of malnutrition are seen as deeply rooted in environmental factors, such as poverty and lack of education. In any attempt to improve nutritional status it is therefore important to assess the relationship between certain environmental factors and nutritional status indicators. The aim of this study was to assess nutritional status (anthropometric status and dietary intake) and household resources (household and parent/caregiver particulars), in an attempt to identify specific issues that play a role in the development of malnutrition. The main objective of this study was thus to provide baseline data on causes of malnutrition in two areas of Mangaung, namely JB Mafora and Namibia. Household information and socio-demographic status were determined by means of a questionnaire completed in an interview. BMI of caregivers and weight-for-age, height-for-age and weight-for-height of children younger than six years were obtained using standard techniques. Dietary intake was determined by a questionnaire during an interview. The results in the study identified a number of socio-demographic factors associated with malnutrition. A concerning percentage of households had no income and in most households only one person contributed to income. Although a large proportion of breadwinners in the study areas were employed, a large proportion of household members where either unemployed or were dependent on another source of income, i.e. pension. In a large proportion of households, none of the women used any family planning. The percentage of respondents who ever attended clinics, were high. Level of education of household members older than 18 years showed that only a few of household members received education on tertiary level, while more than ten percent had no schooling. Regarding medical conditions a significant amount of household members indicated hypertension. As expected, diarrhea, loss of appetite and weight loss was generally more prevalent in underweight caregivers, but differences were not statistically significant. The prevalence of overweight and obesity in the studied group of household members was an outstanding anthropometric feature, with almost half of caregivers falling in the overweight or obese categories. Results of this study indicated that the number of well-nourished children in this study was small. The percentage of underweight children (17%) was higher when compared with the NFCS (1999), while a large percentage (30.3%) of children were stunted. As expected, a much smaller percentage of children (9.2%) in the study had a reduced weight-for-height than a weight-for-age or height-for-age. A relatively large proportion of the respondents did not consume foods from all three groups during each meal. Almost all adults did not consume a balanced breakfast, the majority did not include all three food groups for lunch and more than half did not have a balanced supper. In the case of children, a high percentage did not eat a balanced diet. In the case of babies (between birth and six months), results showed that approximately 80.0% of babies received a well balanced diet throughout the day. This is due to the high percentage of mothers who exclusively breastfed their babies. With the view to implementing a relevant nutrition education intervention program in Mangaung in the future, this base-line study (2004) was considered essential. Findings on the existing nutritional status and specific causes of nutritional problems of the community of Mangaung, can make a meaningful contribution to the design of effective nutrition intervention programmes.
Open Access
Eating practices, nutritional knowledge and body weight in nursing science students at the University of Fort Hare
(University of the Free State, 2009-09) Okeyo, Alice Phelgona; Dannhauser, A.
English: The prevalence of overweight and obesity in college and health science students is increasing. This study determined whether eating practices and nutrition knowledge are associated with body weight in nursing science students. The study also evaluated the association between socio-demographic factors and body weight status. A cross-sectional survey of 161 full time undergraduate nursing science students (31.7 % male and 68.3 % female), aged 18 and above, were chosen randomly from the University of Fort Hare. Validated questionnaires were used to determine the socio-demographic factors, eating practices and nutrition knowledge. Eating practices were determined by means of a 24-hour recall and a short food frequency questionnaire. Standard techniques involving a calibrated platform electronic scale and stadiometer, as well as a standard tape measure were used to measure weight, height, waist and hip circumference so as to calculate body weight status (Body mass index (BMI), Waist circumference (WC), and Waist hip ratio (WHR)). Descriptive statistics were used to describe the data, including, frequencies and percentage for categorical variables and means and standard deviations or medians and percentiles for continuous data. The underweight, normal weight and overweight/obese groups were compared by means of 95 % confidence intervals for median differences. This study showed that less than half of the students (46.0 %) were of normal weight (58.8 % male students compared to 40.0 % female students). The prevalence of overweight and obesity was more common among female students compared to males (36.4 % and 21.8 % versus 21.6 % and 9.8 %, respectively). In contrast, 9.8 % male students were underweight compared to 1.8 % females. Sixty two students had WC values above the cut off points (≥ 88 cm: F; ≥ 102 cm: M) while sixty students had WHR values above the cut off points (≥ 0.8: F; ≥ 0.9: M). Important observations of the usual daily food intake showed that less than the daily recommended number of food portions from the food groups were consumed for milk and milk products (92.6% of students); vegetables (97.5 %) and fruits (42.2 %). More than the recommended number of portions per day was consumed for meat and meat alternatives (81 %), sweets and sugar (77.8 %), fats and oils (50 %). The recommended number of servings per day was only met for bread and cereals (82.7 %). Median daily energy intake for female students (5543.3 kJ) was significantly lower than that of males (6333.3 kJ). For all students the median energy and fat intakes were relatively low, while carbohydrate and protein intakes were higher than the RDA. Usual meal patterns showed that 59 % of students ate three meals daily and the most frequently skipped meal was breakfast. Foods most often consumed on a daily basis were salt/stock/royco (85.8 %), margarine/oils/fats (67.9 %), sugar (58.6 %), bread (55.6 %) and cereal (34.7%). Foods most often not consumed included low fat/skim milk (76.5 %), alcohol (73.5 %), cremora (48.2 %), soy mince/legumes, baked beans, dried beans/peas and lentils (45.7 %), and peanut butter (42.6 %). A significant higher percentage of underweight (14.3 %) than overweight/obese (1.3 %) individuals consumed bread and cereals below the recommended daily requirements. More overweight/obese (72.5 %) than underweight (28.6 %) students ate chips/crisps on a daily basis. Fat consumption in underweight students was significantly less than that of overweight/obese students. Significantly more overweight/obese (90 %) than underweight (57.1 %) students ate sweets and chocolate on a daily basis, and significantly more underweight (57.1 %) than normal weight (16.2 %) students consumed low fat/ skim milk on a daily basis. Of 162 students, 69.3 % were uninformed of the food groups to eat the most and 24.9 % of which food groups to eat least, according to dietary guidelines. The recommended daily portions from the food groups were not known by the students: 85.7 % of students did not know the daily recommended servings for bread, cereal and pasta, 54.7 % did not know the recommended servings for vegetables and 54.7 % did not know the recommended serving for meat, poultry, fish dry beans, eggs and nuts. Over 60.2 % did not know the daily recommended servings for milk and milk products. Over 55.3 % of students knew the recommended servings for fruits, 92.6 % knew foods with high fiber content, 50.3 % knew that peanut butter has a high fat content, while 96.3 % knew the best sources of beta carotene. The median percentage for correct answers obtained in the nutrition knowledge test was 56.3 %. Of 162 students, 34.2 % scored less than 50 % while 65.8 % scored more than 50 % in a nutrition knowledge questionnaire. There was no statistical significant difference between BMI categories in terms of the score in the nutrition knowledge test. However, significantly more underweight (63.5 %) than overweight/obese (1.4 %) students knew the recommended servings for milk, cheese and yoghurt. Significantly more normal weight students (20.3 %) than overweight/obese (8.8 %) students knew the daily recommended servings for bread, cereal, rice and pasta. Significantly more overweight (95.0 %) than underweight (71.1 %) students knew carrot as a good source of ß-carotene. In conclusion, healthy eating practices need to be emphasized in this group while ensuring an adequate awareness campaign. The findings suggest the need for strategies designed to improve competence in the area of nutrition, especially with respect to information relating to guidelines for healthy eating practices and healthy weight management. Nutritional education for female students, especially related to body weight management is recommended. Interventions for the prevention and control of obesity must go much further than simply prompting nutrition knowledge.
Open Access
The effect of a combination of short-chain fatty acids on glycometabolic control in men
(University of the Free State, 2002-12) Van Onselen, Annette; Dannhauser, A.; Veldman, F. J.
English: Dietary fibre has revealed benefits for health maintenance and disease prevention and as a component of medical nutrition therapy. Dietary fibre forms an important part of the Westemised diet, which is characterised by low-fat, low-carbohydrate and low-fibre intake. A high-fibre diet may favourably influence glycometabolic control. It is believed that short-chain fatty acids (SCF As) may partially be responsible for some of the beneficial effects of dietary fibre on metabolism. These SCFAs namely, acetate, propionate and butyrate arc the major products of colonic fibre fermentation. Some of the SCFAs have been shown to improve blood glucose and insulin levels. However, the effect of a combination of SCFAs on glycometabolic control is still unclear. The main aim of the study was to determine the effect of a combination of SCFAs (acetate: propionate: butyrate in the ratio of 70: 15: 15, respectively) and (acetate & propionate: in the ratio of 50:50, respectively) on glycometabolic control in men. The study was a randomised, placebo-controlled, double-blinded clinical trial. Voluntary subjects were recruited for this study using a very strict set of inclusion criteria. All subjects received a placebo for a period of one week following the collection of baseline blood samples and other information. A second baseline blood sample was collected from each individual at the end of this period to ensure accurate reflection of the variables and a stable baseline. Subjects were randomly assigned to three different intervention groups and consumed the different mixtures of either placebo, acetate-propionatebutyrate or acetate-propionate supplement for a period of four weeks following the second baseline blood collection. Supplementation of eight capsules daily was sustained for four weeks. Metabolic indicators (serum glucose, serum insulin, serum albumin, total protein, total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, non-esterified fatty acids (NEF A), anthropometric status and blood pressure were measured at baseline two (day 8) and after supplementation (day 36). A wash-out period of one week following the supplementation period measured any changes in the metabolic indicators (day 43). The usual dietary intake of the subjects was obtained using a food frequency questionnaire (FFQ) at baseline one (day 0) and after supplementation (day 36). Anthropometric status included body mass index (BMI) and waist-to-hip ratio (WHR), which were measured by means of standardised methods (on days 1, 8 and 36). The BMI and WHR fell within the normal range, and remained within the normal range during the study. This indicated that the subjects were apparently healthy. The study group was also of homogeneous nature, mainly as a result of the strict inclusion criteria applied at the time of recruitment of the subjects. The fasting serum glucose levels were within the higher normal range (5.1 - 5.7mmollL). No statistically significant changes were observed in any of the glycometabolic parameters following supplementation with the different SCFAs regimens (acetate, propionate and butyrate; acetate and propionate). Total cholesterol (TC) levels of the subject group as a whole fell within the normal range of the population (3.0 - 5.2mmollL). However, the observed levels fell in the higher normal range (4.1 - 4.8mmol/L). The HDL-C levels increased slightly in group three (acetate and propionate) and slightly decreased in group two (acetate, propionate and butyrate), however not significantly. The LDL-C significantly decreased in group two (acetate, propionate and butyrate). The observed decreased in systolic blood pressure were statistically significant after the intervention period in group two (acetate, propionate and butyrate). However, observed changes in LDL-C and systolic blood pressure were of no clinical importance. The FFQ indicated a tendency towards the adoption of an atherogenic Westenised diet. This study could not shown that a combination of short chain fatty acids have a beneficial effect on glycometabolic control. The findings of this study are supported by other studies, which indicate that acetate, propionate and butyrate do not improve glucose metabolism in healthy subjects. In contrast, other studies indicated a decrease in fasting serum glucose concentration from propionate (Todesco et aI., 1991) and acetate (Jenkins et aI., 1991) as well as from a combination of acetate, propionate and butyrate (De Wet, 1999). The controversial results regarding the effect of short chain fatty acids on glucose metabolism emphasize the importance of further investigation about the association between physical characteristics and formation of SCFAs, as well as the different combinations of SCFAs over a longer period of time.
Open Access
The effect of a combination of short-chain fatty acids on plasma fibrinogen concentrations in Westernised black men
(University of the Free State, 1999-11) De Wet, Martie; Dannhauser, A.; Veldman, F. J.
English: The incidence of the western diseases, atherosclerosis, CHD and stroke is progressively rising in black populations worldwide and in South Africa. Stroke is an important cause of death in black populations in South Africa and may increases even further if risk factor (coronary and some haemostatic risk factors) prevalence is altered by change in lifestyle and diet, westernisation and migration to an urban environment. Raised fibrinogen levels which are more prevalent in westernised black men than white men, are accepted as an important risk factor for stroke and CHD. It is believed that the possible protective effects of diet against the development of atherosclerosis and thrombosis could be mediated, in part, through haemostasis. A prudent low-fat, high-fibre diet may favourably influence haemostasis. More specifically, oat bran (soluble fibre) has been shown to have beneficial effects on some coronary risk factors and haemostasis. The physiological effects of dietary fibre are strongly related to SCFAs, which are produced by colonic fibre fermentation. According to available literature, SCFAs could possibly have a beneficial effect on lipid profiles and haemostatic risk factors. Little information is, however, available on the effect of a specific combination of SCFAs on fibrinogen levels and other haemostatic factors in human subjects. The main objective of the study was to examine the effect of a combination of SCFAs, resembling oat bran (acetate:propionate:butyrate – 65:19:16) on plasma fibrinogen levels, some haemostatic risk factors and other related risk factors for CHD and stroke in westernised black men. The study was a randomised, placebo-controlled, double-blind clinical trial. 22 subjects falling within a pre-determined set of inclusion criteria, and with higher normal fibrinogen levels were randomly selected into an experimental group (n = 11) and placebo group (n = 10). Supplementation of 12 capsules daily was sustained for five weeks. Total plasma fibrinogen, fibrin monomer concentration, fibrin network properties, factor VII and factor VIII activity, serum lipids, glucose concentrations, some metabolic indicators and fasting acetate concentrations were measured at baseline and at the end of supplementation, in all subjects. The usual dietary intake of the subjects was obtained using a food frequency questionnaire and a 24-hour recall. According to the baseline results, the subject group was homogeneous with an apparently healthy clinical and physical appearance. Although both subject groups had a favourable coronary and haemostatic risk profile, total cholesterol levels as well as factor VII and factor VIII activity were in the higher normal ranges. Furthermore, the 24-hour recall indicated a tendency towards the adoption of an atherogenic Westernised diet. Although SCFA supplementation had no effect on the fibrinogen concentrations, a significant decrease was observed in the fibrin monomer concentrations, network fibrin content, factor VII and factor VIII activity. A significant increase was observed in the compaction of the fibrin networks, as well as a tendency for the mass to length ratio of the fibrin fibres to increase. Furthermore, a statistically significant although not clinically significant increase was indicated in HDL cholesterol concentrations after SCFA supplementation. It was evident from these findings that SCFA supplementation may have a direct effect on haemostasis, especially the fibrin network characteristics, factor VII and factor VIII activities, as well as fibrin monomer concentration. This observation suggests that SCFA supplementation may have a strong protective effect against atherosclerosis and thrombosis. In conclusion, the hypothesis that soluble dietary fibre will influence fibrinogen concentrations and other haemostatic risk factors through production of SCFAs, was proven to be partially true. It was clear that, although fibrinogen concentration was not influenced by SCFA supplementation, beneficial effects on the fibrin network architecture and the positive cascade effect on haemostasis may be a direct effect of SCFAs supplementation. The study further indicated that the known protective effects of dietary fibre on CHD could partially be mediated through effects of SCFAs on fibrin networks. It is recommended that the role of fibrin networks as a risk factor for CHD and the effect of diet on haemostasis should be further investigated.
Open Access
Evaluation of the iodine deficiency disorders control program in Lesotho
(University of the Free State, 2003-05) Sebotsa, Masekonyela Linono Damane; Dannhauser, A.; Jooste, P. L.
The broad range of disorders in a population caused by an inadequate dietary supply of iodine was denoted as iodine deficiency disorders (JDD), which include endemic goitre, hypothyroidism, cretinism and congenital anomalies. When iodine deficiency is widespread, mental retardation impedes national human resource development. Despite the known effective control measures, 130 WHO member states have a significant JDD problem. Severe to mild JDD have been reported in Lesotho since 1960. The most cost-effective and sustainable intervention to eliminate JDD is the iodisation of all edible salt. However, several countries with long standing salt iodisation programs have reported declining levels of urinary iodine. In Lesotho, the legislation on universal salt iodisation was promulgated in 2000. Therefore the aim of the study was to evaluate the salt iodisation program in Lesotho in terms of process, impact and sustainability indicators. A 30 cluster national survey was conducted where the proportion to population size method was administered. In each cluster, 30 women aged 15 to 30 years, and 30 primary school children aged 8 to 12 years, were randomly selected. The selected women and children were palpated and thyroid size graded according to WHOIUNICEFIICCJDD (2001) criteria and urine samples collected. 30 salt samples were collected from these selected women, 6 samples from 2 randomly selected retailers in each cluster, and 107 samples collected from all the commercial entry points in the country. The salt samples were analysed using the iodometric titration method while urine samples were analysed using the method using ammonium persulfate according to WHOIUNICEFIICCJDD (2001) recommendations. This analysis was performed at the Medical Research Council in Cape Town (South Africa) where the Coefficient of Variation for urinary iodine analysis was 7.7 at a concentration of IOug/l, and was 2.7 at a concentration of 70ppm for titration method of salt analysis. The statistical analysis was done using the SAS program at the University of the Free State (South Africa). A total of927 children and 930 women who were palpated, and 912 children and 924 women who gave urine samples, were included in the analysis of the results. 930 salt samples from household level, 186 from retail level and 107 from entry point level were analysed. 3 salt samples from entry point, 18 and 6 data sheets for urinary iodine of women and children respectively were not included during statistical analysis. The median iodine concentration of salt was 36.2ppm (ranging from 30.5-55.4ppm in the different entry points), 37.3ppm (ranging from 12.4-50.2ppm in the different districts) and 38.5ppm (ranging from 29.2-43.2ppm in the different districts) at entry point, retail level and household level respectively. At household level only 1.6 percent used non iodised salt and 86.9 percent used adequately iodised salt. The analysis of the urine samples showed that the median urinary excretion was 214.7flg/1 (ranging from 62.9flg/1 to 302.6flg/l in the different districts) for the children and 280.1flg/ (ranging from 124.8flg/1 to 381.6flg/l in the different districts) for the women, indicating more than adequate iodine intake according to the WHOIUNICEFIICCIDD (2001) report. The median iodine concentration was higher in boys (219.3flg/l) than in girls (212.6flg/I), higher in the Lowlands (256.0 flg/l in children and 329.9 ug/l in women) than in the Mountains (99.30flg/l for children and 182.6flg/1 in women) and higher in non-pregnant women (283.0 ug/l) than in pregnant women (212.1 ug/l). In the whole country, the prevalence of goitre was 10.7 percent (ranging from 6.6% to 22.6 % in the different district) in children and 19.4 percent (ranging from 6.7% to 36.7% in the different districts) in women, which indicates mild IDD (WHOIUNICEFIICCIDD, 2001). IDD were observed more in females (14.0%) than in males (7.0%) and was less (4.3%) in children aged 8 than in children aged 12 years (12.9%). In women IDD increased with age from the age group of 15 to 19 (17.3%) to the age group of 20 to 25 (22 %) and decreased in the age group of 26 to 30 (18.4%). Similar to urinary iodine results, IDD was observed more in the Mountains (17.7% for women and 18.1% for children) than in the Lowlands (14.3% for women and 6.7% for children). Only the urinary iodine excretion reached the WHOIUNICEFIICCIDD (2001) sustainability goals. At household level, 86.9 percent of the households, which is slightly lower than the recommendation of at least 90 percent, use adequately iodised salt. Out of 10 programmatic indicators of sustainability, only 4 indicators have been attained by the salt iodisation program in Lesotho. According to the WHOIUNICEFIICCIDD (2001) at least 8 of the programmatic indicators should be attained for sustainable elimination ofIDD. The study demonstrates a major achievement in the household use of iodised salt and adequately iodised salt. However, salt is not iodised according to the legislation on universal salt iodisation in Lesotho due to under iodisation and non- uniformity of salt iodisation at the production site. Iodine deficiency has been eliminated as a public health problem in Lesotho and this is due to the introduction of the legislation on universal salt iodisation. This study highlighted the effectiveness of iodised salt in increasing urinary iodine concentration. Iodine deficiency increased with age and was higher in girls than in boys, and higher in the Mountains than in the Lowlands. IDD elimination in Lesotho will be sustainable if more than 90 percent of the households use adequately iodised salt and the programmatic indicators such as commitment to reassessment, political commitment, implementation of social mobilization program and reqular monitoring are achieved by the IDD control task force. The administrative structure and activities of the IDD control task force need to be revised and strengthened for the sustainable elimination ofIDD. The terms of reference of the committee should be revised, budgets for the activities be drawn, new members added and trained and responsibilities given to each member. Awareness campaigns, which will start at policy makers' level, should be initiated. Law enforcement should be an integral part of the salt iodisation program. Effective regular monitoring of salt iodine content at all levels with special attention to iodisation of coarse salt is recommended together with periodic evaluation of the iodisation program.
Open Access
The goitre prevalance and urinary iodine status of primary school children in Lesotho
(University of the Free State, 2000-11) Sebotsa, Masekonyela Linono Damane; Dannhauser, A.; Jooste, P. L.
English: Iodine deficiency has been called the world's most significant cause of mental retardation. Studies conducted since 1960 have indicated iodine deficiency as public health problem in Lesotho. The ICCIDD has been instrumental in focusing the world's attention on 100 and the goal of virtual elimination of 100 as a public health problem by the year 2000 was accepted by the united systems in 1990. This goal was reaffirmed by the e" World Health Assembly in 1993, which also provided a strategic guidance including emphasis on salt iodisation. The main objective of this study was to estimate the current 100 situation in Lesotho 5 years after the 1993 National Micronutrient Survey which was followed by iodised oil capsule supplementation as a short term intervention and the introduction of the legislation on universal salt iodisation as a long term intervention. This was a cross sectional study where stratified random sampling was used to select 5 schools in each of the 10 districts of Lesotho. All children aged 8 to 12 years from the selected schools participated in the study. The size of the thyroid gland was determined by palpation and graded according to the Joint criteria of the WHO/UNICEF/ICCIDD (1994). Casual urine samples were obtained from 10 children in each school in the morning during school hours and frozen until they were analysed for urinary iodine level using the Sandell-Kolthoff reaction involving alkaline ashing at the National University of Lesotho. Using a structured questionnaire, iodised oil supplementation coverage was determined. Salt samples brought by children were also analysed for the presence of iodine using the rapid (spot) test kits. The SAS package was used for statistical analysis of the results at the University of Orange Free State. 4071 primary school children were palpated and responded to the questionnaire, 4071 salt samples and 500 urine samples were analysed. The median urinary iodine concentration of 26.3IJg/l, which ranged from 22.3IJg/1to 47.91Jg/l and from 25.7IJg/1 to 27.2IJg/1 in the different districts and ecological zones respectively, indicated moderate 100. The prevalence of goitre, which increased with age and was higher in females than males, ranged from 2.2 to 8.8 percent and from 2.3 to 6.3 percent in the different districts and ecological zones respectively indicating mild to normal iodine deficiency. The adjusted prevalence of goitre for the whole country was 4.9 percent, indicating the absence of 100. 94.2 percent of salt samples were iodised. Coverage on iodised oil capsules supplementation, which was 55.1 percent, was not adequate. Lesotho was found in this study as having mild to moderate 100, which is still of public health concern according to WHO/UNICEF/ICCIOO (1994). Iodine deficiency was higher in the Mountains than in the Lowlands. However there is an improvement in controlling 100 in Lesotho as observed from the results of the present study and those of the previous studies. The use of iodised salt and iodised oil capsules has most likely contributed to a decrease in the 100 prevalence. Similar studies using ultrasonography and the titration method need to be conducted in the future. More iodised oil supplementation is recommended in the Mountains and in schools, which never received the capsules and this needs to be coupled with efficient awareness programs. An effective monitoring program needs to be initiated to ensure that the entire population use adequately iodised salt.
Open Access
Impact of a diet intervention program on the serum albumin concentrations, antropometrical status and quality of life of breast cancer patients receiving chemotherapy
(University of the Free State, 2005-11) Smalberger, René; Dannhauser, A.
English: Breast cancer patients receiving chemotherapy at ECOC, often present with lowered serum albumin concentrations, so much so that the lowered serum albumin concentrations first has to be treated before the next cycle of chemotherapy can be administered. The delay in chemotherapy treatment had financial, medical and emotional effects on the patients. The objective of this study was to determine the effect of an optimal energy increased protein (OEIP) dietary treatment on serum albumin concentrations, anthropometrical status and quality of life of breast cancer patients receiving chemotherapy. In a clinical trial, 27 female breast cancer patients were randomised to an experimental group (E) (n=13), receiving an individualized OEIP diet consisting of food and a nutritional supplement, or a control group (C) (n=14), receiving no dietary intervention. Baseline and three-weekly visits involved determining serum albumin concentrations; anthropometrical assessment, including body weight; BMI, MUAC, TSF, MAFA, MAMA, BF% and LM%; and the completion of a quality of life questionnaire. Both groups kept a food diary for the duration of the study. Median ages of the E-and C-groups were 52.62 and 51.19 years respectively, ranging from 29 to 59 years. Statistical analysis included, median and percentiles for continuous data, and frequencies and percentages for categorical data, with 95% CI for median differences. Due to the small sample size, nonparametric statistics were used to compare results. By taking a daily nutritional supplement, the E-group was able to consume a significantly better amount of all macro- and micronutrients. The C-group showed a median drop of 3 g/dL in serum albumin concentrations with a median end value of 36.5 g/dL, while the E-group showed a statistically significant [2; 6] median increase of 1.5 g/dL, with a median end value of 39 g/dL, suggesting that the dietary intervention had been successful in improving serum albumin concentrations over the treatment period. No statistically significant changes were noted in either the E- or C- group’s performance status scoring. The Rotterdam Quality of Life Survey found the Egroup had a significant improved quality of life scoring during Visits 5:B, compared to the C-group for the same period. Other studies have also shown an improvement in quality of life measurement after the implementation of a dietary intervention programme in cancer patients. An optimal energy diet, sufficient to maintain the patient’s ideal body weight and not actual body weight, with a protein intake of 1.04 g/kg/day was sufficient to significantly improve serum albumin concentrations, to such an extent, that chemotherapy cycles did not have to be postponed. Regardless of nutritional intake, no statistically significant changes were found in weight, BMI, MUAC, TSF, MAFA or MAMA. The E-group showed a significant increase in BF% and a decrease in LM% for the duration of the study, compared to the C-group. The increase in BF% could possibly be explained by the high-energy, increased fat intake of the E-group. Changes in protein metabolism and the increased protein needs of the body could possibly explain the changes in LM%. From this study it may be concluded that an OEIP diet is not effective in preventing LM wasting. An OEIP (1-1.5 g/kg/day) dietary intervention, is therefore recommended for breast cancer patients receiving chemotherapy. Nutritional intervention should commence at an earlier point to determine the effect of such intervention on patients’ quality of life. It is recommended that the study be repeated with a larger sample size, to confirm tendencies found in the present study and to determine the long-term effect of an OEIP diet intervention on serum albumin concentrations, the anthropometrical status, and the quality of life of breast cancer patients receiving chemotherapy.
Open Access
The impact of an enzyme-modified enriched maize-based supplement on the anthropometric nutritional status of institutionalised HIV+ children
(University of the Free State, 2013-07) Van der Walt, Erika; Dannhauser, A.; Veldman, F. J.
English: HIV/AIDS negatively influences the health, quality of life and nutritional status of infected individuals. The negative influence on nutritional status is even worse in children than in adults, due to children’s additional needs for growth. The aim of this study was to determine the impact of an enzyme‐modified, enriched maizebased supplement on the anthropometric nutritional status of children infected with HIV, and residing in or attending day care at institutions for HIV‐infected and affected children in Mangaung. A total of 155 food secure HIV‐infected children aged 1 – 10 years were screened to determine HIV status. HIV‐infection was confirmed in 37 clinically stable, antiretroviral naïve children, who were included in the study sample. The study was a randomised, double blind, clinically controlled, prospective trial. Intervention over a period of 16 weeks consisted of an experimental and control supplement given to the children in the experimental‐ (E) and control (C) groups respectively. Both products were enriched maize/soy blends of exactly the same nutritional value, except that α‐amylase was added to the E‐product. The addition of α‐amylase to starchy foods decreases the viscosity of the mixed product, enabling the individual to consume larger quantities for more energy and nutritional benefit, especially in the case of young children with high nutritional needs but lack of capacity to consume large enough quantities to provide in these needs. Twenty‐nine children completed the intervention. The mean age of the 29 (E=14; C=15) at baseline was 64.1 months (SD 23.6 months). Baseline nutritional status of the children was poor. Underweight for age was identified in 42.9% of both the E‐ and C‐groups. The median Z‐score for WAZ was ‐1.9 for both the E‐ and the C‐group. These findings support findings of other researchers that growth in HIV‐infected children is significantly slower than in noninfected children. A high percentage of stunting was found in both groups: 57.1% in the E‐group and 80% in the C‐group were stunted. The median Z‐scores for HAZ were ‐2.3 for the E‐ and ‐2.9 for the C‐group. This was in accordance with findings of other researchers who reported that HIVinfected children are more often stunted than non‐infected children. The prevalence of stunting in this study is high in comparison to existing national data for children of unknown HIV status. The poor anthropometric nutritional status in children in care centres emphasises the detrimental effect of HIV‐infection on the nutritional status and growth in young children, as well as the importance of extending community based nutrition intervention initiatives to care centres and other facilities taking care of HIV‐infected and HIV‐affected children. Although the data of the intervention phase of this study did not show significant improvement in the anthropometrical nutritional status, other studies using a product with added α‐amylase did show improvement in anthropometrical nutritional status. The practical problems experienced in the present study may have had a negative effect on the outcome of the study. In conclusion, the high prevalence of malnutrition found at baseline, indicate that children infected with or affected by HIV are vulnerable and that being a resident or being registered at a care centre does not necessarily protect them from malnutrition. It is important that children in these facilities are included in routine health and nutritional assessments and that the centres are included in initiatives that target malnutrition. HIV‐infected children in care centres should receive more aggressive nutrition support to make provision for their increased requirements and also to protect them from malnutrition and early disease progression. The inclusion of additional sources of energy dense supplements such as RUTF to current supplementation regimens for malnourished children may be needed to achieve catch‐up growth in malnourished children.
Open Access
Prevalence of the known risk factors in women diagnosed with breast cancer at Queen II Hospital, Maseru
(University of the Free State, 2011-11) Lehlasoa, 'Mamotlatsi Rose; Dannhauser, A.; Van den Berg, V. L.
English: Breast cancer is the leading cancer in the world among women, both in industrialised and developing countries. While the USA has the highest prevalence and mortality rates of the disease, with middle prevalence rates in Eastern Europe; Africa and Asia have low rates. In South Africa breast cancer is the most common cancer and is being diagnosed with increasing prevalence among the black population. No literature is, however, currently available regarding the prevalence of breast cancer, the prevalence of the risk factors for breast cancer, or the associated mortality rates for breast cancer in Lesotho. The aim of this study was to determine the prevalence of the known risk factors for breast cancer among adult women who were diagnosed with the disease at the Queen Elizabeth II hospital, Maseru. A descriptive survey was conducted on 52 adult breast cancer patients seen at the Queen II hospital in Maseru, who gave informed consent. A trained researcher performed anthropometric measurements and administered a questionnaire on usual dietary intake and non-modifiable and modifiable risk factors for breast cancer, during structured interviews. Reliability was ensured by repeating the same questionnaire with 10% of the sample a month after conducting the main study. Regarding the non-modifiable risk factors for breast cancer, the majority of the Basotho women in this study were diagnosed with breast cancer at 46 years and older (78.7%), experienced menarche at 12 years and older, (93.9%), had reached natural menopause, did not use hormone replacement therapy, and had reached menopause before the age of 55 years (96.8%). Regarding the modifiable risk factors for breast cancer, the Basotho women had a low risk profile with low levels of education (80.8% had only primary or high school educations), low incomes (59.6%), low oral contraceptive use (65.4% had never used), and were mostly non-drinking (48.1%) and low-drinking (36.5%). Most were also, or had been, married at the time of the study (82.7%), had children (80.8%), and had breastfed for ≥12 months (86.8%). However, these Basotho women were very inactive (82.6%), with high body mass indexes (21.1% overweight; 63.5% obese), waist circumferences, and waist to hip ratios putting them at high risk for breast cancer and other chronic diseases of lifestyle. Their self-reported median total energy and macronutrient intakes were 5414.5 kJ, 49g protein (0.63 g/kg/day), 210g carbohydrate, and 21.5g fat. Dietary intakes were evaluated according to the recommendations of the USDA Food Guide Pyramid and the Dietary Guidelines for Americans 2010. Although they had low intakes of meat, particularly red meat, drank tea regularly, and used cooking methods that did not produce cancer promoting agents, all of which protect against breast cancer development; their low intakes of fruits, and low variety of plant foods put them at risk of breast cancer and other diseases due to low supply of protective antioxidants and phytochemicals. Particularly vegetables were mostly only consumed as green leafy types (moroho), while other vegetables were only consumed occasionally and by small percentages. This study is the first to report on the known risk factors of breast cancer among women in Lesotho. In summary, these Basotho patients were found to have a low risk profile for breast cancer with regard to non-modifiable risk factors, reproductive history and socio-demographic factors. The main risk factors for breast cancer were inactivity and obesity, combined with a diet low in variety of protective plant foods. Intervention programmes should thus focus on addressing these modifiable risk factors.
Open Access
Supplement consumption and energy intake of HIV+ children receiving an enzyme-modified, enriched maize supplement
(University of the Free State, 2005-05) Cox, Cindy Deborah; Dannhauser, A.
English: Protein-energy malnutrition (PEM) is an important clinical manifestation of human immunodeficiency virus (HIV) infection in children and have immunosuppressive effects. Reduced energy and oral intake are the most prominent contributing factors leading to malnutrition. Several studies have proven that addition of amylase to bulky cereals decreases the viscosity of cereals and increases children’s dietary intake. However, the impact of amylase modified supplements (AMS) on actual AMS consumption and energy intake from AMS by HIV-infected children is unknown. The main objective of this study was to determine the actual supplement consumption and energy intake from a supplement by HIV-infected children. The study design was a double-blinded, randomized, clinical controlled prospective trial, and included 16 HIV-infected children resident in Lebone House. Children were stratified according to baseline age, CD4+ counts and weight-for-age, and randomly placed into an experimental (E-) group and a control (C-) group. The E-group received an enzyme-modified, enriched maize supplement (E-supplement) and the C-group received an enriched maize supplement (C-supplement). The supplements were served as a breakfast replacement on 4 days per week, for a total period of 16 weeks. The actual supplement consumption was determined by subtracting the amount of leftover supplement from the amount of supplement served. The energy intake from the supplements was calculated by the Department of Biostatistics, University of Free State. The actual supplement consumption was expressed as the mean amount of supplement consumed, the mean percentage of the served supplement consumed, and the percentage of days the participants consumed the entire supplement. The data on the actual supplement consumption demonstrated that the participants consumed large amounts (E-group 489g; C-group 490g) of supplements, which accounted to 98.1 percent and 98.6 percent of the E- and C-supplements served. The median of the percentage of times the E-group consumed the entire served supplement was 94.4 percent and 92.9 percent for the C-group. No statistical significant difference was established between mean amount of supplement consumed (p=0.83), mean percentage of supplement consumed (p=0.67) and the percentage of times the entire served supplement was consumed (p=0.83). The actual supplement consumption was influenced by the viscosities of the supplements and cultural acceptability. The mean energy intake from the supplement for both groups were high (E-group 2540.4 kJ; C-group 2553.2 kJ). The mean percentage of energy consumed from the supplement served was identical to the percentage of the served supplement consumed. No significant difference was observed for the energy intake between the two groups in terms of mean energy intake (p=0.67) and the mean percentage of energy consumed from the portion served (p=0.67). The energy intake of these HIV-infected children was increased with approximately 2000 kJ per day with the addition of a single portion of either supplement, even when the supplements were served as a replacement for their usual breakfast. In conclusion, this study demonstrated that reducing the viscosity of the experimental supplement with amylase did not significantly increase the consumption or the energy intake. Both supplements were palatable and acceptable for these HIV-infected children and also increased the total daily energy intake of the children. Both supplements can therefore be used in the rehabilitation of HIV-infected children in South Africa. Future research should evaluate whether the addition of amylase to an enriched soy-maize supplement would have a positive effect on the weight, immune status and health status of HIV-infected children in comparison to the control supplement without the added amylase. Future research should address the limitations mentioned in this study. Future application of the research if proven to have a significant benefit may include the use of the supplement as part of existing or new feeding schemes to improve the nutritional status of HIV-infected children.

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Browsing Masters Degrees (Nutrition and Dietetics) by Author "Dannhauser, A."

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