Research Articles (Nutrition and Dietetics)
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Item Open Access Iron status, anemia, and birth outcomes among pregnant women in urban Bloemfontein, South Africa: the NuEMI study(BioMed Central, 2024) Carboo, Janet Adede; Ngounda, Jennifer; Baumgartner, Jeannine; Robb, Liska; Jordaan, Marizeth; Walsh, Corinna May𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱 Despite routine iron supplementation for pregnant women in South Africa, anaemia and iron deficiency (ID) in pregnancy remain a public health concern. 𝗢𝗯𝗷𝗲𝗰𝘁𝗶𝘃𝗲 To determine the associations between iron status and birth outcomes of pregnant women attending antenatal clinic at a regional hospital in Bloemfontein. 𝗠𝗲𝘁𝗵𝗼𝗱𝘀 In this cross-sectional study of 427 pregnant women, blood was taken to analyze biomarkers of anaemia (haemoglobin), iron status (ferritin and soluble transferrin receptor) and inflammation (C-reactive protein and α-1-acid glycoprotein). A questionnaire was used to collect information about birth outcomes (birth weight and gestational age at birth), HIV exposure, sociodemographics, iron supplement intake, and maternal dietary iron intake using a validated quantified food frequency questionnaire. 𝗥𝗲𝘀𝘂𝗹𝘁𝘀 The median (Q₁, Q₃) weeks of gestation of participants was 32 (26, 36) at enrolment. Anaemia, iron deficiency (ID), ID anaemia (IDA) and ID erythropoiesis (IDE) were present in 42%, 31%, 19% and 9.8% of participants, respectively. Median (Q₁, Q₃) dietary and supplemental iron intake during pregnancy was 16.8 (12.7, 20.5) mg/d and 65 (65, 65) mg/d, respectively. The median (max-min) total iron intake (diet and supplements) was 81 (8.8-101.8) mg/d, with 88% of participants having a daily intake above the tolerable upper intake level of 45 mg/d. No significant associations of anaemia and iron status with low birth weight and prematurity were observed. However, infants born to participants in the third hemoglobin (Hb) quartile (Hb > 11.3–12.2 g/dL) had a shorter gestation by 1 week than those in the fourth Hb quartile (Hb > 12.2 g/dL) (𝘱 = 0.009). Compared to pregnant women without HIV, women with HIV had increased odds of being anaemic (OR:2.14, 95%CI: 1.41, 3.247), having ID (OR:2.19, 95%CI: 1.42, 3.37), IDA (OR:2.23, 95%CI: 1.36, 3.67), IDE (OR:2.22, 95%CI: 1.16, 4.22) and delivering prematurely (OR:2.39, 95%CI: 1.01, 5.64). 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻 In conclusion, anaemia, ID, and IDA were prevalent in this sample of pregnant women, despite the reported intake of prescribed iron supplements, with HIV-infected participants more likely to be iron deficient and anaemic. Research focusing on the best formulation and dosage of iron supplementation to enhance iron absorption and status, and compliance to supplementation is recommended, especially for those living with HIV infection.Item Open Access Bridelia ferruginea tea consumption improves antioxidant status in individuals living with Type 2 Diabetes(MDPI, 2025-01-07) Appiah, Collins Afriyie; Ngounda, Jennifer; Boakye-Yiadom, Mavis; Mills-Robertson, Felix Charles; Nel, Mariette; Johnson, Rabia; Walsh, Corinna𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱: It is well-known that persistent hyperglycaemia predisposes individuals with diabetes to oxidative stress. 𝘉𝘳𝘪𝘥𝘦𝘭𝘪𝘢 𝘧𝘦𝘳𝘳𝘶𝘨𝘪𝘯𝘦𝘢 Benth., a tropical African plant, is known for its antioxidant activity. 𝗠𝗲𝘁𝗵𝗼𝗱𝘀: This comparative cross-sectional study assessed the oxidative status and associated parameters in 70 individuals living with type 2 diabetes (ILWT2D) who were receiving standard diabetes treatment and consistently drank Bridelia tea (Bridelia group) compared to 92 ILWT2D receiving standard diabetes treatment only (comparator group). Lipid peroxidation assessed using thiobarbituric acid reactive substances (TBARS) served as an indicator of oxidative stress. In addition, the total antioxidant capacity (TAC), glycated haemoglobin (HbA1c), and dietary intake of antioxidant-rich foods were assessed. 𝗥𝗲𝘀𝘂𝗹𝘁𝘀: The comparator group had significantly better glycaemic control [median HbA1c—7.7% (IQR 6.7–9.4)] than the Bridelia group [9.2% (7.6–11.4)], 𝘱 = 0.001. The comparator group had been on metformin treatment for a significantly longer period than the Bridelia group (𝘱 < 0.0001). Participants in the comparator group consumed antioxidant-rich fruits more frequently (monthly basis) than those in the Bridelia group who ate fruits seldomly (𝘱 < 0.0001). There was no significant difference (𝘱 = 0.11) observed in oxidative stress levels between the Bridelia group and the comparator group [TBARS: 323.0 ng/L (287.5–374.0) and 317.0 ng/L (272.5–342.0), respectively]. Nonetheless, the Bridelia group had significantly higher antioxidant capacity (𝘱 = 0.001) compared to the comparator group [TAC: 1.01 mmol/L (0.93–1.10) versus 0.92 mmol/L (0.84–1.03), respectively]. Participants in the comparator group, who did not drink Bridelia tea, had been on longer metformin treatment with better glycaemic control. However, those who drank the Bridelia tea showed comparable levels of oxidative stress and exhibited elevated antioxidant levels compared to those who did not. 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻𝘀: Bridelia tea consumption may serve as a sustainable source of antioxidants; however, its effect on mitigating oxidative stress in ILWT2D requires further investigation, particularly given that no significant improvement in TBARS was observed. Future studies are needed to clarify the potential role of Bridelia tea in oxidative stress management in resource-limited settings like Ghana.Item Open Access Nutrigenomics: perceptions of South African dietitians and general practitioners(Karger, 2022) Greyvensteyn, Desire; Walsh, Corinna May; Nel, Mariette; Jordaan, Elizabeth MargarethaIntroduction: Although investigations into the emerging field of nutrigenomics are relatively limited and more research in this field is required, experts agree that there is potential for it to be incorporated into health care practice. If health care professionals can promote healthy dietary behavior based on nutrigenomic testing, it can assist in addressing the health consequences of poor diet and lightning the strain on the South African health care system. Methods: Registered dietitians (RDs) and general practitioners (GPs) registered with the Health Professions Council of South Africa (HPCSA) who obtained their qualification in South Africa (SA) were eligible to participate in this cross-sectional study. Participants were identified using convenience and snowball sampling. A self-administered electronic survey using EvaSys Software® was completed by those that agreed to participate. Results: Nearly all RDs (97.3%), but less than a third of GPs (30.4%), had heard of the term nutrigenomics. Approximately three-quarters of RDs (74.7%) and GPs (73.9%) had or would personally consider undergoing genetic testing. More than 40% (43.5%) of RDs ranked direct-to-consumer genetic testing companies as the most equipped, while 31.8% of GPs ranked RDs as the most equipped to provide patients with nutrigenomic services. Both RDs and GPs ranked similar reasons as “strongly agree” for why consumers were motivated to make use of nutrigenomic services, which included “motivated by a desire to prevent or manage disease” (56.7%), “prevent a disease based on family history” (65.9%), “control health outcomes based on family history” (54.9%), and “improve overall health-related quality of life” (48.6%). Cost concerns were reported as the greatest barrier to implementing nutrigenomic services (75.7%). Other barriers included confidentiality issues (47.8%) and moral concerns (37.3%). Greater individualization of diet prescription (66.5%), stronger foundations for nutrition recommendations (62.4%), and dietary prescriptions that would manage or prevent certain diseases more effectively (59.0%) were all perceived as benefits of including nutrigenomics in practice. Conclusion: This study identified perceived consumer motivators and barriers that might affect the willingness to seek nutrigenomic services in SA. In addition, the need for more nutrigenomic training opportunities, including the planning of personalized diets based on genetic testing results and interpretation of results, was confirmed. However, both RDs and GPs felt that the emerging field of nutrigenomics needs further development before it can be applied effectively in routine private and public health care in SA.Item Open Access Adherence to the Mediterranean diet of pregnant women in Central South Africa: the NuEMI study(SAGE, 2022) Spies, Hermina Catharina; Nel, Mariette; Walsh, Corinna MayIntroduction: The Mediterranean diet (MeD) has been shown to have significant health benefits for adults and children. A mother’s diet during pregnancy directly impacts the health of her offspring. This study aimed to investigate the adherence to the MeD of pregnant women attending antenatal care at a Regional Hospital in Bloemfontein, South Africa (SA). Methods: A cross-sectional study was conducted on a consecutive sample of 681 pregnant women who attended the antenatal clinic of a Regional Hospital in Bloemfontein. Socio-demographics included: age, highest level of education, household income, employment status, and income stability. Food group intake was assessed with a quantitative food frequency questionnaire. The adapted Mediterranean Diet Adherence Screener (MeDAS) consisted of 13 of the original 14 questions that measured intake of key food groups (score of ⩽7 poor, 8-9 moderate, ⩾10 good) (wine intake was excluded for pregnant women). Results: A total of 681 pregnant women with a median age of 31.8 years (IQR: 26.8-36.5 years) and a median gestational age of 32.0 weeks at the time of the interview participated in the study. The vast majority showed poor adherence to the MeD (99.6%), with only 0.4% (n = 3) having moderate adherence and 0% good adherence. The median adherence score was 5 points and the maximum 8 points. Of those with poor adherence, only 11.5% had tertiary education, 43.2% earned less than R 3000 (<201 USD) per month, 52.5% were unemployed, and 42.0% did not have a stable income in the past 6 months. Of the 3 participants with moderate adherence, all had grade 11 to 12 education, 2 out of the 3 earned more than R3000 (201 USD), one was unemployed, and 2 had a stable income over the past 6 months. Compared to those with an income ⩽ R3000 (⩽201 USD), those with an income above R3000 were significantly more likely to eat nuts (including peanuts) (2.0% vs 4.6%, P = .05), and adhere to sofrito (similar to tomato and onion relish) intake (9.2% vs 15.6%, P = .02). Compared to those who only had a primary education level up to grade 10 (n = 229), those who had a secondary education level or more (grade 11 and higher, n = 452) were significantly more likely to consume enough olive oil per day (1.3% vs 5.0%, P = .01), and to consume sofrito (6.6% vs 18.0%, P = .02). Conclusion: Pregnant participants showed poor adherence to the MeD. Although almost all women fell in the poor adherence group, secondary education contributed to consuming recommended amounts of olive oil and sofrito and higher income was associated with an adequate intake of nuts and sofrito. Based on the findings, we recommend the development of a contextualized MeDAS tool that includes foods that are typically eaten by most South Africans for similar MeD benefits.