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Browsing Department of Global Health by browse.metadata.advisor "Blaauw, Renee"
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- ItemAssessing the extent and effectiveness of diabetes self-management education in public health care institutions in Harare, Zimbabwe(Stellenbosch : Stellenbosch University, 2016-12) Nkomani, Sanele; Blaauw, Renee; Rusakaniko, Simba; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.ENGLISH SUMMARY : Introduction: Nutrition focused diabetes self-management education (DSME) provided by a dietitian or diabetes educator considerably improves glycaemic control, reduces the rate of complications, and reduces costs. Little is known about the effectiveness of DSME interventions, despite the rising prevalence of type 2 diabetes (T2DM) in Harare. This study therefore aimed to assess the extent to which existing DSME interventions improve nutrition focused knowledge, attitudes and practices (KAP). Secondly, health facility resoures to support effective DSME were assessed. Methods: A cross sectional survey design was used to determine nutrition focused diabetes KAP for 156 participants with T2DM attending eight public health facilities within the Harare metropole. The final sample size detected an effect size of 0.4 between two groups perceived to differ with regard to DSME received, i.e. central hospital outpatient clinic attendees and city health clinic attendess. Two (out of two) central hospital clinics in Harare were selected and six city health clinics (representing six of nine health districts in Harare) were selected using a multiple stage sampling strategy. Participants were divided equally between the two groups. Mean KAP scores from a reseacher designed questionnaire were compared between clinic groups, consultation with a dietitian and a diabetes educator. Nineteen health professionals involved in diabetes management at the sampled facilities also completed a self assessment on the primary care resources available to deliver quality DSME at their respective clinics. Results: The majority of participants (90.3%, n=139) reported recieving DSME, while fewer had consulted a dietitian (49.0%, n=76) or diabetes educator (52.0%, n=80). Dietitian (χ2=10.61,p=0.01) and diabetes educator (χ2=12.31,p=0.00) led interventions occurred more frequently at central hospitals. Participants showed better knowledge (p<0.01), and attitudes (p<0.00) for other self-care behaviours compared to nutrition knowledge (p<0.01). Significantly higher levels of knowledge were observed for central hospital clinic atendees (p=0.00), consultation with a dietitian (p<0.01) or diabetes educator (p=0.00). However, no differences were observed in attitudes for clinic group (p=0.10), consultation with a dietitian (p=0.30) or diabetes educator (p=0.19). Only those that had consulted a dietitian reported better adherence to dietary guidelines (p=0.00) and physical activity (p=0.02) self-care behaviours. Over half of the health professionals (57.9%, n=19) and (68.4%, n=19) scored resources for patient and organisational support respectively as inconsistent and limited. Health professionals from city health clinics rated their patient (p<0.01) and organisational (p<0.01) support capacity higher than health professionals from central hospital clinics. Conclusion: DSME intervention occurs more frequently at central hospitals, although no evidence of structured DSME programmes exists. Only dietitian led interventions significantly improved both knowledge and practices, highlighting a need to scale up dietetic intervention, particularly in city health clinics were very little DSME occurs. Health professional perceived resources for DSME to be inadequate and inconsistent, revealing the need for improved training of health professonals involved in diabetes management.
- ItemAssessment of knowledge, attitude and practice of nurses regarding enteral nutrition at a military hospital(Stellenbosch : Stellenbosch University, 2017-12) Ramuada, Londolani Goodness; Blaauw, Renee; Veldsman, Lizl; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.ENGLISH SUMMARY : Background: Enteral nutrition support plays a vital role in reducing malnutrition in hospitalised patients, and its provision is primarily a nurse’s role. Therefore, nurses need to have adequate knowledge and a positive attitude with regard to enteral nutrition. Objectives: The objectives of this study are to determine the knowledge, attitudes and practices regarding enteral nutrition learnt during the undergraduate qualification of nursing personnel at the nursing college of 1 Military Hospital and to determine differences based on professional rank. Method: A descriptive, cross-sectional design with an analytical component was used to collect data from military nurses through self-administered questionnaires. A score of 80% and above was rated as adequate knowledge, and questions regarding attitude were measured by means of a Likert scale. The data collected was captured using Microsoft Excel. Descriptive statistics were employed to describe the results of the study participants; Chi-Square tests were applied to determine the level of association between groups, and correlations were used to determine relationships between continuous variables. A p-value of <0.05 was used to test the hypothesis. Results: In total, 207 (86.2% response rate) questionnaires were completed and captured. The average knowledge score was 46.3%. Participants scored above 80% in the individual questions relating to enteral nutrition as part of the medical treatment and the definition of EN. More than two-thirds (75.4%) of the participants consider themselves competent to administer enteral nutrition and have protocols in their workplace (29.3%), with 79.6% referring to them once or twice per month. The most common sources of nutrition knowledge are in-service training (24.9%) and the nursing college (20.6%). Participants prefer lectures (45.4%) provided by the dietician to upgrade their nutrition knowledge. No significant differences were found between knowledge and professional rank or in the relationship between knowledge and years of working experience (r = -0.01; p=0.85). Conclusion: Nursing personnel have inadequate enteral nutrition knowledge, irrespective of their professional rank and experience. However, they are perceived to have positive attitudes towards the importance and administration of enteral nutrition. Future research should focus on whether continual in-service training improves the knowledge and practice of enteral nutrition among nurses.
- ItemAssessment of the perceived impact of diabetes on quality of life in a group of South African diabetic patients(Stellenbosch : Stellenbosch University, 2008-12) Katzenellenbogen, Leanne; Blaauw, Renee; Steyn, Nelia; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition.OBJECTIVES: To determine perceived Quality of Life (QOL) of the diabetic patient and to assess whether QOL is associated with diabetes-related markers. DESIGN: This was a descriptive cross sectional study. SETTING: A multiethnic group of type 1 and 2 diabetic patients (n= 68) attending a diabetic clinic in Alberton, South Africa, were evaluated. SUBJECTS OUTCOME MEASURES: QOL was assessed by means of the Audit of Diabetes-Dependant Quality of Life (ADDQoL) questionnaire. Glycaemic control, duration of Diabetes Mellitus (DM), type of DM, diabetic complications, level of education and nutritional status were evaluated. RESULTS: Ninety eight percent of diabetic patients perceived their DM to impact negatively on their QOL (p=0.03). QOL and glycaemic control were significantly (p=0.03) related. QOL and the duration (p=0.80) or type (p=0.77) of DM were not significantly related. QOL ratings were lower in participants who had hypertension and hyperlipidaemia, whereas this trend was not present in those with microvascular complications. There was a trend towards a negative relationship between QOL and weight (p=0.10), BMI (p=0.10) and WC (p=0.41). All 13 individual life domains were significantly related (p < 0.05) to QOL for the group as a whole. Rankings of individual life domains differed between type 1 and type 2 diabetics (p<0.05) as well as between black and white subjects (p<0.05). CONCLUSIONS: These results show that DM impacts on various aspects of QOL and that various population sub-groups perceive their DM to impact differently on their QOL. QOL assessments should therefore form part of DM management and should be culturally sensitive.
- ItemThe association between glycaemic control and lifestyle habits in adults with Type 2 Diabetes Mellitus attending selected private health care practices in Thabazimbi, Limpopo Province.(Stellenbosch : Stellenbosch University, 2013-12) Carstens, Maryke; Blaauw, Renee; Fouche, Leon; Nel, D. G.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition.ENGLISH ABSTRACT: Introduction: Intensive lifestyle intervention in people with Type 2 Diabetes Mellitus (T2DM) is associated with weight loss, significant reductions in HbA1c% and a reduction in cardiovascular disease risk factors. Small towns unfortunately experience a deficit of dieticians, thus limiting access to lifestyle intervention. Furthermore, a limited number of South African studies have evaluated the effect of dietary habits, anthropometric status, activity level (AL) and dietician-led medical nutrition therapy (MNT) on glycaemic control in patients with T2DM. This study thus aimed to identify the association between glycaemic control and lifestyle habits in adults with T2DM living in Thabazimbi. The role of the dietician with regard to optimal glycaemic control was also investigated with great interest. Methods: Individuals (>18 years) with T2DM who had a recent HbA1c test result and no acute infection/illness were included in the study over a 7 month recruitment period. Weight, height and waist circumference were measured, AL and dietetic contact evaluated, and dietary habits assessed by means of a structured questionnaire. Six home-measured post-prandial glucose (PPG) measurements and HbA1c% were used to evaluate glycaemic control. Results: A total of 62 (59.7% males) patients were included. The mean age was 60.13 ±10.85 years and mean T2DM disease duration was 121 ±96.56 months. Only 6.45% of participants had a normal Body Mass Index classification. Most (90.32%) participants had a substantially increased waist circumference (WC). Half of the participants had a sedentary/low AL, whilst 48.39% had an active/moderately active AL. Almost all (95%) participants indicated it was necessary for persons with DM to consult a dietician for MNT, however only 63% of participants actually consulted one. Mean dietary compliance was 74.53 ±10.93%. The average HbA1c% and PPG of participants were respectively 7.50 ±1.62% and 8.90 ±3.21mmol/l. A significant negative association (r=-0.31; p=0.02) was found between HbA1c% and percentage dietary compliance. The number of dietetic sessions completed and average PPG were also significantly [(r=0.40; p=0.001), (r=-0.34; p=0.01)] associated with percentage dietary compliance. In turn PPG had a significant positive (r=0.30; p=0.02) association with DM disease duration. Both the good HbA1c and good PPG control groups had significantly (p=0.01, p=0.04) better dietary habits than the poor HbA1c and PPG control groups. When compared to the poor PPG group, the good PPG group made significantly (p=0.04) better dietary decisions with regard to the main meal’s carbohydrate quality and quantity. Body Mass Index, WC, AL and extent of dietetic contact didn’t play a significant role in the glycaemic classification (good vs. poor) of participants. Conclusion: The longer T2DM is present, the worse PPG control becomes. Optimal dietary habits play a significant positive role in both the long- and short term glycaemic control of people with T2DM in Thabazimbi. The choice and portion size of the main meal’s carbohydrates has been identified to be the most important dietary role-player in the glycaemic control of this study population. This study also shows that if individuals with DM spend enough time with a dietician, it could potentially contribute to better dietary compliance and subsequent better glycaemic control.
- ItemThe association between tuberculosis and the development of insulin resistance in adults with pulmonary tuberculosis in the Western Sub-District of the Cape Metropole region(Stellenbosch : Stellenbosch University, 2015-12) Philips, Lauren; Visser, Janicke; Blaauw, Renee; Nel, D. G.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.ENGLISH SUMMARY : Introduction: The existence of a bi-directional relationship between tuberculosis (TB) and insulin resistance (IR)/diabetes has been alluded to in literature. Although diabetes has been linked to increased TB risk, the relationship between TB as a causative factor for IR remains unclear. The study aimed to determine if an association existed between TB and IR development in adults with newly diagnosed pulmonary tuberculosis (PTB) at baseline. It was additionally aimed to document changes in IR status during follow-up. Methods: This observational, cross-sectional study evaluated ambulatory participants at baseline for IR prevalence via anthropometrical and biochemical measures, together with diagnostic IR tests [homeostasis model assessment–IR (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI)]. In addition, a prospective cohort sub-section study was performed on approximately half of the baseline study population (n=29), who were followed-up at two and five months whilst on TB treatment. Summary statistics, correlation co-efficients and appropriate analysis of variance were used to describe and analyse data. Participants were excluded if they presented with other forms of TB, were HIV-positive, obese or had any pre-disposing IR conditions such as diabetes or metabolic syndrome. Results: A total of 59 participants were included from August 2013 until December 2014. The majority of participants were male (81.4%) and the mean age was 33.95 ±12.02 years. The prevalence of IR was 25.4% at baseline, determined by using a calculated HOMA-IR cut-off point of 2.477. Patients with IR were shown to be younger (p=0.04) and had a higher fasting insulin level (p<0.01). Although the difference between IR levels in participants between baseline and follow-up was not significant, a decrease was experienced over time. Most participants (61.0%) presented with a normal BMI at baseline and the majority of anthropometrical measurements showed a significant increase over the follow-up period, mainly in the first two months of treatment. The majority of participants (84.7%) had an increased mean CRP (60.18 ±50.92 mg/L) and decreased mean HDL-cholesterol level [69.5% (males: 0.94 ±0.88 mmol/L; females: 1.14 ±0.88 mmol/L)] at baseline. Mean baseline values of fasting glucose and albumin were within normal ranges (4.82 ±0.80 mmol/L and 39.32 ±4.35 g/L respectively). According to fasting glucose levels at baseline, 1.7% and 3.4% of participants presented with impaired fasting glucose and diabetes mellitus respectively. Several biochemical markers (CRP, albumin and white cell count) showed an improvement during the follow-up period. Conclusion: The study found an association between TB and IR development in newly diagnosed PTB patients. Many anthropometrical and biochemical measures showed improvements with time, especially during the intensive phase of treatment. Although not significant, IR levels decreased over time, which could be indicative of a clinical improvement. IR participants were shown to be younger and had a higher fasting insulin measurement. A high prevalence of IR among TB patients therefore highlights the need for early identification in order to facilitate a reversal of IR and prevent possible IR-related complications.
- ItemDeterminants of serum 25-hydroxyvitamin D levels in healthy young adults living in the Western Cape(Stellenbosch : Stellenbosch University, 2018-03) Knight, Kimberley; Visser, Janicke; Blaauw, Renee; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.ENGLISH SUMMARY : Background: The prevalence of vitamin D deficiency is fast emerging as a global pandemic. In South Africa, however, few studies have been conducted to determine the vitamin D status of the healthy population. While the effects of vitamin D on the body have been known for centuries, vitamin D has recently garnered great attention, with new evidence surrounding vitamin D and health emerging at a rapid rate. Previously thought to only be important for bone health, new research into the role of vitamin D in the body has revealed the importance of sufficient vitamin D levels for overall health. Aim: The main aim of this study was to investigate the vitamin D status of adults in the Western Cape. Objectives sought to determine whether skin tone, gender, basic anthropometrical measurements, diet, and lifestyle factors had an effect on serum 25(OH)D levels. Methods: This descriptive, cross-sectional study investigated the vitamin D status of healthy, undergraduate students (mean age: 20.41 ± 2.29 years) at Stellenbosch University. Serum 25(OH)D was collected and analysed, along with basic anthropometrical measurements (weight, height, BMI and waist circumference). A food frequency questionnaire was used to estimate dietary vitamin D intakes. Skin tone was measured using the Fitzpatrick Skin Type (FST) Classification, and a skin reflectometry device was used to measure dermal melanin content. Results: A total of 242 undergraduate students (with equal gender representation) were included in this study during September 2016. The results showed a mean serum 25(OH)D of 63.80 ± 41.35 ng/ml and a high prevalence of vitamin D sufficiency (90% of participants). The relationship between gender and serum 25(OH)D was found to be significant (p<0.01), with more females experiencing suboptimal vitamin D levels than males (18% vs. 5%). Just over half of the participants identified themselves as skin type IV when using the FST classification, and participants with lighter skin tones had higher levels of 25(OH)D than those with darker skin tones (p=0.02). The majority of the participants (60.74%) had normal BMIs, although the relationship between BMI and serum 25(OH)D was not statistically significant (p=0.09). Total mean dietary vitamin D intake was 7.99 ± 13.81mcg, with 87.2% of participants consuming less than the recommended daily intake of vitamin D (15mcg). The relationship between total vitamin D intake and serum 25(OH)D was found to be weak, but statistically significant (p=0.003). Sun exposure and lifestyle factors were not found to have an effect on serum 25(OH)D levels in this study. Conclusion: This study found a low prevalence of vitamin D deficiency amongst young adults, despite low dietary vitamin D intakes. Significant relationships were found between serum Stellenbosch 25(OH)D and gender, skin tone, and vitamin D intake. While this study population was homogenous, it encompassed a very specific group of young, healthy undergraduate students and further studies need to be done before the results are applied to the greater public.
- ItemDetermination of the most effective nutritional risk screening tool to predict clinical outcomes in intensive care unit patients(Stellenbosch : Stellenbosch University, 2012-12) Blanckenberg, Christa; Blaauw, Renee; Kruger, Jeanne-Marie; Nel, D. G.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition.ENGLISH ABSTRACT: Introduction: Malnutrition, as defined by the Malnutrition Universal Screening Tool (MUST), Mini-Nutritional Assessment-Short Form (MNA-SF), Subjective Global Assessment (SGA), Nutritional Risk Screening Tool-2002 (NRS-2002), Short Nutritional Assessment Questionnaire (SNAQ), Nutritional Risk Indicator (NRI) and Malnutrition Screening Tool (MST), has been associated with adverse outcomes in hospitalised patients. Therefore nutritional risk screening is recommended for all hospitalised patients to improve the recognition and treatment of malnutrition. However, little is known about the use of screening tools in an intensive care unit (ICU) setting. The aim of this study was to assess which of these screening tools could best predict clinical outcomes in ICU patients and to comment on their feasibility, in order to make suggestions on their applicability for this patient population. Methods: Over an eight month study period all patients (>18years) with a surgical ICU stay of >48 hours were included. Patients were screened within 48 hours of admission using each of the seven screening tools. Clinical outcomes (mortality, APACHE II score, length of stay (LOS), length of ventilation (LOV), complications, serum-albumin, white cell count (WCC) and C-reactive protein) were recorded until discharge or death. Feasibility and applicability of the screening tools were also assessed. Results: A total of 206 patients (62.6% males) were included. The average age was 49.5 ±17.4 years and average LOS was 5.7 ± 5.5 days. Screening was not feasible in 18.3% of patients. The MUST classified 18.9% of patients as at risk of malnutrition and 30.1% as malnourished, but was not predictive of any clinical outcomes. According to the MNA-SF, 52.2% of patients were at risk of malnutrition and 16.5% were malnourished. This was associated with progressively decreasing serum-albumin levels (p<0.01) and WCC (p=0.01). The SGA classified 30.6% of patients as moderately and 18.4% of patients as severely malnourished and was significantly associated with LOS (p=0.03), LOV (p=0.01), mild complications (p=0.04) and serum-albumin (p=0.01). However, except for serum-albumin which progressively declined with a poorer nutritional status, the moderately malnourished patients showed the worst outcomes and the severely malnourished patients the best. According to the NRS-2002, 72.8% of patients were malnourished; and this correlated significantly with LOV (p=0.02) and the development of moderate (p=0.04) and total (p=0.01) complications. A non-significant but consistent trend for worse results in the malnourished group was also seen for the other outcomes studied. The SNAQ classified 35.9% of patients as malnourished or at risk thereof. This was associated with lower serum-albumin levels (p=0.04), but also with decreased LOV (p<0.01). The NRI classified 2.3% of patients as mildly malnourished, 21.0% as moderately malnourished and 75.0% as severely malnourished and only effectively predicted serum-albumin (p<0.01). The MST classified 78.2% of patients as malnourished and this was predictive of developing more complications (p<0.01). Almost all of the other variables also showed worse outcomes for the malnourished group, but this was not significant. Conclusion: Screening in an ICU seems to have only moderate feasibility and applicability and limited value. Only the NRS-2002 and MST showed potential for predicting clinical outcomes in ICU patients.
- ItemDetermining the influence of maternal body composition and glucose control during pregnancy on fetal outcome(Stellenbosch : Stellenbosch University, 2021-03) Mookadam, Iman; Blaauw, Renee; Van Zyk, D. G.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.ENGLISH SUMMARY: Introduction: Gestational Diabetes Mellitus (GDM); abnormal oral glucose tolerance test (OGTT) and maternal obesity (body mass index (BMI >30kg/m2)) are risk factors for the rise in macrosomic neonates (i.e. birth weight >4kg). The OGTT is usually done around 20–24 weeks gestation, by which time fetal programming has already occurred. The only reliable anthropometric measurement to use during pregnancy is the mid-upper arm circumference (MUAC), since maternal MUAC changes minimally during pregnancy and often is a good indicator of pre-pregnancy nutritional status. MUAC is also done routinely at clinics in South Africa. As both maternal anthropometry and abnormal glucose control contribute to macrosomic neonates, the question can be asked: which can be considered a better predictor of neonatal macrosomia? Aim: The aim of the study was to compare whether maternal anthropometry or maternal glucose control best predicted fetal outcome (i.e. macrosomia) in a group of women with a high risk of GDM. Methodology: The study design was an ambidirectional cohort study – combining both retrospective and prospective components. There was a total of 300 participants, divided into two groups. The GDM group comprised the retrospective component, using an existing database. The non-GDM group constituted the prospective component, where pregnant women were followed up until birth. Several statistical tests were used to prove the hypotheses. Results: The majority of participants in the study were of African race. The mean age of the participants was 34 years; however, maternal age was not found to be significantly associated with fetal birthweight (r=0.014 p=0.5220). As expected, gestational age (34.61 5.68) was found to be significantly associated with fetal birthweight (r=0.453; p<0.001), showing that as gestational age increases, so too does birth weight. Although maternal blood glucose control and GDM are risk factors for delivering a large-for-gestational age (LGA) or macrosomic baby, no significant association between the two variables was found in this study (Chi2 = 2.24; p=0.523). A significant correlation was found between maternal BMI and fetal birth weight in the non-GDM group (p=0.032), clearly indicating that as maternal BMI increases, so too does fetal birth weight. Similarly, a significant correlation was found between maternal MUAC and fetal birth weight (r=0.235; p<0.001). It was found that as maternal MUAC increases, the greater the chance of delivering an LGA or macrosomic baby. After adjusting for confounding factors, for every centimetre increase in maternal MUAC, fetal birth weight increased by 0.029kg, keeping all other variables constant. If maternal MUAC was >31cm, it was 2.89 times more likely that the mother would deliver an LGA or macrosomic baby. Similarly, for every week increase in gestational age, the baby’s birth weight increased by 0.173g. Conclusion: This study showed that maternal obesity (i.e. raised BMI and MUAC) was significantly associated with neonatal LGA and macrosomia. Guidelines on weight gain and a management protocol on overweight and obesity in pregnancy are urgently needed in South Africa. Closer monitoring of these ‘high-risk’ patients with a maternal MUAC >31cm is needed to decrease the risk of delivering LGA and macrosomic babies.
- ItemDetermining the level of comprehension of registered dietitians in South Africa with regard to the glycemic index (GI) used in the treatment of Diabetes Mellitus(Stellenbosch : University Stellenbosch, 2009-12) Strydom, Hildegard; Blaauw, Renee; Steenkamp, Gabi; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition.ENGLISH ABSTRACT: The glycemic index (GI) has proven to be a valuable nutritional tool in the management and prevention of diabetes and other chronic diseases of lifestyle 1,3,4,5,6,79,12,14,15. In this quantitative, cross-sectional, observational and descriptive study, the aim was to determine the knowledge and level of comprehension of South African registered dietitians with regard to GI and glycemic load (GL) as well as to determine their ability to use/implement the GI in the treatment of diabetes / insulin resistance. A questionnaire was emailed to 388 registered dietitians for completion. The questionnaire was based on relevant scientific literature and divided into three parts. The first part gathered demographical information about the participants, with special emphasis on where they had acquired their knowledge of GI principles. The second and third parts contained closed-end questions to which the participants were required to answer ‘true’ or ‘false’ or were presented with a multiple choice. Twenty-five questions specifically focused on the GI and the other 12 focused on GL. One hundred and fourteen subjects took part in the study. The results showed that most dietitians (54 %) did not learn GI principles at university and that the year that they qualified did not affect test results. The University attended did not seem to affect test results either, with the exception of Medunsa (Medical University of South Africa), where graduates scored on average significantly lower than the rest of the group). The test scores varied between 43% and 97%. The average test score for the group was 71% with those dieticians in private practice scoring the highest average (76%) compared to those working in other practice areas. Although 84% percent of participants reportedly used GI principles in their daily practice with patients, compared to only 33% who reportedly used GL principles, results showed no significant difference between knowledge or comprehension levels of GI and GL or the ability to implement GI or GL principles. To conclude, South African dietitians seem to have a good general knowledge of GI, but there is still room for improvement in order to ensure that dietitians can become experts in the field. It is recommended that curricula be revised to give this subject more attention during formal university training.
- ItemExploring the obesogenic environment and behaviour in adolescents : a qualitative study, in the Cape Town Metropole of the Western Cape(Stellenbosch : Stellenbosch University, 2019-04) Berry, Laura Jayne; Blaauw, Renee; Du Plessis, Lisanne Monica; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.ENGLISH SUMMARY : Background: Obesity is now seen as a global pandemic in adults and children. There are many factors that are understood to have an impact on the obesogenic environment for adolescents including those that affect physical activity and nutrition at different levels of the socio-ecological model. However, much more needs to be understood about this complex phenomenon, to tailor programmes for adolescent health needs and address the growing SA adolescent obesity problem. Aim: The aim of this study was to perform an assessment of school nutrition policies and programmes in the context of the Integrated School Health Policy (ISHP) and in relation to adolescents and the obesogenic environment in urban areas of the City of Cape Town. This was done by engaging with stakeholders and learners through a participatory approach to identify opportunities for having an impact on obesogenic behaviour. Method: This was a qualitative study that made use of focus-group discussions (FGDs) for school learners and individual in-depth interviews (IDIs) for members of the school health team to engage with relevant stakeholders. Seven schools took part in the study. Fourteen FGDs and twenty-one IDIs were held. A boy and girl FGD of 8−12 participants was held at each school. Participants for the IDIs were purposively selected from members of the school health team including: principals, life orientation (LO) teachers, parent-teacher association (PTA) representatives, counsellors and food service managers. The data was audio recorded and transcribed using a transcription service. The raw data was analysed using the qualitative software package Atlas.ti 8. Content analysis was performed and the ‘thematic analysis’ approach was employed to interpret the data. Results: There are many factors that affect the obesogenic environment for urban SA adolescents from Cape Town. The main physical-activity barriers include: intrapersonal factors (feeling lazy, not enough time, low self-esteem and not enjoying the feeling of exercise); interpersonal factors (lack of role models, lack of parental support and not wanting to be a nuisance to parents); environmental factors in the school (lack of resources including school sport facilities and sports equipment); and community safety (gang-related crime). Physical-activity enablers include: intrapersonal (enjoying the feeling of exercise and finding it fun); interpersonal (team spirit and camaraderie); and environmental factors (school sport facilities and equipment; community fun walk/runs). The main barriers to healthy eating include: intrapersonal (taste preferences, knowledge and psychological); interpersonal (working parents); and environmental aspects, such as easily available (tuck shops, fence vendors, fast-food outlets) and accessible (cheap) unhealthy junk food, together with the limited availability (fewer items in tuck shop) and inaccessibility (more expensive) of healthy food. Opportunities for heathy eating include: intrapersonal (taste enjoyment of healthy foods), together with limited environmental factors (provision of healthy foods by home, feeding schemes and some tuck shops). Further to these findings, there appear to be several gaps in the implementation of the ISHP within the school environment, particularly with regards to nutrition policy awareness/knowledge, implementation, monitoring and collaboration. Conclusion: Findings from this study highlight several obesogenic barriers and enablers having an impact on adolescent physical-activity levels and nutrition. The main factors that emerged are at the environmental (school and community) level, including food security and accessibility of physical activity. The results of this study should be shared with the Departments of Health and Education as a matter of urgency. Further research is needed to identify the best ways to overcome the identified barriers and use the enablers to curb the growing problem of obesity.
- ItemFistuloclysis : an option for the nutritional management of adult intestinal failure patients in South Africa(Stellenbosch : Stellenbosch University, 2016-03) Du Toit, Anna-Lena; Blaauw, Renee; Boutall, Adam; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.ENGLISH SUMMARY : Introduction: The development of intestinal failure is the consequence of diverse aetiologies and pathophysiological causes. Fistuloclysis is an effective means of nutritional support in selected intestinal failure patients. This study aimed to investigate the management of adult intestinal failure patients in hospitals in South Africa, determining how practical and acceptable fistuloclysis is. Methods: The study included three phases. Phase 1 consisted of a retrospective record review of adult patients admitted to Groote Schuur Hospital Intestinal Failure Unit between January 2009 and May 2014. Data collected included demographics, surgical interventions, gastrointestinal anatomy, nutritional management, biochemical markers and intake and output. Phase 2 consisted of a purposefully selected case study report published in a peer-reviewed journal. Phase 3 investigated the current management of type 2 and type 3 intestinal failure patients in South African hospitals, evaluating perceptions and opinions among South African doctors, stoma therapists and dietitians by means of occupation-specific questionnaires. Results: Phase 1: Seventeen intestinal failure patients receiving fistuloclysis were included in the study. During the fistuloclysis period, the median daily output was 1 478ml with a median of 71% of effluent received back via fistuloclysis. Four patients went home for a median period of 32,5 days on fistuloclysis. There was a statistically significant increase in the median albumin level between day 0 and day 28 of fistuloclysis, however body weight did not improve during this period. Postoperative complications occurred in only three patients. Patients were discharged after a median of 12 days post definitive surgery, with three complicating postoperatively and all patients regaining nutritional autonomy. Phase 3: Twenty-seven dietitians participated in the survey, the majority (67%) having been involved with patient management in this field for one – five years. All indicated high fistula outputs would be defined as intestinal failure. Only 47% gave the correct definition, with 28% currently utilising fistuloclysis. All respondents agreed that unsuccessful implementation of fistuloclysis was due to training shortfalls and resistance from clinicians and nursing staff. Ten stoma therapists entered the survey but only two fitted the inclusion criteria. Both worked in the private sector, with >10 years of experiece in the management of intestinal failure patients. Only one of the two proceeded with further questions. Four doctors managing intestinal failure responded. All respondents indicated high fistula outputs as associated with intestinal failure. The aetiology of intestinal failure indicated was postoperative complications by 75% of the respondents. The majority of respondents (75%) indicated that keeping patients nil by mouth was common practice, 50% of respondents indicated routine usage of pharmacological agents to decrease output or transit time. All respondents gave the correct explanation of fistuloclysis with 50% currently using fistuloclysis. Conclusion: Fistuloclysis is not superior, but equivalent to conventional methods of intestinal failure management. From this study and other available literature it is evident that fistuloclysis can replace PN support in selected patients. From the different occupation group surveys it is evident that there is a positive perception and awareness of fistuloclysis; however numerous stumbling blocks hamper the wider use of this novel treatment.
- ItemIdentifying nutritional and life-style risk factors associated with the development of osteoporosis in women of Asian origin at the Aga Khan University Hospital, Nairobi, Kenya(Stellenbosch : University of Stellenbosch, 2006-12) Chaudhri, Tauseef; Blaauw, Renee; Labadarios, D.; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition.INTRODUCTION: Postmenopausal osteoporosis is associated with significant morbidity, mortality, reduction in quality of life, and increasing health care costs OBJECTIVE: The study objective was to identify the risk factors associated with the occurrence of osteoporosis, in Kenyan Asian women seen at the Aga Khan University Hospital, Nairobi, Kenya since there is no literature on the prevalence of all these risk factors for osteoporosis in a similar middle aged population sample of Kenyan Asian women. METHOD: The study was of a retrospective design and used recall as a basis of data collection. A socio-demographic questionnaire was completed and anthropometric measurements, of height, weight, waist and hip circumference taken. Bone mineral density (BMD) had been measured previously using Quantitative Computed Tomography (QCT) at the lumbar spine, T11 to L4. Nutrient intake was assessed using a validated food frequency questionnaire (FFQ) and physical activity was determined using the Epic Physical Activity Questionnaire 2 (EPAQ2). BMD scans had been done on all study participants from January 2004 to December 2004 and the subjects were aware of their bone status. RESULTS: Risk factors that were identified by being associated with the development of osteoporosis in Asian women were age (p<0.001), waist size (p<0.001), hip size (p<0.001) and BMI (p<0.001), low physical activity (p=0.001) and use of prescription drugs. Seventy two percent of the study sample was using prescription drugs and the effect on bone mass was most likely detrimental. Anti-hypertensive (p=0.002), non steroidal anti inflammatory drugs (p=0.003) and anti-diabetic drugs (p=0.033) had a significant negative association with bone health. Energy, protein, fat and carbohydrate intake in all the groups was above the EAR and comparatively similar. The intake of all the micronutrients in the study group was above the DRI. There were no statistical significant differences in most of the trace element intake between the two groups, apart from iodine, biotin and manganese. No dietary risk factors were identified which impacted adversely on bone health in this group. The impact of gynaecologic history (parity, oral contraceptive use, age of menarche) on BMD was uncertain. The educational level of the study sample was high as 50% of the subjects were graduates and had a relatively better diet. CONCLUSION: As Kenyan Asian women age they experience the menopausal transition and the risk of developing osteoporosis increases. No nutritional factors were identified that were adversely associated with BMD. Low level of physical activity, prescription drugs for chronic diseases like hypertension, asthma, diabetes and arthritis, age, weight and body mass index were identified and found to be adversely associated with bone mineral density. Early detection, and implementation of patient education, physical activity, and a diet rich in all nutrients, will help to slow down the progression of osteoporosis.
- ItemThe impact of intravenous fluid and electrolyte administration on total fluid, electrolyte and energy intake in critically ill adult patients(Stellenbosch : Stellenbosch University, 2013-12) Veldsman, Lizl; Blaauw, Renee; Richards, G. A.; Nel, D. G.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition.ENGLISH ABSTRACT: Objectives: The objectives of this study were to determine the nutritional content/ contribution of intravenous (IV) fluid and electrolyte administration on the total feeding prescription of intensive care unit (ICU) patients. Methods: Retrospective review of ICU charts of consecutive patients (>18 years) with APACHE II scores ≥10 and on ≥72 hours nutrition therapy (NT) admitted to a medical/surgical ICU. Total fluid, electrolyte, energy and macronutrient intake from nutritional and non-nutritional sources were reviewed from ICU admission until discharge, discontinuation of NT or death for ≤7 days. Energy and protein delivery were compared to calculated targets of 25.4 – 28.6kCal/kg and 1.3 – 1.5g/kg respectively. Summary statistics, correlation coefficients and appropriate analysis of variance were used to describe and analyse the data. Results: A total of 71 patients (49% male), average age 49.2 ± 17.1, average APACHE II score 21.0 ± 6.1, 68% medical and 32% surgical, were included. Fluid and nutrient intake were reviewed over a mean of 5.7 ± 1.1 days. Mean daily fluid delivery was 3.2 ± 0.6L. IV fluid therapy (IVFT) contributed 32.0 ± 12.0% to total fluid delivery (TFD), whereas IV drug administration, including fluids used for reconstitution and dilution purposes, contributed 20.7 ± 8.1% to TFD. Balanced electrolyte solutions (BES) were the crystalloid of choice, prescribed in 91.5% of patients with a mean daily volume (MDV) of 0.5 ± 0.4L. Hypertonic low molecular weight (LMW) 130/0.4kD hydroxyethyl starch (HES) was the colloid of choice, prescribed in 78.9% of patients with a MDV of 0.2 ± 0.1L. Potassium salts were the most frequently prescribed IV electrolyte supplement (IVES), prescribed in 91% of patients (±20 – 60mmol per administration). NT was initiated within 14.5 ± 14.1 hours. The majority (80%) received enteral nutrition (EN). The mean daily energy delivered was 1613 ± 380kCal (25.1kCal/kg), meeting 93.6 ± 17.7% of mean target range (MTR). Mean daily protein delivery (PD) was 72 ± 22g (1.1g/kg), meeting 82.8 ± 19.9% of MTR. Non-nutritional energy sources (NNES), mostly derived from carbohydrate-containing IV fluids, contributed 10.1 ± 7.5% to total energy delivered (156kCal/d). Mean cumulative energy and protein balance was -674.0 ± 1866.1kCal and -86.0 ± 106.9g respectively. The majority (73%) received >90% of the minimum energy target but only 49% >90% of minimum protein target; 59% of those with energy intake 90-110% of target had adequate protein intake. A significant negative correlation was found between cumulative energy/protein balance and the time to initiation of NT (energy: r=-0.28, p=0.02; protein: r=-0.32, p=0.01). Conclusion: In this ICU BES are the crystalloid of choice and hypertonic LMW 130/0.4kD HES the colloid of choice for IVFT. Potassium salts are the most frequently prescribed IVES. NNES added significantly to energy delivery and should be included in the calculation of feeding prescriptions to avoid the harmful effects of overfeeding. Early initiation of EN with conventional products which are energy rich is insufficient to achieve adequate PD. EN formulae with a more favorable nitrogen to non-protein energy ratio could help to optimise PD during the first week of ICU care.
- ItemThe impact of recall bias on the accuracy of dietary information(Stellenbosch : Stellenbosch University, 2014-04) Van Zyl, Zoe; Venter, Carina; Blaauw, Renee; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Division of Human Nutrition.ENGLISH ABSTRACT: Background: A number of observational studies where information was obtained retrospectively have been used in the past to inform guidelines regarding allergy prevention. Studies looking at the causative/protective properties of infant dietary factors on diseases that occur later in life also rely on maternal recall many years later. It is unclear however what the effect of the recall bias was on the accuracy/quality of the information obtained. Objectives: The aim of the study was to determine the impact of recall bias 10 years retrospectively on the accuracy of dietary information in relation to breast feeding, weaning age and introduction of allergenic foods. A literature review was performed into studies assessing the accuracy of data obtained retrospectively and into studies using retrospective data to draw conclusions on the protective/causative factors of infant feeding in relation to food allergy. Methodology: An infant feeding questionnaire was developed from some of the same questions that were asked by mothers recruited into the FAIR study, a prospective birth cohort on the Isle of Wight. Families had been recruited and followed up since 2001/2002 and data has been gathered when the mothers were 36 weeks pregnant, and then when their child was 3, 6, 9 months and 1 and 2 years old. Mothers were asked in 2012, when their children were 10 years of age, to complete this questionnaire. Agreement of answers was computed using Kappa coefficients, Spearman’s correlation and percentage agreement. Results: One hundred and twenty five mothers completed the questionnaire. There was substantial agreement for recall of whether mothers breast fed, the duration of EBF and breast feeding 10 years earlier (k = 0.79, r = 0.70 and r = 0.84 respectively). Seven per cent (n = 9) of mothers however who did breast feed reported not to have. Eighty four per cent (n = 103) of mothers recorded correctly whether their child had a bottle of formula milk in hospital. Ninety four per cent (n = 116) of mothers recalled accurately that their child had received formula milk at some stage of their infancy. The exact age at which formula milk was first given to their child was answered accurately (r = 0.63). The brand of formula milk provided was poorly recalled. Answers to when mothers first introduced solid foods into their child’s diet were not accurate (r = 0.16). The age of introduction of peanuts was the only food allergen that mothers recalled accurately for when they first introduced this into their child’s diet (86% correct answers). Recall of whether peanuts were consumed during pregnancy was accurate after two years (k = 0.64) but not after 8 years (k = 0.39). Conclusion: The study highlights the importance of possible recall bias of infant feeding practices by mothers over a period of 10 years. Recall related to breast feeding and formula feeding were accurately recorded for, but not for age of introduction of solid foods and introduction of allergenic foods. Studies relying on maternal recall of weaning questions need to be cautious.
- ItemThe influence of nutrition labelling and logos on food purchasing behaviour in Cape Town, Western Cape, South Africa(Stellenbosch : Stellenbosch University, 2017-12) Koen, Nelene; Blaauw, Renee; Wentzel-Viljoen, Edelweiss; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.ENGLISH SUMMARY : Introduction: Nutrition information on food labels is a population-based approach to nutrition education that enables consumers to make healthier food choices. In South Africa (SA) there has been a paucity of data on food and nutrition labelling and the consumer since the publication of the new food-labelling legislation. Rationale: A better understanding of how consumers engage with nutrition information on food labels is required to make recommendations to improve education campaigns to assist consumers in making healthier food choices. Additionally, food-labelling factors that influence consumer food-purchasing behaviour, and expectations/barriers to reading nutrition information on labels, could assist in making recommendations for a single front-of-pack labelling scheme to be used in SA as well as for its development. Methods: A multi-stage mixed-methods design was employed. In phase one, a cross-sectional, descriptive, interviewer-administered electronic survey was conducted on adult consumers (N=960) at 16 randomly selected grocery stores in four health districts of Cape Town (CT). In phase two, nine focus-group discussions (FGDs) were held with purposively selected consumers (N=67) to further explore phase one’s findings and what type of health- endorsement logos (HELs) are preferred and why. In phase three, ten HELs were developed by a graphic design company based on the data collected in previous phases. A modified Delphi technique, conducted with experts in the fields of nutrition/food science (N=19), was employed to eliminate lowest scoring HELs and to improve the design of the HELs. Participants from the initial survey and/or FGDs took part in pilot testing of the HELs during four FGDs. Results: Main self-reported factors influencing food-purchasing behaviour included price, sell-by date and products on special/promotion, with price being the most important. Taste, brand loyalty, marketing and convenience were also major influencers. Less than half of participants indicated that nutrition information always influenced their product choice. The main reasons for not reading nutrition information included buying the same type of product all the time and being uninterested in the information. In exploring this further with FGDs, a lack of time, poor understanding of nutrition information (specifically the nutrition information table) and lack of trust in labelling information also emerged as important factors. The mean food and nutrition label knowledge score was 44%. The majority of participants preferred a single HEL to be used on food products as they don’t understand the various HELs used. Such a logo should include pictures/symbols directly related to health and/or food and should state “healthy choice”. During the pilot testing, three HELs (developed and improved during two rounds of scoring) received overall rankings of 3.08/5, 3.28/5 and 3.39/5 respectively. Conclusion: CT consumers have poor food and nutrition label knowledge and nutrition information on food labels is not a major influencer of food-purchasing behaviour. Consumers struggle to understand the nutrition information provided and have expressed a need for a single HEL to be used. Consumer education on utilising the nutrition information on labels and the development of a single HEL for SA, could assist consumers to make healthier food choices and in turn address the high incidence of non-communicable diseases in SA.
- ItemMicronutrient supplementation for critically ill adults : a systematic review of the evidence(Stellenbosch : Stellenbosch University, 2008-12) Visser, Janicke; Labadarios, D.; Blaauw, Renee; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition.Background Critical illness is associated with increased production of reactive oxygen species and oxidative stress, and low levels of most micronutrients with resultant diminished endogenous antioxidant defences. Micronutrient supplementation is thought to be beneficial to the critically ill patient by ameliorating oxidative stress and by improving clinical outcome. Objectives This systematic review assessed the effects of micronutrient supplementation on adults recovering from critical illness. Primary outcomes included clinical endpoints [mortality, infectious complications, length of intensive care unit and hospital stay (LICU and LOS)]. Secondary outcomes included descriptions of practice issues, micronutrient status, morbidity, course of the acute phase response and oxidative stress. Search strategy An electronic bibliographic database search was carried out, bibliographies of retrieved articles were reviewed and personal files searched to obtain additional citations. Databases were searched from inception until 29 February 2008. Selection criteria Randomized controlled trials (RCTs) of micronutrient supplementation (by any route) in adult critically ill patients, given in addition to their routine care, were included. Data collection and analysis Two authors independently extracted data and assessed trial quality. For the primary outcomes the random-effects model was used to estimate overall relative risk / mean difference and effect size due to the presence of study heterogeneity. Selected exploratory analyses were undertaken. Differences at the level of p<0.05 was considered to be statistically significant. The secondary outcomes were sparse and variably recorded such that this data was not formally aggregated. Main results Fifteen RCTs involving 1714 participants and 18 RCTs involving 1849 participants were included for the primary and secondary objectives respectively. The quality of the RCTs, as reported, was disappointing, particularly for allocation concealment. Fourteen trials (n=1468) of micronutrient supplementation showed a statistically significant reduction in overall mortality [relative risk (RR) 0.78, 95% confidence interval (CI) 0.67-0.90, I2=0%, p=0.0009]. An asymmetrical funnel plot necessitates caution when directly interpreting these results. Six RCTs (n=1194) indicated a statistically significant reduction in 28 day mortality (RR 0.75, 95% CI 0.63-0.88, I2=0%, p=0.0006) (symmetrical funnel plot). Micronutrient supplementation in this systematic review was not associated with a reduction in infectious complications, LICU or LOS. In sub-group analyses, single nutrients were associated with borderline statistical significance (RR 0.82, 95% CI 0.66-1.01, I2=0%, p=0.06) in terms of mortality, whist a sensitivity analysis of combined micronutrients indicated a significant reduction in mortality (RR 0.69, 95% CI 0.54-0.90, I2=2%, p= 0.006). This review did not find clear evidence that parenteral is superior to enteral administration in terms of clinical outcomes. The secondary outcomes confirmed that timing, duration and dosing are key factors to ensure optimal clinical benefit. Conclusion This review does suggest potential benefit of micronutrient supplementation in critically ill adults for some clinical outcomes (especially mortality), but also highlights that caution is warranted as nutrient interactions and risk of toxicity are not clearly defined in critical illness. More large multi-centre randomized trials are necessary to assess the effects of different types and doses of micronutrient supplementation in selected groups of patients with different types of critical illness.
- ItemNeonatal and paediatric parenteral nutrition prescription practices in South Africa : a cross-sectional survey(Stellenbosch : Stellenbosch University, 2018-03) Flint, Cristen Sarah; Blaauw, Renee; Van Niekerk, Evette; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.ENGLISH SUMMARY : Objectives: The objective of this study was to describe the current parenteral nutrition (PN) prescription practices and knowledge of prescribers (paediatric doctors and dietitians) for their neonatal and paediatric patients, in South Africa, and to establish the factors which influence usage and adherence to the available guidelines. Methods: A descriptive cross-sectional survey was conducted from November 2016 to March 2017 through a self-administered online questionnaire. PN prescription factors were assessed in terms of timing, patient type and diagnosis, use of macronutrients, and fluid allocations. Prescriber knowledge of the ESPGHAN international guidelines was assessed, as well as access to information. Knowledge and practice score competency levels were set, a priori, at 60% and 80% respectively. Respondents were stratified according to work sector (state / private) or professional group (dietitian / paediatric doctor) for statistical comparison. Summary statistics, chi-squared tests and correlation coefficients were used to describe and analyse the data. Results: A total of 72 survey respondents were included, 58% dietitians and 42% paediatric doctors; 47% private sector and 53% state sector based. The primary indications for PN use were gut abnormalities and intolerances, prematurity and critical illness. Doctors prioritised fluid calculation in determining their PN prescription. Dietitians were significantly more likely to calculate the patient-specific protein requirements (p < 0.001). Only 36% of prescribers commenced PN feeding within the first 24 hours of admission, but the majority (67%) introduced intravenous lipid emulsion (IVLE) from day 1 of PN. The main reasons given for IVLE delay were habit, liver function concerns, and PN bag availability. The mean practice score was 75% (SD ± 17). There was no significant difference in mean score between the work sector subgroups (75 ± 20% state versus 76 ± 15% private; p = 0.82). The dietitians, however, scored significantly higher for practice outcomes compared with the doctors (82 ± 12% versus 65 ± 19 %; p < 0.001). The main potential factors that influenced the delay or non-use of PN when it was indicated included concerns regarding infectious complications and financial resource constraints. Inadequate access to PN, and a lack of trained staff to administer the PN, also impacted on its use. Only 64 of the respondents completed the knowledge section of the questionnaire. The mean knowledge score was 74% (SD ± 12), range 50 – 100%. There was no significant difference in mean score between the work sector subgroups (73 ± 13% for state versus 76 ± 12 % for private; p = 0.32). The mean knowledge score for the dietitians (77 ± 13%) was however significantly higher than that of the doctors (71 ± 11%); (p = 0.04). Conclusion: PN prescribing practices in South Africa for neonatal and paediatric patients are not yet optimal in many respects. Prescribers require access to clear PN therapy guidelines, as well as guidance on how to implement these recommendations effectively in daily clinical practice. A multidisciplinary approach to PN feeding is paramount. Our findings emphasise the role of the dietitian as part of the multidisciplinary team in achieving optimal feeding. Additional research is warranted to further assess the PN feeding practices in this vulnerable patient group.
- ItemNutrient intake, gastrointestinal microbiota and the effect of Lactobacillus plantarum 299V in irritable bowel syndrome patients(Stellenbosch : Stellenbosch University, 2014-12) Stevenson, Cheryl; Roux, Saartjie; Blaauw, Renee; Visser, Janicke; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences:. Division of Human Nutrition.ENGLISH ABSTRACT: Background: Irritable bowel syndrome (IBS) is a common gastrointestinal (GI) disorder. GI symptoms and impaired quality of life affect between 10-20% of all adults, corresponding to about 25-50% of all patients who visit a gastroenterologist’s clinic. In recent years, several novel mechanisms of IBS that likely relate to previously established theories have been identified. Inflammation, postinfectious low-grade inflammation, immunological and genetic predisposition along with altered microbiota are critical in IBS development, while several dietary factors may also play a role in this syndrome. However, none of these factors accounts for the full repertoire of IBS symptoms, and the pathophysiology of this condition is not fully understood. The overarching aim of this study was to investigate the nutrient intakes, GI microbiota and the effect of Lactobacillus plantarum (L.plantarum) 299v in IBS patients. Sub-aims: 1) Update healthcare professionals on current probiotic information and provide an overview of probiotic treatment approaches, with special emphasis on IBS, 2) conduct a well designed randomised, double blind, placebo-controlled trial (RCT) with L. plantarum 299v as part of an intervention and establish whether a course of probiotics may alleviate undesirable symptoms of IBS and improve quality of life, 3) assess nutrient intake in patients with irritable bowel syndrome (IBS) compared to dietary recommendations, 4) validate and assess the reproducibility of food records and 5) identify possible nutrient risk components for establishing GI microbiota involved in IBS and as part of an intervention, determine whether a course of probiotics may alter stool microbiota. Results: 1) A review article published by the author provides an overview of current probiotic treatment options to health care professionals and indicates certain probiotics are a promising therapeutic treatment option for management of IBS symtpoms, 2) the effects of the single strain probiotic, L. plantarum 299v, supplementation was evaluated in a RCT. Compared to placebo, the probiotic supplementation showed no significant reduction in GI symptom severity scores, particularly abdominal pain relief. Quality of life was also not improved in the treatment versus control group. Both the treatment and placebo groups improved significantly over the trial period, indicating a large placebo effect, 3) nutrient intakes of the IBS patients compared to current dietary reference recommendations indicates that this group of patients are at risk for nutrient inadequacies in key macro and micronutrients, 4) the validity and reliability of the dietary data showed good reliability but poor validity as measured by plasma fatty acids and 5) the GI microbiota composition in the phenotypically different diarrhoea-predominant IBS (D-IBS) vs. constipation-predominant IBS (C-IBS) showed that D-IBS patients had significantly lower counts of Lactobacillus plantarum compared to C-IBS patients. The probiotic had no significant effects on the GI microbiota as measured by quantitative polymerase chain reaction (qPCR). It was found that nutrient intakes had a significant impact on the microbiota. Lower fibre intakes were associated with higher Bacteroides spp., lower Bifidobacteria bifidum and Lactobacillus plantarum counts in both IBS groups. Conclusion: Taken together, L.plantarum 299v did not alleviate the GI symptoms of IBS, nor was it associated with significant changes in the GI microbiota. IBS patients may be at risk of key nutrient inadequacies. The influence of nutrient intakes on the GI microbiota provides an attractive explanation as a potential pathophysiological factor for IBS.
- ItemNutritional factors associated with oral lesions in HIV disease and TB infection(Stellenbosch : Stellenbosch University, 2003-12) Phooko, Puleng M. (Puleng Mpopi); Labadarios, D.; Blaauw, Renee; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences.ENGLISH ABSTRACT: Problem Definition: In the context of HIV/AIDS malnutrition is almost universal among children, and of the adverse effects of Protein Energy Malnutrition, the most frequent seems to be the occurrence of opportunistic infections with micro-organisms such as oral Candida. Objective: The aim of this study was to determine the nutritional status of children with oral complications in relation to HIV/AIDS as well as the effects of the oral lesions on nutritional status. Subjects/setting: The subjects of study were 24 children co-infected with TB and HIV who were admitted consecutively to the paediatric ward of Brooklyn Chest Hospital in Cape Town, South Africa. The nutritional status of the children was assessed over a maximum period of six months by nutrient intake, anthropometric status, and by biochemical parameters and clinical and oral examination on admission and at discharge from hospital. Results: Children with HIVand TB infection presenting with or without oral lesions were similarly malnourished throughout the period of hospitalization. There was no improvement in the nutritional status as indicated by height and weight measurements. Throughout the time of hospitalization, 7% of the children had a combination of stunting, underweight and wasting. Average nutrient intake was not found to be higher than the Recommended Dietary Allowance (RDA) in any of the children. At the time of admission to hospital and at discharge, carbohydrate intake provided most of the daily energy (36% and 42%, the difference not being statistically significant). There was a significant increase in the intake of energy (p=O.04) and a decrease in total fat intake (p=O.03) at discharge. Although not significant, mean protein intake at admission was higher than at time of discharge. Selected sub-optimal biochemical values were prevalent among the children studied, with 45% and 41% showing low serum albumin values «2.9g/dL) at the time of admission and at discharge respectively. Both on admission and at discharge, 38% of the children had Haemoglobin levels below normal values. Serum ferritin levels below normal values were present in almost all the children and the trend was similar for the prevalence of low zinc values. Sub-normal plasma retinol was present in 79% of the children at time of admission, while only 21% had deficient values at time of discharge (p=O.03). On admission, 29% of the children had vitamin evalues below the normal range whereas at time of discharge 17% of the children had values below normal (p=O.04). A total of 29% children presented with oral complications on admission. These included oral herpes, oral thrush, reflux, bleeding gums and stomatitis/angular cheilosis. Two children were asymptomatically colonized with Candida of the oral cavity. Mean total protein intake was higher (p=O.057) among the children who were not diagnosed with oral complications. Conclusions: This study confirmed that malnutrition is not only a common and serious problem associated with HIVand AIDS, but also that nutritional problems cannot be dealt with in isolation where Opportunistic Infections are present. The severity of malnutrition depends on various factors including oral complications. Additionally, appropriate management and treatment of tuberculosis did not appear to affect the nutritional status significantly. Recommendations: On the basis of these findings, and because of the increased risk of growth failure and developmental delays, children should be referred for full nutritional evaluation as soon as possible after diagnosis of HIV -infection. In addition, there is a need for intervention programmes to identify the immediate underlying causes of malnutrition and the ways in which such causes interact, in order to ensure that such interventions increase the resistance of HIV infected infants and children to the disease.
- ItemThe nutritional management of adult burn wound patients in South Africa(Stellenbosch : University of Stellenbosch, 2007-12) Ellmer, Marlene; Blaauw, Renee; Van der Merwe, Sulene; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition.OBJECTIVE: The objectives of this study were to determine the nutritional practices used in burns units in South Africa and to compare them with the latest available literature in order to make appropriate recommendations for possible implementation. METHODS: Validated questionnaires were sent out to surgeons, dietitians and professional nurses working in burns units that complied with the inclusion criteria. Information on the units was obtained from an advertisement placed via email through ADSA. Non-random sampling was done and all the burns units were included in the study. Descriptive cross-sectional statistics were used to analyze the data. RESULTS: Twelve burns units were identified. Ten of the burns units’ health professionals (surgeons, dietitians and professional nurses) participated in the study. All the health professionals had experience in burned patients’ management judging by the average number of year’s experience. The average number of adult burned patients treated was 188 (58-350) and the mortality per year was 16% [Standard Deviation (SD) 6.4%] About half of the professionals indicated they used a protocol for the implementation of nutrition support. A degree of miscommunication was noted between the health professionals working in the units. Very few units (n=2) were able to perform wound excisions within 72 hours post-burn. All the dietitians used predictive equations when estimating energy requirements and the most popular formula remained the Curreri formula. Various different predictive equations were used. Even though most institutions indicated that micronutrient supplementation was routine practice, no standard regimen existed and supplementation varied significantly between units. The oral route, enteral route or a combination were used to feed patients with different degrees of burns, and the majority (60%) of the health professionals stated that they waited until oral diets were tolerated before enteral nutrition was stopped. The nasogastric enteral route remained the most popular route. Very few units used other feeding routes, and they would rather opt for TPN if nasogastric feeding should fail. The estimated nutritional requirements were met in 90% of patients in whom the feeding tube was successfully placed. From the results it appeared that dietitians were less confident regarding the use of immunonutrition in burned patients, in spite of the available literature. Anabolic agents were not very commonly used in South Africa, probably due to the high cost. Patients were not followed-up regularly by dietitians. CONCLUSION The results of this study indicated that despite the use of correct recommendations in certain instances there remained a definite degree of variation and uncertainty amongst health professionals. There also appeared to be poor communication between health professionals. The burns units in South Africa should use set standards for nutritional managements, obtain and implement strict feeding protocols and improve communication amongst the health professionals.