Browsing by Author "Blaauw, Renee"

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    Allied health professional rural education: Stellenbosch University learners’ experiences
    (Health & Medical Publishing Group, 2016-10) Pillay, M.; Bester, J.; Blaauw, Renee; Harper, A.; Msindwana, A.; Muller, J.; Philips, L.
    ENGLISH SUMMARY : Background: Rural clinical training is not widely established or documented for allied health sciences (AHS) learners. This article focuses on the experiences of AHS learners from Stellenbosch University’s uKwanda Rural Clinical School. Objective: To explore learners’ practices with regard to rural clinical training in the AHS. Methods: A total of 22 documented reflections and seven educator or learner semi-structured focus group discussions, using critical conversations, were analysed with methods such as textual and thematic analysis and qualitative research software (ATLAS.ti, Germany). Results: The perception of rural clinical training was reported as an overwhelmingly positive experience. Practices positioned ‘rural’ as a catalyst for developing learners’ emerging identities as policy brokers, and as best when delivered by team participation. Professional education curricula were reported as dependant on: (i) context; (ii) educators; and (iii) how time was managed. Conclusion: Rural-based learning is a humanising experience for health science learners.
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    The anthropometric, vitamin A and iron status of pre-school children in the Western and Northern Cape Provinces
    (Stellenbosch : Stellenbosch University, 1998-11) Blaauw, Renee; Labadarios, D.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Human Nutrition.
    ENGLISH ABSTRACT: Vitamin A deficiency (VAD) and anaemia are major nutritional disorders worldwide, including Africa . It has been estimated that ½ million children go blind annually due to vitamin A deficiency, whereas anaemia affects approximately a quarter of the world's population. Furthermore, protein energy malnutrition (PEM) is known to be responsible for 55 % of childhood deaths worldwide. n view of these relationships, the aims of this study were to establish the anthropometric, vitamin A and iron status of pre-school children in the Western Cape (as part of a national survey), as well as to identify major factors contributing to poor status.
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    An anti-inflammatory approach to the dietary management of multiple sclerosis : a condensed review
    (Co-published by Medpharm Publications and Taylor & Francis, 2017) Labuschagne, I. L.; Blaauw, Renee
    Multiple sclerosis (MS) is a chronic, inflammatory, neurodegenerative demyelinating disease of the central nervous system (CNS). Inflammation is increased by high-energy Western-style diets, typically high in salt, animal fat, red meat, sugar-sweetened drinks and fried food, and low in fibre, as well as lack of physical exercise. An anti-inflammatory dietary regimen, with or without administration of dietary supplements, supporting the general trend towards an amelioration of inflammatory status, should be considered. Understanding the role of gut microbiota in health and disease can lay the foundation to treat chronic diseases by modifying the composition of gut microbiota through lifestyle choices, including dietary habits and possibly probiotic supplementation. Evidence from experimental, epidemiologic and clinical studies supports the potential association between poor vitamin D status and the risk of developing MS, as well as an adverse disease course. Correcting vitamin D status seems plausible in patients with MS
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    Application of evidence on probiotics, prebiotics and synbiotics by food industry : a descriptive study
    (London : Biomed Central, 2014-10) Mugambi, Mary N.; Young, Taryn; Blaauw, Renee; Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition.
    ENGLISH ABSTRACT: This study assessed how the food industry applies the knowledge and evidence gained from synbiotics, probiotics or prebiotics research in infants, on the general paediatric population. This study also explored: what happens after the clinical trials using infant formula are completed, data is published or remains unpublished; the effectiveness and type of medium the formula manufacturers use to educate consumers on probiotic, prebiotic or synbiotic infant formula. Findings: This was a descriptive study (a survey) that used a structured questionnaire. All listed companies that manufacture and / or market food products with added probiotics, prebiotics or synbiotics for infants were identified and invited to participate. People responsible for research and development were invited to participate in the survey. A letter of invitation was sent to selected participants and if they expressed willingness to take part in the study, a questionnaire with a written consent form was sent. Descriptive statistics and associations between categorical variables were to be tested using a Chi-square test, a p < 0.05 was statistically significant. A total of 25 major infant formulas, baby food manufacturers were identified, invited to participate in the survey. No company was willing to participate in the survey for different reasons: failure to take any action 5 (20%), decision to participate indefinitely delayed 2 (8%), sensitivity of requested information 3 (12%), company does not conduct clinical trials 1 (4%), company declined without further information 4 (16%), erroneous contact information 6 (24%), refusal by receptionists to forward telephone calls to appropriate staff 3 (12%), language barrier 3 (12%), company no longer agrees to market research 1 (4%). Conclusion: Due to a poor response rate in this study, no conclusion could be drawn on how the food industry applies evidence gained through probiotics, prebiotics or synbiotics research on infants for the benefit of the general paediatric population. More information and greater transparency is needed from the infant formula manufacturers on how they apply the evidence gained from the research on probiotics, prebiotics and synbiotics on infants
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    Assessing the utilization of a child health monitoring tool
    (Health and Medical Publishing Group, 2017) Blaauw, Renee; Daniels, L.; Du Plessis, L. M.; Koen, N.; Koornhof, H. E.; Marais, M. L.; Van Niekerk, E.; Visser, J.
    Objective: The study assessed the implementation of growth monitoring and promotion, immunisation, vitamin A supplementation, and deworming sections of the Road-to-Health Booklet. Caregivers and health care workers knowledge, attitudes and practices were investigated as well as health care workers perceptions of barriers undermining implementation. Methods: A cross-sectional descriptive study was conducted on a proportional sample of randomly selected Primary Health Care facilities across six health districts (35%; n=143) in the Western Cape Province. Health care workers involved in the implementation of the Road-to-Health Booklet, children (0-36 months) and CGs were included. Information was obtained through scrutiny of the Road-to-Health Booklet, observation of consultations and structured questionnaires. Results: A total of 2442 children, 2481 caregivers and 270 health care workers were recruited. Weight (94.7%) measurements were performed routinely. Less than half (40.2%) of caregivers reported that their child’s growth was explained. Sixty-eight percent of health care workers correctly identified criteria for underweight, whereas only 55% and 39% could do so for stunting and wasting respectively. Road-to-Health Booklet sections were completed adequately for immunization (89.3%), vitamin A supplementation (94.6%) but not for deworming (48.8%). Most health care workers (94%) knew the correct regimes for vitamin A supplementation and deworming, but few caregivers knew when treatment was due for vitamin A supplementation (16.4%) and deworming (26.2%). Potential barriers identified related to inadequate training, staff shortages and limited time. Conclusion: Focussed effort and resources should be channelled towards health care workers training and monitoring regarding growth monitoring and promotion to optimize utilization of the Road-to-Health Booklet. Mobilisation of community health workers is needed to strengthen community awareness of preventative health interventions.
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    Association between funding source, methodological quality and research outcomes in randomized controlled trials of synbiotics, probiotics and prebiotics added to infant formula : a systematic review
    (BioMed Central, 2013-11) Mugambi, Mary N.; Musekiwa, Alfred; Lombard, Martani; Young, Taryn; Blaauw, Renee
    Background: There is little or no information available on the impact of funding by the food industry on trial outcomes and methodological quality of synbiotics, probiotics and prebiotics research in infants. The objective of this study was to compare the methodological quality, outcomes of food industry sponsored trials versus non industry sponsored trials, with regards to supplementation of synbiotics, probiotics and prebiotics in infant formula. Methods: A comprehensive search was conducted to identify published and unpublished randomized clinical trials (RCTs). Cochrane methodology was used to assess the risk of bias of included RCTs in the following domains: 1) sequence generation; 2) allocation concealment; 3) blinding; 4) incomplete outcome data; 5) selective outcome reporting; and 6) other bias. Clinical outcomes and authors’ conclusions were reported in frequencies and percentages. The association between source of funding, risk of bias, clinical outcomes and conclusions were assessed using Pearson’s Chi-square test and the Fisher’s exact test. A p-value < 0.05 was statistically significant. Results: Sixty seven completed and 3 on-going RCTs were included. Forty (59.7%) were funded by food industry, 11 (16.4%) by non-industry entities and 16 (23.9%) did not specify source of funding. Several risk of bias domains, especially sequence generation, allocation concealment and blinding, were not adequately reported. There was no significant association between the source of funding and sequence generation, allocation concealment, blinding and selective reporting, majority of reported clinical outcomes or authors’ conclusions. On the other hand, source of funding was significantly associated with the domains of incomplete outcome data, free of other bias domains as well as reported antibiotic use and conclusions on weight gain. Conclusion: In RCTs on infants fed infant formula containing probiotics, prebiotics or synbiotics, the source of funding did not influence the majority of outcomes in favour of the sponsors’ products. More non-industry funded research is needed to further assess the impact of funding on methodological quality, reported clinical outcomes and authors’ conclusions.
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    Body fat distribution as a risk factor for osteoporosis
    (Health & Medical Publishing Group, 1996) Blaauw, Renee; Albertse, E. C.; Hough, S.
    Objective. The aim of this study was to compare the body fat distribution of patients with osteoporosis (OP) with that of an appropriately matched non-OP control group. Design. Case control study. Setting. Department of Endocrinology and Metabolism, Tygerberg Hospital. Participants. A total of 56 patients with histologically proven idiopathic OP, of whom 39 were women (mean age 61 ± 11 years) and 17 men (49 ± 15 years), were compared with 125 age- and sex-matched non-OP (confirmed by dual energy X-ray absorptiometry) subjects, 98 women (60 ± 11 years) and 27 men (51 ± 16 years). Outcome measures. Anthropometric data, including weight, height, skinfold measurements, mid-upper arm, waist and hip circumferences, as well as elbow breadth. Results. The men and women with OP were significantly shorter (P = 0.04 and P = 0.03 respectively) and of lower body mass (P = 0.04 and P = 0.02 respectively) than the control subjects, although their mean body mass indices were comparable. The OP population had significantly lower skinfold, elbow breadth and arm circumference values, although the majority of subjects in both groups fell within the 15 - 85th percentiles. Despite their lower body mass, both the OP women (P = 0.009) and men (P = 0.002) had significantly higher waist/hip ratios than corresponding controls. Conclusion. Whatever the underlying pathogenesis, this new finding suggests that, should these results be confirmed by larger studies, OP can be added to the list of diseases associated with a waist fat distribution.
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    Determinants of serum 25-hydroxyvitamin D levels in healthy young adults living in the Western Cape, South Africa
    (South African Academy of Family Physicians, 2019-10-28) Visser, Janicke; Knight, K.; Philips, L.; Visser, W.; Wallace, M.; Nel, D. G.; Blaauw, Renee
    Background: Vitamin D deficiency is fast emerging as a global pandemic. In South Africa few studies have been conducted to determine the vitamin D status of the healthy population. Methods: This prospective study with an analytical component investigated vitamin D status of healthy undergraduate students at two time points (winter and summer) at Stellenbosch University. Serum 25(OH)D was determined, anthropometric measurements taken and dietary vitamin D intake estimated (food-frequency questionnaire). Skin tone was determined (Fitzpatrick skin type classification), and a skin reflectometry device used to measure dermal melanin content. Results: Results of 242 students indicated a mean serum 25(OH)D of 63.80 ± 41.35 ng/ml and a high prevalence of vitamin D sufficiency (88%). Significantly more females experienced suboptimal vitamin D levels than males (18 vs. 5%; p < 0.01). Participants with lighter skin tones had higher levels of 25(OH)D than those with darker skin tones (chi-square = 24.02; p = 0.02). The majority (60.74%) had a normal BMI, although there was no significant relationship between BMI and serum 25 (OH)D (Spearman’s r=–0.11; p = 0.09). Total mean dietary vitamin D intake was 7.99 ± 13.81 mcg, with 87.2% having inadequate intake (< 15 mcg). The relationship between total vitamin D intake and serum 25(OH)D was found to be significant in winter (p < 0.001) and summer (p = 0.01). Serum vitamin D levels were significantly higher in the winter phase (p < 0.001). Conclusions: A low prevalence of vitamin D deficiency was found amongst healthy young adults, despite low dietary vitamin D intakes. Significant relationships were found between serum 25(OH)D and gender, skin tone and vitamin D intake. Further studies need to be conducted, especially in high-risk groups, before results are applied to the greater South African public.
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    The development of a single health-endorsement logo for South Africa
    (Cambridge University Press, 2018) Koen, Nelene; Wentzel-Viljoen, Edelweiss; Blaauw, Renee
    Objective: To develop health-endorsement logos (HEL) for food products indicating healthy choices based on the South African nutrient profile model and to pilot test these logos with consumers. Design: Multistage mixed-methods design. Setting: Cape Town, South Africa. Subjects: Nine focus group discussions (FGD) were conducted with adult consumers to explore what types of HEL are preferred and why. Based on the findings, ten HEL were designed by a graphic design team. A modified Delphi technique, conducted with experts in the fields of nutrition and food science, was employed to eliminate lowest-scoring HEL and to improve the design of the remaining logos. Participants from the initial FGD participated in pilot testing the improved logos. Results: Participants from FGD (n 67) were positive about a single HEL, stating it would make food labelling less confusing as they did not understand the various HEL used. Participants indicated the logo should include wording related to ‘healthy choice’ or ‘better choice’ and pictures/symbols related to health and/or food. During two rounds of scoring and comments by experts (n 19), five logos were eliminated and the design of the remaining five improved. Three of five remaining logos received overall rankings of 3·08/5, 3·28/5 and 3·39/5, respectively, during FGD (n 36) in the pilot-testing phase. Conclusion: HEL were designed and consumer tested. Three designs were submitted to the national Department of Health to consider for implementation, after further testing, as a tool to assist in addressing the high incidence of non-communicable diseases in South Africa.
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    Diagnosis of hospital malnutrition in the adult population
    (Taylor & Francis, 2019-04-01) Blaauw, Renee
    It is well known that malnutrition is associated with increased morbidity (increased complications1-3 and longer length of ICU and hospital stay1-4) as well as increased mortality.1-6 Early identification and appropriate management of malnutrition on the other hand is associated with improved outcomes.7 Nutritional status screening and assessment therefore should be performed on all patients on admission to hospital.8,9 Those identified as malnourished or at-risk of developing malnutrition should be referred for specialised nutrition support in an attempt to correctly manage and improve nutritional status.
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    Dietary management of people with diabetes mellitus : Association for Dietetics in Southern Africa (ADSA)
    (Health and Medical Publishing Group (HMPG), 1997-10) Badenhorst, A. M.; Badham, J.; Blaauw, Renee; Dannhauser, A.; Du Toit, W.; Herbert, C.; Johnson, J.; Joubert, P. A.; Menssink, E.; Peberdy, C.; Silvis, N.; Slabber, M.; Wilson, R.
    AIM: The aim of these recommendations is to encourage a uniform approach to the nutritional management of diabetes in South Africa. Although the implementation of these recommendations will vary according to intake of traditional, ethnic and cultural foods, these recommendations apply to all population groups, and should be tailored to individual needs, circumstances and preferences.
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    The effect of ß-glucan prebiotic on kidney function, uremic toxins and gut microbiome in stage 3 to 5 chronic kidney disease (CKD) predialysis participants : a randomized controlled trial
    (MDPI, 2022-02-14) Ebrahim, Zarina; Proost, Sebastian; Tito, Raul Yhossef; Raes, Jeroen; Glorieux, Griet; Moosa, Mohammed Rafique; Blaauw, Renee
    There is growing evidence that gut dysbiosis contributes to the progression of chronic kidney disease (CKD) owing to several mechanisms, including microbiota-derived uremic toxins, diet and immune-mediated factors. The aim of this study was to investigate the effect of a ß-glucan prebiotic on kidney function, uremic toxins and the gut microbiome in stage 3 to 5 CKD participants. Fifty-nine participants were randomized to either the ß-glucan prebiotic intervention group (n = 30) or the control group (n = 29). The primary outcomes were to assess kidney function (urea, creatinine and glomerular filtration rate), plasma levels of total and free levels of uremic toxins (p-cresyl sulfate (pCS), indoxyl-sulfate (IxS), p-cresyl glucuronide (pCG) and indoxyl 3-acetic acid (IAA) and gut microbiota using 16S rRNA sequencing at baseline, week 8 and week 14. The intervention group (age 40.6 ± 11.4 y) and the control group (age 41.3 ± 12.0 y) did not differ in age or any other socio-demographic variables at baseline. There were no significant changes in kidney function over 14 weeks. There was a significant reduction in uremic toxin levels at different time points, in free IxS at 8 weeks (p = 0.003) and 14 weeks (p < 0.001), free pCS (p = 0.006) at 14 weeks and total and free pCG (p < 0.001, p < 0.001, respectively) and at 14 weeks. There were no differences in relative abundances of genera between groups. Enterotyping revealed that the population consisted of only two of the four enterotypes: Bacteroides 2 and Prevotella. The redundancy analysis showed a few factors significantly affected the gut microbiome: these included triglyceride levels (p < 0.001), body mass index (p = 0.002), high- density lipoprotein (p < 0.001) and the prebiotic intervention (p = 0.002). The ß-glucan prebiotic significantly altered uremic toxin levels of intestinal origin and favorably affected the gut microbiome.
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    The effects of anti-inflammatory agents as host-directed adjunct treatment of tuberculosis in humans : a systematic review and meta-analysis
    (BioMed Central, 2020-08-26) Hayford, Frank Ekow Atta; Dolman, Robin Claire; Blaauw, Renee; Nienaber, Arista; Smuts, Cornelius Mattheus; Malan, Linda; Ricci, Cristian
    Background: The potential role of adjunctive anti-inflammatory therapy to enhance tuberculosis (TB) treatment has recently received increasing interest. There is, therefore, a need to broadly examine current host-directed therapies (HDTs) that could accelerate treatment response and improve TB outcomes. Methods: This systematic review and meta-analysis included randomised controlled trials of vitamin D and other HDT agents in patients receiving antibiotic treatment for pulmonary TB. Sputum smear conversion rate at 4–8 weeks was the primary outcome. Secondary outcomes included blood indices associated with infectivity and inflammation, chest radiology and incidence of adverse events. Results: Fifty-five studies were screened for eligibility after the initial search, which yielded more than 1000 records. Of the 2540 participants in the 15 trials included in the meta-analysis, 1898 (74.7%) were male, and the age at entry ranged from 18 to 70 years. There was a 38% significantly (RR 1.38, 95% CI = 1.03–1.84) increased sputum smear negativity in patients administered with vitamin D in addition to standard TB treatment than those receiving only the TB treatment. Patients treated with other HDT anti-inflammatory agents in addition to TB treatment also had a 29% significantly increased sputum smear conversion rate (RR 1.29, 95% CI = 1.09–1.563). Lymphocyte to monocyte ratio was significantly higher in the vitamin D treatment groups compared to the controls (3.52 vs 2.70, 95% CI for difference 0.16–1.11, p = 0.009) and (adjusted mean difference 0.4, 95% CI 0.2 -- 0.6; p = 0.001); whilst tumour necrosis factor-alpha (TNF-α) showed a trend towards a reduction in prednisolone (p < 0.001) and pentoxifylline (p = 0.27) treatment groups. Vitamin D and N-acetylcysteine also accelerated radiographic resolution in treatment compared to placebo at 8 weeks. No differences were observed in the occurrence of adverse events among all HDT treatments. Conclusions: Vitamin D and other anti-inflammatory HDT medications used as adjunct TB treatment may be well tolerated and effective. They significantly improved sputum smear conversion rate and chest radiological appearance, and also exhibited an inflammation resolution effect.
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    Effects of rising food prices on household food security on femaleheaded households in Runnymede Village, Mopani District, South Africa
    (MedPharm Publications, 2016) Mkhawani, K.; Motadi, S. A.; Mabapa, N. S.; Mbhenyane, X. G.; Blaauw, Renee
    Background: Rising food prices can have a devastating effect on the health of poor households by making it more difficult for them to afford basic food baskets. Although South Africa is food secure as a nation, it does not mean that every household is able to access nutritionally adequate food. Objective: The objective of the study was to determine the effects of rising food prices on people’s perceptions and coping strategies regarding household food security. Setting: Sixty femaleheaded households were selected from 250 households in Runnymede Village in the Greater Tzaneen Local Municipality, Mopani District, Limpopo province, South Africa. Design: A descriptive and exploratory study was conducted using quantitative methods by means of an administered, structured questionnaire. The accessible population was femaleheaded households residing in Runnymede Village. Participants representing 60 femaleheaded households were purposively selected from the 250 households. Open and closed-ended questions were used to collect the data. Results: The majority (58%) of participants indicated that their eating habits had changed owing to rising food prices. Approximately 60% of the participants indicated that they bought food in bulk as a shortterm strategy to cope with rising food prices. Approximately 50% had a vegetable garden to alleviate food unavailability, and harvested for subsistence to meet non-food expenses. The majority (57%) of participants converted to buying cheaper brands, such as generic store brands. In addition, rising food prices made high quality food scarce for poorer households, forcing them to resort to cheaper or less nutritious foods. Conclusion: Rising food prices had a negative impact on poor, femaleheaded households in Runnymede Village.
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    Efficacy and safety of saccharomyces boulardii in the treatment of acute gastroenteritis in the paediatric population : a systematic review
    (MedPharm Publications, 2018-04-12) Padayachee, Morgambal; Visser, Janicke; Viljoen, Estelle; Musekiwa, Alfred; Blaauw, Renee
    Context: Gastroenteritis (GE) remains the second major cause of death in the most vulnerable of the world’s populations. Potential treatments include the use of probiotics, with the yeast Saccharomyces boulardii being one such option. Objectives: The primary objective was to assess the efficacy and safety of Saccharomyces boulardii in the treatment of acute GE in the paediatric population. Method: Major electronic databases were searched from April 2014 to January 2015. Additional literature was obtained through hand-searching and reviewing of reference lists of articles and other systematic reviews. Randomised controlled trials (RCTs) in a hospital setting, involving participants < 16 years were used as the data source. Two reviewers independently screened studies for eligibility, assessed study quality and performed data extraction. Review Manager 5 was used to analyse data and a random-effects model of meta-analysis was applied owing to heterogeneity. Results: Ten of 190 articles were selected for final inclusion. A meta-analysis of five of the included studies showed that Saccharomyces boulardii compared with the control significantly shortened the duration of diarrhoea (in days) (MD –0.57, 95% CI –0.83 to –0.30, p < 0.0001), but there was no difference between groups regarding time to achieving formed stools. No adverse effects were reported. The GRADE tool assessed overall methodological quality as moderate. Conclusion: Saccharomyces boulardii showed a potential benefit in treating acute GE in the paediatric patient. A dose of 250 mg 1–2 times per day for up to 5 days showed some benefit and appears safe. Larger, rigorous RCTs are needed to investigate the efficacy and safety of Saccharomyces boulardii in order to offer specific treatment guidelines.
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    Endemic fluorosis -a model for studies examining the effect of fluoride on bone
    (Health & Medical Publishing Group, 1997) Honiball, S. C.; Blaauw, Renee; Martell, R.; Taljaard, J. J. F.; Stokol, J. M.; Hough, F. S.
    The use of fluoride in the treatment of osteoporosis is complicated by concerns about the integrity of the newly formed bone, as well as the fact that not all patients respond to the drug. In an attempt to broaden insight into the varied skeletal response to fluoride exposure, we studied (clinical, dietary analysis, radiology, biochemistry and genetic markers) all 114 permanent inhabitants of an endemic fluorosis area. Unequivocal radiological evidence of osteofluorosis was present in 26% of subjects, while 48% had normal skeletal radiological results and 4% were found to be osteopenic. Twenty-two per cent were unclassifiable. Individuals with fluorosis were older and predominantly male. Although musculoskeletal symptoms occurred more frequently in patients with osteofluorosis, these subjects did not have an increased fracture prevalence and were, in fact, found to have a higher metacarpal as well as femoral cortical bone mass. In subjects with osteofluorosis, the average fluoride intake and residency in the area were similar to those of unaffected Kenhardt individuals, implying that there are causative factors other than fluoride exposure. Moreover, renal excretion of fluoride was comparable, as was the average energy, protein, mineral and alcohol intake. Mean serum calcium, phosphate, alkaline phosphatase, parathyroid hormone, calcitonin and 25-hydroxyvitamin D levels were unremarkable and similar in subjects with and without osteofluorosis. However, a family tree analysis of the population revealed that 4 very closely related subjects had osteopenia, which suggests that a genetic predisposition may at least partially explain why the skeletal response to fluoride is not determined by fluoride exposure alone.
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    Enteral formula : selecting the right formula for your patient
    (Medpharm Publications, 2017) Blaauw, Renee; Du Toit, Anna-Lena
    The availability of various enteral formulae on the market assists in the individualized management of patients. It provides variety in terms of macronutrient content, fluid options and the addition or omission of certain components, e.g. fibre, electrolytes and immunonutrients. It is imperative that health care practitioners should be familiar with all products locally available and should have the ability to select the most appropriate products to meet the patient’s needs. We provide a brief summary of all enteral formulae in terms of unique features and recommendations for use. Practical application is discussed by means of two case studies.
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    Examining associations of HIV and iron status with nutritional and inflammatory status, anemia, and dietary intake in South African school children
    (MDPI, 2021) Goosen, Charlene; Baumgartner, Jeannine; Mikulic, Nadja; Barnabas, Shaun L.; Cotton, Mark F.; Zimmermann, Michael B.; Blaauw, Renee
    The etiology of multifactorial morbidities such as undernutrition and anemia in children living with the human immunodeficiency virus (HIV) (HIV+) on antiretroviral therapy (ART) is poorly understood. Our objective was to examine associations of HIV and iron status with nutritional and inflammatory status, anemia, and dietary intake in school-aged South African children. Using a two-way factorial case-control design, we compared four groups of 8 to 13-year-old South African schoolchildren: (1) HIV+ and low iron stores (inflammation-unadjusted serum ferritin ≤ 40 µg/L), n = 43; (2) HIV+ and iron sufficient non-anemic (inflammation-unadjusted serum ferritin > 40 µg/L, hemoglobin ≥ 115 g/L), n = 41; (3) children without HIV (HIV-ve) and low iron stores, n = 45; and (4) HIV-ve and iron sufficient non-anemic, n = 45. We assessed height, weight, plasma ferritin (PF), soluble transferrin receptor (sTfR), plasma retinol-binding protein, plasma zinc, C-reactive protein (CRP), α-1-acid glycoprotein (AGP), hemoglobin, mean corpuscular volume, and selected nutrient intakes. Both HIV and low iron stores were associated with lower height-for-age Z-scores (HAZ, p < 0.001 and p = 0.02, respectively), while both HIV and sufficient iron stores were associated with significantly higher CRP and AGP concentrations. HIV+ children with low iron stores had significantly lower HAZ, significantly higher sTfR concentrations, and significantly higher prevalence of subclinical inflammation (CRP 0.05 to 4.99 mg/L) (54%) than both HIV-ve groups. HIV was associated with 2.5-fold higher odds of iron deficient erythropoiesis (sTfR > 8.3 mg/L) (95% CI: 1.03–5.8, p = 0.04), 2.7-fold higher odds of subclinical inflammation (95% CI: 1.4–5.3, p = 0.004), and 12-fold higher odds of macrocytosis (95% CI: 6–27, p < 0.001). Compared to HIV-ve counterparts, HIV+ children reported significantly lower daily intake of animal protein, muscle protein, heme iron, calcium, riboflavin, and vitamin B12, and significantly higher proportions of HIV+ children did not meet vitamin A and fiber requirements. Compared to iron sufficient non-anemic counterparts, children with low iron stores reported significantly higher daily intake of plant protein, lower daily intake of vitamin A, and lower proportions of inadequate fiber intake. Along with best treatment practices for HIV, optimizing dietary intake in HIV+ children could improve nutritional status and anemia in this vulnerable population.
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    Food and nutrition labelling : the past, present and the way forward
    (MedPharm Publications, 2016) Koen, N.; Blaauw, Renee; Wentzel-Viljoen, E.
    Current global mortality from noncommunicable diseases (NCDs) remains unacceptably high and is increasing. A major reduction in the burden of NCDs should come from population-wide interventions, including the promotion of a healthy diet through the provision of adequate nutrition information on food labels. However, in order for this type of intervention to be successful, it is important to have a better understanding of the consumer. This review focuses on the need for food and nutrition labelling (the section of information on a food label that specifically declares nutrient content) within the context of NCDs, as well as consumer nutrition label use, and understanding and the impact of nutrition labelling on purchasing behaviour. It provides a summary of the latest global nutrition labelling trends, the current situation in South Africa and the way forward. Consumer knowledge, use and understanding of nutrition labelling has been investigated extensively in the international literature. However, the majority of these investigations were conducted in developed countries. Therefore, additional research on the impact of nutrition labelling in developing countries is necessary, and should be a priority. There have been many developments in South Africa in terms of food and nutrition labelling in the last decade. Although the food industry, health professionals and consumers face many changes, challenges and opportunities with regard to food, and specifically to nutrition labelling, this is also the ideal time to promote the use and understanding of nutrition information on labels by health professionals to consumers.
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    Food avoidance in irritable bowel syndrome leads to a nutrition-deficient diet
    (MedPharm Publications, 2014-08) Stevenson, Cheryl; Blaauw, Renee; Fredericks, Ernst; Visser, Janicke; Roux, Saartjie
    Objective: The objective was to assess the dietary intake of subjects with irritable bowel syndrome (IBS) and to compare it to that of international recommendations. The hypothesising assumption of this study was that a situation in which subjects insist that diet or trigger foods play a part in symptom generation may lead to an unbalanced dietary intake. Design: This was a descriptive observational study, with an analytical component. Setting: A private, secondary care-level clinic in South Africa. Subjects: The study population comprised 122 participants. Each subject completed an estimated, three-day dietary record. The data were analysed using a computerised food analysis programme. The fructose intake was analysed semi-quantitatively. IBS subjects’ protein and carbohydrate intake were significantly higher than the recommended dietary allowance for protein and carbohydrate (p-values < 0.000 and < 0.000, respectively). Outcome measures: The identification of dietary risk factors that affect IBS. Results: The IBS subjects’ daily total dietary fibre (15.13 g ± 13.11) was significantly lower (p-value < 0.000) than the dietary reference intake (DRI) target intake of 24.76 g/day, and the intake of micronutrients, calcium, iron and folate) was significantly less than the DRI. There was no significant difference in macronutrient intake between the diarrhoea-predominant IBS (D-IBS), constipation-predominant IBS (C-IBS) and the control groups. The total number of fructose serves per day was not statistically significant between the three groups (C-IBS 2.68 ± 1.68, D-IBS 2.15 ± 1.86, and controls 3.17 ± 2.39, p-value = 0.157). Conclusion: The IBS subjects in this study consumed diets that were deficient in key micronutrients and total fibre when judged against the recommended DRIs. Dietary adjustments may have been tailored by subjects to minimise symptom development and this led to nutritionally deficient diets.