Masters Degrees (Human Nutrition)

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Browsing Masters Degrees (Human Nutrition) by Subject "Anthropometry"

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    Impact of highly active antiretroviral therapy (HAART) on body composition and other anthropometric measures of HIV-infected women in a primary healthcare setting in KwaZulu-Natal : a pilot study
    (Stellenbosch : Stellenbosch University, 2008-12) Esposito, Francesca; Coutsoudis, A.; Visser, J.; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition.
    Background and objectives: An understanding of the effect of HAART on different aspects of health, including nutritional status, of HIV-infected individuals in South Africa is needed to ensure that appropriate population-specific guidelines and policies can be developed. This study aimed to investigate the impact of HAART on nutritional status, focusing on changes in anthropometric measures, and to explore the relationship between these measures and immunological and virological response to HAART. Methods: A prospective study of 30 adult females was carried out at a clinic in Cato Manor, KwaZulu-Natal. Anthropometric measurements, including weight, mid-upper arm circumference (MUAC), waist circumference, hip circumference, body mass index (BMI) and waist-to-hip ratio (WHR), were performed at baseline and 12 and 24 weeks after commencing HAART. Laboratory values, including CD4 lymphocyte count, viral load, albumin and haemoglobin as well as bioelectrical impedance analysis data, including lean body mass (LBM), fat mass (FM) and body fat percentage (BF%), were collected at baseline and after 24 weeks on HAART. Results: Overall, there was a statistically significant increase in all anthropometric measures, except WHR and LBM. The mean weight change was 3.4±5.8kg (p=0.006). Fifty percent of the subjects had a BMI above normal at baseline and mean BMI increased from 25.6±5.7kg/m2 to 27.3±5.6kg/m2 (p=0.007). Seventy percent of subjects gained weight, 18.5% had a stable weight and 11.1% lost weight. The weight gain in most subjects was attributable to a gain in FM while in subjects who lost weight, the loss consisted mainly of LBM. Some patients with stable body weight experienced changes in the relative proportions of fat and lean mass. Six patients showed evidence of disproportionate gains and losses in body circumference measurements which may be indicative of fat redistribution. Subjects with lower CD4 lymphocyte counts experienced greater increases in weight, BMI, FM and BF%. The strongest correlation was observed with FM (rs=-0.53; p=0.00). Greater increases in weight, BMI, MUAC, waist circumference, hip circumference, FM and BF% were seen in those with lower baseline haemoglobin. Baseline viral load and albumin did not correlate significantly with changes in any anthropometric variables. Change in CD4 count was only significantly associated with baseline MUAC (rs=0.40; p=0.04). Change in viral load was significantly correlated with baseline weight, LBM, FM, BF% and MUAC with the strongest correlation being with weight (rs=0.44; p=0.01). No significant association was found between anthropometric changes and changes in CD4 count and viral load between baseline and the 24-week visit. Conclusion: Overall, subjects experienced a significant increase in most anthropometric measures. There appears to be a relationship between some anthropometric and laboratory measures but this needs clarification. The findings of this study demonstrate the value of including circumference measurements and body composition techniques as part of nutritional status assessment and demonstrate the need for studies to determine the prevalence and significance of overweight and obesity in the HIV-infected population. Research is needed to determine the best methods of bringing about the most favourable anthropometric changes to enhance the health of patients on HAART.
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    A secondary analysis of anthropometric data from the 1999 National Food Consumption Survey, using different growth reference standards
    (Stellenbosch : Stellenbosch University, 2008-12) Bosman, Lise; Herselman, M. G.; Labadarios, D.; Kruger, H. S.; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition.
    INTRODUCTION: The best known reference standards used to evaluate the growth and development of infants and children are the 1977 National Centre for Health Statistics (NCHS) - , the 2000 Centres for Disease Control and Prevention (CDC) - and the World Health Organization (WHO) (2006). The NCHS reference standards were used to analyse anthropometric data from the 1999 National Food Consumption Survey (NFCS). It was anticipated that using the 2000 CDC and the 2006 WHO reference standards may lead to differences in the previously estimated prevalences of stunting, wasting, underweight, risk of overweight, overweight and obesity in the study population. AIM: To compare the anthropometric status of children aged 12 - 60 months when using the 1977 NCHS -, the 2000 CDC -, and the 2006 WHO reference standards. METHODS: A secondary analysis of anthropometric data from the 1999 NFCS was conducted using different reference standards to compare anthropometric status in terms of the prevalences of stunting, wasting, underweight, risk of overweight, overweight and obesity. Relationships between anthropometric status and other variables such as breastfeeding, maternal education level and type of housing were explored. RESULTS: The prevalences of stunting, obesity and overweight were significantly higher and the prevalence of underweight and wasting were lower when using the 2006 WHO compared to the 1977 NCHS and the 2000 CDC reference standards. A significant relationship was found between weight-forheight and breastfeeding when using any one of the reference standards and between BMI-for-age and breastfeeding when using the 2006 WHO reference standard. A significant relationship was shown between maternal education level and height-for-age and weight-for-age when using any one of the three reference standards and a significant association was found between weight-for-height and BMI-for-age and the type of housing when using any of the three reference standards. CONCLUSIONS: The prevalences of stunting and obesity were higher when using the 2006 WHO reference standards compared to the 1977 NCHS and 2000 CDC reference standards. This may be due to the linear growth and rate of weight gain of breastfed infants differing from formula fed infants and the 2006 WHO reference made use of the exclusively and predominantly breastfed infant living under normal healthy conditions as the normative model which is a prescription of how children should not grow and .not an indication of how children are growing. In conclusion, the 2006 WHO reference standard must be the only reference standard used nationally and internationally when assessing the growth and nutritional status of infants and children.
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    The use of anthropometric indices as an alternative guide to initiating antiretroviral therapy (ART) in children at the Mildmay Centre in Uganda
    (Stellenbosch : Stellenbosch University, 2008-12) Nyakwezi, Sheila; Labadarios, D.; Van Wyk, E.; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition.
    Introduction: More than half a million children worldwide die from the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) each year. In Uganda, HIV/AIDS is a major cause of infant and childhood mortality. Although the government of Uganda, through various strategies, has increased access to antiretroviral drugs (ARVs), resulting in national scaling up of accessibility to antiretroviral therapy (ART), initiation of ART in resource-limited areas remains a challenge due to constraints such as the absence of or limited number of CD4 machines and related laboratory constraints. Further scaling up of ART for children would be greatly strengthened by increased access to laboratory services for CD4 counts or the introduction of alternative indicators or guidelines for the initiation of ART. Aim: This study therefore set out to investigate, through the analysis of retrospectively collected data, whether anthropometric indices (wasting - weight for height; underweight - weight for age; and stunting - height for age) could provide a useful alternative guide when deciding about initiation of ART in children aged 2-12 years in the absence of sophisticated clinical and laboratory support. Methods: The study was conducted at the Mildmay Centre, an HIV/AIDS specialist centre located in Kampala, Uganda. Parameters such as the age at which children had been initiated onto ART, duration on ART, World Health Organisation (WHO) and Centre for Disease Control (CDC) disease stages at time of initiation, anthropometry at time of initiation, CD4% staging at time of initiation, support received from food aid programmes, referral to other health centres as a result of malnutrition and care-giver nutrition education/counselling were all determined retrospectively from clinical records. Results: It was found, based on CDC (2000) growth reference charts, that of the total number of children who took part in this study (N=125), 98.4% were mildly wasted, 52.8% mildly underweight and 75.2% mildly stunted when they were initiated onto ART. Of the children, who had WHO disease staging documented - 40% (N=50), the majority - 86% (N=43) were in WHO disease staging II and III during initiation of ART. and 96% (N=48) were mildly wasted. However, the relationship between WHO disease staging and wasting, underweight, and stunting at initiation of ART in children at the Mildmay centre was not significant. The relationship between CD4% and underweight or stunted children was also not significant. It was established however, that in the absence of CD4 laboratory parameters (since CD4% is vital in the initiation of ART in children) as is the case in resource limited areas, anthropometric indices (moderate to severe wasting, weight for height -W/H) could be used concurrently with CDC and WHO disease staging to initiate ART in children. However, it is important to note that anthropometric indices on their own cannot be used as a guide for initiating ART in children. Conclusion: Anthropometric status alone cannot be used to accurately determine when to initiate ART in children 2-12 years.