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BACKGROUND: Breastfeeding protects against a range of conditions in the infant, including sudden infant death syndrome (SIDS), diarrhoea, respiratory infections and middle ear infections [1, 2]. The World Health Organization (WHO) recommends exclusive breastfeeding until six months of age, with continued breastfeeding recommended for at least two years and other complementary nutritious foods [3]. The 2017-18 National Health Survey (NHS) and 2018-19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) reported that the proportion of breastfeeding in Aboriginal and Torres Strait Islander infants (0-2 years) were less than half that of non-Indigenous infants (21.2% vs. 45%, respectively)[4]. There is a lack of research on interventions supporting Aboriginal women to breastfeed, identifying an evaluation gap related to peer support interventions to encourage exclusive breastfeeding in Aboriginal women. METHODS: We will evaluate the effect of scheduled breastfeeding peer support for and by Aboriginal women, on breastfeeding initiation and the prevalence of exclusive breastfeeding. This MRFF (Medical Research Future Fund) funded project is designed as a single-blinded cluster randomised controlled trial recruiting six sites across New South Wales, Australia, with three sites being randomised to employ a peer support worker or undertaking standard care. Forty pregnant women will be recruited each year from each of the six sites and will be surveyed during pregnancy, at six weeks, four and six months postnatally with a single text message at 12 months to ascertain breastfeeding rates. In-depth interviews via an Indigenous style of conversation and storytelling called 'Yarning' will be completed at pre- and post-intervention with five randomly recruited community members and five health professionals at each site" [5]. Yarns will be audio recorded, transcribed, coded and thematic analysis undertaken. Health economic analysis will be completed to assess the

Abstract Objective: This scoping review sought to describe the policy actions that urban local governments globally have implemented to facilitate healthy and environmentally sustainable diet-related practices. Setting: Urban local government authorities. Design: Five databases were searched to identify publications which cited policies being implemented by local governments within the 199 signatory cities of the Milan Urban Food Policy Pact (MUFPP) that targeted at least one healthy and sustainable diet-related practice. Grey literature was then searched to retrieve associated policy documentation. Data from both sources were charted against the MUFPP’s monitoring framework to analyse the policy actions included in each overarching policy. Results: From 2624 screened peer-reviewed studies, 27 met inclusion criteria and cited 36 relevant policies amongst signatory cities to the MUFPP. Most were from high income countries (n 29; 81 %), considered health (n 31; 86 %), equity (n 29; 81 %) and the broader food system beyond dietary consumption (n 34; 94 %). Of the 66 policy actions described, the most common involved food procurement within public facilities (n 16; 44 %) and establishing guidelines for school-feeding programs (n 12; 33 %). Conclusions: This review has demonstrated that urban local government authorities are implementing policies that consi

Globally, there is increasing interest in monitoring actions to create healthy, equitable and environmentally sustainable food environments. Currently, there is a lack of detailed tools for monitoring and benchmarking university food environments. This study aimed to develop the University Food Environment Assessment (Uni-Food) tool and process to benchmark the healthiness, equity, and environmental sustainability of food environments in tertiary education settings, and pilot test its implementation in three Australian universities in 2021. The Uni-Food tool development was informed by a review of the literature and input from an expert advisory panel. It comprises three components: (1) university systems and governance, (2) campus facilities and environments, and (3) food retail outlets. The process for implementing the tool is designed for universities to self-assess the extent to which they have implemented recommended practice in 68 indicators, across 16 domains, weighted based on their relative importance. The pilot implementation of the tool identified moderate diversity in food environments across universities and highlighted several opportunities for improvements at each institution. The assessment process was found to be reliable, with assessors rating the tool as easy to use, requiring minimal resources. Broad application of the tool has the potential to increase accountability and guide best practice in tertiary education and other complex institutional settings.

Globally, there is increasing interest in monitoring actions to create healthy, equitable and environmentally sustainable food environments. Currently, there is a lack of detailed tools for monitoring and benchmarking university food environments. This study aimed to develop the University Food Environment Assessment (Uni-Food) tool and process to benchmark the healthiness, equity, and environmental sustainability of food environments in tertiary education settings, and pilot test its implementation in three Australian universities in 2021. The Uni-Food tool development was informed by a review of the literature and input from an expert advisory panel. It comprises three components: (1) university systems and governance, (2) campus facilities and environments, and (3) food retail outlets. The process for implementing the tool is designed for universities to self-assess the extent to which they have implemented recommended practice in 68 indicators, across 16 domains, weighted based on their relative importance. The pilot implementation of the tool identified moderate diversity in food environments across universities and highlighted several opportunities for improvements at each institution. The assessment process was found to be reliable, with assessors rating the tool as easy to use, requiring minimal resources. Broad application of the tool has the potential to increase accountability and guide best practice in tertiary education and other complex institutional settings.

Introduction: Previous research suggests there may be differences in the effects of adrenaline related to the initial cardiac arrest rhythm. The aim of this study was to assess the effect of adrenaline compared with placebo according to whether the initial cardiac arrest rhythm was shockable or non-shockable. Methods: Return of spontaneous circulation (ROSC), survival and neurological outcomes according to the initial arrest rhythm were compared amongst patients enrolled in the PARAMEDIC-2 randomised, placebo controlled trial. The results of the PARAMEDIC-2 and PACA out of hospital cardiac arrest trials were combined and meta-analysed. Results: The initial rhythm was known for 3929 (98.2%) in the placebo arm and 3919 (97.6%) in the adrenaline arm. The effect on the rate of ROSC of adrenaline relative to placebo was greater in patients with non-shockable cardiac rhythms (1002/3003 (33.4%) versus 222/3005 (7.4%), adjusted OR: 6.5, (95% CI 5.6–7.6)) compared with shockable rhythms 349/716 (48.7%) versus (208/702 (29.6%), adjusted OR: 2.3, 95%CI: 1.9–2.9)). The adjusted odds ratio for survival at discharge for non-shockable rhythms was 2.5 (1.3, 4.8) and 1.3 (0.9, 1.8) for shockable rhythms (P value for interaction 0.065) and 1.8 (0.8–4.1) and 1.1 (0.8–1.6) respectively for neurological outcome at discharge (P value for interaction 0.295). Meta-analysis found similar results. Conclusion: Relative to placebo, the effects of adrenaline ROSC are greater for patients with an initially non-shockable rhythm than those with a shockable rhythms. Similar patterns are observed for longer term survival outcomes and favourable neurological outcomes, although the differences in effects are less pronounced. ISRCTN73485024.

Copyright © 2018 Massachusetts Medical Society. BACKGROUND Concern about the use of epinephrine as a treatment for out-of-hospital cardiac arrest led the International Liaison Committee on Resuscitation to call for a placebocontrolled trial to determine whether the use of epinephrine is safe and effective in such patients. METHODS In a randomized, double-blind trial involving 8014 patients with out-of-hospital cardiac arrest in the United Kingdom, paramedics at five National Health Service ambulance services administered either parenteral epinephrine (4015 patients) or saline placebo (3999 patients), along with standard care. The primary outcome was the rate of survival at 30 days. Secondary outcomes included the rate of survival until hospital discharge with a favorable neurologic outcome, as indicated by a score of 3 or less on the modified Rankin scale (which ranges from 0 [no symptoms] to 6 [death]). RESULTS At 30 days, 130 patients (3.2%) in the epinephrine group and 94 (2.4%) in the placebo group were alive (unadjusted odds ratio for survival, 1.39; 95% confidence interval [CI], 1.06 to 1.82; P = 0.02). There was no evidence of a significant difference in the proportion of patients who survived until hospital discharge with a favorable neurologic outcome (87 of 4007 patients [2.2%] vs. 74 of 3994 patients [1.9%]; unadjusted odds ratio, 1.18; 95% CI, 0.86 to 1.61). At the time of hospital discharge, severe neurologic impairment (a score of 4 or 5 on the modified Rankin scale) had occurred in more of the survivors in the epinephrine group than in the placebo group (39 of 126 patients [31.0%] vs. 16 of 90 patients [17.8%]). CONCLUSIONS In adults with out-of-hospital cardiac arrest, the use of epinephrine resulted in a significantly higher rate of 30-day survival than the use of placebo, but there was no significant between-group difference in the rate of a favorable neurologic outcome because more survivors had severe neurologic impairment in the epinephrine grou

Reducing salt intake is a cost-effective public health intervention to reduce the global burden of non-communicable disease (NCDs). Ultra-processed foods contribute ~80% of dietary salt in high income countries, and are becoming prominent in low-middle income countries. Instant noodle consumption is particularly high in the Asia Pacific region. The aim of this study was to compare the sodium content of instant noodles sold worldwide to identify potential for reformulation. Analysis was undertaken for 765 instant noodle products from 10 countries using packaged food composition databases of ultra-processed foods compiled by the Global Food Monitoring Group (GFMG) and national shop survey data. Sodium levels were high and variable, within and between countries. Instant noodles in China had the highest mean sodium content (1944 mg/100 g, range: 397-3678/100 g) compared to New Zealand (798 mg/100 g, range: 249-2380 mg/100 g). Average pack size ranged from 57 g (Costa Rica) to 98 g (China). The average packet contributed 35% to 95% of the World Health Organization recommended daily salt intake of <5 g. Forty-one percent of products met the Pacific Island (PICs) regional sodium targets, 37% met the South Africa 2016 targets, and 62% met the UK 2017 targets. This study emphasises a need for stronger regulation and closer monitoring to drive rigorous reformulation of salt in ultra-processed foods.

Background & aims In June 2016, South Africa implemented legislation mandating maximum sodium levels in a range of processed foods with a goal of reducing population salt intake and disease burden from hypertension. Our aim was to explore the relationship between salt and blood pressure (BP) in a subsample of the World Health Organization Study on global AGEing and adult health (SAGE) Wave 2 before implementation of legislation in South Africa. Methods & results Blood pressure (BP) was measured in triplicate (n = 2722; median age 56 years; 33% male) and 24-h urine collected in a nested subsample (n = 526) for sodium, potassium and creatinine analysis. Hypertension prevalence was 55% in older adults (50-plus years) and 28% in younger adults (18–49 years). Median salt intake (6.8 g/day) was higher in younger than older adults (8.6 g vs 6.1 g/day; p < 0.001), and in urban compared to rural populations (7.0 g vs 6.0 g/day; p = 0.033). Overall, 69% of participants had salt intakes above 5 g/day. Potassium intakes were generally low (median 35 mmol/day) with significantly lower intakes in rural areas and older adults. Overall, 91% of adults failed to meet the daily potassium recommendation of 90 mmol/d. Salt intakes above 5 g/day, and to a greater extent, a dietary sodium-to-potassium (Na:K) ratio above 2 mmol/mmol, were associated with significantly steeper regression slopes of BP with age. Conclusion These preliminary results indicate that high dietary Na:K ratio may lead to a greater increase in BP and hypertension risk with age. Interventions to increase potassium intakes alongside sodium reduction initiatives may be warranted

Consumption of anthocyanins from fruit sources may exert protection against hypertension and improve cognition. However, the effect of dose-timing in studies is rarely considered. We hypothesized that timed-dose consumption of juice from an anthocyanin-rich Japanese plum variety (Queen Garnet plum, QGP) will have acute and dose-timing effects on cardiovascular responses, cognition, and urinary anthocyanin excretion profiles. Our study objective was to investigate the impact of plum juice on these health parameters. Twelve (12) older (65y+) and 12 younger (18-45y) adults participated in an acute crossover study. Participants received, randomly, either a 1x300ml or 3x100ml plum juice over 3h on two different occasions with a 2-week washout period. A battery of cognitive tasks was administered at 0h and 6h on each study day. BP and urinary anthocyanin/metabolite excretion profiles were measured over 24h. Area under the Curve for BP was calculated (0-6h). A significant reduction in BP and cardiovascular responses was observed in both age groups which was more obvious in the older age group on the single dose for SBP, DBP, Mean Arterial Pressure and Heart Rate (p-values=0.035, 0.028, 0.017 and 0.006 respectively). No significant difference was observed between dose-timing regimens for either age group. There was no observed effect on cognition. Native QGP anthocyanins, as well as methylated/glucuronidated metabolites were detected in urine with no significant differences between age groups or dose-timing. High anthocyanin plum juice significantly reduced blood pressure but dose-timing did not appear to be a significant factor in the potential acute BP-lowering effect of QGP juice.

Background Preclinical evidence suggests that the anthocyanins, which comprise a subclass of dietary flavonoids providing the purple and red pigmentation in plant-based foods, may have a beneficial impact on cognitive outcomes. Methods A systematic review was conducted to identify the published literature on food-based anthocyanin consumption and cognitive outcomes in human intervention trials. The literature search followed PRISMA guidelines and included six databases, as well as additional hand searching. Results Seven studies were included in this review, comprising acute trials (n = 4) and longer-term (n = 3) interventions that assessed multiple cognitive outcomes in children, adults and older adults with cognitive impairment. Six of seven studies reported improvements in either a single, or multiple, cognitive outcomes, including verbal learning and memory, after anthocyanin-rich food consumption. As a result of methodological limitations and the large clinical and methodological diversity of the studies, the pooling of data for quantitative analysis was not feasible. Conclusions The impact of food-based anthocyanin consumption on both acute and long-term cognition appears promising. However, adequately powered studies that include sensitive cognitive tasks are needed to confirm these findings and allow the translation of research into dietary messages.

The development of central fatigue is prominent follow- ing exercise-induced hyperthermia, but the contribution of supraspinal fatigue is not well understood. Seven endurance-trained cyclists (mean ± SD peak O 2 uptake, 62.0 ± 5.6 mL/kg/min) completed two high-intensity constant-load cycling trials (296 ± 34 W) to the limit of tolerance in a hot (34 °C, 20% relative humidity) and, on a separate occasion, for the same duration, a control con- dition (18 °C, 20% relative humidity). Core body tem- perature (T c ) was measured throughout. Before and immediately after each trial, twitch responses to supramaximal femoral nerve and transcranial magnetic stimulation were obtained from the knee extensors to assess neuromuscular and corticospinal function, respec- tively. Exercise time was 11.4 ± 2.6 min. Peak T c was higher in the hot compared with control (38.36 ± 0.43 °C vs 37.86 ± 0.36 °C; P = 0.035). Post-exercise reductions in maximal voluntary contraction force (13 ± 9% vs 9 ± 5%), potentiated twitch force (16 ± 12% vs 21 ± 13%) and voluntary activation (9 ± 7% vs 7 ± 7%) were similar in hot and control trials, respectively. However, cortical voluntary activation declined more in the hot compared with the control (8 ± 3% vs 3 ± 2%; P = 0.001). Exercise- induced hyperthermia elicits significant central fatigue of which a large portion can be attributed to supraspinal fatigue. These data indicate that performance decrements in the heat might initially originate in the brain

The World Health Organization promotes salt reduction as a best-buy strategy to reduce chronic diseases, and Member States have agreed to a 30% reduction target in mean population salt intake by 2025. Whilst the UK has made the most progress on salt reduction, South Africa was the first country to pass legislation for salt levels in a range of processed foods. This paper compares the process of developing salt reduction strategies in both countries and highlights lessons for other countries. Like the UK, the benefits of salt reduction were being debated in South Africa long before it became a policy priority. Whilst salt reduction was gaining a higher profile internationally, undoubtedly, local research to produce context-specific, domestic costs and outcome indicators for South Africa was crucial in influencing the decision to legislate. In the UK, strong government leadership and extensive advocacy activities initiated in the early 2000s have helped drive the voluntary uptake of salt targets by the food industry. It is too early to say which strategy will be most effective regarding reductions in population-level blood pressure. Robust monitoring and transparent mechanisms for holding the industry accountable will be key to continued progress in each of the countries.

of a poster that presented at 20th International Congress of Nutrition, Granada, Spain, September 15-20, 2013.

Increased salt intake leads to an increase in blood pressure and decreased sodium intake relative to the usual or increased intake results in lowered blood pressure in adults, with or without hypertension. Blood pressure is a strong proxy indicator for the risk of cardiovascular disease, coronary heart disease and strokes. Hypertension is estimated to have caused 9% of all deaths in South Africa in 2000. In 2008, 42% of men and 34% of women aged 35-44 years, and 60% of men and 50% of women aged 45-54 years, were hypertensive. More than 70% of both men and women older than 65 years of age were hypertensive in 2008. Multilevel and multisectorial strategies are required to lower salt intake at population level, including the legislation of food supply, clearer labelling and signposting of food packaging, and improved consumer education on behavioural change regarding salt usage practices. A comprehensive national strategy that focuses on salt reduction is needed to reduce national blood pressure levels in the future. Legislating the levels of salt in processed food is only one part of this national strategy. All health professionals and educators should also provide appropriate nutritional recommendations that will educate, motivate and enable consumers to change their nutritional behaviour to reduce salt intake to less than 5 g per day, as recommended. The aim of this review is to revise the current food-based dietary guideline for salt, the implementation of which would contribute to lowering population salt intake, and blood pressure and cardiovascular disease, in South Africa.

Increased salt intake leads to an increase in blood pressure and decreased sodium intake relative to the usual or increased intake results in lowered blood pressure in adults, with or without hypertension. Blood pressure is a strong proxy indicator for the risk of cardiovascular disease, coronary heart disease and strokes. Hypertension is estimated to have caused 9% of all deaths in South Africa in 2000. In 2008, 42% of men and 34% of women aged 35-44 years, and 60% of men and 50% of women aged 45-54 years, were hypertensive. More than 70% of both men and women older than 65 years of age were hypertensive in 2008. Multilevel and multisectorial strategies are required to lower salt intake at population level, including the legislation of food supply, clearer labelling and signposting of food packaging, and improved consumer education on behavioural change regarding salt usage practices. A comprehensive national strategy that focuses on salt reduction is needed to reduce national blood pressure levels in the future. Legislating the levels of salt in processed food is only one part of this national strategy. All health professionals and educators should also provide appropriate nutritional recommendations that will educate, motivate and enable consumers to change their nutritional behaviour to reduce salt intake to less than 5 g per day, as recommended. The aim of this review is to revise the current food-based dietary guideline for salt, the implementation of which would contribute to lowering population salt intake, and blood pressure and cardiovascular disease, in South Africa

of poster that presented at 20th International Congress of Nutrition, Granada, September 2013.

of oral presentation that presented at ICCAS 2013: International Conference on Culinary Arts and Sciences VIII.

of poster that presented at the 20th International Congress of Nutrition: Granada, Spain, September 15-20, 2013.

presented at the 35th ESPEN Congress, 31 August 2013 - 03 September 2013, Leipzig, Germany

Background/Objectives: Older malnourished patients experience increased surgical complications and greater morbidity compared with their well-nourished counterparts. This study aimed to assess whether nutritional status at hospital admission predicted clinical outcomes at 18 months follow-up. Subjects/Methods: A retrospective analysis of N=2076 patient admissions (65+ years) from two subacute hospitals, New South Wales, Australia. Analysis of outcomes at 18 months, according to nutritional status at index admission, was performed in a subsample of n=476. Nutritional status was determined within 72 h of admission using the Mini Nutritional Assessment (MNA). Outcomes, obtained from electronic patient records, included hospital readmission rate, total Length of Stay (LOS), change in level of care at discharge and mortality. Survival analysis, using a Cox proportional hazards model, included age, sex, Major Disease Classification, mobility and LOS at index admission as covariates. Results: At baseline, 30% of patients were malnourished and 53% were at risk of malnutrition. LOS was higher in malnourished and at risk, compared with well-nourished patients (median (interquartile range): 34 (21, 58); 26 (15, 41); 20 (14, 26) days, respectively; P

presented at the Annual Scientific Meeting of the Nutrition Society of Australia, 27-30 November 2012, Wollongong, Australia

Objectives Community-based services, such as Meals on Wheels (MOW), allow older adults to remain in their homes for as long as possible. Many MOW recipients experience decreased appetite that limits intake at mealtimes. This pilot study aimed to determine the feasibility of providing high protein high energy snacks to improve nutrient intakes of MOW clients in a regional centre of New South Wales, Australia. Participants A convenience sample of 12 MOW clients. Intervention Participants received snacks five times a week, in addition to their usual MOW order, for four weeks. Measurements Nutritional status was assessed using the Mini Nutritional Assessment tool. Pre-post changes in dietary intake were assessed using a diet history and food frequency questionnaire. Qualitative interviews conducted in clients’ homes were digitally recorded, transcribed verbatim, and themes identified. Results Post-intervention, there was a trend for an increased energy (mean = +415kJ (SD=1477)/day) and protein (+7.2 (±14.06) g/day) intake. MNA scores significantly increased (P= 0.036) and proportion of respondents categorised as ‘malnourished’ or ‘at risk of malnutrition’ decreased from 17% to 8%, and 67% to 25%, respectively (P Conclusion Provision of an additional daily mid-meal snack may be a useful addition to existing MOW services, for improved energy and protein intakes. However, not all MOW clients at risk of malnutrition perceived the snacks to be beneficial to them.

presented at the Annual Scientific Meeting of the Nutrition Society of Australia, 27-30 November 2012, Wollongong, Australia

BACKGROUND AND AIMS: Decreasing energy intake relative to energy expenditure is the indisputable tenet of weight loss. In addition to caloric restriction modification of the type of dietary fat may provide further benefits. The aim of the present study was to examine the effect of energy restriction alone and with dietary fat modification on weight loss and adiposity, as well as on risk factors for obesity related disease. METHODS AND RESULTS: One-hundred and fifty overweight men and women were randomized into a 3month controlled trial with four low fat (30% energy) dietary arms: (1) isocaloric (LF); (2) isocaloric with 10% polyunsaturated fatty acids (LF-PUFA); (3) low calorie (LF-LC) (-2MJ); (4) low calorie with 10% PUFA (LF-PUFA-LC). Primary outcomes were changes in body weight and body fat and secondary outcomes were changes in fasting levels of leptin, insulin, glucose, lipids and erythrocyte fatty acids. Changes in dietary intake were assessed using 3day food records. One-hundred and twenty-two participants entered the study and 95 completed the study. All groups lost weight and body fat (P<0.0001 time effect for both), but the LC groups lost more weight (P=0.026 for diet effect). All groups reduced total cholesterol levels (P<0.0001 time effect and P=0.017 intervention effect), but the LC and PUFA groups were better at reducing triacylglycerol levels (P=0.056 diet effect). HDL increased with LF-LC and LF-PUFA but not with LF-PUFA-LC (0.042 diet effect). The LF and LF-LC groups reported greater dietary fat reductions than the two PUFA groups (P=0.043). CONCLUSION: Energy restriction has the most potent effect on weight loss and lipids, but fat modification is also beneficial when energy restriction is more modest.

To validate a revision of the Mini Nutritional Assessment short-form (MNAA (R)-SF) against the full MNA, a standard tool for nutritional evaluation. A literature search identified studies that used the MNA for nutritional screening in geriatric patients. The contacted authors submitted original datasets that were merged into a single database. Various combinations of the questions on the current MNA-SF were tested using this database through combination analysis and ROC based derivation of classification thresholds. Twenty-seven datasets (n=6257 participants) were initially processed from which twelve were used in the current analysis on a sample of 2032 study participants (mean age 82.3y) with complete information on all MNA items. The original MNA-SF was a combination of six questions from the full MNA. A revised MNA-SF included calf circumference (CC) substituted for BMI performed equally well. A revised three-category scoring classification for this revised MNA-SF, using BMI and/or CC, had good sensitivity compared to the full MNA. The newly revised MNA-SF is a valid nutritional screening tool applicable to geriatric health care professionals with the option of using CC when BMI cannot be calculated. This revised MNA-SF increases the applicability of this rapid screening tool in clinical practice through the inclusion of a "malnourished" category.

Background: A large proportion of resources allocated to the Community-Based Nutrition Programme (CBNP) of the Department of Health in the Western Cape is spent on crèche-feeding schemes. To date, little evaluation of the CBNP has been undertaken. Aim: A cross-sectional study was conducted to assess the nutritional adequacy of meals provided, and facilities available, at state-funded crèches in the Cape Metropole. Methods: A questionnaire was administered to managers of 43 conveniently sampled crèches in two districts of Cape Town. Twenty-two of the crèches were randomly selected for nutrient assessment of a duplicate meal, and a typical meal sample was weighed and analysed for this purpose. Anthropometric measurements for a random sample of 10% of the children (N = 275) attending these 22 crèches were obtained. Results: Only one crèche did not have food preparation and storage facilities (due to theft). Toilet facilities were inadequate at some crèches. The ratio of children to toilets was 23.7 (± 16.6):1, ranging from 6.5:1 to 91:1. None of the meals provided met one-third of the age-related Recommended Dietary Allowance (RDA) for energy, calcium, iron or phosphorus. With regard to protein, 86.4% of the meals sampled did meet one-third of the RDA for 1 - 3-year-olds and 68.2% for 4 - 6-year-olds. At crèches where the meals provided ≥ 15% of the RDA for energy for 4 - 6- year-olds, it was reported that a mean of R1.18 (± R0.48)/child/day was spent on food, compared with a mean of R0.89 (± R0.20) /child/day in crèches at which the meals provided < 15% of the RDA for energy (P = 0.14). According to the World Health Organisation classification of moderate undernutrition, in the age group ≤ 60 months (N = 170) there was found to be a low prevalence of stunting (7%), a moderate prevalence of underweight (16%) and a very high prevalence of wasting (11.8%). In children older than 60 months (N = 105) there was found to be a low prevalence of stunting (12.4%), underweight (

Aim. To assess the appropriateness of the preliminary South African food-based dietary guidelines (FBDGs) as a nutrition education tool for women in KwaZulu-Natal (KZN) and the Western Cape (WC) in terms of comprehension, interpretation and implementation. Methods. This was a qualitative study using focus group discussions. Focus groups were held in five magisterial districts within KZN, and the Cape Town metropolitan area of the WC, to evaluate the comprehensibility and applicability of the FBDGs. Groups were randomly selected according to settlement type (non-urban, urban informal, urban formal) and ethnicity (black, coloured (of mixed origin), Indian, white) to reflect the KZN and WC population. Focus groups were conducted in the home language of the participants, namely, English, Zulu, Xhosa and Afrikaans. Participants included 137 women aged 19-63 years, with no formal nutrition training and who were responsible for food purchasing and food preparation decisions in the household. Results. In general, women understood many of the FBDGs and the suggested food categories, and could construct a day's meals using the FBDGs. Areas of confusion were identified regarding certain terminology and concepts, such as the terms 'legumes', 'foods from animals', and 'healthier snacks'. Primary constraints to implementation of the FBDGs included cost and availability of food, household taste preferences, routine food purchasing habits, habitual or traditional food preparation and cooking methods, time constraints, accessibility (primarily transport difficulties) and underlying attitudes towards health and nutrition. Conclusion. The findings from this study have been used to revise the preliminary FBDGs, in order to provide an appropriate tool for effective nutrition education, for the purpose of improving nutrition knowledge, attitudes and dietary behaviours of South Africans.

The salt-blood pressure hypothesis states that an excessive salt intake leads to an increase in blood pressure in genetically susceptible persons and, if high intake is maintained long term, ultimately leads to sustained hypertension. It is estimated that about 3.3 million South Africans (12.6% and 16.3% of adult men and women, respectively) are hypertensive. However, not all subjects within a particular population respond equally to exposure to high-salt diets. Methods to identify those who are 'salt sensitive' remain in the research domain; therefore a population approach to the restriction of dietary salt intake is warranted. The message to 'eat salt sparingly' will not interfere with the current nutritional and legal requirements regarding iodation of table salt. A salt intake as low as 5 g per day would provide an adequate amount of iodine, provided the salt is sufficiently iodated. Dietary factors other than sodium which have been shown to influence blood pressure include potassium, magnesium, calcium and alcohol. The 'Dietary Approaches to Stop Hypertension' (DASH) randomised controlled trial found that subjects fed a diet rich in fruit and vegetables for 8 weeks significantly reduced both systolic and diastolic blood pressure, compared with subjects on a typical American control diet. A 'combination' diet, rich in fruit, vegetables and low-fat dairy products, and with a reduced saturated and total fat intake, resulted in an even greater reduction in blood pressure. Translated into a practical diet, this information suggests a daily diet that includes large amounts of fruit and vegetables, a moderate intake of low-fat dairy products, lean meat and chicken, and a prudent alcohol intake. Salt should be used sparingly, if at all, at the table and in the preparation of meals, and the intake of processed foods high in salt should be limited. This would result in a reduction in intake from an average of around 9 g salt to about 6 g salt per day, which is the curren

Objective The purpose of this study was to investigate whether differences exist in eating attitudes and body shape concerns amongst adolescent schoolgirls representing South Africa's ethnically and culturally diverse population currently undergoing epidemiological transition. Method A questionnaire survey, including the Eating Attitudes Test, Body Shape Questionnaire and a Body Silhouette Chart, was administered to 228 South African schoolgirls (60 black, 83 mixed race and 85 white) aged 15-18 years from five secondary schools in the greater Cape Town area. Results Black girls had significantly higher mean BMI values (24.1 (3.3)) than either white (21.9 (3.0)) or mixed race girls (22.1 (3.7)) (P < 0.05). Controlling for differences in BMI, white subjects scored significantly higher on the Body Shape Questionnaire than did mixed race or black subjects, whereas no ethnic differences were found for Eating Attitude Test scores. A comparable percentage (mean=18.8%) of black, mixed race and white girls had scores indicative of eating disorder pathology on the Eating Attitudes Test, while a higher percentage of white, compared to mixed race and black, girls had abnormal scores on the Body Shape Questionnaire (33%, 26% and 20%, respectively; P < 0.05). The ideal body size desired by white girls was significantly smaller than that of the mixed race or black samples. Dissatisfaction with present body size was significantly higher in white, compared to black or mixed race girls (P < 0.001). Conclusion These findings suggest that the prevalence of abnormal eating attitudes is equally common in South African schoolgirls from different ethnic backgrounds. White girls exhibit greater body image concerns and body image dissatisfaction than mixed race or black individuals. These findings reinforce the notion that eating disorders are culture-reactive rather than culture-bound phenomena and provide insight into the extent of eating-related problems and body image issues in developin

Invited plenary paper for the 8th World Salt Symposium, held 7 - 11 May 2000 in Hague, the Netherlands.

of a study that assesses the effectiveness of a low-intensity, community-based exercise program in older adults from 3 disadvantaged community centres. Presented at the American College of Sports Medicine; 46th Annual Meeting; Washington State; Convention & Trade Center; June 2-5, 1999

This review article investigates the influence of living arrangements on the dietary intake and nutritional status of elderly men. Elderly men living alone have been identified as a group particularly at risk of poor dietary habits, however available evidence is inconsistent. Data from the United States suggests that low income elderly men living alone are at high risk of an inadequate dietary intake, and that a low energy intake is the most important predictor of a poor quality diet in this group. In Australia, older men living with a spouse have a better quality diet (higher nutrient density) than those living alone or with a person or persons other than a spouse, particularly regarding fruit and vegetable intake; differences in nutrient intake are not explained by lower energy intakes. In contrast, older men in European countries who live alone appear to have a more favourable dietary intake as compared to their counterparts in other living arrangements. Information on the association between living arrangements and household food security in the elderly in developing countries is sparse, however single living among older men is rare and the ethos of the extended family appears to remain intact. The inconsistencies in the apparent level of nutritional risk associated with living alone in elderly men in different countries necessitates the development and validation of screening programmes and nutrition services which are country-specific.

Editor — We are interested in Scrimshaw's allusion to populations in Latin America in his editorial on the relation between fetal malnutrition and chronic disease in later life. There, in the 1960s, despite a high prevalence of low birth weight, the preva­ lence of atherosclerosis and of myocardial infarction was low.

Objective. To investigate the dietary intake and nutritional status of older coloured South Africans in the Cape Peninsula with regard to their micronutrient status. Design. Cross-sectional analytical study. Methods. A random sample of 200 non-institutionalised subjects in Cape Town aged ^ 65 years was drawn using a two-stage cluster design. Trained fieldworkers interviewed subjects to obtain demographic, dietary and lifestyle data, to draw fasting blood samples for biochemical, haematological, iron status and vitamin D (serum 25-hydroxyvitamin D (25(OH)D)), serum vitamin B12 and red blood cell folate analyses. Nutrient intake was assessed with a validated quantified food frequency questionnaire. Results. The micronutrient density of the diet of the majority of the subjects was inadequate, particularly in respect of calcium, zinc and vitamin D intakes. Seventeen per cent of the subjects had serum 25(OH)D levels in the deficient range for the elderly (< 10 ng/ml). Fourteen per cent of subjects were anaemic, classified on the basis of suboptimal haemoglobin concentrations; however, only one-third (31 %) of those with anaemia had haemopoietic nutrient deficiencies, associated with either iron (63%) folate (38%) or vitamin BI2 (25%) deficiency. A low prevalence of either folate or vitamin B12 deficiency was found. Raised serum ferritin concentrations (> 300 ug/l) were found in 6.4% of subjects and were probably caused by excessive alcohol consumption. Conclusions. The findings indicate a need for health promotion activities that will encourage an increased consumption of vegetables, fruit (especially those rich in vitamin C), wholegrain cereals, low-fat dairy products, fish, eggs, lean meat and liver in this age group to prevent the nutrient deficiency disorders identified in the present study.

Aims: To investigate the association between added sugar intake and (i) micronutrient intake, (ii) energy profiles and (iii) body mass index (BMI) of a sample of older South Africans. Methods: A sample of 200 free-living South Africans of mixed ancestry, aged 65 years and older and resident in Cape Town, was randomly drawn using a two-stage cluster design. Dietary intake was assessed using an interviewer-administered quantified food frequency questionnaire. Statistical analyses: Spearman correlation coefficients were used to investigate the associations between (i) sugar intake and (ii) total energy intake, and macro- and micronutrient intakes and BMI. Differences between the subgroups according to either tertiles of sugar or total energy intake were tested for significance at the P=0.05 level using analysis of variance (ANOVA ). Age was controlled for in the ANOVA models, according to two groups: 65–74 years and >75 years. Results: For both men and women, the proportion of energy provided by sugars did not differ across the tertiles of energy intake, suggesting that subjects with the highest energy intakes consumed greater quantities of all foods, rather than selecting foods high in sugar. An inverse association was found between the proportion of total energy provided by sugar and (i) the proportion of food energy provided by fat ( r=−0.53; P< 0.0001) and (ii) dietary fibre intake per 4.18 MJ/day ( r=−0.48; P<0.0001). In men the intake of thiamin, vitamin E, iron, zinc, copper and magnesium per 4.18 MJ significantly decreased ( P<0.05) as sugar intake as a percentage of total energy intake (%E) rose. In women, micronutrient intake expressed per 4.18 MJ showed a significant negative trend with sugar intakes as %E for all of the micronutrients investigated, except for vitamins D and E. Body mass index tended to decrease as sugar intake rose, but this difference did not reach significance. Conclusion: The findings of this study did not demonstrate an association betw

A cross-sectional analytical study was undertaken to investigate the macronutrient intake and cardiovascular risk factor profile of community-dwelling older coloured (mixed descent) South Africans. A sample of 200 subjects aged 65 years and above in Cape Town was randomly drawn using a two-stage cluster design. Trained field workers interviewed subjects to obtain demographic, dietary and life-style data, to draw fasting blood samples for the analysis of plasma lipids, and to take anthropometric measurements. Nutrient intake was assessed using a validated quantified food frequency questionnaire. Blood pressure was measured according to the guidelines of the American Heart Association. The mean daily energy intake was 7984 (3245) kJ and 6979 (2219) kJ for men and women, respectively. Twenty-nine per cent of the subjects had energy intakes less than two-thirds of the RDA. Dietary fat intake comprised 32.4% of total energy intake, which is in line with the prudent dietary guidelines. The inadequate fibre intake (mean = 17(8) g/day) was attributed to the low consumption of fruit and vegetables. Anthropometric assessment indicated that the women tended towards overnutrition, while the men appeared to be undernourished. Lipid profiles fell within the lower end of the moderate risk band for cardiovascular disease and a high prevalence of hypertension (71.7%) was identified. The survey findings indicate a need for health promotion activities to encourage increased physical activity levels and an increased consumption of vegetables, fruit, wholegrain cereals and low fat dairy products in this population.

OBJECTIVES: To determine the prevalence of anaemia and the haemopoietic nutrient status of older mixed ancestry (coloured) South Africans. DESIGN: A cross-sectional analytic study. SUBJECTS: A random sample of 200 non-institutionalized subjects aged > or = 65 y of age, resident in urban Cape Town, was drawn using a two-stage cluster design. METHODS: Trained fieldworkers interviewed subjects to obtain demographic and lifestyle data. Dietary intake was assessed using a validated food frequency questionnaire. Fasting blood samples were drawn for the determination of haematological parameters, serum vitamin B12, serum folate, RBC folate and a full blood count. RESULTS: The prevalence of anaemia was 13.9. Eight of the 26 cases of anaemia (31) were associated with suboptimal haemopoietic nutrient status; 2(25) and 3(38) cases of these 8 anaemic subjects had suboptimal vitamin B12 and folate status, respectively. Iron deficiency anaemia accounted for 5(63) of the subjects with nutrition-related anaemia. Ten men and two women (6.5 of subjects) had raised serum ferritin concentrations, half of whom had abnormal biochemical parameters indicative of alcohol abuse. CONCLUSIONS: Older coloured South Africans, particularly women, should be encouraged to eat diets with a high nutrient density and to consume adequate amounts of foods high in iron, folate and vitamin B12. Further investigation regarding the high prevalence of hyperferritinaemia found in the men in this population is indicated.

Aims: A cross-sectional study was undertaken among elderly men living alone in Sunderland to (1) assess their dietary intake and food habits, (2) to identify factors which influence their food choice, and (3) to investigate perceived needs regarding nutrition education activities.Methods: A random sample of 66 men, aged 70 years and over was drawn from members of luncheon clubs (n=33) and residents of sheltered housing accommodation (n=33). Dietary intake was assessed using a validated semi-quantified food frequency questionnaire (FFQ).Results: Intake of all nutrients, with the exception of energy, vitamin D and fibre was adequate. Almost half of the subjects (47%) had energy intakes below the EAR, and the majority tended towards underweight, as indicated by the age-adjusted reference standards for BMI. Taste and enjoyment were the factors which most influenced food choice. The main identified source of nutrition information was the media, followed by relatives and friends. Only half of the subjects perceived that they would benefit from nutrition education and 58% reported a willingness to participate in such activities if they were available.Conclusion: The findings suggest that although most subjects were aware of the role of dietary factors in the maintenance of an optimal health status, this age group is not a receptive audience for nutrition education activities. The targeting of elderly men living alone presents a challenge to nutrition educators.