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Background Nigeria is still one of the most affected countries in the world with the global burden of HIV/AIDS. Presently, there seems no published research in Nigeria that explored perceptions of adults living with HIV (ALH) in Abeokuta, Nigeria on factors affecting their food intakes. Objective To explore perceptions of adults living with HIV (ALH) in Abeokuta, Nigeria on factors affecting their food intakes. Study Design, Setting, Participants Phenomelogical in-depth interview in a qualitative domain with 20 ALH in Abeokuta taking part in an exploratory study that aimed to develop, implement a theory guided nutrition education program (NEP) and to evaluate the program's impact on the quality of life (QoL), nutrition knowledge attitude and practices (KAP), and dietary quality (DQ) of ALH who attended the Federal Medical Center (FMC) and Ijaye State Hospital (ISH) in Abeokuta, Nigeria. Participants were interviewed in focus group discussions (FGDs) on their perception of their food intakes. Measurable Outcome/Analysis Thematic framework was used for the data analysis. Results Findings show that nutrition intervention was not part of the ongoing intervention program in Nigeria, and participants’ direct quotes also confirmed that they received very limited nutrition supports from the government. The Nigerian government initiatives of proving highly active antiretroviral therapy (HAART) to relieve mortality rates associated with HIV, to improve health status and QoL were also perceived inadequate for positive living. Participants perceived one of the ways to manage common HIV/AIDS related symptoms, especially diarrhea, was by complete abstinence from vegetables intake. This suggested a need for NEP. Conclusions The results of this study indicated that an NEP tailored to the needs of ALH (such as guidelines on good nutrition with limited resources, planning a well-varied meal, dealing with barriers to healthy eating, and tips on dietary diversity and adherence to HAART) may be needed to help slow disease progression of AIDS, leading to an improved QoL. Funding None.

Indigenous plant foods play a major nutritional and cultural role in the diets of rural people in Africa. However, they can contain high levels of antinutrients, which may exacerbate nutritional and health problems in young children consuming nutrient deficient diets. Also, the rapid increase in urbanization in Africa has led to the need for convenience type meals. This study investigated the potential of micronization (infrared treatment) in combination with extrusion cooking in developing a ready-to-eat sorghum and cowpea based porridge supplemented with cooked cowpea leaves for young child-feeding. Micronization not only inactivated the trypsin inhibitors in cowpea, it also produced an instantized product with excellent hydration properties. When served as a stiff porridge with cooked cowpea leaves in the recommended portion sizes for children aged 2–5 years, one daily serving would meet 40% of the children's protein and lysine requirements. Further, the calculated Protein Digestibility Corrected Amino Acid Score would be comparable to commercial maize-soy instant products. This is notwithstanding that the cowpea leaves had a negative effect on protein digestibility due to their high tannin content. This nutritious ready-to-eat meal from locally available plant foods could contribute substantially to food security in both urban and rural communities in Africa.

Qualitative investigation can provide invaluable information towards understanding the influence of school nutrition education (NE). The study explored teachers’ perceptions of the immediate impact of NE on learners’ eating behaviours. Twenty-four primary school teachers in the Bronkhorstspruit district, Gauteng, South Africa, who taught nutrition topics to grades four to seven learners, participated in three focus group discussions. Transcript data obtained was analysed using the thematic approach of the framework method. Findings indicated that school support for NE was limited, which undermined the capacity of school NE to influence healthy eating behaviours of learners. The need to strengthen teachers’ capacity to model positive eating behaviours was identified. Learners were perceived as being not completely ignorant of healthy eating, with limited capacity to effect changes within the resource-constrained environment. Negative influences like unhealthy choices of food from food vendors and peer influences were identified as needing to be discouraged. Positive influences like the National School Nutrition Programme (NSNP) and the school vegetable garden were to be encouraged. Understanding the prevailing school situation and environment and teachers’ perceptions and roles in school NE is important in addressing issues that weaken the influence of NE on learners’ eating behaviours.Keywords: eating behaviour; environmental influences; learners; school nutrition education; teachers

South Africa, burdened with the emerging chronic diseases, is home to one of the largest migrant Indian population, however, little data exists on the risk factors for non-communicable diseases in this population. The aim of this study was to determine the prevalence of yet undiagnosed selected intermediate risk factors for non-communicable diseases among the Indian population in KwaZulu-Natal. We randomly selected 250 apparently healthy Indians, aged 35–55 years, living in KwaDukuza to participate in this study. Clinical and anthropometric measurements were taken under prescribed clinical conditions using Asian cut-off points. Pearson correlations was used to detect associations between anthropometric and clinical risk markers. A large percentage of participants’ systolic blood pressure fell within the normal range. Diastolic blood pressure was >85 mmHg for 61 % of the participants and triglyceride levels were >1.69 mmol/L for 89 % of the participants’; 94 % of the women and 87 % of the men were classified as centrally obese. Raised fasting blood glucose was seen in 39 % of participants’. Waist circumference and body mass index showed statistically significant associations with all clinical risk markers except for diastolic blood pressure. Our findings suggest that the use of ethno specific strategies in the management of the disease profile of South African Indians, will enable the South African health system to respond more positively towards the current trend of increased metabolic and physiological risk factors in this community. Moreover, key modifiable behaviours such as increased physical activity and weight reduction may improve most of these metabolic abnormalities

In South Africa, noncommunicable diseases and obesity are increasing and also affect children. No validated assessment tools for fat intake are available.To determine test-retest reliability and relative validity of a pictorial modified meats, eggs, dairy, fried foods, fats in baked goods, convenience foods, table fats, and snacks (MEDFICTS) dietary fat screener.We determined test-retest reliability and diagnostic accuracy with the modified MEDFICTS as the index test and a 3-day weighed food record and parental completion of the screener as primary and secondary reference methods, respectively.Grade-six learners (aged 12 years, 4 months) in an urban, middle-class school (n=93) and their parents (n=72).Portion size, frequency of intake, final score, and classification of fat intake of the modified MEDFICTS, and percent energy from fat, saturated fatty acids, and cholesterol of the food record.For categorical data agreement was based on kappa statistics, McNemar's test for symmetry, and diagnostic performance parameters. Continuous data were analyzed with correlations, mean differences, the Bland-Altman method, and receiver operating characteristics.The classification of fat intake by the modified MEDFICTS was test-retest reliable. Final scores of the group did not differ between administrations (P=0.86). The correlation of final scores between administrations was significant for girls only (r=0.58; P=0.01). Reliability of portion size and frequency of intake scores depended on the food category. For girls the screener final score was significantly (P0.5) correlated to total, saturated fat, and cholesterol intakes (but not to percent energy from fat and saturated fatty acids intakes). The sensitivity of the modified MEDFICTS was very high (90%), but chance corrected agreement between the classifications was poor. Parents did not agree with their children.Test-retest reliability and relative validity of a modified MEDFICTS dietary fat screener in South African schoolchildren depended on the use and outcome measures applied.

We investigated the nutrition education (NE) practices of teachers of grade 4‒7 learners in 11 primary schools (85% of total number) of the Bronkhorstspruit district (Gauteng Province) to identify opportunities for improving NE in these schools. A descriptive cross-sectional survey was carried out among a convenient sample of the teachers (N = 73) using a structured nutrition education practice questionnaire. Descriptive data analysis was done. Results showed that the majority of the teachers taught nutrition in about 10% to 20% of their teaching time. Thirty percent had no training to teach nutrition, and most teachers (86%) would like to receive training in nutrition. Teachers mostly taught nutrition as part of the curriculum (67%) and very few (18%) integrated nutrition into other subjects. Needing improvement were adequate classroom time for nutrition education delivery, continuing training in nutrition for teachers, and provision of up-to-date instructional materials for teaching nutrition.

As part of justifiable nutrition promotion, this study aimed to determine internal consistency of a dietary fat screener and to compare self-assessment to maternal assessment of fat intake of grade six (about 12 years old) learners in a South African public primary school. The children completed in school a pictorial, quantitative food frequency-type screener consisting of 10 high-fat food categories; mothers individually completed a text version. Internal consistency was measured with item-total correlations, Cronbach's alpha and the split-half method. Child-mother comparison was based on kappa (κ) statistics, McNemar's tests, Wilcoxon signed-rank test and the Bland-Altman method. In total, 101 (93.5%) children and 78 (72.2%) mothers responded. The screener was internally consistent, regardless of data source and statistical technique. For portion sizes and frequency of intake, children consistently reported higher intake than mothers. This resulted in systematic error, also evidenced by a significant difference from zero for the difference between child's and mother's final test scores for the whole group, and for boys and girls separately (always P < 0.001). In 76% of the pairs, classification into high fat or prudent intake was identical, yet the chance-corrected agreement was poor (κ = 0.16) and non-agreement was non-symmetrical (P = 0.001). Children and mothers reported high fat intakes (93% and 75%, respectively). It was concluded that the dietary fat screener was internally consistent, yet children and mothers did not agree in their assessment. The high fat intakes reported by children and mothers warrant measurement refinement and implementation of primary prevention programmes.

Background: The objective was to determine the reproducibility of two, three, four and five repeated 24-hour recalls among peri-urban African adolescents.Method: A prospective study design was used within the multidisciplinary PhysicaL Activity in the Young (PLAY) study. Eighty-seven Grade 9 learners (59 girls and 28 boys, aged 10-18 years) with a mean age of 14.7 ± 1.5 years, who had completed five 24-hour recalls, were investigated. The learners were from Seiphemelo Secondary School in Ikageng, a peri-urban area in the North West province of South Africa.Reproducibility coefficients (RCs) and 95% confidence intervals (CIs) were calculated, using the intraclass correlation coefficient formula for transformed values of selected nutrients and food groups, for two, three, four and five repeated 24-hour recalls. The RCs and 95% CIs were compared in order to identify the optimum number of 24-hour recalls to give the best reproducibility results.Results: The RCs were nutrient- and food-group sensitive and ranged from 0.25 (riboflavin) to 0.6 (carbohydrate). Although differences were not statistically significant, RCs for four and five 24-hour recalls were higher than those obtained for two and three 24-hour recalls. For most nutrients and food groups, four 24-hour recalls gave the highest RCs, with non-significant differences overall between the four and five 24-hour recalls.Conclusion: The results suggest that four 24-hour recalls would be sufficient to provide acceptable reproducibility of reported food group and nutrient intakes among peri-urban African adolescents.Keywords: adolescents, dietary assessment, reproducibility, 24-hour recalls, North West, peri-urban

Background The insecticide dichlorodiphenyltrichloroethane (DDT) has been used for malaria vector control in the northern and eastern parts of the Vhembe District of Limpopo Province, South Africa, since 1945. Bioaccumulation of DDT raises concern because it reportedly affects thyroid function. Objective Our objective was to investigate the association between DDT uptake (as reflected in plasma concentrations) and thyroid homeostasis while considering related factors. Methods We compared dietary intake, serum retinol-binding protein (RBP), transthyretin (TTR) and albumin concentrations, and liver and thyroid function between cases with evidence of a body burden of DDT in the circulation (concentration of any DDT isomer ≥ 0.02 μg/g lipid; n = 278) and controls (concentration of all DDT isomers < 0.02 μg/g lipid; n = 40) in a cross-sectional study. Further analyses were performed to assess the relevance of changes in RBP status associated with DDT uptake. Results RBP concentrations below the reference range were more prevalent in cases (54% vs. 10% in controls; χ2 = 27.4; p < 0.001), which could not be explained by nutrient intake. We observed significantly lower thyroid hormone concentrations among cases (p ≤ 0.01). We also observed a significant linear trend for serum concentrations of free thyroxine and free triiodothyronine (p < 0.001) and a significant quadratic trend for serum thyroid-stimulating hormone (p = 0.025) and TTR (p < 0.001) across the control group and case groups with normal and relatively low RBP concentrations. Relatively low RBP concentrations were associated with significantly higher DDT and 1,1-dichloro-2,2-bis(p-chlorophenyl) ethylene (DDE) isomer concentrations and with a higher DDE/DDT ratio (p ≤ 0.01), which signifies long-term exposure. Inadequate intake of vitamin A and zinc were observed in 84% and 58%, respectively, of the total study population. Conclusion RBP concentrations appear to decrease in the presence of long-term DDT uptake, which may have deleterious effects on thyroid function and vitamin A nutritional status. This is of major concern in a population with poor vitamin A and zinc intake.

The duration of pneumonia and of diarrhea is reported to be longer in HIV-infected than in uninfected children. We assessed the effect of a multi-micronutrient supplement on the duration of hospitalization in HIV-infected children. In a double-blind, randomized trial, HIV-infected children (4-24 mo) who were hospitalized with diarrhea or pneumonia were enrolled (n = 118) and given a daily dose of a multi-micronutrient supplement (containing vitamins A, B complex, C, D, E, and folic acid, as well as copper, iron, and zinc at levels based on recommended daily allowances) or a placebo until discharge from the hospital. Children's weights and heights were measured after enrollment and micronutrient concentrations were measured before discharge. On recovery from diarrhea or pneumonia, the children were discharged and the duration of hospitalization was noted. Anthropometric indices and micronutrient concentrations did not differ between children who received supplements and those who received placebos. Overall, the duration of hospitalization was shorter (P0.05) among children who were receiving supplements (7.3 +/- 3.9 d) (mean +/- SD) than in children who were receiving placebos (9.0 +/- 4.9); this was independent of admission diagnosis. In children admitted with diarrhea, the duration of hospitalization was 1.6 d (19%) shorter among children receiving supplements than in those receiving placebos, and hospitalization for pneumonia was 1.9 d (20%) shorter among children receiving supplements. Short-term multi-micronutrient supplementation significantly reduced the duration of pneumonia or diarrhea in HIV-infected children who were not yet receiving antiretroviral therapy and who remained alive during hospitalization.

Human immunodeficiency virus (HIV)-infected children generally show poor growth. Episodes of diarrhoea and pneumonia in HIV-infected children are thought to be more severe than in HIV-uninfected children. The objective of this study was to compare duration of hospitalization, appetite and nutritional status of HIV-infected children with that of uninfected children. A cross-sectional study was performed on children (2–24 months) admitted with diarrhoea or pneumonia to the university hospital. Children were tested for HIV, and the duration of hospitalization was noted for 189 children. Follow-up for blood analysis (n = 154) and appetite measurement (n = 48) was performed 4–8 weeks after discharge. Appetite was measured as ad libitum intake of a commercial infant cereal using highly standardized procedures. Hospitalization (in days) was significantly longer in HIV-infected children; among children admitted with diarrhoea (5.9 ± 1.9 vs. 3.8 ± 1.5) (mean ± standard deviation) and with pneumonia (9.0 ± 2.5 vs. 5.9 ± 1.9). Serum zinc, iron and transferrin concentrations, and haemoglobin levels were significantly lower in HIV-infected children compared with uninfected children. Appetites [amounts eaten (g) per kg body weight] of HIV-infected children were significantly poorer than those of HIV-uninfected children (18.6 ± 5.8 vs. 25.2 ± 7.4). The eating rates (g min-1) of HIV-infected children were also slower (17.6 ± 6.2 vs. 10.1 ± 3.7) Mean Z-scores for length-for-age were significantly lower among HIV-infected children compared with HIV-uninfected children. Weight-for-length Z-scores were not significantly different. In summary, HIV-infected children had a 55% longer duration of hospitalization and a 21% lower appetite.

Objective: To investigate the possibility of micronutrient dilution by alcohol in the diets of an adult population in nutrition transition. Design: A cross-sectional, comparative, population-based study. Setting: The African population of the North West Province, South Africa. Subjects: One thousand seven hundred and fifty-seven participants (742 men, 1 015 women) aged 15 years and older from 37 randomly selected sites from rural and urban areas. Outcome measures: Outcome measures included alcohol consumption at different levels of urbanisation. Nutrient intakes in different alcohol intake categories (abstainers, light-to-moderate, and heavy drinkers) and body mass indices of men and women, separately. Results: Sixty-one per cent of men and twenty-five per cent of women reported alcohol consumption. Mean daily alcohol consumption of light-to-moderate drinking men (< 30 g per day) and women (< 15 g per day) were 8.3 g and 3.7 g respectively and 80.4 g and 36.6 g for “heavy drinkers”, defined as men consuming more than 30 g alcohol/day (18% of the study population) and women who drank more than 15 g alcohol/day (6% of the study population). Sorghum and commercial beer were the most popular alcoholic beverages. Alcohol intake increased from rural to urban middle class, with a shift from sorghum to commercial beer with urbanisation. Men consuming the most alcohol had significantly higher mean intakes of most macro- and micronutrients. For both men and women only the percentage of energy from fat decreased significantly as the alcohol intake increased. The intake of some micronutrients did not meet the Dietary Reference Intake (DRI, Estimated Average Requirement, EAR) at all levels of alcohol consumption. However, the DRIs for pantothenic acid, biotin, magnesium and zinc were met only in men consuming the most alcohol. There was no significant difference in BMI across the different alcohol consumption categories although the total energy intake increased with an increase in alcohol consumption. Conclusion: In this population in transition, urbanisation increased the consumption of alcoholic beverages. Mean energy intake from alcohol of heavy-drinking men (18.1% of total energy, TE) and women (11.7% of TE) was significantly higher than in the other groups but this did not cause an overall micronutrient dilution effect. It seems that respondents who have the money to buy alcoholic drinks can possibly also afford more healthy and nutritious food.

ObjectiveTo measure dietary intakes of young children aged 12–24 months and to determine the impact of poor diets on stunting.DesignA quantitative food-frequency questionnaire was adapted, tested and standardised. Trained enumerators conducted in-depth interviews with the mothers/caregivers of the children. Forty stunted children in urban informal settlements and 30 stunted children in rural areas were selected and pair-matched with controls. The data were captured on the Food Finder Program of the Medical Research Council.ResultsIn both urban and rural areas, the diet of stunted and non-stunted groups did differ significantly and all diets were of poor nutritional quality.ConclusionDiets in both areas resembled the recommended prudent diet, i.e. low in fat and high in carbohydrates. Poor quality diets were not the primary cause of stunting.

Aim: To investigate the determinants of overweight and obesity among 10- to 15-yearold schoolchildren in a population in the transitional phase in the North West Province of South Africa. Methods: A cross-sectional survey was used to investigate weight status (anthropometric indicators) and determinants of overweight/obesity including dietary intake, physical activity and socio-economic status. A single, random sample (n ¼ 1257), stratified for gender, type of school and ethnic group, was used. Data were collected on demographics, family circumstances, habitual physical activity, dietary intake and anthropometry to evaluate weight status and body fat content. One-way analysis of variance, the generalised linear models procedure of SAS and the Tukey post hoc honest significant difference test were used to analyse the data. Results: Few children were overweight or obese (7.8%) according to International Obesity Task Force (IOTF) standards (body mass index (BMI)-for-age). These standards were compared with other accepted standard values. Both Cole’s IOTF/BMI-for-age standard and the sum of skinfold thicknesses standard classified normal-weight status similarly at a level of 92% (P , 0.01) and were found to be useful in determining overweight/obesity. The prevalence rate was higher in females and white children, and was more apparent in urban areas, smaller households and children of parents with low- or high-income occupations. Boys and pre-menarcheal girls had mean body fat percentage in the normal/optimal range, whereas that of post-menarcheal girls was moderately high. Few variables showed a significant association with high body fat percentage: in boys, only the number of members in the household and physical activity levels over the weekend; in girls, only age. The overweight/obese boys mostly lived in smaller households, and the overweight/obese post-menarcheal girls were most inactive on both weekdays and weekends, and more overweight with increasing age. Conclusion: Smaller households, inactivity and increasing age for girls were found to be determinants that influence the development of overweight/obesity, while female gender and age post-menarche were identified as determinants of higher body fat content. For overweight/obesity prevention, the focus should be on pre-menarcheal girls, aged 10‐13 years, using these determinants to identify overweight/obesity risk. Preventive programmes should aim to increase the physical activity of children to improve their current and future weight status.

Objectives. To determine the prevalence and immediate and underlying causes of stunting in black children aged 12 - 24 months living in rural and urban South Africa.Design. A cross-sectional survey.Setting. Two poor rural villages in Limpopo and two poor urban informal settlement areas in Atteridgeville, Gauteng.Population. All households with mothers/caregivers (M/Cs) of children aged 12 - 24 months in the selected areas. All households meeting the inclusion criteria in the urban areas ( N = 380) and in the two rural villages ( N = 156) were included in the sample.Methods. Trained interviewers collected data using a standardised socio-demographic questionnaire. Heights and weights of M/Cs and their children were measured. Stunting was defined as a z-score less than -2 for height for age. Body mass index (BMI) values were calculated for the M/C. Data were analysed using a stepwise logistical regression analysis.Results. A stunting rate of 18% was documented in the rural areas, with a difference of...

Background : Despite the recommendation of the World Health Organization (WHO) of exclusive breastfeeding for the first 4-6 months of life, several South African studies on infant feeding practices have shown that the introduction of feeds other than breastmilk before 4 months is a common practice. The timing of initiation of complementary feeding within the first 4 months is, however, difficult to determine. Objective : To determine feeding practices of mothers of infants 8 weeks of age or younger, attending the postnatal clinic at Ga-Rankuwa Hospital. Methods : A cross-sectional study of mothers attending the postnatal clinic at Ga-Rankuwa Hospital using a standardised interview schedule. Results : A total of 150 mothers were interviewed. All infants in the sample were younger than 9 weeks of age. The mean age of the sample was 37.4 (5.2 weeks) ±12.1 days. Although 99% of infants were breastfed, exclusive breastfeeding was practised by only 4.6% of the sample. Water was given to 88%, infant formula to 43% and complementary feeds to 37%. Forty-six per cent of mothers said that the reason for giving water to their babies was to prevent constipation. Infant formula was added because mothers believed that their breastmilk was insufficient for their infants\' needs. Of the complemented infants, 91% had received complementary feeds before 7 weeks of age. Thin maize meal porridge providing less than 1 kJ/ml and negligible protein was the most commonly given first food. Conclusion : Breastfeeding was almost universal, exclusive breastfeeding was the exception. Mixed feeding was common, with the introduction of complementary feeds occurring within the first 2 months of life, well before the WHO recommendations. South African Journal of Clinical Nutrition Vol. 18(2) 2005: 70-75

Objective:To compare the relationships between food (nutrient) intakes and biochemical markers of nutritional status of asymptomatic HIV-infected with HIV-uninfected subjects, to gain more information on the appropriate diet for HIV-infected persons at an early stage of infection.Design:Cross-sectional population-based survey.Setting:North West Province, South Africa.Subjects:Two hundred and sixteen asymptomatic HIV-infected and 1550 HIV-uninfected men and women volunteers aged 15 years and older, recruited as ‘apparently healthy’ subjects from 37 randomly selected sites.Outcome measures:Food and nutrient intakes, measured with a validated food-frequency questionnaire, and nutritional status indicated by anthropometric and biochemical variables, measured by a standardised methodology.Results:The prevalence of HIV infection in the study population was 11.9%. The anthropometric indices and nutrient intakes of HIV-infected and uninfected subjects did not differ significantly, indicating that these 216 HIV-infected subjects were at an early stage of infection. Of the biochemical nutritional status variables, high-density lipoprotein cholesterol and total cholesterol, haemoglobin, albumin and triglycerides were significantly lower in infected subjects. They also had higher globulin and liver enzyme levels than uninfected subjects. In infected subjects, serum albumin correlated significantly with serum lipids, serum vitamin A, serum vitamin E, serum iron, total iron-binding capacity and haemoglobin. The significant positive correlations of the liver enzymes with serum lipids, albumin, vitamin A and iron, observed in HIV-uninfected subjects, disappeared in the infected subjects. Polyunsaturated fat intake showed significant positive correlations with the increased liver enzymes in infected subjects. A principal components analysis indicated that, in infected subjects, increased liver enzymes correlated with higher consumption of maize meal and lower consumption of meat and vegetables.Conclusions and recommendations:This survey indicated that asymptomatic HIV-infected subjects who followed a diet rich in animal foods had smaller decreases in serum albumin, haemoglobin and lipid variables, and smaller increases in liver enzymes, than those who consumed a diet based on staple foods. This suggests that animal foods are associated with improved nutritional status in HIV-infected persons. These results should be confirmed with intervention studies before dietary recommendations for asymptomatic HIV-infected individuals can be made.

Objective:To develop and assess the reproducibility of a quantitative food frequency questionnaire (QFFQ) sensitive to the culture of the African population of the North West Province, South Africa.Design:A cross-sectional study.Setting:A community-based field study in a population stratified according to level of urbanization from deep rural to urban upper class.Subjects:A total of 144 (99 women and 45 men) residents of the North West Province, aged between 15 and 65 years, participated in the study.Methods:A culture-sensitive, 145-item interviewer-administered QFFQ was designed to cover the whole diet. Portion sizes were estimated from a food portion photograph book (FPPB) showing foods in three portion sizes. The QFFQ was administered twice, 6–12 weeks apart.Results:Spearman rank correlation coefficients between the two administrations varied from 0.14 for calcium to 0.75 for alcohol. The mean percentage difference between intakes was 8.5 (standard deviation = 9.9). Energy, protein, carbohydrate and calcium gave differences within 10%. Few significant differences among correlation coefficients or percentage difference for gender, age group or strata of urbanization were present. Bland–Altman plots showed significant proportional bias for protein, fibre and vitamin C. More than 70% of the participants were classified into adjacent quintiles for all nutrients. For food groups, correlation coefficients ranged from 0.25 for milk to 0.45 for vegetable and maize meal groups and 80% of participants were classified into adjacent quintiles.Conclusions:The QFFQ appeared to be a reproducible dietary intake assessment instrument.

Objective:To apply structural equation modelling (SEM) and estimation of variance components to the relative validation data obtained from the quantitative food frequency questionnaire (QFFQ) used in the Transition, Health and Urbanisation in South Africa (THUSA) study.Design:A cross-sectional study.Setting:A community-based field study in an African population conducted during 1996.Subjects:Residents of the North West Province, South Africa, aged between 15 and 65 years.Methods:Relative validity of the QFFQ was tested against 7-day weighed food records, 24-hour urinary nitrogen (UN) excretion and estimated basal metabolic rate (BMR). SEM and estimation of variance components were applied to the log-transformed energy, protein, fat, calcium, iron, vitamin A and vitamin C intakes. UN excretion was used as a biomarker in the application of the SEM to protein and estimated BMR to energy intakes.Results:Constant bias (αQ) derived by the SEM varied from 0.85 (vitamin C) to 5.8 (energy). There was significant proportional bias for all nutrients except vitamin C. Validation coefficients (ρ(Q,T)) varied from 0.3 (fat, calcium, iron) to 0.7 (vitamin C). The inclusion of estimated BMR in the SEM for energy increased ρ(Q,T) from 0.38 to 0.42. The estimation of variance components gave slightly lower correlations for the relationship between intakes from the QFFQ and the unknown true intake.Conclusions:Robust statistical methods were successfully applied in a relative validation study for a QFFQ in an African population. Estimated BMR as a biomarker for energy intake produced more meaningful results than UN excretion as a biomarker for protein intake.

Non-uniform, unclear, or incomplete presentation of food intake data limits interpretation, usefulness, and comparisons across studies. In this contribution, we discuss factors affecting uniform reporting of food intake across studies. The amount of food eaten can be reported as mean portion size, number of servings or total amount of food consumed per day; the absolute intake value for the specific study depends on the denominator used because food intake data can be presented as per capita intake or for consumers only. To identify the foods mostly consumed, foods are reported and ranked according to total number of times consumed, number of consumers, total intake, or nutrient contribution by individual foods or food groups. Presentation of food intake data primarily depends on a study’s aim; reported data thus often are not comparable across studies. Food intake data further depend on the dietary assessment methodology used and foods in the database consulted; and are influenced by the inherent limitations of all dietary assessments. Intake data can be presented as either single foods or as clearly defined food groups. Mixed dishes, reported as such or in terms of ingredients and items added during food preparation remain challenging. Comparable presentation of food consumption data is not always possible; presenting sufficient information will assist valid interpretation and optimal use of the presented data. A checklist was developed to strengthen the reporting of food intake data in science communication. http://www.sciencedirect.com/science/article/pii/S0899900713002062 http://dx.doi.org/10.1016/j.nut.2013.03.016 http://www.journals.elsevier.com/nutrition/

Objective: The objective was to investigate the absolute micronutrient intake and the possibility of micronutrient dilution of added sugar in the diets of an African population in nutritional transition. Design: A cross-sectional, comparative, population-based design was used. Respondents who consumed sugar were divided into four quartiles of percentage of added sugar intake. Setting: The setting was 37 randomly selected rural and urban areas of the North West province. Subjects: The subjects were 1 742 adult volunteers (739 men and 1 003 women), aged between 15-65 years. After exclusion of low-energy reporters, the sample comprised 1 045 subjects (472 men and 573 women). Outcome measures: The outcomes measures were the macronutrient and micronutrient intakes of subjects in different quartiles of added sugar intake and body mass index (BMI). Results: The average intake of added sugar was 10.01% of total energy (67.12 g) in men and 11.2% total energy (67.10 g) in women. Respondents who consumed the most added sugar had significantly lower mean intakes of alcohol, but higher intakes of energy, macronutrients and most micronutrients. The diets of those in the highest sugar intake group contained significantly less thiamine, riboflavin, niacin, vitamin B 12 , pantothenic acid, biotin, magnesium, phosphorus and zinc per 4.18 MJ. At every level of added sugar consumption, the mean intakes of fibre (men only), folate, ascorbic acid and calcium (men and women) did not meet the dietary reference intakes [estimated average requirements (EAR)] and pantothenic acid and biotin (women only) did not meet the adequate intake. There were no significant differences in mean BMI across the quartiles of added sugar intakes in men, but the mean BMI of women who consumed the most added sugar was significantly higher than that of those who consumed less sugar. Respondents who consumed the most added sugar had significantly higher intakes of fruit (men only), bread and soft drinks, and lower intakes of maize meal and alcohol (men and women). Conclusion: Absolute intakes of most micronutrients were significantly higher in consumers with a high sugar intake [Quartile (Q) 4] compared with the lowest consumers of sugar (Q1). The lowest percentages of participants whose micronutrient intakes fell below the EAR were in Q4 and Q3. However, expression of micronutrient intake per 4.18 kJ (micronutrient dilution) revealed significantly less of most micronutrients per 4.18 MJ for men and women who consumed the most added sugar, compared with those who consumed the least.

Background/objective: The objective of this study is to determine the relative validity of reported energy intake (EI) derived from multiple 24-h recalls against estimated energy expenditure (EE(est)). Basal metabolic rate (BMR) equations and physical activity factors were incorporated to calculate EE(est). Subjects/methods: This analysis was nested in the multidisciplinary PhysicaL Activity in the Young study with a prospective study design. Peri-urban black South African adolescents were investigated in a subsample of 131 learners (87 girls and 44 boys) from the parent study sample of 369 (211 girls and 158 boys) who had all measurements taken. Pearson correlation coefficients and Bland-Altman plots were calculated to identify the most accurate published equations to estimate BMR (P

Diarrheal disease remains one of the major causes of morbidity and mortality in young children in South Africa. Although a rotavirus vaccine will reduce rotavirus diarrheal morbidity and mortality, its introduction and sustainability will incur considerable costs. The aim of this study was to estimate the costs associated with diarrheal disease of all etiologies in children5 years of age at Dr George Mukhari Hospital, a tertiary level hospital in Gauteng, South Africa.Cost data were obtained by a review of systematically selected records of patients admitted for diarrhea during 2004 and the prospective recording of the treatment of consecutive inpatients admitted for diarrhea from February through June 2005. Data on hospital stay, medications, nondrug orders, and diagnostic tests were abstracted using standardized recording forms. Costs were calculated using 2004 and 2005 prices. Carers were interviewed using a standard interview schedule to determine out-of-pocket expenses. Stool samples were tested for rotavirus by the Medical Research Council Diarrheal Pathogens Unit.The review sample comprised 86 (20 rotavirus positive) patient records. The prospective sample comprised 77 inpatients (25 rotavirus positive). The mean duration (+/- standard deviation [SD]) of hospital stay was 4.6 +/- 3.4 days and 5.7 +/- 4.7 days for the review and prospective samples, respectively. The mean total inpatient cost (+/-SD) was R5963 +/- R4070 (review sample) and R7256 +/- R5599 (prospective sample; P.05). Although mean total costs did not differ significantly between rotavirus-negative and -positive samples, mean facility and antibiotic costs were significantly higher for the rotavirus-negative sample (P.05) in the prospective sample. Mean out-of-pocket expenses (+/-SD) were R100.00 +/- R112 for inpatients.Although total inpatient costs did not differ significantly between the rotavirus-negative and -positive patients, costs for the rotavirus-negative patients tended to be higher. Although a rotavirus vaccine will reduce the burden of diarrheal disease, it is imperative that measures for reducing the incidence and severity of diarrheal disease due to other pathogens are strengthened.

Objectives. To determine the knowledge and intake of calcium among white adolescent girls in Gauteng, South Africa. Design. A quantitative study using a questionnaire interview conducted over 13 months (1 June 2000 - 31 July 2001). Settings. Sixteen randomly selected private and state schools in the Gauteng area. Subjects. Adolescent white girls aged between 15 and 17 years. Outcome measures. Calcium intake and knowledge using a food frequency questionnaire (FFQ) and 7-day weighed records (WRS). Results. Mean calcium intake according to the FFQ was 811 mg/day (adequate intake (AI) 1 300 mg/day). Fiftyone per cent of participants had not been given any information relating to calcium and its benefits. Teachers and parents are the most noted sources of information and 31% of the participants knew that adolescence was the most important period for calcium absorption and bone building. Conclusions. Adolescents have low intakes of calcium compared with what is recommended. It is important to develop intervention programmes that target children, adolescents, teachers and mothers alike. It is also imperative to develop awareness of the importance of calcium consumption during childhood and adolescence in order to minimise the possibility of osteoporosis in later life. South African Journal of Clinical Nutrition Vol.17(3) 2004: 102-108

Objective:To determine the relative validity of the culture-sensitive quantitative food frequency questionnaire (QFFQ) developed for the Transition, Health and Urbanisation in South Africa (THUSA) study by 7-day weighed food records, urinary nitrogen excretion and basal metabolic rate (BMR).Design:A cross-sectional study.Setting:A community-based study in a population stratified according to level of urbanization.Subjects:Residents of the North West Province, South Africa, aged between 15 and 65 years. The weighed food record study comprised 74 participants while 104 participants collected 24-hour urine samples.Methods:All participants were interviewed using the QFFQ. For the weighed food record study, participants kept detailed weighed food diaries for seven consecutive days. For the urinary nitrogen study, participants made one 24-hour urine collection. Completeness of the urine collections was checked against 240 mg para-aminobenzoic acid. BMR was estimated by the Schofield equations.Results:Spearman rank correlation coefficients between the QFFQ and weighed food record ranged between 0.14 (fibre) and 0.59 (vitamin C). The QFFQ tended to underestimate intakes compared with the weighed records. Quintile distributions were similar for both methods. The correlation between urinary nitrogen excretion and dietary intake was poor. Possible underreporting was identified for 43% of the participants with the QFFQ and 28% with the weighed food record.Conclusions:The QFFQ appeared to be a relatively valid instrument for the assessment of dietary intakes of the population of the North West Province. The use of biomarkers in this population was difficult and needs further investigation.

Aim: The aim of this review is to explore the validity and/or reproducibility of dietary assessment methods used to assess food and nutrient intakes of adolescents.Method: A detailed literature search was undertaken to trace articles reporting on the validity and/or reproducibility of food records, food frequency questionnaires (FFQs) and 24-hour recalls for the dietary assessment of adolescents, especially among South Africans, in the following databases: Medline, Science Direct, Academic Search Premier, Health Source, PubMed and the South African e-publications database(SAE). Original studies published between 1990 and 2009, and relevant original articles published before 1990, were included. Of these, only three were South African-based studies reporting testing for reproducibility and/or validity.Results: Results indicated that adolescents comply better with estimated food records than with weighed food records. However, energy intake was underestimated in adolescents (by 18–42%) when using food record methods. The relative validity of FFQs among adolescents was moderate, with correlation coefficients of > 0.3 for most measured nutrients and food items. Reproducibility was fair to good among female adolescents (0.3–0.83) for most nutrients and foods, but was lower in a South African Tswana-speaking group. The 24-hour recall method showed the least over- and underestimation of all the reviewed methods. When comparing the 24-hour recall method to an observed intake method among adolescents, < 11% underestimation of energy intake was found, while < 4% underestimation was found when the 24-hour recall method was tested against the doubly labelled water method.Conclusion: Based on these outcomes it was concluded that FFQs and 24-hour recalls are valid and reproducible dietary assessment methodsthat can be used when collecting dietary data from adolescents. Factors to consider when choosing the best suitable method should include the gender and ethnicity of the population as well as the time frame for the collection of dietary data.Keywords: dietary assessment methods; reproducibility; validity; adolescents