Search

Introduction: Obesity is a major and challenging public health problem. The aim of this substudy is to evaluate the effect of calcium supplementation on body weight in women recruited in the Calcium and Preeclampsia trial. Methods: Women were recruited before pregnancy and randomized to receive a calcium supplement containing 500 mg of elemental calcium or placebo until 20 weeks’ gestation; all women received 1.5 g from 20 weeks until delivery. Results: A total of 630 women conceived during the study, 322 allocated to calcium and 308 to placebo. Among these, 230 allocated to calcium and 227 allocated to placebo had information on body weight at baseline and at 8 weeks' gestation. During the study period, women allocated to calcium had a mean weight increase of 1.1 (SD ±5.5) kg, whereas those allocated to placebo had a mean increase of 1.5 (SD ±6.1) kg, a mean difference of 0.4 kg (95% −0.4 (−1.4 to 0.6); P =.408). Women classified as obese at the start of the trial had a lower body weight gain at 8 weeks’ gestation (1.0 kg; 95% CI: −3.2 to 1.2; P =.330) and at 32 weeks’ gestation (2.1 kg; 95% CI: 5.6-1.3; P =.225) if they received calcium as compared to placebo. However, none of these differences were statistically significant. Conclusion: The smaller increase in body weight found in women supplemented with 500 mg elemental calcium daily is quantitatively consistent with previous studies. However, in this study, the difference was not statistically significant. Fil: Cormick, Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina. Universidad Nacional de La Matanza; Argentina. University of Cape Town; Sudáfrica Fil: Betrán, Ana Pilar. Organizacion Mundial de la Salud; Argentina Fil: Harbron, Janetta. University of Cape Town; Sudáfrica Fil: Seuc, Armando. Instituto Nacional de Higiene; Cuba Fil: White, Cintia. Universidad Nacional de La Matanza; Argentina Fil: Roberts, James M.. University of Pittsburgh; Estados Unidos Fil: Belizan, Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina Fil: Hofmeyr, G. Justus. University of the Witwatersrand; Sudáfrica

Precise identification of drinking and smoking patterns during pregnancy is crucial to better understand the risk to the fetus. The purpose of this manuscript is to describe the methodological approach used to define prenatal drinking and smoking trajectories from a large prospective pregnancy cohort, and to describe maternal characteristics associated with different exposure patterns. In the Safe Passage Study, detailed information regarding quantity, frequency, and timing of exposure was self-reported up to four times during pregnancy and at 1 month post-delivery. Exposure trajectories were developed using data from 11,692 pregnancies (9,912 women) where pregnancy outcome was known. Women were from three diverse populations: white (23%) and American Indian (17%) in the Northern Plains, US, and mixed ancestry (59%) in South Africa (other/not specified [1%]). Group-based trajectory modeling was used to identify 5 unique drinking trajectories (1 none/minimal, 2 quitting groups, 2 continuous groups) and 7 smoking trajectories (1 none/minimal, 2 quitting groups, 4 continuous groups). Women with pregnancies assigned to the low- or high-continuous drinking groups were less likely to have completed high school and were more likely to have enrolled in the study in the third trimester, be of mixed ancestry, or be depressed than those assigned to the none/minimal or quit-drinking groups. Results were similar when comparing continuous smokers to none/minimal and quit-smoking groups. Further, women classified as high- or low-continuous drinkers were more likely to smoke at moderate-, high-, and very high-continuous levels, as compared to women classified as non-drinkers and quitters. This is the first study of this size to utilize group-based trajectory modeling to identify unique prenatal drinking and smoking trajectories. These trajectories will be used in future analyses to determine which specific exposure patterns subsequently manifest as poor peri- and postnatal outcomes.

The objective of this study was to determine the prevalence and socio-demographic predictors of malnutrition in two urbanized economically active provinces (Gauteng N = 733, Western Cape N = 593) in South Africa. A multistage stratified cluster random sampling design was applied. Fieldworkers visited homes, measured children aged 1-&lt, 10-years old (N = 1326) and administered a questionnaire (mother/primary caregiver). In under-five year old children (N = 674) 21.6% were stunted [height-for-age z-score &lt, &minus, 2 SD], 5.6 % underweight [weight-for-age z-score &lt, 2 SD], 10.3% overweight (body mass index-for-age z-score) (BAZ)&gt, +2 SD &le, +3 SD] and 7.0% obese (BAZ &gt, +3 SD). In 5&ndash, &lt, 10-year olds (N = 626) 6.7% were stunted, 6.8% underweight, 13.4% overweight and 6.8% obese. Stunting and overweight in the same child was present in 5.7% under-five year olds and 1.7% in 5&ndash, 10-year olds. Multiple logistic regression analyses identified having a mother with a post-grade 12 qualification (OR = 0.34) and having an obese mother (OR 0.46) as protectors and being in the under-five age group (OR = 3.73) as a risk factor for stunting. Being in the under-five age group was also a risk factor for a BAZ &gt, 1 (OR 2.39), while being in the third wealth quintile was protective (OR = 0.62). Results indicate that stunting and overweight/obesity are still present at concerning levels, especially in the under-five age group.

This study aims to determine the prevalence of risk of malnutrition on admission and discharge in African hospitals, and to identify the association with selected indicators. In this multi-center prospective cohort study, adult patients from hospitals in South Africa, Kenya, and Ghana were screened on admission and discharge and contacted 3 months post-discharge. Relevant morbidity and mortality outcomes were assessed. At risk of malnutrition was indicated if NRS-2002 score &ge, 3. Adult patients (n = 2126, 43.11 years, IQR: 31.95&ndash, 55.60, 52.2% female) were screened on admission and 61% were identified as at risk of malnutrition. The proportion of at-risk patients for the three hospitals in Kenya and Ghana (66.2%) were significantly higher than that of the three South African hospitals (53.7%) (Chi2 = 31.0, p &lt, 0.001). Discharge risk of malnutrition was 71.2% (n = 394). Mean length of stay (LOS) was 6.46 &plusmn, 5.63 days. During hospitalization, 20.6% lost &ge, 5% body weight, 18.8% were referred for nutrition support, and discharge BMI (23.87 &plusmn, 7.38 kg/m2) was significantly lower than admission BMI (24.3 &plusmn, 7.3 kg/m2) (p &lt, 0.001). Admission nutrition risk was associated with lower admission and discharge BMI (p &lt, 0.001), longer LOS (p &lt, 0.001), increased 3-month re-admission rates (Chi2 = 1.35, p = 0.245) and increased mortality (Chi2 = 21.68, 0.001). Nearly two-thirds of patients were at risk of malnutrition on admission. This was associated with longer LOS and greater hospital mortality. The nutritional status of patients deteriorated during hospitalization. Routine screening practices with appropriate nutrition support action should be implemented as a matter of urgency.

Background: Literature and practice recommendations for lifestyle interventions to treat the increasing number of obese patients with non-communicable diseases (NCDs) or risk factors for NCDs attending resource-constrained public healthcare facilities in South Africa are scarce. Aim: To compare the impact of a facility-based therapeutic group (FBTG) intervention with usual care on weight in obese participants, with NCDs or risk factors for NCDs. Setting: Public healthcare facility providing primary healthcare services in Cape Town, South Africa. Methods: A quasi-experimental study design was used where participants chose to receive weight loss treatment with either the FBTG or usual care interventions. Both interventions involved a one-on-one medical and dietetic consultation, while FBTG participants had six additional group sessions. Follow-up assessments took place 6 months after baseline. Socio-demographic variables, blood pressure, smoking status, weight, height, waist circumference, dietary intake, physical activity and stage of change were measured. Results: Of the 193 obese adults enrolled, 96 selected the FBTG and 97 selected usual care. There were no significant differences at baseline between the two groups. Weight loss over 6 months was greater ( p < 0.001) in FBTG (median [IQR] of −2.9 [−5.1; −0.3] kg) than usual care (−0.9 [−0.9; 0.6] kg) participants. At 6 months, more FBTG completers reached the weekly target of 150 min ( p = 0.009), while both groups showed improvements in dietary intake. More FBTG (74%) than usual care (49%) participants were in the action stage of change by 6 months ( p = 0.010). Conclusions: The group-based intervention was more effective than usual care in weight reduction as well as improvements in physical activity and stage of change.

This study investigated the dietary intake of pregnant women with gestational diabetes mellitus (GDM) and their beliefs relating to the consumption of fruits and vegetables (F&amp, V) and sugary foods and drinks. A cross-sectional study was conducted on 239 pregnant women with GDM in Cape Town. Dietary intake was assessed using a quantified Food Frequency Questionnaire and beliefs relating to food choices were assessed using the Theory of Planned Behaviour (TPB). The mean energy intake was 7268 KJ, carbohydrate was 220 (±104.5) g, protein 60.3 (±27.5) g and fat 67.7 (±44.2) g. The macronutrient distribution was 55% carbohydrates, 14.5% protein and 30.5% fat of total energy. The majority of the sample had inadequate intakes of vitamin D (87.4%), folate (96.5%) and iron (91.3%). The median (IQR) amount of added table sugar and sugar sweetened beverages (SSBs) was 4.0 (0.00–12.5) g and 17.9 (0.0–132.8) mL per day, respectively. Only 31.4% met the recommendation (400 g per day) for F&amp, V. Beliefs that it was not easy to exclude sugary foods/drinks and that knowing how to control cravings for sugary foods/drinks are areas to target messages on the sugar content of SSBs. In conclusion, the dietary intake of these women was not optimal and fell short of several nutritional guidelines for pregnant women with hyperglycaemia. The strongly held beliefs regarding sugary foods/drinks may contribute to poor adherence to nutritional guidelines among pregnant women with GDM in South Africa.

Background: Maternal nutritional status before and during pregnancy is an important contributor to pregnancy outcomes and early child health. The aim of this study was to describe the preconceptional nutritional status and dietary intake during pregnancy in high-risk women from South Africa and Zimbabwe. Methods: This is a prospective observational study, nested to the CAP trial. Anthropometric measurements before and during pregnancy and dietary intake using 24-h recall during pregnancy were assessed. The Intake Distribution Estimation software (PC-SIDE) was used to evaluate nutrient intake adequacy taking the Estimated Average Requirement (EAR) as a cut-off point. Results: Three hundred twelve women who had pre-eclampsia in their last pregnancy and delivered in hospitals from South Africa and Zimbabwe were assessed. 73.7 and 60.2% women in South Africa and Zimbabwe, respectively started their pregnancy with BMI above normal (BMI ≥ 25) whereas the prevalence of underweight was virtually non-existent. The majority of women had inadequate intakes of micronutrients. Considering food and beverage intake only, none of the micronutrients measured achieved the estimated average requirement. Around 60% of pregnant women reported taking folic acid or iron supplements in South Africa, but almost none did so in Zimbabwe. Conclusion: We found a high prevalence of overweight and obesity and high micronutrient intake inadequacy in pregnant women who had the previous pregnancy complicated with pre-eclampsia. The obesity figures and micronutrient inadequacy are issues of concern that need to be addressed. Pregnant women have regular contacts with the health system; these opportunities could be used to improve diet and nutrition. Fil: Cormick, Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina. University of Cape Town; Sudáfrica Fil: Betrán, Ana Pilar. World Health Organization; Suiza Fil: Harbron, Janetta. University of Cape Town; Sudáfrica Fil: Dannemann Purnat, Tina. World Health Organization; Dinamarca Fil: Parker, Catherine. University of Fort Hare; Sudáfrica. Walter Sisulu University; Sudáfrica. University of the Witwatersrand; Sudáfrica Fil: Hall, David. Stellenbosch University; Sudáfrica Fil: Seuc, Armando H.. Instituto Nacional de Higiene; Cuba Fil: Roberts, James M.. University of Pittsburgh; Estados Unidos Fil: Belizan, Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina Fil: Hofmeyr, G. Justus. University of the Witwatersrand; Sudáfrica. Walter Sisulu University; Sudáfrica. University of Fort Hare; Sudáfrica

Background: Insights into the characteristics of treatment seekers for lifestyle changes and treatment preferences are necessary for intervention planning. Aim: To compile a profile of treatment-seeking obese patients with non-communicable diseases (NCDs) or NCD risk factors and to compare patients who choose group-based (facility-based therapeutic group [FBTG]) versus usual care (individual consultations) treatment. Setting: A primary healthcare facility in Cape Town, South Africa. Methods: One hundred and ninety-three patients were recruited in this cross-sectional study. Ninety six chose FBTG while 97 chose usual care. A questionnaire, the hospital database and patients’ folders were used to collect data. Weight, height and waist circumference were measured. STATA 11.0 was used for descriptive statistics and to compare the two groups. Results: The subjects’ mean age was 50.4 years, 78% were women and of low education levels and income, and 41.5% had type 2 diabetes, 83.4% hypertension and 69.5% high cholesterol. Mean (s.d.) HbA1c was 9.1 (2.0)%, systolic BP 145.6 (21.0) mmHg, diastolic BP 84.5 (12.0) mmHg, cholesterol 5.4 (1.2) mmol/L), body mass indicator (BMI) 39.3 (7.3) kg/m2 and waist circumference 117 (12.6) cm). These figures were undesirable although pharmacological treatment for diabetes and hypertension was in place. Only 14% were physically active, while TV viewing was > 2h/day. Mean daily intake of fruit and vegetables (2.2 portions/day) was low while added sugar (5 teaspoons) and sugar-sweetened beverages (1.3 glasses) were high. Usual care patients had a higher smoking prevalence, HbA1c, number of NCD risk factors and refined carbohydrate intake, and a lower fruit and vegetable intake. Conclusion: Treatment seekers were typically middle-aged, low income women with various modifiable and intermediate risk factors for NCDs. Patients choosing usual care could have more NCD risks. Keywords: Non-communicable diseases; primary health care; family medicine; obesity; diabetes; treatment preference; dietary intake; NCD risk factors; group-based treatment; stages of change