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Background: Obesity and other noncommunicable disease (NCD) risk factors are increasing in low- and middle-income countries. There are few data on the association between increased added sugar intake and NCD risk in these countries. Objective: We assessed the relation between added sugar intake and NCD risk factors in an African cohort study. Added sugars were defined as all monosaccharides and disaccharides added to foods and beverages during processing, cooking, and at the table. Design: We conducted a 5-y follow-up of a cohort of 2010 urban and rural men and women aged 30–70 y of age at recruitment in 2005 from the North West Province in South Africa. Results: Added sugar intake, particularly in rural areas, has increased rapidly in the past 5 y. In rural areas, the proportion of adults who consumed sucrose-sweetened beverages approximately doubled (for men, from 25% to 56%; for women, from 33% to 63%) in the past 5 y. After adjustment, subjects who consumed more added sugars (≥10% energy from added sugars) compared with those who consumed less added sugars had a higher waist circumference [mean difference (95% CI): 1.07 cm (0.35, 1.79 cm)] and body mass index (in kg/m2) [0.43 (0.12, 0.74)] and lower HDL cholesterol [−0.08 mmol/L (−0.14, 0.002 mmol/L)]. Conclusions: This cohort showed dramatic increases in added sugars and sucrose-sweetened beverage consumption in both urban and rural areas. Increased consumption was associated with increased NCD risk factors. In addition, the study showed that the nutrition transition has reached a remote rural area in South Africa. Urgent action is needed to address these trends

BACKGROUND More than 80% of deaths from cardiovascular disease are estimated to occur in low-income and middle-income countries, but the reasons are unknown. METHODS We enrolled 156,424 persons from 628 urban and rural communities in 17 countries (3 high-income, 10 middle-income, and 4 low-income countries) and assessed their cardiovascular risk using the INTERHEART Risk Score, a validated score for quantifying risk-factor burden without the use of laboratory testing (with higher scores indicating greater risk-factor burden). Participants were followed for incident cardiovascular disease and death for a mean of 4.1 years. RESULTS The mean INTERHEART Risk Score was highest in high-income countries, inter- mediate in middle-income countries, and lowest in low-income countries (P<0.001). However, the rates of major cardiovascular events (death from cardiovascular causes, myocardial infarction, stroke, or heart failure) were lower in high-income countries than in middle- and low-income countries (3.99 events per 1000 person- years vs. 5.38 and 6.43 events per 1000 person-years, respectively; P<0.001). Case fatality rates were also lowest in high-income countries (6.5%, 15.9%, and 17.3% in high-, middle-, and low-income countries, respectively; P=0.01). Urban com- munities had a higher risk-factor burden than rural communities but lower rates of cardiovascular events (4.83 vs. 6.25 events per 1000 person-years, P<0.001) and case fatality rates (13.52% vs. 17.25%, P<0.001). The use of preventive medications and revascularization procedures was significantly more common in high-income countries than in middle- or low-income countries P<0.001). CONCLUSIONS Although the risk-factor burden was lowest in low-income countries, the rates of major cardiovascular disease and death were substantially higher in low-income countries than in high-income countries. The high burden of risk factors in high- income countries may have been mitigated by better control of risk factors and mo

Background: Sub-Saharan Africa (SSA) has the highest burden of HIV in the world and a rising prevalence of cardiometabolic disease; however, the interrelationship between HIV, antiretroviral therapy (ART) and cardiometabolic traits is not well described in SSA populations. Methods: We conducted a systematic review and meta-analysis through MEDLINE and EMBASE (up to January 2012), as well as direct author contact. Eligible studies provided summary or individuallevel data on one or more of the following traits in HIVþ and HIV-, or ARTþ and ART- subgroups in SSA: body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TGs) and fasting blood glucose (FBG) or glycated hemoglobin (HbA1c). Information was synthesized under a random-effects model and the primary outcomes were the standardized mean differences (SMD) of the specified traits between subgroups of participants. Results: Data were obtained from 49 published and 3 unpublished studies which reported on 29 755 individuals. HIV infection was associated with higher TGs [SMD, 0.26; 95% confidence interval (CI), 0.08 to 0.44] and lower HDL (SMD, 0.59; 95% CI, 0.86 to 0.31), BMI (SMD, 0.32; 95% CI, 0.45 to 0.18), SBP (SMD, 0.40; 95% CI, 0.55 to 0.25) and DBP (SMD, 0.34; 95% CI, 0.51 to 0.17). Among HIVþ individuals, ART use was associated with higher LDL (SMD, 0.43; 95% CI, 0.14 to 0.72) and HDL (SMD, 0.39; 95% CI, 0.11 to 0.66), and lower HbA1c (SMD, 0.34; 95% CI, 0.62 to 0.06). Fully adjusted estimates from analyses of individual participant data were consistent with meta-analysis of summary estimates for most traits. Conclusions: Broadly consistent with results from populations of European descent, these results suggest differences in cardiometabolic traits between HIV-infected and uninfected individuals in SSA, which might be modified by ART use. In a region with the highest burden of HIV, it will be important

Background: The dietary shift from indigenous and traditional plants (ITPs) to cash crops and exotic plant food sources increases the risk of malnutrition and other nutrition-related non-communicable diseases, especially in poor rural communities. Farm communities in South Africa have been associated with poor nutritional status and extreme poverty. ITPs have been found to be affordable sources of several micronutrients. However, knowledge of and the use of these plants are declining, and little is known about the child’s acceptance of dishes prepared with ITPs. This knowledge can be used to improve the general acceptance of ITPs. This study aimed to gain insight into parents’ knowledge and perceptions and their use of ITPs in a farming community in the North West Province and to assess children’s acceptance of and preference for dishes made with African leafy vegetables (ALVs) and Swiss chard. Methods: Parents (n = 29) responsible for food preparation for children in grade 2 to 4 in two schools were purposively selected for four focus group discussions. A sensory evaluation assessed the children’s (n = 98) acceptance of, preference for and intended consumption of dishes made with leafy vegetables. The dishes were made of Amaranthus spp., Cleome gynandra, Cucurbita maxima, Vigna unguiculata and Beta vulgaris. Results: Parents mentioned 30 edible ITPs during the focus group discussions. Parents had knowledge of available ITPs and their use as food. Location, seasonal variation and rainfall affected the availability of and access to ITPs. Sun-dried ITPs were stored in sacks for later use. ITPs were perceived as healthy, affordable and delicious, hence acceptable to the parents. The children also evaluated the dishes made with ALVs as acceptable in terms of colour, smell and taste. Swiss chard was preferred, most likely because of the children’s exposure to this vegetable. Children indicated that they would like to eat these leafy vegetables twice a week. Conclusion: T

Background: The PURE study was established to investigate associations between social, behavioural, genetic, and environmental factors and cardiovascular diseases in 17 countries. In this analysis we compare the age, sex, urban/rural, mortality, and educational profiles of the PURE participants to national statistics. Methods: PURE employed a community-based sampling and recruitment strategy where urban and rural communities were selected within countries. Within communities, representative samples of adults aged 35 to 70 years and their household members (n = 424,921) were invited for participation. Results: The PURE household population compared to national statistics had more women (sex ratio 95.1 men per 100 women vs 100.3) and was older (33.1 years vs 27.3), although age had a positive linear relationship between the two data sources (Pearson's r = 0.92). PURE was 59.3% urban compared to an average of 63.1% in participating countries. The distribution of education was less than 7% different for each category, although PURE households typically had higher levels of education. For example, 37.8% of PURE household members had completed secondary education compared to 31.3% in the national data. Age-adjusted annual mortality rates showed positive correlation for men (r = 0.91) and women (r = 0.92) but were lower in PURE compared to national statistics (7.9 per 1000 vs 8.7 for men; 6.7 vs 8.1 for women). Conclusions: These findings indicate that modest differences exist between the PURE household population and national data for the indicators studied. These differences, however, are unlikely to have much influence on exposure-disease associations derived in PURE. Further, incidence estimates from PURE, stratified according to sex and/or urban/rural location will enable valid comparisons of the relative rates of various cardiovascular outcomes across countries.

Background: All rigorous primary cardiovascular disease (CVD) prevention guidelines recommend absolute CVD risk scores to identify high- and low-risk patients, but laboratory testing can be impractical in low- and middle-income countries. The purpose of this study was to compare the ranking performance of a simple, non-laboratory-based risk score to laboratory-based scores in various South African populations. Methods: We calculated and compared 10-year CVD (or coronary heart disease (CHD)) risk for 14,772 adults from thirteen cross-sectional South African populations (data collected from 1987 to 2009). Risk characterization performance for the non-laboratory-based score was assessed by comparing rankings of risk with six laboratory-based scores (three versions of Framingham risk, SCORE for high- and low-risk countries, and CUORE) using Spearman rank correlation and percent of population equivalently characterized as ‘high’ or ‘low’ risk. Total 10-year non-laboratory-based risk of CVD death was also calculated for a representative cross-section from the 1998 South African Demographic Health Survey (DHS, n = 9,379) to estimate the national burden of CVD mortality risk. Results: Spearman correlation coefficients for the non-laboratory-based score with the laboratory-based scores ranged from 0.88 to 0.986. Using conventional thresholds for CVD risk (10% to 20% 10-year CVD risk), 90% to 92% of men and 94% to 97% of women were equivalently characterized as ‘high’ or ‘low’ risk using the non-laboratory-based and Framingham (2008) CVD risk score. These results were robust across the six risk scores evaluated and the thirteen cross-sectional datasets, with few exceptions (lower agreement between the non-laboratory-based and Framingham (1991) CHD risk scores). Approximately 18% of adults in the DHS population were characterized as ‘high CVD risk’ (10-year CVD death risk >20%) using the non-laboratory-based score. Conclusions: We found a high level of correlation between a si

Multidisciplinary partnerships in community-specific writing or storytelling projects – A case study. Partnerships are used as strategy in various sectors of society, especially in order to reach goals which are unattainable for independent individuals, institutions or academic disciplines. The complexity of community-specific creative writing and storytelling projects (including the variety of languages, literacy levels and socio-economic issues in the country, as well as practical aspects such as funding, access to communities et cetera) means that such projects cannot easily be run by individual persons or organisations but that collaboration is needed. The aim of this overview article is to investigate multidisciplinary partnerships in community projects which promote community-specific writing and storytelling, focusing on one such project in particular. As background the situation in South Africa with regard to writing and storytelling in communities is sketched. The focus then shifts to multidisciplinary partnerships. A case study is discussed to highlight the complexity of such partnerships. This article addresses the dearth of research on partnerships in the context of creative writing or storytelling projects in communities. Although multidisciplinary partnerships do have their challenges, the article concludes that they can bring balance and wealth to community development previously unexplored. OPSOMING: Vennootskappe word in verskeie sektore van die samelewing as strategie gebruik, veral om doelwitte na te streef wat buite bereik is van individue, instansies of akademiese dissiplines wat onafhanklik werk. Die kompleksiteit van gemeenskapseie woordkunsprojekte (onder andere die verskeidenheid tale, geletterdheidsvlakke, en sosiaal-maatskaplike problematiek in die land, asook praktiese aspekte soos befondsing, toegang tot gemeenskappe, ensovoorts) bring mee dat sodanige projekte gewoonlik nie deur ’n enkelpersoon of -instansie uitgevoer kan word nie, maar

High susceptibility of the African population to develop cardiovascular disease obliges us to investigate possible contributing risk factors. Our aim was to determine whether low 25(OH)D status is associated with increased blood pressure and carotid-radial pulse wave velocity in black South African women. We studied 291 urban women (mean age: 57.5669.00 yrs.). 25(OH)D status was determined by serum 25(OH)D levels. Women were stratified into sufficient (.30 ng/ ml), and insufficient/deficient (,30 ng/ml) groups. Cardiovascular variables were compared between groups. Women with low 25(OH)D levels had significantly higher SBP (150.8627.1 vs. 137.6621.0), DBP (94.7614.5 vs. 89.3612.3) and PP (53.15(50.7;55.7) vs. 46.3(29.4;84.6)) compared to women with sufficient levels. No significant difference was observed with regards to c-rPWV. ANCOVA analyses still revealed significant differences between the two groups with regards to SBP, DBP as well as PP. Partial correlations revealed significant inverse association between SBP and 25(OH)D (p = .04;r =2.12). Women with low 25(OH)D levels were ,2 times more likely to have high SBP (95% CI: 3.23;1.05). To conclude, women with deficient/insufficient 25(OH)D had significantly higher SBP compared to women with a sufficient 25(OH) status

Objective : This study examined whether the association between socio-economic status (SES) and cardiovascular disease (CVD) risk factors in black South Africans from the North West Province had shifted from the more affluent groups with higher SES to the less affluent, lower SES groups over a period of nine years. Method : Cross-sectional baseline data of 2 010 urban and rural subjects (35 years and older) participating in the Prospective Urban and Rural (PURE) study and collected in 2005 were analysed to examine the relationship of level of education, employment and urban or rural residence with dietary intakes and other CVD risk factors. These relationships were compared to those found nine years earlier in the Transition and Health during the Urbanisation of South Africans (THUSA) study conducted in the same area. Results : The results showed that urban women had higher body mass index (BMI), serum triglyceride and fasting glucose levels compared to rural women and that both urban men and women had higher blood pressures and followed a more Westernised diet. However, rural men and women had higher plasma fibrinogen levels. The more highly educated subjects (which included both urban and rural subjects) were younger than those with no or only primary school education. Few of the risk factors differed significantly between education groups, except that more highly educated men and women had lower BMIs, and women had lower blood pressure and triglyceride levels. These women also followed a more prudent diet than those with only primary school education. Employed men and women had higher BMIs, higher energy intakes but lower plasma fibrinogen levels, and employed women had lower triglyceride levels. No significant differences in total serum cholesterol values were observed. Conclusion : These results suggest a drift of CVD risk factors from groups with higher SES to groups with a lower SES from 1996 to 2005, indicating that interventions to prevent CVD should also b

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 B12, 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

This study aimed to investigate consumers' expectations of furniture labels during the pre-purchase information search, in order to propose furniture labels that would serve as a more relevant source of external information during the consumer decision-making process. A mixed-method approach using a two-phase exploratory design was followed. The qualitative phase consisted of semi-structured interviews with experienced sales assistants, while the quantitative phase entailed a questionnaire filled out by consumers during furniture shopping. These results were used to design potential furniture labels during a final phase. Qualitative findings indicated participants' opinions regarding the appearance of and information on specific types of furniture. General information requested to be on furniture labels included price, care instructions, guarantees, warrantees, style and dimensions. Quantitative results showed that the majority of respondents deemed the price, materials used, cleaning instructions, guarantees and warrantees as important information that should appear on furniture labels. This coincided with their pre-purchase search criteria. There was no practically significant difference between consumers' expectations of the information and appearance of different types of furniture labels. Consumers therefore expect all labels to be similar in appearance and to contain general information, apart from product-specific information that would be necessary on different types of furniture, for example leather furniture. Appearance characteristics of furniture labels, such as colour, size and layout, were summarized and potential furniture labels were recommended accordingly. These labels can be used by product developers, marketers and the furniture industry to assist consumers during their pre-purchase information search.

The study was conducted to obtain background information on consumers’ beliefs on Indigenous and Traditional Foods (ITF) and to assess consumers’ acceptance of, preference for and intended consumption of products made with cowpea leaves. Four focus groups investigated consumers’ beliefs on ITF. Thematic analysis identified three major themes in relation to ITF consumption. These were benefits of ITF consumption, barriers of ITF consumption as well as suggestions on how to increase ITF consumption. Consumers’ acceptance of, preference for and intended consumption of products made with cowpea leaves were assessed by 87 respondents. A 5-point hedonic scale and 7-point food action rating scale was used for sensory evaluation. Sample B (Cowpea leaves stewed with tomatoes, potatoes and onions with salt and vegetable oil added) was scored statistically higher for acceptance of general appearance, colour, smell, texture and taste with means ≥4 on a 5-point hedonic scale by respondents of the total study sample. The acceptability, preference and intended consumption of samples differed significantly between the communities, age groups and education levels. Overall, Sample B was the most acceptable, preferred and respondents’ intended to eat it more often than the others except for acceptance by respondents from Tlakgameng.

Studies in populations of European descent show longer plasma clot lysis times (CLT) in patients with cardiovascular disease (CVD) than in controls. No data are available on the association between CVD risk factors and fibrinolytic potential in black Africans, a group undergoing rapid urbanisation with increased CVD prevalence. We investigated associations between known CVD risk factors and CLT in black Africans and whether CLTs differ between rural and urban participants in light of differences in CVD risk. Data from 1000 rural and 1000 urban apparently healthy black South Africans (35–60 years) were cross-sectionally analysed. Increased PAI-1act, BMI, HbA1c, triglycerides, the metabolic syndrome, fibrinogen concentration, CRP, female sex and positive HIV status were associated with increased CLTs, while habitual alcohol consumption associated with decreased CLT. No differences in CLT were found between age and smoking categories, contraceptive use or hyper- and normotensive participants. Urban women had longer CLT than rural women while no differences were observed for men. CLT was associated with many known CVD risk factors in black Africans. Differences were however observed, compared to data from populations of European descent available in the literature, suggesting possible ethnic differences. The effect of urbanisation on CLT is influenced by traditional CVD risk factors and their prevalence in urban and rural communities

Background Although most cardiovascular disease occurs in low-income and middle-income countries, little is known about the use of eff ective secondary prevention medications in these communities. We aimed to assess use of proven eff ective secondary preventive drugs (antiplatelet drugs, β blockers, angiotensin-converting-enzyme [ACE] inhibitors or angiotensin-receptor blockers [ARBs], and statins) in individuals with a history of coronary heart disease or stroke. Methods In the Prospective Urban Rural Epidemiological (PURE) study, we recruited individuals aged 35–70 years from rural and urban communities in countries at various stages of economic development. We assessed rates of previous cardiovascular disease (coronary heart disease or stroke) and use of proven eff ective secondary preventive drugs and blood-pressure-lowering drugs with standardised questionnaires, which were completed by telephone interviews, household visits, or on patient’s presentation to clinics. We report estimates of drug use at national, community, and individual levels. Findings We enrolled 153 996 adults from 628 urban and rural communities in countries with incomes classifi ed as high (three countries), upper-middle (seven), lower-middle (three), or low (four) between January, 2003, and December, 2009. 5650 participants had a self-reported coronary heart disease event (median 5・0 years previously [IQR 2・0–10・0]) and 2292 had stroke (4・0 years previously [2・0–8・0]). Overall, few individuals with cardiovascular disease took antiplatelet drugs (25・3%), β blockers (17・4%), ACE inhibitors or ARBs (19・5%), or statins (14・6%). Use was highest in high-income countries (antiplatelet drugs 62・0%, β blockers 40・0%, ACE inhibitors or ARBs 49・8%, and statins 66・5%), lowest in low-income countries (8・8%, 9・7%, 5・2%, and 3・3%, respectively), and decreased in line with reduction of country economic status (ptrend<0・0001 for every drug type). Fewest patients received no drugs in high-income countries (

The objective of this narrative review is to examine the nutrition transition and its consequences when populations in Africa modernize as a result of socio-economic development, urbanization, and acculturation. The focus is on the changes in dietary patterns and nutrient intakes during the nutrition transition, the determinants and consequences of these changes as well as possible new approaches in public health nutrition policies, interventions and research needed to steer the nutrition transition into a more positive direction in Africa. The review indicates that non-communicable, nutrition-related diseases have emerged in sub-Saharan Africa at a faster rate and at a lower economic level than in industrialized countries, before the battle against under-nutrition has been won. There is a putative epigenetic link between under- and over-nutrition, explaining the double burden of nutrition-related diseases in Africa. It is concluded that it is possible to steer the nutrition transition into a more positive direction, provided that some basic principles in planning public health promotion strategies, policies and interventions are followed. It is suggested that sub-Saharan African countries join forces to study the nutrition transition and implemented interventions on epidemiological, clinical and molecular (genetic) level for better prevention of both under- and over-nutrition.

Objective: To examine the associations between measures of iron status and cardiovascular disease (CVD) risk factors in South African women. Method: In a cross-sectional study, demographic information and health history were obtained during individual interviews using validated questionnaires in the North West Province, South Africa. Anthropometric indices, iron indices, blood pressure, blood glucose and lipid profiles were measured using standard procedures in 1 262 apparently healthy black South African women aged 35 years or older. Iron status was assessed using serum concentrations of ferritin, transferrin receptor (TfR) and TfR:ferritin ratio. Results: Associations between iron status parameters and CVD risk factors were generally weak (r < 0.3, p < 0.01) and were not retained when adjustment was made for age, body mass index, smoking, alcohol consumption and C-reactive protein in the analysis. Waist circumference (WC) and waist:hip ratio (WHR) were higher in the fourth quartile of serum ferritin than in the third quartile, and also in the third quartile compared to the second quartile (P < 0.05). Based on WC and WHR respectively, 31% and 52% of the women had excess abdominal obesity. The mean (95% confidence interval) serum TfR concentration was high, at 9.09 ?g/ml (8.77, 9.44), indicating risk of iron deficiency. The mean (95% confidence interval) concentrations of lipids [total cholesterol 4.78 mmol/l (4.64, 4.93), high-density lipoprotein cholesterol 1.45 mmol/l (1.39, 1.52), low-density lipoprotein cholesterol 1.65 mmol/l (1.53, 1.78), triglyceride 1.12 mmol/l (1.07, 1.18)] were within reference ranges. Conclusion: No significant association was found between iron status parameters and established CVD risk factors. However, excessive abdominal adiposity indicated by high WC and WHR contributes significantly to increased serum ferritin concentration in this population.

This study explored the effect of the Lifeplan® programme on a rural South African community's psychological wellbeing. Participants were adult Individuals (N=99) between 20 and 83 years (mean age = 43 years, SD=13.28). A mixed method sequential explanatory research design was followed with quantitative data obtained through standardised scales, which included the General Psychological Wellbeing Scale (GPWS), Patient Health Questionnaire (PHQ-9), Coping Self-Efficacy Scale (CSE), and Mental Health Continuum - Short Form (MHC-SF). These scales, validated for a Setswana-speaking group, compared the levels of psychological wellbeing between and within an experimental group (n=47) and a control group (n=52), in a pre- and post-evaluation stage. Qualitative data (n=30) was obtained through semi-structured interviews conducted with the experimental group in a post-post evaluation stage. Quantitative findings reflected an increase in general psychological and emotional wellbeing. Small practical significant differences (d=0.19 - 0.40) were found between the experimental and control groups. Qualitative results suggested that participants within the experimental group experienced Lifeplan as educational and contributing towards general wellbeing.

Globally, rural to urban migration is accompanied by changes in dietary patterns and lifestyle that have serious health implications, including development of low bone mass. We hypothesized that serum 25 (OH) vitamin D3 (25[OH]D3) levels will be lower, bone turnover higher, and nutrition inadequate in urban postmenopausal black women, increasing risk for low bone mass. We aimed to assess the prevalence of risk factors for low bone mass in 1261 black women from rural and urban areas in the North West Province of South Africa (Prospective Urban and Rural Epidemiology–South Africa project). Fasting blood samples were taken; and participants were interviewed to complete questionnaires on self-reported diseases, fractures, and dietary intakes. Bone health markers were assessed in a subgroup of 658 women older than 45 years. Specific lifestyle risk factors identified were inactivity, smoking, injectable progestin contraception use, and high alcohol consumption. Dietary risk factors identified were low calcium and high animal protein, phosphorous, and sodium intakes. The 25(OH)D3 and C-terminal telopeptide (CTX) levels were significantly higher in the rural vs the urban women older than 50 years. Parathyroid hormone (PTH) levels increased with age in both groups. The 25(OH)D levels were inversely correlated with CTX and PTH in rural women. In urban women, PTH and CTX were correlated while dietary calcium was inversely correlated with CTX and PTH with 25(OH)D3. The combination of low dietary calcium (<230 mg/d), marginally insufficient 25(OH)D3 status, and raised PTH may result in increased bone resorption. Further research is required to assess bone health and fracture risk in black African women.

In South Africa, malnutrition and poverty often co-exist with urbanization, which is associated with significant dietary change mostly due to neglect of indigenous foods and loss of indigenous knowledge. The article is based on a study that was aimed at assessing the availability, cultivation, consumption and general knowledge about indigenous plant foods in rural and urban communities. A comparative study was conducted in rural and urban populations of the North West Province of South Africa. Data were collected using a questionnaire (n=396 households), key informant interviews (n=4) and four focus groups. The rural area had more plant food available and consumed than the urban area, and fewer species were used as edible food material than expected. Consumers noted a decline in the availability of the species. The main reasons attributed to this decline were insufficient rainfall, poor soil quality, deforestation and over harvesting. Consumption of indigenous foods was influenced by price, culture, seasonality/availability, accessibility and diversity in markets. The elderly were more knowledgeable compared to the younger age groups and knowledge was widely distributed in rural areas. The study revealed that there was no cultivation of indigenous crops in the urban areas. In the rural areas, cultivation of indigenous crops was limited to a number of species and restricted to household consumption.

Objective: To report on the use of different approaches to assess the reproducibility of a culturally sensitive quantified food frequency questionnaire (QFFQ) used for assessment of the habitual dietary intake of Setswana-speaking adults in the North West Province of South Africa. Method: A previously developed and validated QFFQ was completed by trained fieldworkers. Portion sizes were estimated using different methods. Food intake was coded and analysed for nutrient intake per day for each subject. The first interview (n = 1 888) took place during the baseline data collection period. For the second interview (n = 175), a convenient sample from the subjects who had completed the first interview was collected and the interview was conducted within four to six weeks of the first interview. Results: There were good correlations between the first and second QFFQ for all the nutrients (p < 0.0001). The Wilcoxon signed-rank test showed that there were no significant differences in the median intake between the two administrations, except for energy and total fat. The Bland-Altman plots showed good agreement. Between 41% and 58% of the subjects were correctly classified into the same quartile, with less than 3% grossly misclassified. The weighted ? statistics showed moderate agreement between the two applications. Conclusion: Our results show that more than one statistical approach is needed to assess the reproducibility of a QFFQ. The reproducibility of this culturally sensitive QFFQ was good.

The aim of this study was to explore whether coping self-efficacy mediates between various distress related variables on the one hand (symptoms of stress and depression), and the degree of psycho-social well-being as measured on the upper end of the mental health continuum on the other hand. Participants were two multi-cultural student groups (n(1)= 568; n(2)=1480) as well as two community samples of Setswana speaking adults (n(3)=477; n(4)=1275). Students completed the English versions of measures, and the community samples of adults the Setswana versions. Mediation was evaluated through the testing of structural equation models. Coping self-efficacy mediated significantly

The aim of this study was to investigate correlates of fibrinogen concentration in black South Africans, as well as its association with cardiovascular disease (CVD) risk and whether urbanisation influences this association. A total of 1,006 rural and 1,004 urban black South Africans from the PURE study were cross-sectionally analysed. The association of fibrinogen with CVD risk was determined by investigating the association of fibrinogen with other CVD risk markers as well as with predicted CVD risk using the Reynolds Risk score. The rural group had a significantly higher fibrinogen concentration than the urban group, despite higher levels of risk factors and increased predicted CVD risk in the urban group. Increased levels of CVD risk factors were, however, still associated with increased fibrinogen concentration. Fibrinogen correlated significantly, but weakly, with overall predicted CVD risk. This correlation was stronger in the urban than in the rural group. Multiple regression analysis showed that a smaller percentage of the variance in fibrinogen is explained by the traditional CVD risk factors in the rural than in the urban group. In conclusion, fibrinogen is weakly associated with CVD risk (predicted overall risk as well with individual risk factors) in black South Africans, and is related to the degree of urbanisation. Increased fibrinogen concentration, in black South Africans, especially in rural areas, is largely unexplained, and likely not strongly correlated with traditional CVD-related lifestyle and pathophysiological processes. This does, however, not exclude the possibility that once increased, the fibrinogen concentration contributes to future development of CVD.

Objective: Because present recommendations on alcohol intake are based mainly on evidence of beneficial effects in populations of developed countries, this study examines biological effects of alcohol consumption in an African population in transition to assess whether these recommendations are also valid for Africans. Design: A cross-sectional, comparative, population-based study. Setting: Thirty-seven randomly selected sites in the North West province of South Africa, representing both rural and urban areas. Subjects: A total of 1 854 apparently healthy men and women older than 15 years volunteered to participate. Complete data of 1 757 participants were available for analysis. Pregnant and lactating women as well as subjects taking any form of chronic medication, those with oral temperatures above 37 °C and those who were inebriated were excluded. Outcome measures: A validated, quantitative food frequency questionnaire was used to measure dietary intake, including alcoholic beverages, expressed as absolute alcohol in grams per day. Anthropometric measurements and blood pressure were taken in triplicate using standardised equipment and procedures. Fasting blood samples were used to determine biochemical variables related to nutritional status and health. Serum gamma glutamyl transferase was used to examine the reliability of reported alcohol intake. The SPSS package was used to relate alcohol intake to blood pressure and biochemical variables, controlling for age, body mass index and blood glucose. Data from men and women, as well as drinkers and non-drinkers, were analysed separately and compared. Results: In total, 61.5% of the men and 25.2% of the women reported that they consumed alcoholic beverages. The mean alcohol intake of men (30.2 ± 47.8 g/day) exceeded the recommend value of 21 g/day. The women had a mean intake of 11.4 ± 18.8 g/day, falling within the 12 to 15 g/day recommendation. Older drinkers (> 40 years) and those infected with HIV drank more. The

Background: Omega-6 (n–6) polyunsaturated fatty acid (PUFA) intake was previously reported to be adversely related to liver function in HIV-infected subjects, when compared with HIV-uninfected subjects, in a black population in South Africa. It was speculated that the use of heavily oxidized vegetable fats (abused fats) could have been responsible. Objectives: The objectives were to investigate the relation between plasma total PUFA concentrations (a marker of PUFA intake) and liver enzymes in HIV-infected asymptomatic compared with HIVuninfected black South Africans and to investigate the reuse of oil and the use of abused oils. Design: This was a case-control study nested in an epidemiologic study in 305 HIV-infected cases and 301 HIV-uninfected matched controls (matched according to location, sex, and age), as part of the PURE (Prospective Urban and Rural Epidemiology) Study, a prospective cohort study that includes a representative sample of 2000 apparently healthy black volunteers, aged between 36 and 60 y, from the North West Province of South Africa. Results: Plasma total omega-6 PUFA concentrations were negatively (P , 0.05) associated with liver enzymes (c-glutamyl transpeptidase, alanine aminotransferase, aspartate aminotranferase, and alkaline phosphatase) in both HIV-infected and HIV-uninfected subjects (r values ranged from 20.22 to 20.56). Almost all subjects (99%) reported that they did not buy oil that had been used before. Oil was only used a mean (6SD) of 2.23 6 0.85 times for deep frying before being discarded. Conclusions: The adverse relations between omega-6 PUFA intake and liver enzymes that were previously shown could not be confirmed in this study. In contrast, plasma omega-6 PUFA concentration was inversely related to liver enzymes in both HIV-infected and HIV-uninfected subjects. Subjects in this study did not use abused fats, which could partly explain these findings

Health professionals need to have a multi-layered, nuanced understanding of HIV to become aware of the complexity of HIV and how it interacts with all aspects of life, ultimately affecting health and wellbeing. In this article, we critically reflect how we, as Health Sciences lecturers, took on the challenge to integrate HIV education into a multi-disciplinary module presented to second-year health science students. These strategies included: (1) digital recordings on HIV and stigma, (2) HIV as ‘a vehicle’ to understand health-related concepts, and (3) a transdisciplinary health promotion project. We adopted a participatory, engaging pedagogy where students were encouraged to interact through critical discussion to develop critical thinking skills around their own attitudes regarding HIV and the impact on their professional practice. Through critically reflecting on their intersectionality of HIV with many aspects of health and wellbeing, we aimed to deepen students’ understanding of HIV and the effect it has on the lives of their future patients

A continuous assessment and a categorical diagnosis of the presence of mental health, described as flourishing, and the absence of mental health, characterized as languishing, is applied to a random sample of 1050 Setswana-speaking adults in the Northwest province of South Africa. Factor analysis revealed that the mental health continuum–short form (MHC–SF) replicated the three-factor structure of emotional, psychological and social well-being found in US samples. The internal reliability of the overall MHC–SF Scale was 0.74. The total score on the MHC–SF correlated 0.52 with a measure of positive affect, between 0.35 and 0.40 with measures of generalized self-efficacy and satisfaction with life, and between 0.30 and 0.35 with measures of coping strategies, sense of coherence, and community collective self-efficacy. The total score on the MHC–SF correlated −0.22 with the total score on the General Health Questionnaire. Criteria for the categorical diagnosis were applied, and findings revealed that 20% were flourishing, 67.8% were moderately mentally healthy, and 12.2% were languishing. Confirmatory factor analysis supported the hypothesized two-continua model of mental health and mental illness found in the USA. Copyright © 2008 John Wiley & Sons, Ltd.

The role the human immunodeficiency virus (HIV) and antiretroviral treatment on endothelial activation, and the subsequent relationship with cardiovascular disease, is not well understood. We investigated endothelial activation, inflammatory and cardiometabolic profiles, and measures of vascular structure and function of 66 antiretroviral treated (ART), 78 never-treated (no-ART) HIV infected and 165 HIV free Africans. Methods Blood samples were obtained for biochemical analysis and blood pressure, pulse wave velocity (PWV) and carotid intima-media thickness (IMT) measurements were performed. Results The HIV infection duration was at least five years and the treatment 2.86 ± 0.13 years. The intracellular adhesion molecule (ICAM) and vascular cell adhesion molecule (VCAM) levels were elevated in the HIV infected groups compared to the controls. The odds of higher adhesion molecule levels were increased when HIV infected (especially in the no-ART group); OR no-ART vs. no-HIV: ICAM 3.92 (2.2–7.0); VCAM 16.2 (7.5–35). ICAM and VCAM associated with HIV status and interleukin-6 (IL-6) in the total group (all p < 0.01). In both HIV infected groups VCAM associated inversely with CD4 counts (no-ART: β = −0.28, p = 0.01; ART: β = −0.22, p = 0.07) and TC (no-ART: β = −0.36, p < 0.01; ART: β = −0.27, p = 0.03). The ART group had an unfavourable lipid profile compared to the no-ART group. The inflammatory markers (C-reactive protein (CRP) and IL-6), PWV and IMT did not differ between the three groups. Conclusion HIV infected Africans showed endothelial activation when compared to HIV free controls. The endothelial activation was not accompanied by increased inflammation (as measured with CRP and IL-6), arterial stiffness or sub-clinical atherosclerosis.

To examine the association between body composition (fat mass, lean mass and body mass index, BMI) and bone health (bone mineral density, BMD and fracture risk) in urban black South African women.Design:A cross sectional study examining associations between body composition, dietary intake(food frequency questionnaire), habitual physical activity (Activity energy expenditure (AEE) measured using an accelerometer with combined heart rate monitor and physical activity questionnaire) and bone health (BMD using dual–energy X ray absorptiometry, DXA and fracture risk). Setting:Urban community dwellers from Ikageng in the North–West Province of South Africa. Participants: One hundred and eighty nine (189) healthy postmenopausal women aged ?43 years. Results: Fat mass and lean mass were significantly associated with BMD and fracture risk when adjusted for potential confounders. However, lean mass and not fat mass remained significantly associated with femoral neck BMD (? = 0.49, p < 0.0001) and hip BMD (? = 0.59, p< 0.0001). Lean mass was also negatively associated with fracture risk (? = –0.19 p =0.04) when both lean and fat mass were in the same model. Conclusion: Lean mass and fat mass were positively associated with femoral neck, spine and hip BMDs and negatively associated with fracture risk in urban black South African women. Our finding suggests that increasing lean mass rather than fat mass is beneficial to bone health. Our study emphasises the importance of positive lifestyle changes, intake of calcium from dairy and adequate weight to maintain and improve bone health of postmenopausal women.