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Background. Waist circumference (WC) is a useful predictor of cardiometabolic risk in children. Published data on WC percentiles of children from African countries are limited. Objectives. To describe age- and sex-specific WC percentiles in black South African (SA) children from different study sites, and compare these percentiles with median WC percentiles of African-American (AA) children. Methods. Secondary data on WC for 10 - 14-year-old black SA children (N=4 954; 2 406 boys and 2 548 girls) were extracted from the data sets of six studies. Smoothed WC percentile curves for boys and girls were constructed using the LMS method. The 50th percentile for age- and sex-specific WC measurements was compared across study sites and with AA counterparts. Results. Girls had higher WC values than boys from the 50th to 95th percentiles at all ages. The 50th WC percentiles of all groups of SA children combined were lower than those of AA children. When SA groups were considered separately, Western Cape children had median WC values similar to AA children, while rural Limpopo children had the lowest WC values. The 95th percentiles for Western Cape girls exceeded the adult cutoff point for metabolic syndrome (WC =80 cm) from age 11 years. Conclusions. The differences in WC values for 10 - 14-year-old children across the six study sites highlight the need for nationally representative data to develop age-, sex- and ethnic-specific WC percentiles for black SA children. The results raise concerns about high WC among Western Cape girls. [ABSTRACT FROM AUTHOR]

The aim of this paper is to review the latest total fat intake data for South Africa, as well as scientific evidence on the effect of the total amount and quality or type of fat in the diet. The total fat intake of South Africans is within the goal of ≤ 30% of total energy, but the quality or type of fat in the diet requires attention. Fats are key nutrients required for early growth and development, and influence the body’s response to nutrition-related noncommunicable diseases later in life. Based on the total fat intake data for South Africa, and the latest evidence on the unique properties of certain fatty acids for health and disease, revision of the previous food-based dietary guideline (FBDG), “Eat fat sparingly”, was needed. “Use fats sparingly: choose vegetable oils, rather than hard fats” is the new FBDG formulated for the fat intake of South Africans. Replacing animal and plant sources of saturated fatty acids with polyunsaturated fatty acids (PUFAs) and monounsaturated fatty acids is recommended. The regular intake of oily fish to increase omega-3 long-chain PUFAs is important. Energy balance remains an important aspect, in addition to the composition of the diet. The FBDG “Use fats sparingly: choose vegetable oils rather than hard fats” is meant to convey a positive message, to ensure that the right types of fats and oils are eaten and used in food preparation for early development and long-term health. An alternative FBDG is: “Eat and use the right type of fats and oils in moderation”. [ABSTRACT FROM AUTHOR]

Objectives: Factors associated with children's anthropometric status were determined. Design: Secondary analysis was done using data from a cross-sectional survey including children under five years of age (n = 2 485) and their mothers in rural districts of the Eastern Cape and KwaZulu-Natal provinces, South Africa. Methods: Data generated by questionnaire and anthropometric indices were used to construct a logistic regression model, taking into account hierarchical relationships of risk factors to determine the odds of a child being stunted, underweight or overweight. Statistical significance was set at p < 0.05. Results: Factors associated with stunting were child of male gender (odds ratio (OR) = 1.233), the mother's perception that child was not growing well (OR = 1.346), household receiving no food handouts (OR = 0.719) and mother not making important household decisions (OR = 0.760). Underweight was associated with child of male gender (OR = 1.432), low maternal education (OR = 1.720), mother's perception that child was not growing well (OR = 2.526), any current breastfeeding (children < 24 months: OR = 2.022), and prior gastrointestinal symptoms (OR = 1.527). Factors associated with child overweight were the household not having a regular source of income (OR = 1.473), low maternal education (OR = 0.595) and mother's perception that child is not growing well (OR = 0.361). Conclusion: Boys were more likely to be stunted and/or underweight. Children of mothers with less than five years schooling were more likely to be underweight. A regular source of household income was associated with child overweight/obesity. [ABSTRACT FROM AUTHOR]

Objective: This study determined the socio-demographic, nutritional and health status of children and their caregivers in two rural districts in KwaZulu-Natal (KZN) and one rural district in the Eastern Cape (EC), South Africa. Design: A cross-sectional survey was conducted. Setting: The study population resided in Umkhanyakude (sub-district Jozini) and Zululand (sub-district Pongola) in KZN, and in OR Tambo (sub-district Nyandeni) in the EC province. Subjects: Children 0 to 59 months old (Umkhanyakude n = 398; Zululand n = 303; OR Tambo n = 364) and their caregivers were included. Methods: Structured interviewer-administered questionnaires were conducted and height and weight were measured. Results: Households in OR Tambo had less access to services (tap water 3%, toilets 33%), compared to Umkhanyakude (tap water 50%, toilets 82%) and Zululand (tap water 74%, toilets 98%). Wood was the main energy source used to cook food in all three districts (> 75%). Grants were a main source of income (Umkhanyakude and Zululand 61%; OR Tambo 55%). Many households obtained vegetables from their own garden (Umkhanyakude and Zululand 30%; OR Tambo 70%). The households that reportedly had enough food available at all times (Umkhanyakude and Zululand 25%; OR Tambo 17%), were in the minority. The diarrhoea prevalence reported by the caregivers was high (Umkhanyakude 35%; Zululand 24%; OR Tambo 24%). The prevalence of stunting was higher for children older than 12 months and varied between 22 and 26%. The prevalence of overweight among children 0 to 23 months exceeded the prevalence of underweight. The prevalence of overweight and obesity among caregivers was high (Umkhanyakude 42%; Zululand 60%; OR Tambo 56%). Conclusion: Concerted efforts are needed to address the adverse social, nutrition and health conditions in these districts. [ABSTRACT FROM AUTHOR]

Objective: To assess primary health care (PHC) facility infrastructure and services, and the nutritional status of 0 to 71-month-old children and their caregivers attending PHC facilities in the Eastern Cape (EC) and KwaZulu-Natal (KZN) provinces in South Africa. Design: Cross-sectional survey. Setting: Rural districts in the EC (OR Tambo and Alfred Nzo) and KZN (Umkhanyakude and Zululand). Subjects: PHC facilities and nurses (EC: n = 20; KZN: n = 20), and 0 to 71-month-old children and their caregivers (EC: n = 994; KZN: n = 992). Methods: Structured interviewer-administered questionnaires and anthropometric survey. Results: Of the 40 PHC facilities, 14 had been built or renovated after 1994. The PHC facilities had access to the following: safe drinking water (EC: 20%; KZN: 25%); electricity (EC: 45%; KZN: 85%); flush toilets (EC: 40%; KZN: 75%); and operational telephones (EC: 20%; KZN: 5%). According to more than 80% of the nurses, problems with basic resources and existing cultural practices influenced the quality of services. Home births were common (EC: 41%; KZN: 25%). Social grants were reported as a main source of income (EC: 33%; KZN: 28%). Few households reported that they had enough food at all times (EC: 15%; KZN: 7%). The reported prevalence of diarrhoea was high (EC: 34%; KZN: 38%). Undernutrition in 0 to younger than 6 month-olds was low; thereafter, however, stunting in children aged 6 to 59 months (EC: 22%; KZN: 24%) and 60 to 71 months (EC: 26%; KZN: 31%) was medium to high. Overweight and obese adults (EC: 49%; KZN: 42%) coexisted. Conclusion: Problems regarding infrastructure, basic resources and services adversely affected PHC service delivery and the well-being of rural people, and therefore need urgent attention. [ABSTRACT FROM AUTHOR]

Background: The Health Systems Trust implemented a community-based growth monitoring intervention project that fits into the Integrated Nutrition Programme focus areas and commissioned an evaluation of this project. Objective: To assess project volunteers' knowledge on infant and young child nutrition and growth monitoring, and evaluate community-based growth monitoring activities. Design: Five randomly selected growth monitoring sites per sub-district were evaluated. Project volunteers (n = 45) and caregivers (n = 186) attending the growth monitoring sites were interviewed by means of a questionnaire. Growth monitoring and nutrition education activities were observed at the growth monitoring sites. Setting: Two rural districts in KwaZulu-Natal (Umkhanyakude: sub-district Jozini; and Zululand: sub-district Phongola), and one rural district in the Eastern Cape (OR Tambo), South Africa. Results: Project volunteers were mostly women (87%), 38 ± 10 years old, and 27% had matric/Grade 12. There was a high turnover of project volunteers. Their nutrition knowledge varied. Forty-six per cent of the project volunteers and 39% of the caregivers could correctly identify the growth curve of a healthy growing child. Seven of the 13 sites that were visited were at a crèche. There was a referral system between the growth monitoring site and the local clinic, and links with the Department of Agriculture and, to a lesser extent, the Department of Social Welfare. Weighing methods were inconsistent and the steps of growth monitoring were not followed through. Nutrition education to the caregivers was lacking at several of the sites. Conclusion: The study highlighted both strengths and limitations of the project. Areas that need improvement include the selection, training and supervision of project volunteers performing community-based growth monitoring. [ABSTRACT FROM AUTHOR]

Background Reports on fatty acids levels in multiple sclerosis remain inconclusive. Objective To determine the erythrocyte membrane fatty acid levels in multiple sclerosis patients and correlate with Kurtzke Expanded Disability Status Scale. Methods Fatty acid composition of 31 multiple sclerosis and 30 control individuals were measured by gas chromatography. Results The membrane phosphatidylcholine C20:4n - 6 concentration was lower in the multiple sclerosis patients when compared to that of the control group, P = 0.04 and it correlated inversely with the EDSS and FSS. Conclusion Decrease in C20:4n - 6 in the erythrocyte membrane could be an indication of depleted plasma stores, and a reflection of disease severity. [ABSTRACT FROM AUTHOR]

Alterations in the membrane structure and function of hepatocyte membranes by fumonisin B1 (FB1) have been proposed to play an important role in the disruption of growth regulatory effects and hence in the cancer-promoting ability of the mycotoxin. Detailed analyses of lipids in liver microsomal fractions of rats exposed to different dietary levels of FB1 over a period of 21 d indicated an increase in PC, PE, PI, and cholesterol (Chol). These changes decreased the PC/PE and increased the total phospholipid/Chol ratios. When considering FA content, the quantities of total FA increased ( P<0.05) in the major phospholipid fractions as a result of the increased phospholipid levels. However, when considering the relative levels (mg/100 mg of the total FA) of specific FA, the monounsaturated FA (16∶1n−7 and 18∶1n−9) and 18∶2n−6 increased ( P<0.05), whereas the long-chain PUFA decreased ( P<0.05) in the main phospholipid fractions. Enzyme analyses indicated that the activity of the Δ6-desaturase was significantly reduced in liver microsomal preparations in a dose-dependent manner. An increase in the 20∶3n−6/20∶4n−6 ratio also suggested a decrease in the activity of the Δ5-desaturase. Disruption of microsomal lipid metabolism at different levels by FB1 could play an important role in the alteration of growth regulatory effects in the liver. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of the oral administration of evening primrose oil on the radiation response and the blood flow of normal tissue and a tumour in BALB/c mice. Methods and materials: Aliquots of evening primrose oil were fed to BALB/c mice daily and the radiation response of the skin was assessed by the determination of ED[sub 50] values for the incidence of moist desquamation, using probit analysis. Tumour radiosensitivity was investigated by determining the growth delay caused by irradiation of a transplantable rhabdomyosarcoma. The [sup 86]RbCl uptake technique was used to determine the blood flow in normal foot and tumour tissue. The fatty-acid content of red blood cells, plasma and tumour tissue was measured using gas chromatography. Results: Daily evening primrose oil dietary supplementation reduced the sensitivity of skin to radiation-induced moist desquamation and prevented the radiation-associated increase in blood flow that was observed in this tissue. No modification of tumour blood flow or of tumour sensitivity to radiation resulted from evening primrose oil supplementation of mice. Evening primrose oil supplementation resulted in changes in plasma levels of linoleic acid (LA), gamma-linolenic acid (GLA), dihomo-gamma-linolenic acid (DGLA) and arachidonic acid (AA). These changes were contingent on whether the mice had been irradiated or not. In red blood cells evening primrose oil supplementation increased the GLA level of unirradiated mice and the LA level at 20 days after irradiation. There were no changes in tumour fatty-acid levels as a result of evening primrose oil treatment. Conclusions: Daily evening primrose oil supplementation reduced the sensitivity of skin to radiation-induced moist desquamation but did not alter tumour sensitivity to radiation. [ABSTRACT FROM AUTHOR]

The adequacy of food intake of primary school children living in a low socioeconomic rural area, +/- 60 km northwest of Durban, KwaZulu-Natal, South Africa was assessed in a cross-sectional study. Primary school children, 10 and 11 years old and in grades 5, 6 and 7, and their mothers/caretakers were interviewed. Dietary intake was assessed by a 24-h recall and an unquantified food frequency questionnaire. Local food production was assessed by questionnaire. The diet consumed by the children comprised a limited number of food items. Fruit and vegetable consumption was low, resulting in a poor intake of micronutrients. Despite the local production of some vitamin A rich food crops, the quantity grown and eaten was low. The long-term solutions for combatting micronutrient deficiencies in this rural area include targeted local food production accompanied by a nutrition education programme, to be initiated and monitored by a multi-sectoral team of agriculturists and health scientists. [ABSTRACT FROM AUTHOR]

Objective: To examine the effects of lecithin on serum lipoprotein, plasma fibrinogen and macro molecular protein complex (MPC) levels.Subjects and Study Design: Twenty free living hyperlipidaemic men participated in this double-blind study which controlled for possible indirect effects. The subjects were randomly assigned to one of three treatments: frozen yoghurt or frozen yoghurt with 20 g soya bean lecithin or frozen yoghurt with 17 g sunflower oil. Sunflower oil was used to control for the increased energy and linoleic acid intake from lecithin. Yoghurt served as the 'vehicle' for the lecithin and sunflower oil and yoghurt alone was given to one group to control for possible effects due to the yoghurt 'vehicle', as well as other environmental influences. Variables were measured with standard methods twice at baseline and after 2 and 4 weeks of treatment.Results: Plasma linoleic acid levels increased significantly with lecithin and sunflower oil treatments indicating that compliance to the treatments were obtained. Lecithin treatment did not have significant effects on serum total cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, apolipoprotein A, apolipoprotein B or lipoprotein (a) levels. Plasma fibrinogen and MPC levels were also not affected by lecithin therapy. Sunflower oil treatment resulted in significant increased body weight, serum TC and decreased MPC levels.Conclusion: Lecithin treatment had no independent effects on serum lipoprotein, plasma fibrinogen or MPC levels in hyperlipidaemic men. [ABSTRACT FROM AUTHOR]

Objectives: To determine the nutritional status of 0- to 71-month-old children and their caregivers, as well as their socio-demographics, in two provinces in South Africa. Design: Cross-sectional baseline survey. Setting: OR Tambo and Alfred Nzo districts in the Eastern Cape (EC), and Umkhanyakude and Zululand (Nongoma and Pongola subdistricts) in KwaZulu-Natal (KZN), South Africa. Subjects: 0- to 71-month-old children and their caregivers (EC 1 794; KZN 1 988). Methods: Questionnaire and anthropometric survey. Results: The prevalence of childhood malnutrition doubled from the first to second year of life and reached high levels in the EC and Nongoma (KZN). Many caregivers were either overweight or obese (EC 55%; KZN 45%). Initiation of breast-feeding was universal. For infants younger than six months, more than 80% were breast-feeding, and 50% received bottle feeds in addition to breast milk in the EC. Breast-feeding was similar in the two provinces up to the age of 18 months, but differed for 18- to 24-month-old children (EC 50%; KZN 33%). Animal products and yellow/orange-fleshed vegetables were not consumed regularly by children aged two to five years. Immunisation coverage up until 10 weeks was approximately 90%; measles immunisation coverage at 18 months was 40 to 43%. Toilet facilities (31 to 96%), tap water (9 to 38%), electricity (8 to 51%), single mothers (29 to 68%) and unemployed husbands (19 to 55%) varied among provinces. Many households relied on grants for income. In Umkhanyakude, 37% of the caregivers had no formal education. Conclusions: Childhood malnutrition and maternal overweight/obesity co-existed. A large proportion of the study population did not have access to basic services. Differences were observed within and between provinces. Nutrition programmes should be flexible, taking into consideration local conditions. [ABSTRACT FROM AUTHOR]

A group of 102 preschool children aged 13-69 months from a rural area of Lebowa were selected from a cross-sectional study of 659 children for an intervention trial (12 months) to study the effect of catfish (Clarias gariepinus) supplementation on their plasma phospholipid fatty acid status and growth. They were classified into undernourished and control groups according to their weight-for-age. The undernourished children (n = 52) received 43 g fish and 7.5 g sunflower cooking oil per day, whereas a matched (age and sex) well-nourished control group (n = 50) was not supplemented. At baseline, after 6 months and after 12 months of the study, anthropometry, haematology, blood biochemistry and plasma phospholipid fatty acid analyses were done. In the undernourished group, high baseline oleic acid (18:1 9) levels in plasma phosphatidylcholine (PC) were replaced by docosahexaenoic acid (22:6 3) with supplementation. In plasma PC, this reduction in 18:1 9 and increase in 22:6 3 was associated with significant increases in weight-for-age Z-scores, P = 0.0378 and P = 0.0415, respectively. The fish supplement and cooking oil that supplied additional 7% energy (7% E) and nutrients promoted growth of undernourished children, although this was inadequate for sustained growth during the second 6 months of intervention. [ABSTRACT FROM AUTHOR]

Background: Sepsis is characterised by multi-organ failure due to an uncontrolled immune response to infection. Sepsis prevalence is increased in developing countries and requires prompt diagnosis and treatment. Reports, although controversial, suggest that full blood count parameters and cell ratios could assist in the early screening for sepsis., Objective: The study evaluated the use of haematological cell ratios in screening for sepsis in a South African population., Methods: The study retrospectively analysed the complete blood counts, blood cultures (BC) and biochemical test results of 125 adult patients who presented between January 2021 and July 2021 at a hospital in Cape Town. An ISO15189-accredited laboratory performed all of the tests. We compared and correlated the automated differential counts, neutrophil, monocyte and platelet-to-lymphocyte ratios with procalcitonin levels. A p -value of < 0.05 was considered significant., Results: Sixty-two sepsis patients (procalcitonin > 2 ng/L and positive BC) were identified and compared to 63 non-sepsis controls. All cell ratios were significantly elevated in sepsis patients ( p < 0.001). However, the two groups had no significant difference in absolute monocyte counts ( p = 0.377). In addition, no correlation was detected between any cell ratios and procalcitonin., Conclusion: In combination with complete blood count parameters, haematology cell ratios can be used for early sepsis detection. The full blood count is widely available, inexpensive, and routinely requested by emergency care clinicians. Although procalcitonin and BC remain the gold standard, the calculation of cell ratios could provide a simple screening tool for the early detection of sepsis., What This Study Adds: This study adds evidence to the proposal that calculating haematological cell ratios assists in the early screening of sepsis in a South African setting., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2023. The Authors.)

Introduction: South Africa's evolving burden of disease is challenging due to a persistent infectious disease, burgeoning obesity, most notably among women and rising rates of non-communicable diseases (NCDs). With two thirds of women presenting at their first antenatal visit either overweight or obese in urban South Africa (SA), the preconception period is an opportunity to optimise health and offset transgenerational risk of both obesity and NCDs., Methods and Analysis: Bukhali is the first individual randomised controlled trial in Africa to test the efficacy of a complex continuum of care intervention and forms part of the Healthy Life Trajectories Initiative (HeLTI) consortium implementing harmonised trials in Canada, China, India and SA. Starting preconception and continuing through pregnancy, infancy and childhood, the intervention is designed to improve nutrition, physical and mental health and health behaviours of South African women to offset obesity-risk (adiposity) in their offspring. Women aged 18-28 years (n=6800) will be recruited from Soweto, an urban-poor area of Johannesburg. The primary outcome is dual-energy X-ray absorptiometry derived fat mass index (fat mass divided by height 2 ) in the offspring at age 5 years. Community health workers will deliver the intervention randomly to half the cohort by providing health literacy material, dispensing a multimicronutrient supplement, providing health services and feedback, and facilitating behaviour change support sessions to optimise: (1) nutrition, (2) physical and mental health and (3) lay the foundations for healthier pregnancies and early child development., Ethics and Dissemination: Ethical approval has been obtained from the Human Ethics Research Committee University of the Witwatersrand, Johannesburg, South Africa (M1811111), the University of Toronto, Canada (19-0066-E) and the WHO Ethics Committee (ERC.0003328). Data and biological sample sharing policies are consistent with the governance policy of the HeLTI Consortium (https://helti.org) and South African government legislation (POPIA). The recruitment and research team will obtain informed consent., Trial Registration: This trial is registered with the Pan African Clinical Trials Registry (https://pactr.samrc.ac.za) on 25 March 2019 (identifier: PACTR201903750173871)., Protocol Version: 20 March 2022 (version #4). Any protocol amendments will be communicated to investigators, Institutional Review Board (IRB)s, trial participants and trial registries., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Background: Information regarding circulating fatty acids (FA) in association with metabolic health in black Africans is scarce, while the usefulness of circulating FAs as biomarkers of dietary fat intake and predictors for medical conditions is increasing., Objective: We compared eleven dietary and the levels of 26 plasma phospholipid FAs in metabolically healthy and unhealthy phenotypes in black South African adults., Methods: Adults from the South African arm of the Prospective Urban and Rural Epidemiology study baseline (n = 711) were categorised into four groups, namely normal weight without metabolic syndrome (MetS) (MHNW), normal weight with MetS (MUNW), metabolically healthy overweight/obese (MHO) and metabolically unhealthy overweight/obese (MUO). Dietary and plasma phospholipid FAs were measured by a quantitative food frequency questionnaire and gas chromatography-tandem mass spectrometry, respectively. We compared dietary FAs, plasma phospholipid FAs, and estimated desaturase activity between the metabolic status groups using ANCOVA adjusted for age and energy intake., Results: MetS was diagnosed in 35% of the participants. After adjustment for age and total energy intake, in comparison to the MHNW reference group, saturated dietary FAs (C14:0 to C18:0) and alpha-linolenic acid intakes were higher in both overweight/obese groups (MHO and MUO), while linoleic acid intakes were higher in the MUO group only. Plasma levels of most saturated FAs (C18:0 to C22:0) and PUFAs were higher, whereas selected MUFAs, palmitic acid, and estimated desaturase activities were lower in the overweight/obese groups., Conclusions: The overweight groups generally had higher fat intakes than normal-weight groups, but lower plasma levels of palmitic, palmitoleic, oleic, cis-vaccenic and estimated desaturase activities. Therefore, in this population, lower plasma levels of palmitic, palmitoleic, oleic, and cis-vaccenic acids and decreased estimated desaturase activities may be biomarkers of abnormal metabolic health in overweight/obese study participants., Competing Interests: Declaration of Competing Interest Authors declare no competing interests., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Evidence regarding the relationship of plasma clot properties with fatty acids is contradictory, owing to different experimental protocols employed. The relationship of fibrinogen and plasma fibrin clot properties with plasma phospholipid fatty acids were cross-sectionally investigated in a population-based setting in 900 individuals. Composite saturated fatty acids (driven by stearic acid) and composite n-3 and n-6 polyunsaturated fatty acids (driven by docosahexaenoic and arachidonic acid respectively) were associated with prothrombotic clot properties. Composite monounsaturated fatty acids (driven by oleic acid) were associated with a profibrinolytic clot phenotype. Fibrinogen and BMI partly mediated these relationships. Individual plasma fatty acids from the same composite group had opposing associations with clot properties indicating that associations with composite fatty acid groups is dependent on the relative composition of the comprising fatty acids. The relationship of the plasma phospholipid fatty acid profile with disease should not be interpreted without considering the role of regulatory mechanisms., (Copyright © 2019 Elsevier Ltd. All rights reserved.)