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The burden of malnutrition experienced globally, coupled with the increasing rate of micronutrient deficiencies, compromises the health and well-being of women during their reproductive years. Obesity places young South African women at particular risk during pregnancy, and increases obesity risk for their offspring. To address these risks, the Bukhali trial is being implemented in Soweto, South Africa with 18–28-year-old women, as part of the Healthy Lifestyle Trajectory Initiative. A dietitian is part of the Bukhali intervention team (community health workers) to provide nutritional support for overweight/obese trial participants, making use of the International Federation of Gynaecology and Obstetrics (FIGO) Nutrition Checklist. This paper reflects on the experiences and lessons learned by the Bukhali dietitian, including the use of the FIGO Nutrition Checklist and Healthy Conversation Skills to facilitate conversations about making healthy dietary behaviour changes. Identified challenges that influence nutrition and behaviour are discussed, including lack of food affordability, cultural and social influences on healthy food choices, unsupportive environments and food insecurity. Strategies to optimise this nutritional support are also mentioned. The Bukhali trial is showing that introducing additional nutrition support by a dietitian for at-risk participants has the potential to encourage young women to prioritise nutrition and health, even in the midst of contextual challenges to both nutrition and health. [ABSTRACT FROM AUTHOR]

Complementary medicines (CMs) that are formulated to facilitate weight loss are a popular and widely available treatment option, particularly among women. There is limited research regarding their use in the South African context. The aim of this study was to gather information on the use and perceived effectiveness of CMs for weight loss among adult women. A quantitative, descriptive survey design was used. Johannesburg, South Africa. A purposive sample of women over the age of 18 years who had used CMs for weight loss within the past five years were recruited from health stores and a university campus healthcare centre. Data were obtained through a self-administered 29-item, paper-and-pen questionnaire. Responses were descriptively analysed using cross-tabulation, multiple response analysis and frequency tables. Data from 160 questionnaires were analysed and the results demonstrated that a wide variety of CM products are used for weight loss, with branded combination products, green tea, Garcinia cambogia and conjugated linoleic acid being the most popular. Most participants also adopted lifestyle interventions such as exercise and calorie restriction during their weight loss attempt. While minor side effects were experienced by over half of the participants, the majority were satisfied with their product choice as well as the amount of weight that they lost. Most participants perceived their CM weight loss product of choice to be effective. However, other concomitant weight-loss strategies that were employed may have been responsible for these results. Despite their popularity, there is only very limited research surrounding the safety and efficacy of these weight-loss products, with most studies being conducted on single constituents rather than whole formulations as sold on the market. Healthcare providers should encourage the disclosure of the use of CM weight-loss products to ensure safe and effective patient care and mitigate the potential risks associated with their inappropriate use. [ABSTRACT FROM AUTHOR]

Food-based dietary guidelines (FBDGs) are not a new concept and are being used in many countries to promote healthy eating and the prevention of diet-related chronic diseases. The Food and Agriculture Organization (FAO) recommended FBDGs as an approach to prevent malnutrition and promote healthy dietary behaviours in populations, taking into consideration local conditions, traditional dietary practices and socioeconomic and cultural factors whilst at the same time using evidence-based scientific principles. South Africa (SA) currently has two sets of guidelines, namely the paediatric food-based dietary guidelines and the South African FBDGs for the population aged seven years and older. The recognition that elderly malnutrition remains a major public health concern in SA led to the formulation of a specific set of guidelines for this vulnerable population group based on existing nutrition-related health issues, local dietary habits and barriers to food intake experienced by those aged 60 and above. This introductory paper on the development of the elderly food-based dietary guidelines (EFBDGs) will be followed by six technical papers motivating why these guidelines are suited to address nutrition-related issues among the elderly in SA. [ABSTRACT FROM AUTHOR]

Background: The Asenze study has the long-term goal of promoting better physical, cognitive and psychosocial functioning of children in a rural area in KwaZulu-Natal, 50 km from Durban, with a view to planning interventions to promote growth and development for very young children. The specific objective in this paper was to provide information for the Child Health and Development project of the Valley Trust to assist with intervention planning. The broader goal was to assess developmental delays in communities ravaged by the HIV epidemic. The Asenze study was designed in two phases from 2008 and 2012. The current paper reports on 1 581 4–6-year-old children in the baseline phase (2008–2010) in the five adjacent tribal areas in the study area. Method: The participants included all the 4–6-year-olds whose parents had consented to inclusion in the project and their caregivers. Data were derived from a brief questionnaire administered in the homes of participants, and subsequently from medical and psychological assessments of the children and their caregivers at the Asenze clinic. The association between child factors and other factors (geographic area, socioeconomic status (SES), parental level of education, the child's preschool education) on the one hand, and the child's cognitive performance (as measured by the Grover Counter and subtests of the KABC-11) were analysed. Linear regression models were employed to determine which predictor variables of interest in a model were associated with the children's cognitive scores as the dependent variables. Results: Based on the data, the principal factors associated with children's cognitive outcomes were height-for-age z-score (HAZ), preschool education and the area of residence. Generally children who had low cognitive scores were more often stunted (as defined by the WHO anthropometric tables), had not had preschool education, and came from areas less favourable in terms of local infrastructure and access to employment opportunities and arable land. Conclusion: The finding from this cross-sectional analysis of baseline data showed that in addition to height for age and preschool education, which are commonly thought to impact on cognition, the local authority area where the children lived was associated with their scores on cognitive tests. This has implications for intervention planning. The functioning of local government in promoting the type of community development that will protect the rights of children should be taken into account. [ABSTRACT FROM AUTHOR]

Introduction: Infant health and nutrition in South Africa are a priority, as evidenced by the political commitment and policy development history of the last 25 years. Current efforts focus on improving breastfeeding rates, but the action plan for complementary feeding receives less attention and resourcing. A thorough analysis of the current infant feeding situation is required to assist with policy and targeted programmes associated with complementary feeding. Aim: The aim of this review was to identify and collate all published research in South Africa on the complementary feeding practices of infants and young children, aged 0–24 months. Methodology: Searches included English-language research published between 2006 and 2017, within PubMed, Scopus, Web of Science and Google Scholar. All papers included in the review had to meet defined eligibility criteria. Papers older than 11 years were excluded. In total 34 papers relevant to South Africa were identified and included in this review. Main findings: Early introduction of foods and liquids other than breast milk is a common practice. Maize porridge is a common first food for infants, but there is also a high reliance on commercial infant cereal. Water and other liquids (e.g. tea, herbal mixtures) are commonly given to infants younger than six months. There is little information on the number of meals per day. The diets of many older infants do not meet the criteria for a minimally acceptable diet. Few animal source foods are used in complementary feeding. There are indications that processed meats, soft drinks, sweets and salty crisps are given regularly to older infants between six months and one year. Conclusion: Complementary feeding practices in South Africa are suboptimal and appropriate action is needed to improve this situation. Further investigation is needed on whether older infants and young children can achieve their required dietary intakes from the food that is available to them. If a change in older infant and young child feeding behaviour is desired, then existing methods and approaches need to change. [ABSTRACT FROM AUTHOR]

Background: This paper provides an overview of a series of studies undertaken to assess the appropriateness and understanding of the revised, draft South African Paediatric Food-Based Dietary Guidelines (SA-PFBDGs) amongst mothers/caregivers of children aged 0–5 years. Previous exposure to guidelines with similar messages, barriers and enablers to following the guidelines were also assessed. Design: Qualitative methods were used to collect data from 38 focus-group discussions (isiXhosa = 11, Afrikaans = 11, English = 10 and siSwati = 6) resulting in 268 participants. Setting: Breede Valley sub-district (Worcester), Stellenbosch Municipality (Stellenbosch, Pniel and Franschhoek) and Northern Metropole (Atlantis, Witsand, Du Noon and Blouberg), City of Cape Town, Western Cape province, as well as Ehlanzeni District (Kabokweni) in Mpumalanga province. Subjects: Mothers/caregivers older than 18 years who provided informed consent to participate. Results: The majority of participants had previous exposure to guidelines with similar messages to the SA-PFBDGs. Information sources included nurses, local clinics, family, friends and media. Possible barriers to following the guidelines included limited physical and financial access to resources; cultural/family practices, poor social support and time constraints. Outdated information, misconceptions, inconsistent messages and contrasting beliefs were evident. The vocabulary of some messages was not well understood. Education on infant and young child feeding and visual portrayal of the guidelines could aid understanding. Conclusion: A degree of rewording should be considered for improved understanding of the revised, draft SA-PFBDGs. Once adopted, the guidelines can be used to educate various stakeholders, including parents, caregivers, healthcare providers and educators, on the correct nutritional advice for children aged 0–5 years ensuring the healthy growth and development of young children in South Africa. [ABSTRACT FROM AUTHOR]

Studies have shown that the elderly are at a higher risk of developing malnutrition due to physiological and pathological changes. Several studies have confirmed that older South Africans have insufficient dietary diversity, resulting in nutritional deficiencies. Furthermore, poor and uninformed dietary choices are associated with the development of several diseases and increased mortality. Following the Elderly Food Based Dietary Guidelines (EFBDGs) related to promoting elderly health could ensure that the elderly have an adequate intake of nutritious foods. This paper provides an overview of six FBDGs relating to promoting health and is based on the South African Food Based Dietary Guidelines. [ABSTRACT FROM AUTHOR]

Dietary patterns among South African older adults indicate a moderate intake of total fat and salt, as well as a high sugar intake. Total fat, saturated fat, sugar and salt intakes are associated with non-communicable diseases (NCDs) and mortality. Processed and ultra-processed foods are common in elderly households and contain high levels of fat, sugar and salt and are associated with frailty. This paper aims to review the available scientific evidence on the effect on health status of dietary sugar, fat and salt consumption among the elderly. This information will be used to confirm the need for dietary sugar, fat and salt food-based dietary guidelines for the elderly South African population. [ABSTRACT FROM AUTHOR]

The goal of this paper is to support the 'Be active!' food-based dietary guideline (FBDG) for South Africans of seven years and older by means of a technical guideline regarding physical activity (PA) specifically for the elderly. Optimal nutrition and physical activity (PA) are essential to ensure healthy ageing. PA is an integral part of a healthy lifestyle; however; the rate of low PA in the elderly (59.7%) is high in South Africa (SA). Regular PA reduces the risks of chronic diseases, such as diabetes, high blood pressure, heart diseases and cancers. Therefore, this review study aims to gather available information concerning PA and suitable methods to promote PA among the elderly in SA. Lack of environmental support for PA, trainers, PA-educated caregivers, poor knowledge about the recommended level of PA and its benefits, lack of motivation by healthcare providers, poor health and nutritional status, and lack of opportunity for social engagement prevent the elderly from participating in PA. Elderly individuals without any physical challenges should participate in at least 150 minutes of moderate-intensity aerobic PA in a week, or at least 75 minutes per week of vigorous-intensity aerobic PA or an equivalent combination of both types of aerobic PA. It is better to start PA slowly and increase the duration and frequency gradually. Even those who have some disease limitations should try to change their status from 'inactive or no activity' to 'some level of activity' to enjoy the health benefits of PA. More research and programmes focusing on promotion of PA need to be implemented in order to improve PA among the elderly in SA. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to assess the iodine status of pregnant women and children age 6 to 12 years feeding from the same food basket in Mopani District. Design: A cross-sectional study was conducted. Setting: The setting was primary health care clinics and households from five municipalities of Mopani District in Limpopo province. Subjects: A total of 565 conveniently selected pregnant women and 116 children aged 6 to 12 years were recruited, of which 116 were mother–child pairs. Methods: The demographic information, iodine nutrition knowledge and salt consumption patterns were obtained using a validated questionnaire. Spot urine, household drinking water and salt samples were collected and analysed for iodine using standard procedures. A professional nurse, using filter paper to determine thyroid stimulating hormone (TSH) levels, collected spot finger-stick blood samples from pregnant women. Results: The findings showed that only 52.5% of household salt had an iodine concentration level of more than and equal to 15 ppm. The median iodine concentration of household drinking water was 46.2 μg/l (interquartile range [IQR] 10.8–73.4 μg/l). The TSH levels of the majority of pregnant women were normal and the maternal overall median urinary iodine concentration (UIC) was 164 μg/l (IQR 92–291 μg/l), indicating maternal iodine sufficiency. However, median UIC in the first and third trimesters was below 150 μg/l, indicating iodine insufficiency. The UIC level of children in the study was 386 μg/l (IQR 200–525 μg/l), signifying iodine excess. Conclusion: Iodine status of pregnant women in this study was sufficient, with UIC for children excessively high, more than two times higher than the iodine status of pregnant women. The reasons for the excessive UIC in school-age children need to be elucidated. [ABSTRACT FROM AUTHOR]

Objectives: The nutrition of construction workers is related to their health and safety (H&S) at work. Research on the factors influencing construction workers' food choices and overall nutrition is limited, in South Africa and indeed Africa as a whole. The present paper aims to develop and validate a questionnaire on factors influencing construction workers' food choices. Design: The study adopted a quantitative approach; 42 items, divided into six constructs, were used to develop a field-survey questionnaire after a detailed literature review. Setting: The study was conducted on eight construction sites (consisting of five building construction and three road construction sites), chosen through heterogeneity sampling, in Midrand, Centurion, Johannesburg and Samrand. Subjects: Participants included construction workers actively involved in site activities. Outcome measures: Principal components analysis (PCA) was conducted to examine the structures and validity of the constructs. Cronbach's alpha test and mean inter-item correlations were used to examine internal consistency reliability. Results: After repeated factor analysis, the questionnaire on food-choice factors revealed seven different factors: food context, biological factors, nutritional knowledge, personal ideas and systems, economic factors, resources and cultural background. These factors explained 60.09% variance. Cronbach's alpha coefficients ranged from 0.62 to 0.85, signifying good internal consistency reliability. Conclusion: The determinants of construction workers' food choices are vital considerations when designing and implementing nutrition interventions in the South African construction industry. Future research can adopt the instrument and developed model when conducting psychometric evaluations of construction workers' food-choice determinants. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to describe the process of the testing of the Elderly Food Based Dietary Guidelines (EFBDGs). Following a literature review, stakeholder discussions and revision, preliminary English EFBDGs were proposed and circulated to an expert panel for input. The developed EFBDGs are based on the existing FBDGs which were revised in 2012 and adapted for older people following the Food and Agricultural Organisation/World Health Organisation (FAO/WHO) guidelines. Minor corrections were received and incorporated, after which the guidelines were tested for comprehension, appropriateness and applicability in consumer groups. A qualitative design was followed with focus group discussions. Firstly, the English EFBDGs were tested with IsiZulu, Afrikaans, IsiXhosa, English and Sesotho speaking elderly aged 60 years and older in KwaZulu-Natal, Gauteng, Eastern Cape and Free State provinces, respectively. Thereafter, they were adapted and translated into IsiZulu, Afrikaans, IsiXhosa and Sesotho. Secondly, the adapted and translated EFBDGs were tested in the mentioned ethnic groups. In general, as expected, the results of the tests showed that the English speaking elderly responded better to the English guidelines than the other ethnic groups. The feedback in respect of the tested translated guidelines was more positive indicating a better understanding of the EFBDGs by the various ethnic groups. This is because, not only were the English guidelines translated, but they were also adapted and words were contextualised according to the day-to-day language use of the groups. It was recommended that the guidelines be incorporated into the Integrated Nutrition Programme for the purpose of nutrition education as well as a guide for food service institutions serving the elderly. Also, it was recommended that the development of support material for health professionals and the wider community be undertaken and the material translated into all the official languages. Future strategies should include the implementation, evaluation and impact of the EFBDGs. [ABSTRACT FROM AUTHOR]