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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 o

OBJECTIVE: This study investigated associations between anthropometric measures and physical performance in black South African adults. It was hypothesized that noninvasive, simple anthropometric measurements, such as calf circumference (CC) and body mass index (BMI), may be useful predictors of physical performance and strength. METHODS: Black human immunodeficiency virus (HIV) negative men and women (aged 32-93 years) participating in the Prospective Urban and Rural Epidemiology (PURE) study were enrolled at baseline in 2005 = 1428). Men and women's anthropometry, socio-demographics and physical activity (PA) were assessed at baseline, 5- and 10-year follow-up. Physical performance (walk speed, chair stand and handgrip strength [HGS]) were assessed at 10-year follow-up. Linear regression models adjusted for potential confounders were used to evaluate the association between anthropometric measures and physical performance. RESULTS: The combined overweight and obesity prevalence among both men (P = .02) and women (P < .001) increased significantly over 10 years, with significant increases over time in BMI and CC in the women, whereas PA decreased significantly over time in both men and women (P < .0001). BMI and CC were positively associated with HGS in the men (P = .02, P < .0001) and women (P < .0001), while CC was positively associated with walk speed in men only (P = .006) in the cross-sectional analysis of 2015 measurements. CONCLUSION: BMI and CC in both men and women were positively associated with HGS, but CC was associated with walk speed in the men only. Our study suggests that CC may be a useful predictor of physical performance in black men and to a limited extent in black women

To assess the level of agreement between body size self-perception and actual body size determined by body mass index (BMI) z-score and body fatness measured by the deuterium dilution method (DDM) in South African children aged 6–8 years. A cross-sectional sample of 202 children (83 boys and 119 girls) aged 6–8 years from the Body Composition–Isotope Technique study (BC–IT) was taken. Subjective measures of body image (silhouettes) were compared with the objective measures of BMI z-score and body fatness measured by the DDM. The World Health Organization BMI z-scores were used to classify the children as underweight, normal, overweight, or obese. DDM-measured fatness was classified based on the McCarthy centile curves set at 2nd, 85th and 95th in conjunction with fatness cut-off points of 25% in boys and 30% in girls. Data were analyzed using SPSS v26. Of 202 children, 32.2%, 55.1%, 8.8%, and 2.4% perceived their body size as underweight, normal, overweight, and obese, respectively. Based on BMI z-score, 18.8%, 72.8%, 6.9%, and 1.5% were classified as underweight, normal, overweight, and obese, respectively. Body fatness measurement showed that 2.5%, 48.0%, 21.8%, and 29.7% were underweight, normal weight, overweight, and obese, respectively. The application of silhouettes and BMI z-scores resulted in either overestimation or underestimation of own body size. Overall, the levels of agreements (kappa, κ) between body size perception, body fatness, and BMI for age respectively, were small (κ = 0.083, p = 0.053 and κ = 0.154, p<0.001). Level of agreement between body size perception, body fatness, and BMI z-score was poor. The use of silhouettes made children either overestimate their own body size while being underweight or underestimate their own body size while being overweight or obese. Given the potential health implications associated with misclassification of body size during childhood, correct self-assessment of body size is important, and may be key to the ado

Objectives: The aim was to determine participants’ dietary adherence by calculating a diet adherence score based on the Dietary Approaches to Stop Hypertension (DASH)-style diet; (2) to determine if there was an association between dietary adherence score, anthropometric measurements (waist circumference, body mass index (BMI), waist–hip ratio, waist-to-height-ratio) and blood pressure (BP) in a South African urban black population. Design: Cross-sectional secondary analysis of data collected for the PURE study was undertaken. Setting: Langa, the urban PURE study site in the Western Cape province, South Africa. Subjects: The PURE study Western Cape urban cohort, 454 participants, aged 32–81 years was utilised. Outcome measures: Dietary adherence scores were calculated and the BP and anthropometric measurements, respectively, of participants in the lowest and highest tertiles of dietary adherence scores were compared. Results: Positive correlations were found between age, for both men and women, and systolic and diastolic BP. A significant positive correlation between added sugar intake and systolic blood pressure (SBP) was present only in the women. A significant positive correlation was found between BMI, diastolic BP and SBP in men only. No significant differences existed between BP of men or women in the lowest and top tertile groups according to dietary adherence score, but a significant inverse correlation between the dietary adherence score and SBP was found in women. Conclusions: BMI was positively associated with BP in men, while dietary adherence score was negatively correlated with SBP in women. Summary: Non-adherence to dietary guidelines presenting overconsumption of unhealthy foods may be associated with high blood pressure

Objective: The aim was to assess the relationship between female adiposity and physical attractiveness among men and women in Botswana. Design: A cross-sectional study was undertaken. Setting: Ranaka rural village, Botswana. Subjects: Randomly selected adults (n = 113, men = 48 and women = 65), 18–50 years old were recruited. Outcome measures: Scores to indicate the attractiveness of 21 images of female bodies that represented different percentage body fat (%BF) according to participants’ age, gender and body mass index (BMI) were recorded. Results: The perceptions of physical attractiveness of female body size were similar among men and women, regardless of significant differences between the BMI of men and women. Younger (18–30 years) and older participants (31–50 years) separately, as well as underweight/normal weight versus overweight/obese groups all gave higher attractiveness scores for images with a lower %BF. All groups gave the highest score for the same image (%BF of 19% and waist:hip ratio (WHR) of 0.72), and the lowest score for an image with %BF of 49% and WHR of 0.81. There was a significant negative correlation between attractiveness score and %BF of the images for all groups, but no significant correlation between the attractiveness scores for the images and WHR. There was a consistent outlier in the graphs between attractiveness score and %BF with a % BF of 32% and a WHR of 0.61, with a relatively high score of 7.4 out of 9 for all groups. Conclusions: Participant groups according to gender, age or BMI gave similar attractiveness scores for leaner female body images

Background & aims Cancer is the second most common chronic disease and cause of death in the United States. Our aim was to evaluate the associations of sedentary behavior and nutrient intakes with total and cancer-specific mortality among US cancer survivors. Methods Data from 2371 cancer survivors collected by the US National Health and Nutrition Examination Survey between 1999 and 2014 were linked to the US mortality registry. Multivariable adjusted Cox proportional hazard models were used to estimate the hazard ratios (HR) and 95% confidence intervals (CI) for all-cause and cancer-specific mortality associated with sedentary time and nutrient intakes. The interaction between time spent on sedentary activities and nutrient intake was evaluated on additive and multiplicative scales. Results During a median observational period of 5.7 years, 532 total deaths occurred among cancer survivors, of which 180 were cancer-specific. A monotonic increasing linear relationship between time spent sitting and all-cause mortality was observed (HR = 1.15, 95% CI = 1.03, 1.28 per one standard deviation increment). The highest versus the lowest tertiles of intakes of dietary fiber, carotene, niacin, thiamine, riboflavin, vitamin B6, vitamin B12, and vitamin C were inversely associated with all-cause and cancer-specific mortality (HRs = 0.48 to 0.75). The inverse associations with all-cause mortality were more pronounced for combinations of low sedentary behaviour and high intakes of dietary fiber, carotenoids, vitamin B12, and vitamin C. Conclusion Our findings support recommendations for cancer survivors to reduce time spent sedentary and to follow a balanced diet with adequate intakes of dietary fiber and micronutrients

Beverage consumption, physical activity, body mass index and waist circumference were compared in age-matched (aged 18– 30 years) groups of young South African women from urban (n = 78) and rural (n = 94) settings. Obesity was higher in the rural group, driven by a higher consumption of sugar-sweetened beverages and low physical activity

Background:Despite national efforts to promote exclusive breastfeeding (EBF), South Africa’s EBF rate is only 32 %.The aim of this study was to examine the rate of EBF discontinuation and the lived experiences of breastfeedingmothers at postnatal time points 3–14 days, 4–8 weeks, 10–14 weeks and 20–24 weeks.Methods:This community-based mixed-methods study collected data within a prospective cohort study onsociodemographics, the Edinburgh Postnatal Depression Scale (EPDS) and the Breastfeeding Self-Efficacy Scale-ShortForm (BSES-SF) at 6–8 weeks with infant feeding data collected at 4–8, 10–14 and 20–24 weeks from 159 mothersliving in low income areas. Six focus groups with 32 mothers with infants aged 6–24 weeks were conducted.Descriptive statistics was used for the quantitative data and thematic analysis for qualitative data.Results:The majority of mothers were unmarried (84.9%), living with family (69.2%) and unemployed (74.2%).Exclusive breastfeeding decreased from 34% at 4–8 weeks to 9.7% at 20–24 weeks. Mixed feeding with infantformula increased from 17.0 to 30.6% and food feeding from 3.1 to 54.2%. While there were no statisticallysignificant associations between EBF and any of the quantitative sociodemographic variables, in the qualitative data,codes associated with barriers were more than enablers. The themes wereMothers’attributes (wellbeing,experiences and relationships)with the codemother’s stressthe strongest barrier,Mother’s knowledge, attitudesand practices of breastfeedingwith the codeconventional medicinesthe strongest barrier,Family environmentwith the codehome settingthe strongest barrier,Social environmentwithpublic spaces and placesa barrier and inBaby cuesthe codebaby stomach ailmentsthe barrier. Within these same themesmother’s positive emotions,benefits of breastfeeding,support in the home, access to information and services fromhealth professionalsandbaby’shealthwere strong enabling factors. Conclusions:Low EBF, high mixed feeding and a high

Professor HH (Esté) Vorster was a former Director of the Centre of Excellence for Nutrition in the Faculty of Health Sciences of the North-West University (NWU), Potchefstroom, South Africa. In 1989, she obtained a DSc in Physiology from NWU with a thesis on ‘The effects of dietary fibre on lipid and haemostatic risk factors of non-communicable diseases’. Professor Vorster started Nutrition Research at the University in the 1980s

Background: The impact of a sedentary and unhealthy lifestyle on cardiovascular health is well-documented, however the current obesity and hypertension trends among children is concerning. The ExAMIN Youth SA study aims to investigate the impact of lifestyle behaviors (physical fitness/activity, dietary intake and psychosocial factors) involved in early vascular aging among South African children. Methods: This study is an analytical, multidisciplinary, observational cohort study in a school-based setting. We aim to phenotype a cohort of ∼1,000 primary school children (black and white boys and girls between ages 5–9 years) based on current clinical childhood conditions including hypertension and obesity. The primary phenotype is large artery stiffness and retinal microvascular diameters, both biomarkers of early vascular aging. The risk factors and mediators of early vascular aging and also responsible for the clinical conditions include physical inactivity, unhealthy diet, and life stress. Additionally, urinalysis and salivary analyses will be performed to identify biomarkers related to the pathophysiology of early vascular aging. Discussion: In line with the growing prevalence of obesity and hypertension responsible for the development of early vascular aging from childhood to adulthood, this study will address the critical areas in which we observe unfavorable arterial modulation related to dietary behaviors, physical inactivity, and early life stress. Implementation of novel biological markers may further contribute to our understanding of early cardiovascular adaptations in childhood, and aid in the development of primary prevention programs

CVD is the most common chronic condition and the highest cause of mortality in the USA. The aim of the present work was to investigate diet and sedentary behaviour in relation to mortality in US CVD survivors. The National Health and Nutrition Examination Surveys conducted between 1999 and 2014 linked to the US mortality registry updated to 2015 were investigated. Multivariate adjusted Cox regression was used to derive mortality hazards in relation to sedentary behaviour and nutrient intake. A multiplicative and additive interaction analysis was conducted to evaluate how sedentariness and diet influence mortality in US CVD survivors. A sample of 2473 participants followed for a median period of 5·6 years resulted in 761 deaths, and 199 deaths were due to CVD. A monotone increasing relationship between time spent in sedentary activities and mortality risk was observed for all-cause and CVD mortality (hazard ratio (HR) = 1·20, 95 % CI 1·09, 1·31 and HR = 1·19, 95 % CI 1·00, 1·67, respectively). Inverse mortality risks in the range of 22–34 % were observed when comparing the highest with the lowest tertile of dietary fibre, vitamin A, carotene, riboflavin and vitamin C. Sedentariness below 360 min/d and dietary fibre and vitamin intake above the median interact on an additive scale influencing positively all-cause and CVD mortality risk. Reduced sedentariness in combination with a varied diet rich in dietary fibre and vitamins appears to be a useful strategy to reduce all-cause and CVD mortality in US CVD survivors

This prospective study investigated the association between nutrient intake, dietary patterns, and changes in bone turnover and bone mineral density (BMD) in postmenopausal urban black South African women over two years. These women (n = 144) underwent BMD measurements at the distal radius, lumbar spine, femoral neck (FN), as well as a biochemical analysis which included the parathyroid hormone (PTH), 25-hydroxyvitamin D, C-Telopeptide of type I collagen (CTX-1) in 2010 and 2012. Their dietary intake was assessed in 2010 using a food frequency questionnaire, and sociodemographic and health information was collected. Four dietary patterns explained 54.4% of the variance of dietary intake, namely staple foods and processed meats, home cooking, snacking, and high sugar. Dietary magnesium negatively correlated with CTx-1 in 2012 (r = −0.21, p = 0.02), calcium correlated with distal radius BMD in 2010 (r = 0.22, p = 0.01) and 2012 (r = 0.24, p = 0.005), and the snacking dietary pattern score correlated with FN BMD in 2010 (r = 0.18, p = 0.03) and 2012 (r = 0.21, p = 0.02). The baseline CTx-1 and dietary magnesium intake predicted 22% of the variance in percentage change of CTx-1 over two years (p < 0.001).The magnesium intake predicted short-term bone resorption over two years

Background Evidence on the effect of small-quantity lipid-based nutrient supplements (SQ-LNSs) on early child growth and development is mixed. Objective This study assessed the effect of daily consumption of 2 different SQ-LNS formulations on linear growth (primary outcome), psychomotor development, iron status (secondary outcomes), and morbidity in infants from age 6 to 12 mo within the context of a maize-based complementary diet. Methods Infants (n = 750) were randomly assigned to receive SQ-LNS, SQ-LNS-plus, or no supplement. Both SQ-LNS products contained micronutrients and essential fatty acids. SQ-LNS-plus contained, in addition, docosahexaenoic acid, arachidonic acid (important for brain and eye development), lysine (limiting amino acid in maize), phytase (enhances iron absorption), and other nutrients. Infants’ weight and length were measured bimonthly. At age 6 and 12 mo, psychomotor development using the Kilifi Developmental Inventory and South African Parent Rating Scale and hemoglobin, plasma ferritin, C-reactive protein, and α1-acid glycoprotein were assessed. WHO Motor Milestone outcomes, adherence, and morbidity were monitored weekly through home visits. Primary analysis was by intention-to-treat, comparing each SQ-LNS group with the control. Results SQ-LNS-plus had a positive effect on length-for-age zscore at age 8 mo (mean difference: 0.11; 95% CI: 0.01, 0.22; P = 0.032) and 10 mo (0.16; 95% CI: 0.04, 0.27; P = 0.008) but not at 12 mo (0.09; 95% CI: −0.02, 0.21; P = 0.115), locomotor development score (2.05; 95% CI: 0.72, 3.38; P = 0.003), and Parent Rating Score (1.10; 95% CI: 0.14, 2.07; P = 0.025), but no effect for weight-for-age zscore. Both SQ-LNS (P = 0.027) and SQ-LNS-plus (P = 0.005) improved hemoglobin concentration and reduced the risk of anemia, iron deficiency, and iron-deficiency anemia. Both SQ-LNS products reduced longitudinal prevalence of fever, coughing, and wheezing but increased incidence and longitudinal prevalence of diarrhea

Background: Chronic non-communicable diseases (CNCDs) are increasing with grave consequences to countries’ development. The purpose of this study was three-fold: (1) to determine challenges PURE study participants faced regarding CNCD interventions and what they required from a CNCD intervention programme, and (2) to explore courses of action Department of Health (DoH) officials thought would perform best, as well as (3) to determine what DoH officials perceive to be obstacles in addressing the CNCD epidemic. Design and methods: A subsample of 300 participants from the Prospective Urban and Rural Epidemiological study’s Western Cape urban cohort and six key officers from the DoH were recruited to participate in this cross-sectional study. Questionnaires were used in face-to-face interviews with the PURE study participants and DoH officials, together with the multi-criteria mapper (MCM) interviewing method with the latter. Results: Most PURE participants were overweight/obese, but not keen to participate in weight loss interventions. They sought education on foods associated with weight gain, shopping lists, cooking lessons and recipes from CNCD intervention programmes. Department of Health officials regarded the integration of health services, community participation, amongst others as the most favourable options to address the CNCD epidemic. Conclusions: The integration of health services, community participation, food taxation and improving inter-sectoral partnerships were viewed as the most feasible options to address the CNCD epidemic according to the DoH officials. At community level, the needs for education and practical hints were expressed. Current CNCD interventions should be adapted to include the context-based needs of communities

Background. Healthy Active Kids South Africa (HAKSA) Report Cards were produced in 2007, 2010, 2014 and 2016. Objective. The 2018 Report Card aims to report on the latest available evidence relating to the physical activity (PA), nutrition and body composition of South African (SA) children and adolescents. Methods. A review was conducted using the following databases: PubMed; Africa Journals Online; and Africa-Wide (EBSCOhost). Articles published from January 2016 to September 2018 were included for review by the HAKSA scientific advisory group. Data were extracted, and a grade for each indicator was assigned based on the available evidence and the consensus of the scientific advisory group. This included 12 PA indicators, 6 nutrition indicators and 3 body composition indicators. Results. There was no evidence of a significant change in any of the indicators since the 2016 Report Card. Grades for certain indicators have been downgraded (from 2016) to bring these to the attention of relevant stakeholders and industry. These include food insecurity and grades that relate to the implementation of policy on PA and nutrition in the school environment, and on advertising and media relating to nutrition. Conclusion. Key priorities for action include: safe opportunities for physical activity; minimising the gap between policy and implementation (school culture and environment, and government strategies); and the double burden of over- and undernutrition, which relates to the continuing concern about food insecurity in SA. There is a need for further research, including surveillance, on all indicators, for future Report Cards

Objectives: To investigate the differences between bone mineral density (BMD), lean and fat mass of human immunodeficiency virus (HIV-) positive and HIV-negative black women and to investigate factors associated with low BMD. Methods: Case-control study of black women (n = 565) aged 29–65 years from Potchefstroom, North West province, South Africa, based on secondary analysis of data. Total BMD, left femur neck of the hip (LFN BMD), spine BMD, total fat, fat-free tissue mass and percentage body fat (%BF) were measured by dual-energy X-ray absorptiometry. Results: HIV-negative women had significantly higher median BMD, %BF, appendicular skeletal mass (ASM), ASM index, body mass index (BMI) and waist circumference than HIV-positive women. When the groups were matched for age and BMI, only spine BMD was marginally lower in HIV-positive women. In the total group, age, smoking and HIV status were associated with lower BMD, while calcium intake was positively associated with BMD. Similar variables were associated with BMD in HIV-negative women, while age and educational status were associated with BMD in HIV-positive women. Conclusion: Low BMD was more common among HIV-positive than HIV-negative women. Older HIV-positive women with low educational status are particularly at risk

Background: Diets rich in n-6 polyunsaturated fatty acids (PUFAs) and saturated fatty acids (SFA) have been associated with increased risk of obesity and the metabolic syndrome (MetS), but the evidence is inconsistent, whereas diets high in n-3 long-chain (LC)-PUFAs are associated with lower risk. There is limited information about the association of plasma phospholipid fatty acids (FAs) with obesity and the MetS among black South Africans. Objective: To investigate the association of dietary FAs and plasma phospholipid FA patterns, respectively, with measures of adiposity (body mass index, waist circumference, waist-toheight ratio) and the MetS in black South Africans. Methods: Factor analysis was used to identify FA patterns from 11 dietary FAs and 26 individual plasma phospholipid FAs. Cross-sectional association of the identified patterns with measures of adiposity and the MetS was investigated. A random sample of 711 black South African adults aged 30 to 70 years (273 men, 438 women) from the North West Province was selected from the South African leg of the Prospective Urban and Rural Epidemiology (PURE) study. Sequential regression models adjusted for confounders were applied to investigate the association between dietary FAs and plasma phospholipid FA patterns with measures of adiposity and the MetS. Results: Two patterns were derived from dietary FAs and six patterns from plasma phospholipid FAs that explained the cumulative variance of 89 and 73%, respectively. The association of FA patterns with adiposity and the MetS was weaker for dietary FA patterns than for plasma phospholipid FA patterns. The plasma phospholipid FA pattern with high loadings of saturated FAs (high-Satfat) and another with high loadings of n-3 very-long-chain PUFAs (n-3 VLC-PUFAs) were positively associated with measures of adiposity and the MetS, while patterns with positive loadings of LC mono-unsaturated fatty acids (n-9 LC-MUFA) and a positive loading of n-3 essential FAs (n-3 EFA

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

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities1,2. This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity3,4,5,6. Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017—and more than 80% in some low- and middle-income regions—was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing—and in some countries reversal—of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories

Obesity and salt intake are both established factors contributing to cardiovascular disease development. Recently, studies found a controversial positive relationship between dietary salt and obesity. Therefore, the authors investigated whether obesity‐ related measures are associated with 24‐hour urinary sodium in a healthy biethnic population. The study included 761 adults (20‐30 years) with complete 24‐hour urinary sodium, anthropometry, and bioelectrical impedance measurements. In single regression analyses all obesity‐related measures related positively with 24‐hour urinary sodium (P ≤ .008). However, with multivariate adjustments for energy intake, accelerometery, age, sex, black and white ethnicity, and other covariates, only body surface area (BSA) remained independently associated with 24‐hour urinary sodium (R2 = 0.72, β = .05, P = .039). To conclude, we found a consistent and robust positive relationship between BSA and estimated salt intake – but not with traditional obesity measures such as body mass index (BMI). Further studies are needed to investigate body surface area and potentially, skin area, in salt handling

Background: Sarcopenia, the loss of muscle mass and strength, is associated with adverse health outcomes. Calf circumference (CC) has been proposed as a surrogate measure of muscle mass in the elderly; however, ethnic/sex specific cut-off values remain to be established. Objective: A study was undertaken to investigate the relationship between CC and appendicular skeletal muscle mass (ASM), and the ASM index (ASMI), as well as to determine whether CC could be used to diagnose sarcopenia. Methods: This was a cross-sectional study of 247 older black women living from Tlokwe, South Africa. ASM was measured using dual-energy X-ray absorptiometry, and the ASMI was calculated. Receiver operator characteristics curves and maximum Youden index were applied to identify a CC cut-off point for sarcopenia according to low gait speed (< 0.8 m/s), low hand-grip strength (< 16 kg) and low ASMI using a South African cut-off point for sarcopenia (ASMI < 4.94 kg/m2). Results: A strong positive correlation between CC and ASMI (r = 0.84, p < 0.001) was observed. The CC to predict low hand-grip strength was 34.3 cm and 37.8 cm for low gait speed. A CC of 29.9 cm was indicative of sarcopenia. The area under the curve for all outcomes was > 0.60. Conclusion: A CC of 30 cm is proposed as a simple and inexpensive way to predict, screen or diagnose sarcopenia in black women in low-resource health settings. An accessible, inexpensive screening or diagnostic tool could facilitate timely interventions and prevention

Background and objectives: Obesity-related health risk may differ by ethnicity at the same body mass index (BMI). The objectives of this study were too determine the predictive value of the World Health Organization (WHO) overweight cut-point of BMI of 25 kg.m2 in men and women, respectively, to identify 10-year cardiometabolic risk and to determine optimal male (M) and female (F) BMI cut-points to identify 10-year cardiometabolic risk. Methods: In the longitudinal PURE study of healthy black South Africans (n=2010), aged 30-90 years in 2005, demographic, lifestyle and anthropometric measures were taken and blood pressure, fasting serum triglycerides, high-density lipoprotein (HDL)-cholesterol and blood glucose were measured. Three or more risk factors according to international metabolic syndrome (MetS) criteria (fasting plasma glucose >5.6 mmol/L /oral hypoglycemic drugs, systolic blood pressure (SBP) >130 and/or diastolic blood pressure (DBP) >85 /anti-hypertensive drugs, serum TG >1.7 mmol/L, HDL-cholesterol <1 mmol/L M /<1.3 mmol/L F) and waist circumference (WC) above sex-specific cut-points (>94cm M/ >80cm F) in 2015 were defined as elevated cardiometabolic risk. Results: Participants with WC above sex-specific cut-points in 2005 had significantly higher odds of having the MetS in 2015 (odds ratio, OR = 6.99, 95% CI 5.01, 9.75). Participants with BMI in the overweight/obese range (BMI > 25 kg/m2) in 2005 had significantly higher odds of having the MetS in 2015 (OR = 6.38, 95% CI 4.55, 8.94). Receiver Operating Characteristic curves to identify a sex-specific optimal BMI cut-point associated with increased 10-year risk indicated a BMI cut-point of 23.3 kg/m2 in men and 24.6 kg/m2 in women. A BMI cut-point of 30 kg/m2 had poor diagnostic performance. WC cut-points to predict 10-year risk of MetS were 78.0 cm in women and 84.0 cm in men. All cut-points were lower than international proposed cut-points for adiposity. Conclusions: Baseline BMI and WC were signific

The rising prevalence of obesity and excessive adiposity are global public health concerns. Understanding determinants of changes in adiposity over time is critical for informing effective evidence-based prevention or treatment. However, limited information is available to achieve this objective. Cultural, demographic, environmental, and behavioral factors including socio-economic status (SES) likely account for obesity development. To this end, we related these variables to anthropometric measures in 1058 black adult Tswana-speaking South Africans who were HIV negative in a prospective study over five years. Body mass index (BMI) and waist circumference increased in both sexes, whereas triceps skinfold thickness remained the same. Over the five years, women moved to higher BMI categories and more were diagnosed with central obesity. Age correlated negatively, whereas SES, physical activity, energy, and fat intake correlated positively with adiposity markers in women. In men, SES, marital status, physical activity, and being urban predicted increases in adiposity. For women, SES and urbanicity increased, whereas menopause and smoking decreased adiposity. Among men, smokers had less change in BMI than those that never smoked over five years. Our findings suggest that interventions, focusing on the urban living, the married and those with the highest SES—the high-risk groups identified herein—are of primary importance to contain morbidity and premature mortality due to obesity in black South Africans

Objectives To derive percentage body fat (%BF) cut-points according to body mass index (BMI) categories for adult black South African women and to investigate the agreement between adiposity classifications according to WHO BMI and %BF cut-points. The secondary aim was to determine the association between these different adiposity measures and high blood pressure. Methods Black women aged 29–65 years (n = 435) from Ikageng, South Africa, were included in this cross-sectional study. Socio-demographic and anthropometric data were collected (weight, height and BMI). %BF using dual-energy X-ray absorptiometry and blood pressure were measured. Results There was significant agreement between three %BF categories: low/normal (<35.8% age 29–49 years; or <38% age 50–65 years), overweight range (35.8–40.7% age 29–49 years; or 38–42.1% age 50–65 years) and obese (≥40.7% age 29–49 years; or ≥42.1% age 50–65 years) and three BMI categories: low/normal (<25 kg/m2), overweight range (25–29.9 kg/m2) and obese (≥30kg/m2); (κ = 0.62, P < .0001). Despite statistically significant agreement between groups, more than half of overweight individuals were misclassified as having either a normal (30.2%) or obese %BF (25.5%). %BF misclassification was low in the low/normal and obese BMI ranges. After adjustment for confounders, obesity (BMI ≥ 30kg/m2), as well as high %BF were significantly associated with high blood pressure (OR = 1.75, 95% CI 1.09–2.81 versus OR = 1.92, 95% CI 1.15–3.23, respectively). Conclusion Despite significant agreement between BMI and %BF categories, considerable misclassification occurred in the overweight range. Participants with excessive %BF had a greater odds of high blood pressure than those in the highest BMI category

The relationship between 25 hydroxyvitamin D (25(OH)D), parathyroid hormone (PTH) and metabolic traits appear to differ among ethnicities and may be influenced by obesity. The aim of the study was to examine the association of serum 25(OH)D or PTH with metabolic syndrome (MetS) while controlling for adiposity in black women. Using a cross-sectional study design, 209 urban black women aged ≥ 43 years from the North West Province, South Africa, were included. Multiple regression models were used to explore the relationship between 25(OH)D or PTH and body composition. To explore the association between 25(OH)D or PTH and MetS, a separate variable was created including at least 3 of the MetS criteria, but excluding elevated waist circumference as a diagnostic criterion in a logistic regression model. The majority of the women (69.9%) were overweight or obese and 65.5% of the women had excessive adiposity using the age-specific cut-off points for body fat percentage. All body composition variables were positively associated with PTH, whereas body mass index and waist circumference, but not body fat percentage, had negative associations with 25(OH)D also after adjusting for confounders. Before and after adjusting for age, body fat, habitual physical activity, tobacco use, season of data collection, and estimated glomerular filtration rate, neither 25(OH)D nor PTH showed significant associations with MetS. Although PTH was positively associated and 25(OH)D was negatively associated with adiposity in black women, there was no association between either 25(OH)D or PTH and MetS in this study population, nor did adiposity influence these relationships

Objective: To determine the prevalence and factors associated with stunting in 6-month-old South African infants. Design: This cross-sectional study was part of the baseline of a randomized controlled trial. Weight-for-length, length-for-age and weight-for-age Z-scores were based on the WHO classification. Blood samples were analysed for Hb, plasma ferritin and soluble transferrin receptor (sTfR). Socio-economic, breast-feeding and complementary feeding practices were assessed by questionnaire. Setting/Subjects: Infants aged 6 months (n 750) from a peri-urban area of Matlosana Municipality, North West Province of South Africa. Results: Stunting, underweight, wasting and overweight affected 28·5, 11·1, 1·7 and 10·1% of infants, respectively. Exclusive breast-feeding to 6 months of age was reported in 5·9% of the infants. Multivariable binary logistic regression showed that birth weight (OR =0·12; 95% CI 0·07, 0·21, P <0·001) and maternal height (OR=0·94; 95% CI 0·91, 0·98, P =0·001) were inversely associated with stunting; while male sex (OR=1·73; 95% CI 1·10, 2·70, P =0·014) was associated with higher odds for stunting. Stunting was also associated with higher plasma sTfR (>8·3 mg/l) concentrations. Conclusions: The association between stunting and lower birth weight, shorter maternal height and male sex reflects possibly the intergenerational origins of stunting. Therefore, interventions that focus on improving preconceptual and maternal nutritional status, combined with strategies to promote appropriate infant feeding practices, may be an important strategy to prevent stunting in vulnerable settings

Background: Tenofovir disoproxil fumarate (TDF) antiretroviral therapy is associated with disruption of the bone turnover process. Objectives: The objective of this study was to determine the association between tenofovir (TFV) plasma concentration and various bone turnover markers and compare these markers in HIV-infected women and HIV-uninfected controls. Method: A cross-sectional sub-study included 30 HIV-infected women on TDF and 30 HIV-uninfected matched participants. Serum calcium (SrCa), serum phosphate (SrP), C-terminal telopeptide (CTx), parathyroid hormone (PTH), alkaline phosphatase (ALP), C-reactive protein (CRP), vitamin D (VitD) and bone mineral density (BMD) were measured. Plasma TFV was assayed on HPLC-MS/MS. The statistical tests applied were Mann–Whitney test, unpaired t-test, analysis of covariance, regression and correlation analysis. Results: In HIV-infected women, no correlation existed between plasma TFV concentration and CTx, PTH, ALP, SrCa, SrP, VitD or BMD (p > 0.05). After adjusting for smoking and alcohol use, ALP (p < 0.001), CTx (p = 0.027) and PTH (p = 0.050) were significantly higher in HIV-infected compared to HIV-uninfected women. Women with TFV concentration ≥ 120 ng/mL had higher PTH concentrations (p = 0.037) compared to those with ≤ 100 ng/mL. Significant correlations between SrCa and PTH and SrCa and SrP including CTx and PTH (p < 0.05) were present in HIV-uninfected women while absent in HIV-infected counterparts (p > 0.05). Conclusion: The results indicate possible increased bone turnover at higher TFV concentrations. The normal regular bone turnover processes in HIV-infected women on TDF therapy are altered. Larger studies are warranted to confirm these results

Background: Chronic non-communicable diseases (CNCD) have become the greatest contributor to the mortality rate worldwide. Despite attempts by Governments and various non-governmental organisations to prevent and control the epidemic with various intervention strategies, the number of people suffering from CNCD is increasing at an alarming rate in South Africa and worldwide. Objectives: Study's objectives were to explore perceived challenges with implementation of, and adherence to health messages disseminated as part of a CNCD intervention programme; to gain an understanding of participants' expectations of CNCD intervention programmes;, and to explore the acceptability and preference of health message dissemination methods. In addition, participants' awareness of, and willingness to participate inCNCDs intervention programmes in their community was explored. Methods: Participants were recruited from the existing urban Prospective Urban Rural Epidemiology study site in Langa, Cape Town. Focus group discussions were conducted with 47participants using a question guide. Summative content analysis was used to analyse the data. Results: Four themes emerged from the data analysis: practical aspects of implementation and adherence to intervention programmes; participants' expectations of intervention programmes; aspects influencing participants' acceptance of interventions; and their preferences for health message dissemination. The results of this study will be used to inform CNCDs intervention programmes. Conclusions: Our findings revealed that although participants found current methods of health message dissemination in CNCDs intervention acceptable, they faced real challenges with implementing and adhering to CNCDs to these messages

Background: Black women are believed to be genetically less predisposed to age-related sarcopenia. The objective of this study was to investigate lifestyle factors associated with sarcopenia in black South African (SA) urban women. Methods: In a cross-sectional study, 247 women (mean age 57 y) were randomly selected. Anthropometric and sociodemographic variables, dietary intakes, and physical activity were measured. Activity was also measured by combined accelerometery/heart rate monitoring (ActiHeart), and HIV status was tested. Dual energy x-ray absorptiometry was used to measure appendicular skeletal mass (ASM). Sarcopenia was defined according to a recently derived SA cutpoint of ASM index (ASM/height squared) < 4.94 kg/m2. Results: In total, 8.9% of the women were sarcopenic, decreasing to 8.1% after exclusion of participants who were HIV positive. In multiple regressions with ASM index, grip strength, and gait speed, respectively, as dependent variables, only activity energy expenditure (β = .27) was significantly associated with ASM index. Age (β = –.50) and activity energy expenditure (β = .17) were significantly associated with gait speed. Age (β = –.11) and lean mass (β = .21) were significantly associated with handgrip strength. Conclusions: Sarcopenia was prevalent among these SA women and was associated with low physical activity energy expenditure

Objective: The aim of this study was to assess the vitamin A and anthropometric status of South African preschool children from four areas with known distinct eating patterns. Methods: Serum retinol, anthropometric indicators, and dietary intake were determined for randomly selected preschool children from two rural areas, i.e. KwaZulu-Natal (n = 140) and Limpopo (n = 206); an urban area in the Northern Cape (n = 194); and an urban metropolitan area in the Western Cape (n = 207). Results: Serum retinol <20 μg/dL was prevalent in 8.2% to 13.6% children. Between 3% (urban-Northern Cape) and 44.2% (rural-Limpopo) children had received a high-dose vitamin A supplement during the preceding 6 mo. Vitamin A derived from fortified bread and/or maize meal ranged from 65 μg retinol activity equivalents (24%–31% of the Estimated Average Requirement) to 160 μg retinol activity equivalents (58%–76% Estimated Average Requirement). Fortified bread and/or maize meal contributed 57% to 59% of total vitamin A intake in rural children, and 28% to 38% in urban children. Across the four areas, stunting in children ranged from 13.9% to 40.9%; and overweight from 1.2% to 15.1%. Conclusion: Prevalence of vitamin A deficiency was lower than national figures, and did not differ across areas despite differences in socioeconomics, dietary intake, and vitamin A supplementation coverage. Rural children benefited more from the national food fortification program in terms of vitamin A intake. Large variations in anthropometric status highlight the importance of targeting specific nutrition interventions, taking into account the double burden of overnutrition and undernutrition.

Introduction: Preliminary evidence indicates that the association of fibrinolytic potential, measured as clot lysis time (CLT), with body composition may differ from that of plasminogen activator inhibitor type–1 (PAI–1). We" therefore investigated the association between fibrinolytic markers (plasminogen activator inhibitor type–1 activity (PAI–1act) and CLT) and body composition using detailed body composition analyses. Materials and methods: Data from 1288 Africans were cross–sectionally analyzed. Body composition analysis "included BMI, waist circumference (WC); waist to height ratio (WHtR), skinfolds and body fat percentage" measured with air–displacement plethysmography and bioelectrical impedance analysis. "Results: PAI–1act and CLT were significantly higher in women than in men, despite adjustment for differences in" "body composition. PAI–1act and CLT showed similar linear positive relationships with body composition (BMI," "WC, WHtR, skinfolds) in men. In women CLT also showed a linear relationship with body composition, while" PAI–1act levels plateaued at higher BMI and did not differ across skinfold categories. PAI–1act showed stronger "correlations with body composition markers in men than it did in women, while no sex differences existed for" "CLT. PAI–1act associated more strongly with central obesity, while CLT associated with total body fat." "Conclusions: Observed differencesmay be related to differences in adipose tissue type, distribution and sequence" "of accumulation between sexes. PAI–1act is strongly influenced by accumulation of visceral adipose tissue, whereas" CLT is associatedwith obesity independent of type and sequence of body fat accumulation in this African adult study population.

Background: Modern culture has stereotyped the female body as one that is continually getting thinner. Internalization of the ‘thin’ ideal is partly attributable to the inner ideal to be successful combined with the external pressure imposed by media and others. Many individuals attempt to achieve these ideals by behavior modification that imposes health risks. Purpose: To investigate disordered eating (DE) behavior and energy status in female student dancers. Methods: Volunteer dancers (n = 26) aged 19.0 (18.0; 21.0) years, matched by controls (n = 26) aged 20.0 (19.0; 21.0) years were recruited. Eating Disorder Inventory-3 (EDI-3) subscales, Three-factor Eating Questionnaire (TFEQ) Cognitive Dietary Restraint (CDR) subscale, and EDI-3 Referral Form behavioral questions assessed DE behavior. Energy status was assessed with a food record and Actiheart monitor. Results: Dancers achieved significantly higher scores than controls in all questionnaires, namely: EDI-3 Drive for Thinness [12.0 (3.0; 19.0) vs. 4.5 (2.0; 9.0), p = .023], EDI-3 Body Dissatisfaction [16.0 (10.0; 25.0) vs. 6.5 (3.0; 14.0), p = .004], and TFEQ-CDR [9.0 (2.0; 15.0) vs. 3.0 (3.0; 7.0), p = .032]; dancers used excessive exercise to lose weight (19.2% vs. 0%, c2 = 5.53, p = .019), and had lower energy availability (24% vs. 8%, p < .05) than controls. The average energy balance (EB) was negative for both groups [dancers: EB = -3896 (-5236; -1222) vs. controls: EB = -2639 (-4744; -789) kJ/day]. Conclusion: Female dancers are at risk for DE behavior and many have suboptimal energy status which may be related to their quest to achieve a more desirable appearance; education on healthy weight management practices is needed.

Background: The continued existence of undernutrition, associated with a steady increase in the "prevalence of overweight and obesity in children and adolescents, necessitates identification of" "factors contributing to this double burden of disease, in order for effective treatment and prevention" programmes to be planned. Aim: To determine the nutritional status of 13 15–year–old children in Bloemfontein and its association with socioeconomic factors. "Setting: Bloemfontein, Free State Province, South Africa (2006)." Methods: This was a cross–sectional analytical study. Randomly selected children (n = 415) completed structured questionnaires on socioeconomic status. The children s weight and height were measured and body mass index–for–age and height–for–age z–scores were computed according to World Health "Organization growth standards in order to determine the prevalence of underweight, overweight," obesity and stunting. Waist circumference was measured to classify the children as having a high or very high risk for metabolic disease. "Results: Of the 415 children who consented to participate in the study, 14.9% were wasted and" 3.4% were severely wasted. Only 6% of the children were overweight/obese. Significantly more boys (23.0%) were wasted than girls (10%) and severe stunting was also significantly higher in "boys than in girls (10.3% and 4.2%, respectively). Children whose parents had graduate occupations" were significantly more overweight/obese than those with parents working in skilled occupations. Stunting was significantly higher in low (31.4%) and medium (30.4%) socioeconomic groups compared to the high socioeconomic group (18.1%). Conclusion: A coexistence of underweight and overweight was found and gender and parental occupation were identified as being predictors of nutritional status.

Objective The objective of this study was to determine the relationship between added sugar and dietary "diversity, micronutrient intakes and anthropometric status in a nationally representative" "study of children, 1 8.9 years of age in South Africa." Methods "Secondary analysis of a national survey of children (weighted n = 2,200; non weighted n =" 2818) was undertaken. Validated 24–hour recalls of children were collected from mothers/ caregivers and stratified into quartiles of percentage energy from added sugar (% EAS). A "dietary diversity score (DDS) using 9 food groups, a food variety score (FVS) of individual" "food items, and a mean adequacy ratio (MAR) based on 11 micronutrients were calculated." The prevalence of stunting and overweight/obesity was also determined. Results "Added sugar intake varied from 7.5 10.3%of energy intake for rural and urban areas," respectively. Mean added sugar intake ranged from 1.0% of energy intake in Quartile 1 (1 3 years) (Q1) to 19.3% in Q4 (4 8 years). Main sources of added sugar were white sugar "(60.1%), cool drinks (squash type) (10.4%) and carbonated cool drinks (6.0%). Added" "sugar intake, correlated positively with most micronutrient intakes, DDS, FVS, and MAR." "Significant negative partial correlations, adjusted for energy intake, were found between" "added sugar intake and intakes of protein, fibre, thiamin, pantothenic acid, biotin, vitamin E," "calcium (1 3 years), phosphorus, iron (4 8 years), magnesium and zinc. The prevalence of" overweight/obesity was higher in children aged 4 8 years in Q4 of %EAS than in other quartiles [mean (95%CI) %prevalence overweight 23.0 (16.2 29.8)% in Q4 compared to 13.0 "(8.7 17.3)% in Q1, p = 0.0063]." Conclusion "Although DDS, FVS, MAR and micronutrient intakes were positively correlated with added" "sugar intakes, overall negative associations between micronutrients and added sugar" "intakes, adjusted for dietary energy, indicate micronutrient dilution. Overweight/obesity wa

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.

"Objective: The objective was to determine the nutritional environment at secondary schools in Bloemfontein, Free State province." "Design: This was a cross–sectional, descriptive study." "Subjects and setting: The subjects were secondary school principals in Bloemfontein, Free State province, in 2006." Method: Principals of 10 secondary schools who were already participating in a larger study on 26 schools completed structured questionnaires on nutrition practices. Results: Four schools utilised nutrition education programmes. None had vending machines. Two schools sold dairy products. Biscuits and "chocolates were sold at eight schools, and sweets, crisps and fast food at all of the schools." Conclusion: The nutrition environment at Bloemfontein secondary schools does not support healthy eating habits. Nutrition policies need to be introduced to improve the nutritional environment at schools as the available food for learners at the tuck shops and/or via the vendors was mostly unhealthy.

Background and aims Simple, low-cost central obesity measures may help identify individuals with increased cardiometabolic disease risk, although it is unclear which measures perform best in African adults. We aimed to: 1) cross-sectionally compare the accuracy of existing waist-to-height ratio (WHtR) and waist circumference (WC) thresholds to identify individuals with hypertension, pre-diabetes, or dyslipidaemia; 2) identify optimal WC and WHtR thresholds to detect CVD risk in this African population; and 3) assess which measure best predicts 5-year CVD risk. Methods and results Black South Africans (577 men, 942 women, aged >30years) were recruited by random household selection from four North West Province communities. Demographic and anthropometric measures were taken. Recommended diagnostic thresholds (WC > 80 cm for women, >94 cm for men; WHtR > 0.5) were evaluated to predict blood pressure, fasting blood glucose, lipids, and glycated haemoglobin measured at baseline and 5 year follow up. Women were significantly more overweight than men at baseline (mean body mass index (BMI) women 27.3 ± 7.4 kg/m2, men 20.9 ± 4.3 kg/m2); median WC women 81.9 cm (interquartile range 61–103), men 74.7 cm (63–87 cm), all P < 0.001). In women, both WC and WHtR significantly predicted all cardiometabolic risk factors after 5 years. In men, even after adjusting WC threshold based on ROC analysis, WHtR better predicted overall 5-year risk. Neither measure predicted hypertension in men. Conclusions The WHtR threshold of >0.5 appears to be more consistently supported and may provide a better predictor of future cardiometabolic risk in sub-Saharan Africa. •Obesity & CVD are increasing rapidly in Africa.•Low cost measures are needed to find those at risk.•Debate continues on the optimum Waist Circumference threshold for African adults.•Waist-to-height ratio predicts current & future CVD risk in South-African adults.•There is greater global agreement on the WHtR threshold (>0.5) for ris

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

Objectives The aim of this study was to determine the best dietary diversity indicator to measure dietary diversity and micronutrient adequacy in children. Methods A national representative cross-sectional survey of children ages 1 to 9 y (N = 2,200) was undertaken in all ethnic groups in South Africa. A 24-h recall was done with the mother or caregiver of each child. A dietary diversity score (DDS), the number of food groups consumed at least once in a period of 24 h, was calculated for each child in accordance with 6-, 9-, 13-, and 21-food group (G) indicators and compared with a mean adequacy ratio (MAR). The nutrient adequacy ratio (NAR) was calculated for 11 micronutrients by comparing the distributions of estimated intakes with the Estimated Average Requirements for that micronutrient. The MAR was the average of all NARs. Correlations were done between MAR and DDS and sensitivity and specificity calculated for each group indicator. Results Pearson’s correlations between food group indicators and MAR indicate that r values were all highly significant (P < 0.0001). There were no consistent or large differences found between the different group indicators although G13 and G21 appeared to be marginally better. Sensitivity and specificity values in the current study lay between DDS of 3 and 5, suggesting one of these as the best indication of (low) micronutrient adequacy. Conclusions Overall results seem to indicate that any of the four G indicators can be used in dietary assessment studies on children, with G13 and G21 being marginally better. A cut-off DDS of 4 and 5, respectively, appear best.

Objective To determine if insulin-like growth factor-1 (IGF-1) is a significant predictor of body fat percentage (%BF), lean body mass, and insulin resistance (IR) in black adolescents presenting with overnutrition and undernutrition. Methods A cross-sectional study was undertaken in 181 adolescents (111 girls, 70 boys, 13–20 years old) from a low socio-economic population in the North-West Province, South Africa. Anthropometric measurements were performed, and %BF and lean mass were assessed by air displacement plethysmography. Serum glucose, leptin, insulin, IGF-1 and IGF-binding protein-3 (IGFBP-3) were measured and homeostasis model assessment of IR (HOMA-IR) was calculated. Predictors of body composition and HOMA-IR were determined in multivariate linear regressions. Results Of the boys, 31% had a %BF >20%, whereas 42% of girls had a %BF >30%. Furthermore, 17.1% male and 18.9% female adolescents were stunted, indicating overnutrition and undernutrition in the same group. IGF-1 showed a negative association with %BF in both sexes, and a positive correlation with height-for-age z-score (HAZ) and lean mass, respectively, in the boys. IGF-1 correlated positively and physical activity correlated negatively with fasting insulin and HOMA-IR in the girls. In both sexes, leptin had the strongest association with %BF in multiple regressions. Leptin and Tanner stage were significant predictors of HOMA-IR in girls, but not in boys. Conclusions IGF-1 was positively associated with lean mass and HAZ in boys, indicating a beneficial relationship with linear growth, but with IR in the girls, indicating possible adverse metabolic effects in the presence of high %BF and physical inactivity. Am. J. Hum. Biol. 26:189–197, 2014. © 2013 Wiley Periodicals, Inc.

BACKGROUND: Child undernutrition remains a major public health concern in developing countries, with many negative consequences to child development. OBJECTIVES: To determine the prevalence of stunting, wasting and underweight amongst Grade 1-learners in the North West Province (NWP) of South Africa (SA), taking into account gender, race and school type. METHOD: Eight hundred and sixteen (419 boys, 397 girls) learners participated in the study (567 black, 218 white, 31 other races). Underweight, stunting and wasting (Weight-for-age, height-for-age, BMI-for-age) were determined using the z-scores of the 2007 WHO reference sample (-2 SD). RESULTS: A higher prevalence of wasting and underweight were found amongst the boys (8.35%; 5.97%) compared with the girls (6.30%; 2.52%), although this was only significant for underweight (p = 0.02), whilst stunting percentages were very similar amongst girls (4.53%) and boys (4.06%). Underweight was the highest in the black group (5.47%;p < 0.01), compared with the white group (0.46%) and the prevalence of the conditions is associated with school types which represent low socio-economic circumstances (Quintile 1-3 schools). Only black learners showed stunting (p < 0.01) and more black learners were wasted (n = 39) compared with white (n = 15; p = 0.08) learners. Quintile 1-3 schools had a significantly higher prevalence of underweight (5.14% - 8.18%) and stunting (3.88% - 10.7%) (p < 0.01) compared with Quintile 4 and 5 schools. CONCLUSION: The prevalence of stunting, wasting and underweight need improvement amongst school beginners, especially in Quintile 1-3 type schools but also amongst black learners living in the NWP of SA as it can have significant hampering effects on the future development and well-being of children.

Background: There is current concern for the health and well-being of children and youth in South Africa, including habits of physical activity (PA) and sedentary behavior. The 2014 Healthy Active Kids South Africa Report Card evaluates the current activity status of children and youth. Methods: The Research Working Group was comprised of 23 experts in physical education, nutrition, sport science, public health and journalism. The search was based on a systematic review of peer-reviewed literature (previous 5 years), dissertations, and nonpeer-reviewed reports (‘gray’ literature) dealing with the PA and nutritional status of South African children and youth 6–18 years of age. Key indicators were identified and data extracted. Grades for each indicator were discussed and assigned. Results: Overall PA levels received a D grade, as roughly 50% or more of children and youth were not meeting recommended levels. Organized sports participation fared better with a C, and government policies were promising, receiving a B. Screen time and sedentary behavior were a major concern and received a grade of F. Under- and over-weight were highlighted, but overweight is on the rise and this indicator was assigned a D grade. Most of the other indicators in South Africa remained the same or became worse so that grades declined from C- to D. In particular, sedentary behavior, soft-drink and fast food consumption, and an ineffectual regulatory environment to control advertising to children were a concern. There is need to engage parents and communities for advocacy and social mobilization.

This narrative review focuses on ethics related to nutrition-specific community-based research, within the framework of science for society, and focusing on the rights and well-being of fieldworkers and research participants. In addition to generally accepted conditions of scientific validity, such as adequate sample size, unbiased measurement outcome and suitable study population, research needs to be appropriate and feasible within the local context. Communities' suspicions about research can be overcome through community participation and clear dialogue. Recruitment of fieldworkers and research participants should be transparent and guided by project-specific selection criteria. Fieldworkers need to be adequately trained, their daily schedules and remuneration must be realistic, and their inputs to the study must be recognized. Fieldworkers may be negatively affected emotionally, financially and physically. Benefits to research participants may include physical and psychological benefits, minimal economic benefit, and health education; while risks may be of a physical, psychological, social, or economic nature. Targeting individuals in high-risk groups may result in social stigmatization. The time burden to the research participant can be minimized by careful attention to study procedures and questionnaire design. Potential benefits to the community, fieldworkers and research participants and anticipated knowledge to be gained should outweigh and justify the potential risks. Researchers should have an exit strategy for study participants. For effective dissemination of results to individual research participants, the host community and nutrition community, the language, format and level of presentation need to be appropriate for the target audience.

This paper aims to propose evidence-based, paediatric food-based dietary guidelines on the complementary feeding period, from six to 24 months, of South Africa. A growing body of evidence supports the World Health Organization recommendation that, following six months of exclusive breastfeeding, appropriate and adequate complementary foods should be introduced, with continued breastfeeding for up to two years of age and beyond. A literature search was done by searching electronic databases (PubMed, the Cochrane Library and Sabinet) and hand searching key reference lists from January 2004 to April 2012, including studies published prior to 2004. Relevant international and national documents from normative bodies, global health and infant feeding authorities, professional and scientific societies and government were identified. It has been established that, in South Africa, high levels of stunting, growing concerns about overweight and obesity and the poor intake of certain micronutrients in the critical six- to 24-month period are, in part, a consequence of poor breastfeeding and complementary feeding practices, as well as the poor quality of the complementary diet. The introduction of semi-solid foods before four months of age is a common practice. The typical maize-based feeding pattern is low in food sourced from animals, vegetables and fruit and omega-3 fatty acids. Efforts by mothers to improve the quality of their children’s diets by adding energy-rich food to maize meal improves energy intake, but not micronutrient intake. Low nutrient-dense liquid, such as tea and coffee, energy-dense sugar-sweetened drinks, an excessive intake of fruit juice and high-fat and salty snacks exacerbate poor nutrient intake and displace nutrient-dense food in the diet. Healthcare workers should provide consistent, evidence-based messages and guidelines to caregivers of future generations. Interventions must be implemented and strengthened at a programme level. These could include

Little is known about the effects of combined micronutrient and sugar consumption on growth and cognition. In the present study, we investigated the effects of micronutrients and sugar, alone and in combination, in a beverage on growth and cognition in schoolchildren. In a 2 £ 2 factorial design, children (n 414, 6–11 years) were randomly allocated to consume beverages containing (1) micronutrients with sugar, (2) micronutrients with a non-nutritive sweetener, (3) no micronutrients with sugar or (4) no micronutrients with a non-nutritive sweetener for 8·5 months. Growth was assessed and cognition was tested using the Kaufman Assessment Battery for Children version II (KABC-II) subtests and the Hopkins Verbal Learning Test (HVLT). Micronutrients decreased the OR for Fe deficiency at the endpoint (OR 0·19; 95% CI 0·07, 0·53). Micronutrients increased KABC Atlantis (intervention effect: 0·76; 95% CI 0·10, 1·42) and HVLT Discrimination Index (1·00; 95% CI 0·01, 2·00) scores. Sugar increased KABC Atlantis (0·71; 95% CI 0·05, 1·37) and Rover (0·72; 95% CI 0·08, 1·35) scores and HVLT Recall 3 (0·94; 95% CI 0·15, 1·72). Significant micronutrient £ sugar interaction effects on the Atlantis, Number recall, Rover and Discrimination Index scores indicated that micronutrients and sugar in combination attenuated the beneficial effects of micronutrients or sugar alone. Micronutrients or sugar alone had a lowering effect on weight-for-age z-scores relative to controls (micronutrients 20·08; 95% CI 20·15, 20·01; sugar 20·07; 95% CI 20·14, 20·002), but in combination, this effect was attenuated. The beverages with micronutrients or added sugar alone had a beneficial effect on cognition, which was attenuated when provided in combination.

Objective: A waist:height ratio (WHtR) higher than 0.5 has been proposed as a cutoff point for abdominal obesity in both sexes and at all ages. It is unknown if this cutoff point is appropriate for previously undernourished adolescents. We assessed the cutoff value of the WHtR associated with an increased metabolic risk in 178 black South African 14- to 18-y-old adolescents (69 boys, 109 girls). Methods: We measured weight, height, waist circumference, fasting plasma glucose and insulin levels, serum high-sensitivity C-reactive protein, and blood pressure and calculated the WHtR and homeostasis model assessment of insulin resistance (HOMA-IR). Using receiver operating characteristics curve analyses, we assessed the WHtR with the highest sensitivity and specificity to discriminate adolescents with increased fasting plasma glucose, HOMA-IR, serum high-sensitivity C-reactive protein, and blood pressure from those with “normal” values. Results: The WHtR cutoff points derived from the receiver operating characteristics curves ranged from 0.40 to 0.41, with best diagnostic value at 0.41. A WHtR of 0.40 had 80% sensitivity and 38.5% specificity to classify adolescents with fasting blood glucose level higher than 5.6 mmol/L (area under the curve [AUC] 0.57). A WHtR of 0.41 had 64% sensitivity and 58.5% specificity for a HOMAIR higher than 3.4 (AUC 0.66), 55% sensitivity and 55.6% specificity for a high-sensitivity C-reactive protein level higher than 1 mg/L (AUC 0.57), and 64% sensitivity and 50.2% specificity for a blood pressure higher than the age-, sex-, and height-specific 90th percentiles (AUC 0.56). Adolescents with a WHtR higher than 0.41 had an odds ratio of 2.46 (95% confidence interval 0.96–6.30) for having a HOMA-IR higher than 3.4. Conclusion: The WHtR cutoff to indicate metabolic risk for black South African adolescents is 0.41, which is lower than the proposed international cutoff of 0.5. The WHtR can be used for screening adolescents with components of the m

The objective of this study was to report on the iron status of South African primary schoolchildren, as reported in independent studies conducted since the last National Food Consumption Survey-Fortification Baseline (NFCS-FB) in 2005. Internet searches were conducted for cross-sectional and randomised controlled trials that reported on the iron status of South African primary schoolchildren, published after the NFCS-FB of 2005. Search engines that were used included Science Direct, Sabinet, PubMed, EBSCOhost (Academic Search Premier, Health Source and Medline) and Web of Knowledge. The search terms in different combinations were “South Africa”, “children”, “iron”, “anaemia”, “iron deficiency”, “micronutrient”, “malnutrition” and “nutritional status”. Secondary analysis was carried out on the NFCS-FB data on children aged 7-9 years at provincial level. Outcome measures used were haemoglobin (Hb) and serum ferritin. The search identified four independent studies that were conducted in four different provinces: KwaZulu-Natal, North West, Western Cape and Northern Cape. All four were conducted in low socio-economic areas and selected children with poor iron status for intervention purposes. The studies reported an anaemia prevalence lower than that of the NFCS-FB: 11.5% vs. 14.4%, KwaZulu-Natal; 6.9% vs. 27%, North West; 17.2% vs. 18.8%, Western Cape; and 5.4% vs. 22.2%, Northern Cape. Serum ferritin was more difficult to interpret because different cut-off points were used. Anaemia prevalence, based on Hb concentration in primary schoolchildren, might have improved in some regions since the NFCS-FB. Regular national surveys are recommended to ensure that the iron status of South African primary schoolchildren is kept under surveillance

Anemia is a common complication of pediatric HIV infection and is associated with suboptimal cognitive performance and growth failure. Routine iron supplementation is not provided to South African HIV-infected children. We hypothesized that dietary iron intake without supplementation is sufficient to protect against iron deficiency (ID) in HIV-infected children receiving highly active antiretroviral therapy. In this prospective study, the difference between dietary intakes of iron-deficient children (soluble transferrin receptor >9.4 mg/L) and iron-sufficient children after 18 months on highly active antiretroviral therapy was examined. The association between iron intake and hemoglobin (Hb) concentration was also assessed. Longitudinal data collected for 18 months from 58 HIVinfected African children were assessed by generalized estimation equations, with adjustment for demographic information, dietary intakes, growth parameters, and CD4%. After adjustment for covariates, the longitudinal association between dietary iron intake and Hb concentration remained significant. This association shows that for every 1-mg increase in iron intake per day, Hb increases by 1.1 g/L (P < .001). Mean Hb increased significantly after 18 months of follow-up (106 ± 14 to 129 ± 14 g/L, P < .01), but soluble transferrin receptor also increased (7.7 ± 2.7 to 8.9 ± 3.0 mg/L, P < .01). The incidence of ID increased from 15.2% at baseline to 37.2% after 18 months. Children with animal protein intakes greater than >20 g/d had significantly lower odds for ID at 18 months than did children with lower intakes (odds ratio, 0.40; 95% confidence interval, 0.21-0.77). Dietary iron intake was insufficient to protect against ID, pointing to a need for low-dose iron supplementation for iron-deficient HIV-infected children and interventions to increase the consumption of animal protein.