South African Journal of Clinical Nutrition

Urgent call for awareness and education about donor breastmilk

2024-04-15T09:21:29+00:00

No Abstract

Knowledge, attitudes and awareness regarding donor breast milk: a crosssectional study of mothers in a high HIV-prevalent area

2024-04-15T09:28:49+00:00

Background: The use of donated expressed breast milk (DBM) is encouraged in South Africa, with donor milk banks and legislated policies and programmes available in hospitals serving populations with a high HIV prevalence. Concerns over poor attitudes amongst mothers towards DBM seem to persist.

Methods: A cross-sectional mixed-methods approach was used in a cohort of mothers of neonates in a regional hospital. Between April 2021 and January 2022, survey data on knowledge, awareness and attitudes towards DBM was collected. Qualitative data from open- ended questions were thematically analysed. Comparative analysis using independent sample t-tests and logistic regression to determine differences in variables and to understand associations related to knowledge was conducted.

Results: A total of 163 mothers with a mean (SD) age of 27.1 ± 6.3 years were included; 49.7% of mothers had post-high-school qualifications, 82.8% were unemployed and 87.0% received social security. Some 64.4% had inadequate knowledge of DBM. Awareness of DBM had the strongest association with better knowledge concerning DBM and AdjOR (25.25 95% CI 10.60– 68.40; p < 0.001). Negative attitudes towards DBM were largely driven by a lack of knowledge regarding human immunodeficiency virus (HIV) screening of donor mothers and fears of HIV transmission when using DBM.

Conclusion: Lack of awareness concerning DBM was associated with poor knowledge of DBM, which may drive poor uptake of this critical nutritional source for at-risk neonates. Implementing targeted awareness programmes on DBM, which begin in the antenatal period and specifically address HIV screening of donor mothers, could address the poor uptake of DBM.

Associations between nutrition knowledge and obesity-related attitudes and physical activity among young adults from Kenya, South Africa, and the United Kingdom

2024-04-15T09:43:22+00:00

Objective: This study’s aim was to test associations between nutrition knowledge and obesity-related attitudes and physical activity (PA) among 3000 18–35-year-old men and women from Kenya, South Africa (SA), and the United Kingdom (UK).

Methods: A cross-sectional online survey was conducted in April 2022. To estimate nutrition knowledge, dietary recommendation knowledge score was computed using the standard General Nutrition Knowledge questionnaire. Obesityrelated attitudes were from the British Social Attitudes Survey. Self-reported days of vigorous and moderate PAs and walking were used. Ordinal logistic regression was employed to test all associations, while adjusting for age group, gender and a household asset score. Using simple mediation, testing was also done to ascertain whether obesity-related attitudes mediated associations between nutrition knowledge and PA.

Results: Consistently, better nutrition knowledge was associated with disagreeing that ‘There is no reason to worry about obesity’ (ORs ≥ 1.09), but lower odds of being against ‘Providing free weight management courses’ and ‘Creating/improving cycle paths and pavements to encourage PA’ (ORs ≤ 0.90). Better nutrition knowledge was also associated with higher vigorous PA in SA (OR = 1.09), and moderate PA (OR = 1.04) and walking (OR = 1.12) in the UK. In the combined sample, associations of nutrition knowledge with vigorous PA were fully mediated by believing that ‘Obesity results from not exercising enough’ (11.1% mediated). Likewise, associations of nutrition knowledge with moderate PA were fully mediated by attitude towards ‘Creating or improving cycle paths and pavements to encourage PA’ in the UK (38.9% mediated).

Conclusions: Nutrition knowledge is associated with obesity-related attitudes and PA among young adults, but some relationships are country-specific. Interventions based on findings from high-income countries should be evaluated before being implemented in low-resource settings.

Agreement between measured energy expenditure and predictive energy equations in paediatric oncology

2024-04-15T09:53:39+00:00

Purpose: Optimal nutritional support in childhood cancer relies on the adequate provision of energy. This study investigated the impact of chemotherapy on resting energy expenditure (REE) during the first six months of treatment and the accuracy of predictive equations in calculating said requirements of newly diagnosed children with cancer.
Methods: REE was measured at diagnosis utilising a validated bioelectrical impedance analysis (BIA) mobile unit and compared with three predictive equations (Schofield 1985, World Health Organization [WHO] 1985 and the Recommended Dietary Allowance [RDA] 1989). Agreement and accuracy of these equations were tested by determining bias and agreement rates and displayed using the Bland– Altman plot. Baseline values were plotted against monthly follow-up measurements over time. Statistical significance was 5% and a priori limits of agreement set between 90% and 110% of measured REE.
Results: Forty-three newly diagnosed children with median age 4 years (IQR 2.0–7.6) were measured prior to chemotherapy initiation. Compared with measured REE (mean ± SD) 719.53 ± 206.29 kcal/day, all predictive equations significantly overestimated REE: WHO 1985 (889.75 ± 323.31 kcal/day; 23% overestimation), Schofield 1985 (899.62 ± 336.10 kcal/day; 25% overestimation) and RDA (1647.67 ± 481.06 kcal/day; 129% overestimation) (p < 0.001). Despite significant proportionate bias in all three equations (p < 0.001), the intra-class consistency coefficient showed good reliability for the Schofield 1985 (0.864) and WHO 1985 (0.849) equations. Though statistically significant (chi-square = 23.11, p < 0.003), the overall 1 kcal/kg (1.3%) increase for all cancer types at six months may not be clinically significant.
Conclusion: Existing predictive equations are unable to calculate REE accurately at childhood cancer diagnosis, highlighting the need for future investigations into the development of cancer-specific equations.

Non-nutritive sweeteners: consumer awareness and inclusion in food and beverage products in South Africa

2024-04-15T10:02:45+00:00

Background: The widespread use of non-nutritive sweeteners (NNSs) in the food and beverage industry has become a global trend.

Objective: A study was undertaken to assess the level of awareness of South Africans of NNSs and to create a scientific product database of NNSs in a sample of packaged products in South Africa.

Design: A cross-sectional survey design was chosen.

Setting: The study was carried out online in South Africa.

Subjects: The study participants were South African adults (n = 388).

Outcome measures: A consumer awareness survey on NNSs and a scientific product database were created to identify products formulated with NNSs.

Results: A large proportion of participants were unfamiliar with most NNSs by name; however, a significant 61% (n = 238) (p < 0.001) of participants were most aware of xylitol, and 45% (n = 174) were aware of aspartame. Despite this, a significant number of participants consumed products labelled ‘sugar-free’ and/or ‘diet’ (p < 0.001). Participants were aware of health concerns and health benefits associated with the consumption of NNSs. A scientific product database consisting of 419 products containing NNSs was created during the study. A combination of NNSs was used in the formulations of 65% (n = 273) of the products, while 35% (n = 146) of the products were formulated with a single NNS.

Conclusion: The outcome of this research highlights key consumer insights into NNSs and their widespread use in product formulations in South Africa. The outcome of this study shows the need for continuous monitoring of the effects of the increasing use of NNSs in product formulation and their impact on health and diet. Consumer education would advance consumer awareness of NNSs.

Job satisfaction and perception of workloads among dietitians and nutritionists registered in South Africa

2024-04-15T10:08:53+00:00

Background: Personal perspective concerning work demands directly impacts quality health care and patient satisfaction. Little is known about job satisfaction amongst dietitians and nutritionist, while workload has not previously been studied in this population.

Methods: A descriptive cross-sectional study was performed using an online questionnaire. Data were collected on sociodemography. Job satisfaction was measured with Spector’s Job Satisfaction Survey (JSS) (including an added subscore for resource availability) and workload with the National Aeronautics and Space Administration Task Load Index (NASA-TLX).

Results: Respondents (n = 238) had a median age of 32.0 years (IQR: 27−39 years); 92.4% were female; 95.7% were dietitians, 2.4% were nutritionists and 18.9% had a postgraduate degree. Respondents had practised the profession for a median of 8 years (IQR 3−15 years), and 225 were in dietetic and nutrition-related jobs. Median scores indicated that they were slightly satisfied with their jobs (n = 224) and experienced slightly high workload (n = 224). Most respondents were moderately satisfied with the nature of their work and found it rewarding. The median scores for salaries, promotion opportunities, work environment and availability of resources were low. Total JSS was higher in older and more experienced dietitians and nutritionists than in younger ones (p < 0.05). Those employed in the government sector (n = 100) experienced higher physical demands and levels of frustration, and had lower JJS than those employed elsewhere (n = 124), particularly regarding promotion opportunities and resources availability.

Conclusion: Despite being generally positive towards practising their profession, South African dietitians and nutritionists, particularly in the public health sector, experienced only slight job satisfaction, related to salary and promotion issues and lack of resources, and were slightly overworked. Understanding the factors that shape perceptions of work within nutrition and dietetics may assist managers in recruiting and retaining a highly skilled workforce, particularly in developing countries with overburdened healthcare systems.

Integration of nutrition support using the FIGO nutrition checklist in the Bukhali trial: a dietitian’s perspective

2024-04-15T10:16:37+00:00

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.