South African Journal of Clinical Nutrition

Knowledge, attitudes and support practices related to breastfeeding promotion of doctors and nurses in Motheo district, Free State province, South Africa

Imke Hennop — 2025-02-18

Background: Breastfeeding is widely acknowledged as the optimal method of infant feeding. However, the percentage of South African mothers who exclusively breastfeed remains alarmingly low. Healthcare workers (HCWs) are pivotal in promoting breastfeeding; however, a deficiency in their knowledge, negative attitudes, and unfavourable practices can impede the promotion and support of breastfeeding.

Aim: To assess the knowledge, attitudes, and support practices related to breastfeeding promotion of HCWs in the Motheo district, Free State province, compared with the 2016 WHO Guideline updates on HIV and infant feeding and 2018 MotherBaby Friendly initiative guidelines.

Methods: A quantitative analytical cross-sectional study involving paediatricians, obstetricians, general practitioners (GPs), and midwives was conducted using a self-administered questionnaire.

Results: Over half of the HCWs (59%) were able to define exclusive breastfeeding (EBF), with a significant majority of GPs (76.1%) and midwives (78.6%) recommending EBF up to six months, compared with only 10% of paediatricians and 25% of obstetricians (p < 0.001). Some 11.1% of the total group of HCWs reported that breastfeeding is contraindicated for HIVinfected mothers, while 15.4% were unsure of the recommendation for breastfeeding among HIV-infected mothers. A higher proportion of midwives, compared with other HCWs, felt highly confident in providing breastfeeding advice (p < 0.001). Additionally, more than half (56%) of HCWs had not completed the 20-hour WHO Lactation Management Training, and 55% believed their prior breastfeeding training was not sufficient to support and educate breastfeeding mothers.

Conclusion: Regular breastfeeding training of HCWs on the latest breastfeeding guidelines is necessary to equip HCWs with the knowledge and competence to successfully promote, protect, and support breastfeeding.

Changes in hepatic volume and body composition following a two-week very low-calorie diet (VLCD) prior to a laparoscopic Nissen fundoplication

Francis-Mico Price — 2025-02-18

An enlarged fatty liver makes laparoscopic surgery of the upper gastrointestinal tract (GIT) more technically challenging.1 A 35-year-old female was referred to the dietitian for a preoperative very low-calorie diet (VLCD) to assist in decreasing hepatic volume and visceral adiposity. This case study highlights that the same benefits shown using preoperative VLCDs in bariatric patients as part of enhanced recovery after surgery (ERAS) guidelines can be observed in non-bariatric upper GIT surgery patients as well.2 In a time period of two weeks on a VLCD, a 50.7% reduction in left hepatic lobe volume (LHLV) was observed, as well as 1.4 kg fat loss around the abdomen.

Healthcare providers and breastfeeding support skills: the need for education and training

Elizabeth A. Symington — 2025-02-18

No Abstract

Energy expenditure measured by indirect calorimetry in a neuroscience intensive care unit: a retrospective observational study

Clarabella Liew — 2025-02-18

Objectives: To compare indirect calorimetry (IC) readings with the Harris–Benedict equation (HBE) predictions of resting energy expenditure (REE) in intubated acute brain-injured patients in a tertiary hospital’s Neuroscience Intensive Care Unit (ICU).

Design: A single-centre, retrospective study.

Setting: Neuroscience Intensive Care Unit at a tertiary hospital.

Subjects: All adult patients admitted to the Neuroscience Intensive Care Unit between June 1, 2020, and June 30, 2021, who had an IC reading.

Outcome measures: Comparison of the measured REE using IC and the predicted REE using the HBE modified for critically ill adults. Subgroup analysis based on body mass index (BMI) was also performed.

Results: A total of 108 patients had IC readings taken during the study period. There was a significant difference between the REE predicted by the HBE and the measured IC readings, with a mean difference of 465.3 kcal (95% CI 408.1–522.5, p = 0.001). A moderate positive correlation was observed (coefficient r = 0.565, p < 0.001). In patients with BMI ≥ 30 kg/m², the HBE significantly overestimated REE compared with IC readings (p = 0.005).

Conclusions: The Harris–Benedict equation tends to overestimate resting energy expenditure, especially in acute brain-injured patients with a BMI ≥ 30 kg/m². Utilising IC-directed nutrition therapy in intensive care units could help in delivering personalised caloric intake, reducing the risks of underfeeding or overfeeding.

Predictors of vitamin D status in undernourished and well-nourished children 6–59 months old, in the JB Marks Municipality of South Africa

J.A. Carboo — 2025-02-18

Objective: to investigate the predictors of vitamin D (vitD) status of undernourished and well-nourished children aged under five years in the North West Province of South Africa.
Design: this cross-sectional study assessed sociodemographic data, nutritional supplement intake, vitD-rich food consumption, and sunlight exposure via a structured questionnaire. Venous blood samples were collected to evaluate vitD, iron, and inflammatory markers.
Setting: the maternal and child wellness departments of six community clinics in the JB Marks Municipality.
Participants: 121 undernourished and 51 well-nourished children, 6–59 months old.
Results: The prevalence of serum 25(OH)D < 30 ng/ml was 20.3%, 19.9%, and 21.6% in the total, undernourished, and wellnourished groups, respectively. The total mean 25(OH)D concentration was 38.41 ± 9.64 ng/ml. Age showed a negative association trend with 25(OH)D in the well-nourished group (β: −0.172, 95% CI −0.353, 0.010, p = 0.063), while household income was inversely associated with 25(OH)D (β = −1.86, 95%CI = −2.99, −0.733, p = 0.001) in the total group. Among the undernourished children, iron-deficiency anaemia (IDA) was associated with almost five times greater odds for 25(OH)D < 30 ng/ml (OR: 4.646, 95% CI 1.339, 16.123, p = 0.016). Intake of vitD supplements, therapeutic foods, multivitamins, and formula milk was associated with significantly higher 25(OH)D concentrations and was adjusted for in subsequent analyses. Additionally, consumption of eggs more than once a month was associated with higher 25(OH)D levels in the wellnourished children aged 24–59 months. Nutritional status, inflammation, and sunlight exposure were not associated with 25(OH)D concentrations.
Conclusion: vitD insufficiency exists in both the undernourished and the well-nourished. Age, egg consumption, and IDA should be considered in the correction of vitD insufficiency in children.

Perceived barriers and enablers for consuming a diverse diet in women residing in resource-poor communities in Cape Town, South Africa: a qualitative study

Samukelisiwe S. Madlala — 2025-02-18

Background: Several studies have shown that South Africans consume a diet low in variety.

Objective: To explore the barriers and enablers for consuming a diverse diet in resource-poor communities around Cape Town.

Design: A qualitative study design was used. Data were collected from focus-group discussions (FGDs) conducted in Afrikaans, IsiXhosa, and English, using a semi-structured guide.

Setting: Twelve community sites in Cape Town, South Africa.

Subjects: Study participants were 24 Black and 21 Mixed-ancestry women (n = 45) with a mean age of 49.7 ± 7.8 years.

Results: Fourteen FGDs were conducted with an average of three participants per FGD. Six themes were identified from the FGDs, which included nutrition knowledge, perceptions of dietary diversity and its impact on health, individual factors, and social, physical environment, and societal influences on food choices. Perceived barriers to consuming a diverse diet included financial constraints, high food prices, and family taste preferences. Perceived enablers identified were individual taste preferences, access to food stores, community food aid, and food-store specials. Proposed facilitators to achieving a diverse diet included budgeting, income-generation activities, lowering food prices, and increasing community food aid.

Conclusions: The findings of this study suggest that financial constraints, high food prices, and social factors limit the ability of women from resource-poor communities to consume a diverse diet and make healthy food choices. Public health interventions aimed at promoting healthier food choices and reducing diet-related diseases should address financial barriers and the cost of food.

Why traditional diets are more relevant than ever today

Karen Cheryl Morris — 2025-02-18

The current epidemic of obesity and its co-morbidities reflect an urgent need to reform our modern eating patterns. This commentary proposes the reclamation of our traditional diets of the precolonial, preindustrial era, which are argued to be more sustainable, in terms of health, economics, and ecology, than the low-carbohydrate or Palaeolithic diet. It is also argued that, via the reclamation of traditional diets, a more successful uptake of the current Food Based Dietary Guideline for increasing intake of pulses could be achieved.

South African Journal of Clinical Nutrition – remembering the past, and a glimpse into the future

Janicke Visser — 2025-02-18

No Abstract.