South African Journal of Clinical Nutrition

Lung transplantation in cystic fibrosis, a South African case study

Tanna Cohen — Mon, 30 Dec 2024 00:00:00 +0000

No abstract

Social media and electronic communication usage by South African dietitians

J. Visser, E. van Niekerk, M.L. Marais, N. Koen — Mon, 30 Dec 2024 00:00:00 +0000

Objectives: This study investigated to what extent South African dietitians make use of social media and electronic communication and their compliance with the ethical guidelines set by the Health Professions Council of South Africa (HPCSA).
Design: Cross-sectional descriptive design.
Setting: South Africa.
Subjects: Registered South African dietitians.
Methods: Data were collected using an online survey (N=125) and an observational checklist for selected digital platforms (N =135). Both parts assessed demographic characteristics, usage of digital platforms and awareness or adherence to ethical guidelines.
Results: Most participants used Instagram (45.5%) and Facebook (31.6%) as these platforms were regarded as user friendly, quick and suitable for their target audiences. Barriers to social media usage included time constraints (53.0%) and being unfamiliar with some platforms (37.3%). Enablers to social media usage included better reach of target population (61.4%) and ease of use (56.6%). The majority of survey participants were aware of the HPCSA Ethical Guidelines for Good Practice (n = 68/75, 90.7%). Overall compliance with the HPCSA guidelines was observed, yet nearly half (37/89, 41.6%) of the dietitians who shared information on digital platforms never provided references. Forms of touting/canvassing were observed on 20.7% (n = 28/135) of the platforms, while 15.6% of dietitians (n = 21) sold products on their websites, mostly meal-plans and supplements.
Conclusion: South African dietitians actively engage with digital platforms to a varied extent, highlighting the importance of being cognisant of, and applying, the HPCSA Ethical Guidelines for Good Practice. The study can be useful in guiding future research on this unexplored, emerging topic.

Estimation accuracy of bean bags as portion size estimation aids for amorphous foods

Friedeburg Anna Maria Wenhold, Una Elizabeth MacIntyre — Mon, 30 Dec 2024 00:00:00 +0000

Objective: A study was undertaken to explore the portion size estimation accuracy of bean bags as low-cost volumetric portion size estimation aids for amorphous foods.
Designs: Three observational, cross-sectional and three experimental/quasi-experimental developmental evaluation sub-studies were carried out.
Settings: Observational, cross-sectional: one retirement village and four schools. Experimental/quasi-experimental: one South African university.
Participants: Observational, cross-sectional: elderly persons, adult women (school educators), school children. Experimental/quasi-experimental: university students. In total N = 541; > 3 800 observations.
Variables measured: Using a standardised set of bean bags (test object; volume range: 60–625 ml), volumes of different amorphous foods (reference objects: actual foods or representations) in varying portion sizes had to be estimated. Accuracy (outcome measure) was perfect if volumes of test and reference object were identical. Acceptable estimation accuracy allowed for misestimation by one bean bag size. Test–retest reproducibility was also assessed.
Analysis: Descriptive statistics (proportions perfect and acceptable accuracy).
Results: Across the sub-studies, perfect accuracy ranged from 22–65% depending on participants, reference food and portion size. Irrespective thereof, acceptable accuracy was noted in > 70% of observations. Reproducibility varied (range: 28–67% agreement).
Conclusions and implications: Perfect portion size estimation of amorphous foods remains challenging. When misestimation by 60–125 ml still serves the purpose of a dietary assessment, bean bags show promise for cost-effective food volume quantification, especially on group level in resource-limited settings.

Perceptions of dietitians and key role players regarding their role in reporting food labelling transgressions in South Africa

M. Profe-Fuchsloch, N Koen, M. Wicks — Mon, 30 Dec 2024 00:00:00 +0000

Objectives: A study was undertaken to describe South African dietitians and key role players’ perceptions regarding their role in reporting food labelling legislation transgressions.
Design: A multimethod study design was employed to explore a previously unstudied topic.
Setting: Dietitians registered with the Health Professions Council of South Africa (HPCSA) together with key role players in food labelling in South Africa.
Methods: Quantitative data were collected using a self-administered electronic questionnaire and qualitative data using a semi-structured interview guide. Quantitative data were analysed using Microsoft Excel and qualitative data using ATLAS.ti software. Data were analysed independently in the results section but integrated for interpretation of the findings.
Results: In total, only 6% (n = 7) of the included dietitians (n = 126) reported food labelling transgressions, and 12% (n = 15) believed dietitians have a role to play in reporting transgressions. Interestingly, half of the included dietitians (50%, n = 63) stated they would report an identified transgression. Dietitians demonstrated a lack of awareness of the current food labelling regulations, with 43% wrongly identifying the draft regulation to consult. Almost all (99%, n = 125) of the included dietitians reported that their transgression reporting practices would improve if a clear guideline from the Department of Health: Directorate Food Control (DoH DFC) was available. Key role players (n = 8) cited enforcement issues and a perceived gap in dietitians’ understanding of legislation and reporting processes as barriers to reporting non-compliance. Key role players identified enablers such as awareness of regulations, contacts within the DoH DFC and familiarity with the reporting process for transgressions. They also provided insight on the proper procedure for reporting food labelling transgressions.
Conclusion: The low prevalence of food labelling transgression reporting by dietitians stems from several barriers, including a perceived lack of confidence regarding the current regulation, awareness of the applicable legislation, uncertainty regarding the correct reporting procedure and scepticism that transgression reports will be acted upon. Regular communication regarding food and nutrition regulations and the development of an easy-to-use transgression reporting framework could support the implementation and impact of food labelling regulations in South Africa.

Muscle ultrasound: a reliable bedside tool for dietitians to monitor muscle mass

Lizl Veldsman, Alison Lupton-Smith, Guy A. Richards, Renée Blaauwa — Mon, 30 Dec 2024 00:00:00 +0000

Objectives: Monitoring muscle mass (cross-sectional area [CSA]) and quality (echogenicity) using ultrasound may help optimise nutrition support in the critically ill. However, to date, ultrasound imaging has not been included in the undergraduate training of dietitians, who are mostly responsible for the nutrition care of critically ill patients. This study assessed the accuracy and reliability of bedside imaging performed by a dietitian trained according to standardised methodology, followed by blinded analyses.
Methods: Two operators (a trainer and dietitian trainee) performed B-mode ultrasonography of the rectus femoris quadriceps muscle. For inter-rater accuracy, imaging was performed independently on 32 subjects by both operators, and for intra-rater reliability both obtained a second image on 15 subjects. A blinded assessor performed analyses (CSA and echogenicity) on all images. In a subset of 11 subjects, a musculoskeletal sonographer repeated all measurements. Inter- and intra-rater reliability were determined by calculating intraclass correlation coefficients (ICC), based on an absolute-agreement, 2-way mixed-effects model. An ICC > 0.75 was classified as good and > 0.90 as excellent.
Results: Intra- (ICC = 0.9–0.94) and inter-rater (ICC = 0.85–0.95) reliability of the imaging performed was good to excellent. No statistically significant differences were found between the two operators (mean difference for CSA = 0.18 cm², 95% CI = −0.38–0.03, p = 0.08; mean difference for echogenicity = 6.88, CI = −0.71–14.78, p = 0.07). Inter-rater reliability for image analyses was excellent (ICC = 0.97–1.0).
Conclusion: Bedside ultrasound performed by a dietitian trained according to standardised methodology shows good to excellent reliability and reproducibility. Training dietitians to perform bedside ultrasound may help to monitor muscle mass and quality in the critically ill.

Risk factor profile for non-communicable diseases: findings of a STEPS survey among the support staff at the University of Pretoria, South Africa

Sithabile Nombulelo Mathunjwa, Tshegofatso Betty Mohlala, Heather Modiehi Legodi — Mon, 30 Dec 2024 00:00:00 +0000

Background: Non-communicable diseases (NCDs) are an important problem in South Africa; they account for 60% of all deaths. Early screening could help lower NCD incidences and long-term consequences.
Objective: The study aimed to profile NCD risk factors among insourced support staff at the University of Pretoria in 2018.
Design: A cross-sectional, descriptive study was conducted at the University of Pretoria, Hatfield Campus. The World Health Organization (WHO) STEPwise approach to chronic disease risk factor surveillance (STEPS) questionnaire was administered
to collect data in three steps. The participants’ behavioural risk profiles were gathered using the face-to-face interview technique (STEP I), followed by their physical risk profile using anthropometric and blood pressure measurements (STEP II). Last was the biochemical risk profile, including finger-prick blood glucose and cholesterol measurement (STEP III). Data were analysed using Epi-Info, version 3.54.
Subjects: A convenient sample of participants aged 18–64 years from the Departments of Industrial Hygiene and Building Services, Landscape Services, Sports Fields Management, and Security Services (n = 146, 60% were females) took part in the study.
Results: Most participants (97.8%) had low daily fruit and vegetable intake. Some 80% of the study population always or often added salt to their food when cooking. Daily alcohol consumption was reported by a quarter of the sample. More than two-thirds of all the participants were overweight or obese and 61% had central obesity.
Conclusion: The study identified a high prevalence of several NCD risk factors. Tailored nutrition education and monitoring are needed to lower the elevated risk.

Change in the prevalence of extra-uterine growth restriction in very low birthweight infants, following the introduction of a written nutrition protocol, in a tertiary neonatal unit

LND Mosidia Mosidi, A. van Niekerk, M. Coetzee — Mon, 30 Dec 2024 00:00:00 +0000

Background: Advances in neonatal medicine, resulting in improved survival, have brought the concept of extra-uterine growth restriction (EUGR), defined as postnatal growth failure secondary to protein and energy deficits, to the forefront as an important cause of morbidity, particularly in very low birthweight (VLBW) neonates.
Objectives: This study’s main objective was to determine the prevalence of EUGR in Steve Biko Academic Hospital in VLBW infants.
Methods: This was a pre- (epoch 1) and post- (epoch 2) intervention study. The intervention was the introduction of a written nutritional protocol in the neonatal unit in mid-November 2017. Three definitions were used to identify EUGR, namely: (1) discharge weight < 10th percentile, (2) a change by −1.28 z-score in weight at discharge, and (3) the discharge weight percentile below the nadir percentile.
Results: The prevalence of EUGR in epoch 1 was 85.7%, 63.5%, and 88.0% using the above definitions, respectively. The prevalence of EUGR in epoch 2 was 73.9%, 65.8%, and 89.4% using the above definitions, respectively. EUGR using the three definitions combined was present in 95.2% and 92.8% of infants in epochs 1 and 2, respectively. None of the differences in EUGR prevalence between the two epochs were significant.
Conclusion: The prevalence of EUGR was not significantly different between the two epochs, although it had been proposed that the introduction of a written nutritional protocol would have decreased the prevalence of EUGR in epoch 2. One of the reasons proposed for this finding was poor adherence to the nutritional protocol during epoch 2.

Estimating portion size in dietary assessment

Mieke Faber — Mon, 30 Dec 2024 00:00:00 +0000

Editorial