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Dietary intake, cost of foods and associated factors of women with gestational diabetes
Get PDFBackground: Gestational Diabetes Mellitus (GDM) prevalence has increased globally over the last 20 years and according to the International Diabetes Federation (IDF), GDM prevalence in South Africa from 2011 to 2021 has increased by 11%. A study conducted in Johannesburg in 2018, highlighted that 9.1% (174/1906) of pregnant women developed GDM. Furthermore, an alarming 40% of women in South Africa with a history of GDM develop Type 2 Diabetes Mellitus (T2DM) within five years following their index pregnancy. Medical Nutrition Therapy (MNT) is essential in the treatment of GDM in combination with physical activity, lifestyle and behaviour change and a need exists for appropriate counselling and education. In low socioeconomic areas, implementing healthy diets is challenging, with affordability and availability being assumed as key barriers, necessitating and understanding food choice determinants. Developing viable solutions to these issues is essential for effective MNT, highlighting the need for further research to overcome these challenges. This Master's dissertation had two aims, with aim 1 investigating the dietary intake and associated factors of women with GDM and aim 2 to investigate determinants of cost and availability of foods (listed in the FFQ) and additional foods (not listed on FFQ) consumed by participants at baseline from the IINDIAGO study and compare to healthy and affordable alternatives where applicable. Methods: A cross-sectional descriptive study was conducted on n=205 women with GDM utilizing data from the IINDIAGO study. The IINDIAGO study is a convergent parallel mixed methods study with the main component being a pragmatic, 2-arm individually randomised controlled trial, which was carried out at five major referral centres and up to 26 well-baby clinics in the Western Cape and Gauteng provinces of South Africa. For the purpose of the current study only the baseline data in Cape Town were analysed. Dietary information was collected with the use of Food Frequency Questionnaires (FFQ) and interviewed-administered questionnaires were used to collect sociodemographic, socioeconomic, health behaviours, food security, psychosocial factors, past behaviour change attempts, perceived behavioural control and perceived barriers information. The costs of FFQ items at various supermarkets in Cape Town and availability of foods in areas participants resided was determined. A detailed cost evaluation was completed, and affordable healthy food alternatives were identified, culminating in the development of a diet plan based on the SEMDSA (2017) guidelines. Data were captured on REDCAP and subsequently transferred to Microsoft Excell 365 (Version 2309). The Statistical Package for Social Science (SPSS) was then used to analyse frequencies and means. Results: The findings revealed that participants' diets were energy-dense (ED) with a mean carbohydrate (CHO) intake of 417.6 ± 209.4g/d (70.4% of TE) and an alarmingly high intake of added sugars of 185.9 ± 191.5g/d (31.7% of TE). Table sugar, amongst the top 20 foods, contributed to the highest total energy intake (43.7%) as well as the top food item contributing to total CHO intake (61.3%). The top 40 commonly consumed food items revealed that sugar and some ED foods and snacks (crisps, fried chips, sausages, fried chicken, sausages, fruit juices) were significantly more expensive per portion per eaters in comparison to sugar sweetened beverages (SSB) and dairy fruit juice mixes. High fibre breakfast cereal (26.2%), brown bread (23.7%), fruit (11.3%), white bread (11%) and fried chips (7.6%) were the top contributors to fibre intake amongst participants. A significant portion of participants reported not consuming various types of porridge, such as 61.5% did not eat oats, 54.6% abstained from maize and a notable 95.6% abstained from consuming sorghum over the past month. Grains most consumed were white rice by 91.7% of participants followed by white pasta by 88.3%, while only 13.7% ate brown rice and 5.4% ate wholewheat pasta over the past month. The mean number of times fast food were consumed over a two-week period was 2.47 with 65.8% of participants consuming take-outs during preceding 2 weeks. The majority of participants added fats when preparing dishes such as rice, samp and barley (42.9%), yellow vegetables (52.7%), other vegetables (47.3%), pasta (64.9%) and baked potato (53.7%). The fats commonly used were soft tub margarine (60.5%), mixed oil or 'fish' oil (57.1%) and sunflower oil (30.2%). The five most commonly consumed foods by participants were fruit, potatoes, yellow vegetables, white rice and pasta. Less than a quarter (18.5%) experienced food security that led to either running out of money for food or the necessity to cut meal sizes or skip meals altogether, with less than 10% going to bed hungry due to affordability issues. The majority of women (81.4%) reported not experiencing food insecurity. A large proportion (60.9%) reported the cost of healthy food as a significant barrier to healthy eating. While the majority of participants were responsible for food preparation, about 40% perceived that they lacked sufficient knowledge in preparing healthy foods. Supermarkets in the areas where most participants resided stocked refined and ED foods (white bread, white pasta, deli-fried chicken, processed meats, hard brick margarine, fried ('slap') chips, doughnuts, potato chips, chocolates, sweets, cookies, crackers and soft drinks. Conversely, brown rice, barley, wholewheat pasta and certain low fat fresh produce (low fat and fat-free milk) were unavailable at some supermarkets. Seven basic healthy foods (wholewheat bread, brown rice, wholewheat pasta, soft tub margarine, grilled chicken, bran flakes, 2% low fat milk) collectively were 8.2% more expensive than their unhealthy counterparts. Utilizing the SEMDSA (2017) guidelines, a comparison of a healthy and unhealthy two-day diet plan revealed a minimal cost variation, with the healthy plan being 6.7% less expensive. The study further included a 7-day 8400 kJ (2000 Kcal) eating plan as a guideline. Regarding mental health, 48.5% of participants had no depression, while 40.1% were mildly to moderately depressed. Most (74.4%) reported receiving substantial social support and scored high (57.3%) for general life satisfaction (GLS). Less than a quarter received minimal social support, especially practical and financial support (14.9%) and 5.8% scored low for GLS. Only 27.8% of participants tried to exercise more to be healthier. Conclusion: Women of low socioeconomic status in Cape Town with GDM largely failed to meet the macronutrient guidelines established by the SEMDSA (2017) and international standards. Their diets were high in refined carbohydrates, sugars and ED foods with some foods such as chocolates, potato chips, fried chicken, processed meats, pies and desserts/puddings being often more expensive per portion per eaters than healthier alternatives. Fibre intake was suboptimal with inadequate vegetable diversity. Despite awareness of the dietary impact on GDM management, adherence to healthy eating was hindered by several barriers, including limited knowledge of nutritious foods, insufficient time for meal preparation and the high cost of healthier options. Although many participants reported food security, this status was likely aided by reliance on social grants by over half of them, raising concerns about sustainability, given the potential temporary nature of this support. For those experiencing food insecurity raises challenges, highlighting vulnerability among those at risk of insufficient support. Furthermore, the prevalence of unhealthy local food options presented additional challenges in making healthy dietary choices. Physical activity (PA) was also low, potentially due to time constraints, and/or insufficient guidance from health care professionals (HCP). While nearly half of participants had no depression, a significant portion experienced mild to moderate depression. Despite this, the majority reported receiving sufficient social support which could play a protective role in managing their mental and emotional well-being. The high levels of GLS for more than half of participants could suggest that many women still maintained a positive outlook on life, possibly aided by social support. The results also highlight gaps in support and proactive health behaviours as a minority received less social support, and a large proportion exercised less which indicates a need for greater focus in promoting health management behaviours, which are crucial for the management of GDM. Although basic healthy foods had minimal price difference in comparison to unhealthy foods and despite the efforts to calculate healthy diets at minimal costs, limited income and monthly costs can significantly burden low-income households, making adherence challenging without governmental assistance and cost-effective strategies. It is worthwhile to note that women with GDM do not necessarily eat drastically differently from non-pregnant or pregnant women of similar socioeconomic status in South Africa. However, their nutritional needs are more acute, and the persistence of poor dietary intake despite existing interventions, highlights a gap in program specificity. This study reinforces the need for targeted interventions and support strategies to assist these women achieve optimal nutrition and well-being and a need exists for further research for improved outcomes not just at baseline, but postpartum and in the prevention of T2DM
Investigation of the underlying, modifiable and non-modifiable risk factors for gestational diabetes among women living in Cape Town
Get PDFGestational Diabetes Mellitus has adverse effects in pregnancy that affects both the mother and infant. These complications include preeclampsia, macrosomia, preterm birth and risk of developing type 2 diabetes later in life. Understanding the risk factors for GDM is important in order to come up with intervention programs. This study aimed to determine the underlying modifiable, non-modifiable and intermediate risk factors of GDM for women living in Cape Town South Africa. We also compared lifestyle factors between women after diagnosis of GDM and women without GDM. Methods: We conducted a case control study among women living in Cape Town. Cases were defined as women diagnosed with GDM recruited at Groote Schuur Hospital while controls were women without GDM recruited from Vanguard clinic. Questionnaires and medical record review were used to collect data. The association between GDM and both risk factors and lifestyle variables was analysed using multivariable logistic regressions, with GDM as a binary outcome variable. Results: A total of 167 cases and 199 controls were included in the study. The mean age of cases was 32.5 years (28.0-37.0) and the mean age of controls was 25 years (22.0-31.0). In adjusted analyses, the risk factors for GDM were; family history of diabetes mellitus (OR 3.10, 95% CI 1.45-6.61, p =003), (MUAC) (OR 1.17, 95% CI 1.04-1.31, p =0.008) and stillbirth (OR 11.61, 95% CI 1.04-129.90, p =0.047), and BMI (OR 1.11, 95% CI 1.05-1.17,
A facility-based therapeutic group programme versus usual care for weight loss in obese patients attending a district hospital in the Cape Metropole
No full textIncludes abstract.Includes bibliographical references.The primary aim of this research was to compare the impact of a six-week facility-based therapeutic group (FBTG) programme with that of usual care on weight loss and reduction in BMI in obese patients with one or more risk factors for the development of NCDs or existing NCDs, attending a district hospital in the Cape Metropole
Risk factors for obesity development in Caucasian and Zulu women : personal and parental weight history, weight management practices, eating behaviour and taste sensitivity : a case-control study
No full textObesity is a significant health problem in South Africa and the need for intervention in this regard has been emphasized. Existing information indicates that modifiable risk factors such as diet and physical activity may be contributing to this problem. However, little other information on many of the other potential risk factors for obesity development is available. The primary aim of this study therefore was to investigate the associations between weight status, personal and parental weight history, weight management practices (including body weight and shape satisfaction), eating behaviour and 6-n-propylthiouracil (PROP) taste sensitivity in Zulu and Caucasian women using a case control design. The secondary aim was to compare Zulu and Caucasian cases as well as Zulu and Caucasian controls for key variables
Lifestyle behaviours and beliefs of pregnant women with gestational diabetes: a longitudinal follow-up study
Get PDFWomen with gestational diabetes mellitus (GDM) have increased risk of adverse pregnancy outcomes such as delivering Large-for-gestational-age babies, preeclampsia or birth trauma, as well as increased risk of developing type 2 diabetes (T2DM) later in life. Lifestyle management through a healthy diet and physical activity both during and after a GDM pregnancy is the first line treatment option in GDM management and for delaying the onset of T2DM. The research for this Master thesis had two main aims: firstly, to investigate the dietary intake and beliefs related to dietary intake of pregnant women with GDM in Cape Town, and whether they adhere to established dietary recommendations and secondly, to investigate the change in dietary intake, physical activity and associated factors as well as beliefs related to these lifestyle behaviours in women with GDM from pregnancy to a postpartum follow-up assessment. Methods: For the first aim a cross-sectional study was conducted on 239 pregnant women with GDM in Cape Town and for the second aim, 98 women were followed-up 3 to 15 months postpartum. Assessments included: a quantified Food Frequency Questionnaire (qFFQ), General Practice Physical Activity Questionnaire (GPPAQ) and beliefs relating to specific dietary components were assessed using the Theory of Planned Behaviour (TPB). Results: At baseline, the majority of the sample had inadequate intakes of vitamin D (87.4%), folate (96.5%) and iron (91.3%), and the dietary intake of these women was not optimal and fell short in meeting several nutritional guidelines for pregnant women with hyperglycaemia. At follow-up, the dietary changes made during pregnancy were not maintained postpartum. Fruit and vegetable intake (F&V) fell short of the recommended 400g intake at both baseline and follow-up. The intake of carbohydrates, added sugar, table sugar, sugar sweetened beverages (SSBs), pulses and energy-dense foods increased significantly from pregnancy to postpartum. In conclusion, women with prior GDM fail to maintain the dietary changes made during pregnancy. These women being at risk for the development of T2DM would benefit from interventions supporting behaviour change towards a healthier lifestyle in pregnancy and continued in the postpartum period
Investigate the nutritional status, including body composition, of oncology patients attending an outpatient clinic at Groote Schuur hospital: a cross-sectional study
Get PDFBackground There is an increase in cancer prevalence globally with an increase in cancer mortality in South Africa. Malnutrition, cancer cachexia and sarcopenia are conditions commonly experienced by people with cancer. Not only is there a deterioration of nutritional status, but these conditions are also known to have negative clinical and patient outcomes that include a decreased quality of life and functional status, increased hospital length of stay, increased treatment toxicity, reduced efficacy of anticancer treatments and an association with depression. Even though there is a greater understanding of the aetiology of cancer cachexia over recent decades, there has not been a global adoption of a definition and a framework for identification of cancer cachexia. Therefore, there is no standardisation of research to compare results related to prevalence and multimodal interventions which hampers implementation of awareness and identification of and treatment for cancer cachexia. The Global Leadership Initiative on Malnutrition (GLIM) identifies and classifies malnutrition across different health care settings. Recently suggested cancer guidelines identified cancer cachexia using amended GLIM diagnostic criteria. With sarcopenia identification, there have been American, Asian and European formulated guidelines with variation in the diagnostic criteria used. This makes it challenging for other countries not represented to create awareness and identification of sarcopenia in different healthcare settings. Gold standard methods in body composition, namely computer tomography (CT) and magnetic resonance imaging (MRI), and reference standard methods, namely dual energy X-ray absorptiometry (DEXA) have highlighted the common phenotypic component of reduced muscle mass in malnutrition, cancer cachexia and sarcopenia, with a plethora of reference populations used and cutoff points determined for different representations of muscle mass. This variety in research has added to the challenges of identifying reduced muscle mass, particularly in resource limited healthcare settings that do not have access to expensive CT, MRI and DEXA scans and relevant reference populations. Therefore, there is a need to identify alternative methods to identify reduced muscle mass earlier in the cancer journey that need to be cheap, accessible, easy to use within the South African health setting. These alternative methods will be helpful in the identification of malnutrition, sarcopenia and cancer cachexia. Aims The first aim was to investigate body composition, with particular focus on muscle mass, using DEXA as the reference standard in this sample of cancer patients, in relation to nutritional status indicators and alternative muscle mass markers. The second aim was to investigate malnutrition in cancer outpatients according to Global Leadership Initiative on Malnutrition (GLIM) using different approaches, including technical (DEXA) and clinical approaches to determine muscle mass. The third aim was to investigate sarcopenia in cancer outpatients according to the newest diagnostic guidelines from the European Working Group on Sarcopenia in Older People (EWGSOP) using muscle mass determined from DEXA (reference standard) and alternative muscle mass markers. The fourth aim was to investigate cancer cachexia using different diagnostic frameworks and the associations with nutritional status indicators in cancer outpatients. Method The study followed a quantitative, cross-sectional design where data were collected over 2 days and twenty-eight eligible cancer patients were recruited through consecutive sampling from colorectal, head and neck, ear, nose and throat oncology outpatient clinics at Groote Schuur Hospital (GSH). A two-phase questionnaire was developed for the purposes of this study where sociodemographic, clinical and cancer related data, biochemistry, physical activity, dietetics related data, a twenty-fourhour recall and semi-quantitative food frequency questionnaire information were collected. On the second data collection day, handgrip strength (HGS), nutrition risk screening-2002 (NRS-2002), patient generated subjective global assessment (PG-SGA), a second a twenty-four-hour recall, alternative muscle mass markers [mid upper arm circumference (MUAC), calf circumference (CC), corrected arm muscle area (cAMA), estimated appendicular skeletal muscle (est ASM), global physical examination (GPE)] and DEXA measurements were collected. Results There is a high prevalence of reduced muscle mass (82.1%) as determined by our reference standard, DEXA, expressed as ASM. From the six alternative muscle mass markers, calf circumference performed best across the different statistical tests in comparison to the reference standard, DEXA. Calf circumference demonstrated fair agreement related to Cohen's kappa, overall fair for sensitivity (73.9%) / specificity (80%) and a percentage agreement of 78.6%. Our results suggest that calf circumference may be used to screen cancer patients to determine those without RMM as the specificity was 80% i.e., only 20% of participants without RMM will be incorrectly categorised. None of our nutritional status indicators can be used as proxies for detecting reduced muscle mass. BMI, scored NRS-2002 and scored PG-SGA were statistically significant in participants identified with reduced muscle mass. Our study confirmed that malnutrition is prevalent in this cancer population ranging from 75.0% to 92.9% depending on the muscle mass assessment method and Global Leadership Initiative on Malnutrition (GLIM) approach used. Out of the six alternative muscle mass markers and not having muscle mass phenotype, calf circumference demonstrated good agreement related to Cohen's kappa, overall fair for sensitivity (73.9%) / specificity (80%) and a percentage agreement of 92.9% suggesting that it may be used as an alternative muscle mass phenotype in the GLIM diagnostic criterium for reduced muscle mass. We found a prevalence of sarcopenia from 7.4% to 18.5%, depending on the muscle mass method used Of the five alternative muscle mass markers, calf circumference agreed perfectly and had 100% sensitivity and specificity. We found that the diagnosis and classification of cancer cachexia varied depending on the diagnostic models used. We used two diagnostic models to identify pre-cachexia and found a range of 17.9% to 28.6%. We used four diagnostic models to identify cancer cachexia and found a range from 45.8% to 82.1%. None of the three diagnostic cancer cachexia frameworks performed well when compared to the most recent cancer cachexia framework adapted from GLIM. In addition, none of our nutritional status indicators performed well across all the different tests when compared to the recent cancer cachexia framework. Therefore, suggesting that our routine use of nutritional status indicators within practice, may not be sufficiently sensitive, specific and agree with our reference framework to diagnose cancer cachexia. Only handgrip strength and albumin are significantly different in the cancer cachexia group. In conclusion, despite our limitation regarding small sample size, calf circumference may be a possible alternative muscle mass marker to screen for reduced muscle mass, may be used as a proxy in the GLIM diagnostic criteria and for sarcopenia diagnosis. As cancer cachexia is recognized as a multifactorial and multi-organ syndrome, all diagnostic components may need to be present, therefore simplistic commonly used clinical and practical approaches may not be adequate to detect cancer cachexia early in the cancer patient's journey
Nutritional and health status of HIV+ adults stable on HAART attending a healthcare facility in Cape Town, South Africa
Get PDFBackground: PLWH have twice the chances of developing cardiovascular disease (CVD) when compared to the uninfected population. This and other NCDs are important cause of non-AIDS related mortality among PLWH, and its prevalence may increase as PLWH continue to age. Factors that may have association with the increased risk of NCDS among PLWH have been identified including the use of HAART, systemic inflammation, male gender, aging, diet, and sedentary lifestyle. The relationship between higher diet quality and a lower risk of NCDs has been reported among PLWH. Furthermore, dietary interventions have reduced the risk of NCDs among PLWH. However, studies assessing dietary intake among PLWH in South Africa are not recent and were conducted among ART-naïve participants. This dissertation contains a scoping review of literature that sought to identify the diet quality and food insecurity indices that have been used among PLWH and how these constructs are associated with the risk of developing CVD. The primary study component assessed the nutritional and health status of adults living with HIV stable on HAART attending the Heideveld CHC in Cape Town. We also investigated the association that may exist between these factors, especially diet quality, and the risks of NCDs. Methods: For this thesis, a scoping review and primary study was conducted. For the scoping review, the frameworks of Arksey and O'Malley, the Joanna Briggs Institute's (JBI) manual for conducting scoping reviews, and the Preferred Reporting Items for Systematic review and Meta Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines were used for the scoping review. The protocol was registered on OSF registries and published in BMJ Open. Extracted data were presented in tables, followed by a descriptive summary of findings. A search strategy was developed, and a preliminary MEDLINE (via PubMed) search was conducted followed by a final search on PubMed, EbscoHost, Scopus, Web of Science, and COCHRANE library databases. The findings from the scoping review were also used to refine the protocol of the cross-sectional study. The primary study was descriptive and cross-sectional including 247 adults receiving HAART from the Heideveld CHC. Eligible participants were HIV positive, on HAART for at least 1 year, aged 18 years or older, and able to communicate in English language, isiXhosa, or Afrikaans. Ethical approvals were obtained from the UCT ethics committee and the Department of Health. Data were collected using an interviewer-administered questionnaire and the patients' folder. Data were collected on socio-demographic variables, HIV infection-related information, anthropometry, biochemical, and clinical measures, as well as weight perception, satisfaction, and management goals. Other measures included dietary intake and habits, food security, physical activity, self-esteem, smoking, and alcohol intake. Data were captured using Microsoft Excel (version 2180) and analyzed using RStudio Version 1.2.5033. Appropriate statistical methods were used to summarize and describe the results. Results: A total of 31 studies were included in the scoping review after the recommended multilevel screening against the inclusion criteria. Three studies assessing food security status showed that food insecurity was high in PLWH. Six studies assessing dietary adequacy using a predefined diet quality index showed that PLWH had moderate adherence to the Healthy Eating Index (HEI) and Mediterranean Diet Score (MDS) guidelines. However, adherence to the recommendation of individual food items or nutrients was low. Other studies presented intakes of individual nutrients or food components. Two African studies were included with none using a diet quality index. The two most reported CVD risks were obesity and hypertension. The association between diet and risk of CVD reported was complex; while some studies found significant associations, some did not. In the primary study, the majority (69.9%) were females with a median age of 46 years. The median duration of infection was 12 years, the median ART duration was 10 years, and 94.7% had a suppressed viral load. One-third of the participants had comorbidities, hypertension was the most prevalent comorbidity reported, followed by dyslipidemia and diabetes. Other comorbidities reported were CVD, renal problems, and cancer. The prevalence of obesity was 40.7% while 27.6% were overweight. Based on predefined criteria, 50.0% of the participants had high blood pressure. Food insecurity was reported by 89.0% of the participants. The median intake of fruits and vegetables was 0.9 and 1.6 servings/day respectively. Habitual consumption of SSB and processed meat on average of 1.0 servings/day was reported. Mean (SD) DASH and Alternate Healthy Eating Index (aHEI) scores were 21.6 (5.1) and 41.9 (9.8) respectively. While 80.0% did not try to gain weight in the previous year, 51.0% gained weight. However, 58.0% were happy with their present weight. There were significant differences between the three BMI categories for gender (p< 0.001), level of education (p< 0.001), ever being pregnant (p=0.046), creatinine (p=0.002), systolic BP (p=0.010), relative hand grip strength (p< 0.001), PA (p<0.001), and being a smoker (p< 0.001). There was a significant difference between those who were hypertensive and those who were not for age (p< 0.001), level of education (p=0.019), and ever being pregnant (p=0.008). There was no significant association between aHEI score and BMI, as well as DASH score and hypertension. Conclusions: Findings from the scoping review suggest that the majority of PLWH are affected by food insecurity and achieve only moderate adherence to recommendations for diet quality. Few studies have used diet quality indices to assess dietary adequacy among PLWH, and the association of diet with risks of CVD is complex and needs further research. In our primary study, the prevalence of obesity and hypertension was high among the participants, and hypertension was the most prevalent comorbidity reported. The participants were mostly middle-aged females, they were on long-term ART and most of them had an undetectable viral load. The dietary habits and consumption of participants did not conform to recommendations. Obesity was more likely among females, those who had completed high school education, women who had been previously pregnant, those who were sedentary, and less likely among those who were previous and current smokers. Hypertension had a significant positive association with age. Diet quality was not significantly different among PLWH with or without comorbidities. The findings of this study emphasize the need to incorporate holistic nutrition education into HIV care at the PHC level. More nutrition-focused research is needed among PLWH in South Africa
The association between genotype and BMI, health and lifestyle indicators as well as weight loss outcomes in overweight/obese Caucasian adults
Get PDFThesis (PhD (Physiological Sciences))--University of Stellenbosch, 2011.Includes bibliography.ENGLISH ABSTRACT: Genetic screening to improve obesity treatment outcomes is available despite the lack of conclusive
evidence, specifically for Caucasian South Africans, in this regard.
The aim of this study was to investigate the association between genotype (seven polymorphisms) and
body mass index (BMI), health and lifestyle indicators in a cross-sectional sample of overweight/obese
Caucasian adults (n=133), as well as the association between genotype and weight loss outcomes following
an intervention (n=88) using a quasi experimental study design (time-series). The intervention consisted of
a 24-week conservative weight loss programme that included dietary, physical activity and behavioural
components.
The primary null hypothesis for the cross-sectional sample, namely that there is no association between
genotype and BMI, has not been rejected. A number of the secondary/exploratory hypotheses were
rejected of which the most plausible associations (based on support by the literature and a physiological
basis for the findng) are: 1) the mutant TT homozygotes of the GNB3 C825T polymorphism may have a
higher risk to develop the metabolic syndrome (MetS) as they had significantly higher fasting triglyceride
and glucose levels, a higher number of traits that met the diagnostic cut-off criteria for MetS and higher
number of these subjects was diagnosed with MetS compared to the wild-type C-allele carriers; and 2)
subjects with mutant alleles of either the FTO rs1421085 or rs17817449 polymorphisms may have poorer
eating behaviours (a higher rigid control, habitual and emotional disinhibition, perceived hunger and
internal locus for hunger) and higher intake of high-fat foods.
The primary null hypothesis for the intervention sample, namely that there is no association between
genotype and weight loss outcome, was not rejected for the FABP2 Ala54Thr, INSIG2 rs7566605, FTO
rs1421085, ADRB3 Trp64Arg and GNB3 C825T polymorphisms. However, it was rejected in some instances
indicating the following associations: 1) The wild-type TT homozygotes of the FTO rs17817449
polymorphism lost significantly more weight during the first two months of the program compared to the
mutant allele carriers (this is a novel finding); 2) The wild-type Arg16Arg homozygotes of the ADRB2
Arg16Gly polymorphism lost significantly more weight during the first month of the program compared to
the mutant allele carriers (this finding is supported by one other intervention study); 3) Subjects with a
mutant C-allele of the INSIG2 rs7566605 polymorphism and a mutant Gly16-allele of the ADRB2 Arg16Gly
polymorphism lost significantly less weight over the six month intervention period (this is a novel genegene
interaction finding). A number of secondary/exploratory hypotheses were rejected, of which the
most plausible finding include that the improvement in emotional disinhibition in the wild-type TT subjects of the FTO rs1421085 polymorphism was associated with a more pronounced decrease in BMI over the six
month weight loss period.
The integration of the results from this study with the literature indicates that there is insufficient evidence
at this stage for genetic screening of the polymorphisms investigated in this study and the provision of
evidence-based personalized recommendations for weight loss in obese individuals. It is recommended
that these associations should be viewed as priority in future research.AFRIKAANSE OPSOMMING: Genetiese sifting om die resultate van vetsug behandeling te verbeter is beskikbaar ten spyte van ‘n tekort
aan genoegsame bewyse, spesifiek ten opsigte van Kaukasiërs van Suid-Afrika.
Die doel van hierdie studie was om die assosiasie tussen genotipe (sewe polimorfismes) en liggaamsmassa
indeks (LMI), gesondheid en lewenstyl indikatore in ‘n dwarssnit (cross-sectional) steekproef van
oorgewig/vetsugtige Kaukasiër volwassenes (n=133) te ondersoek, asook die assosiasie tussen genotipe en
gewigsverlies uitkomste na afloop van ‘n intervensie (n=88) in ‘n kwasi-eksperimentele studie ontwerp (tydreeks).
Die intervensie het bestaan uit ‘n 24-week konserwatiewe gewigsverlies program met dieet, fisieke
aktiwiteit en gedragskomponente.
Die primêre nul hipotese vir die dwarsnit steekproef, naamlik dat daar geen assosiasie tussen genotipe en
LMI is nie, is nie verwerp nie. ‘n Aantal sekondêre/spekulatiewe hipotesis is verwerp waarvan die mees
geloofwaardige assosiasies (gebasseer op ondersteuning van die literatuur en ‘n fisiologiese basis vir die
bevinding) die volgende insluit: 1) die mutante TT homosigote van die GNB3 C825T polimorfisme het
moontlik ‘n hoër risiko vir die ontwikkeling van die metaboliese sindroom (MetS) aangesien hulle
betekenisvolle hoër vastende trigliseriede en glukose vlakke gehad het, ‘n grooter aantal kenmerke gehad
het wat aan die diagnostiese afsnykriteria vir MetS voldoen en ‘n grooter aantal van hierdie persone was
met MetS gediagnoseer in vergelyking met die wilde-tipe C-alleel draers; en 2) persone met die mutante
allele van die FTO rs1421085 of rs17817449 polimorfismes het moontlik ‘n swakker eetgedrag (‘n hoër
rigiede kontrole, gewoonte en emosionele disinhibisie, waarneembare honger en interne lokus van honger)
en ‘n hoër inname van hoë-vet voedsel.
Die primêre nul hipotese vir die intervensie steekproef, naamlik dat daar geen assosiasie tussen genotipe
en gewigsverlies uitkomste is nie, is nie vir die FABP2 Ala54Thr, INSIG2 rs7566605, FTO rs1421085, ADRB3
Trp64Arg en GNB3 C825T polimorfismes verwerp nie. Dit was egter in sommige gevalle vir die volgende
assosiasies verwerp: 1) Die wilde-tipe TT homosigote van die FTO rs17817449 polimorfisme het
betekenisvol meer gewig in die eerste twee maande van die program verloor in vergelyking met die
mutante alleel draers (dit is ‘n nuwe bevinding); 2) Die wilde-tipe Arg16Arg homosigote van die ADRB2
Arg16Gly polimorfisme het betekenisvol meer gewig gedurende die eerste maand van die program verloor
in vergelyking met die mutante alleel draers (hierdie bevinding word ondersteun deur een ander
intervensie studie); 3) Persone met ‘n mutante C-alleel van die INSIG2 rs7566605 polimorfisme en ‘n
mutante Gly16-allele van die ADRB2 Arg16Gly polimorfisme het minder gewig tydens die ses maande
intervensie periode verloor (dit is ‘n nuwe geen-geen interaksie bevinding). ‘n Aantal sekondêre/
spekulatiewe hipoteses is verwerp, waarvan die mees geloofwaardigste bevinding insluit dat ‘n verbetering in emosionele disinhibisie van die wild-tipe TT persone van die FTO rs1421085 polimorfisme geassosieer
was met ‘n meer prominente daling in LMI oor die ses maande gewigsverlies periode.
Die integrasie van die resultate van hierdie navorsing met die literatuur dui aan dat daar op hierdie stadium
onvoldoende bewyse vir genetiese sifting en die voorsiening van bewys-gebasseerde persoonlike
aanbevelings vir gewigsverlies in vetsugtig individue bestaan vir die polimorfismes wat ondersoek is. Dit
word aanbeveel dat hierdie assosiasies as prioriteit in toekomstige navorsing beskou moet word.Doctora
Dietary adequacy, variety and diversity and associated factors (anthropometry and socio-economic status) in pregnant women attending the Bishop Lavis MOU in Cape Town
No full textIncludes bibliographical referencesAim: The aim of this study was to determine the adequacy of the dietary intake of pregnant women attending Bishop Lavis MOU, in the Tygerberg area of Cape Town. Methods: One hundred and fifty-two women between 12 and 20 weeks' gestational age participating in the Main PASS study were recruited. They completed three interviewer-administered 24-hour dietary recall assessments on three different days, each approximately two weeks apart. Dietary reference values for adequate nutritional intake during pregnancy and the South African food based dietary guidelines and NARs and MAR were used to assess the nutritional adequacy. Anthropometric and socio-demographic information was also collected. Results: The results indicate that just over a quarter of the sample were classified as teenage pregnancies. The majority had between grades eight and ten, and had a monthly household income between R500 and R5000. With a mean energy intake of 10 168.4kJ, majority (79.5%) of the study sample did not meet the energy DRI. Close to half (42.8 %) of the study sample did not meet the DRI for protein intake. All participants met the carbohydrate EAR, and many exceeded the recommended fat intake. The intake of sugar and saturated fats exceeded recommendations with sugar contributing to almost half of the total energy from carbohydrates. The intakes of vitamin A, D and E, pantothenate, biotin, folate, calcium, iron, magnesium, potassium, and manganese fell below the recommendations. Sugar was the most commonly consumed food item, followed by potato, chicken, milk, and white bread. Apples were the most commonly consumed fruit. When compared to the FBDG, the study sample consumed double the recommended portions of starch, half the recommended daily fruit and vegetables, and half the recommended legumes. Conclusion: The high intake of refined carbohydrates, especially sugar, and the high intake of foods high in saturated fats needs to be addressed. Micronutrient intake is generally poor, especially with nutrients that are vital to proper growth and development of the foetus. Education on appropriate dietary changes, as well as suggestions to make implementation of such changes affordable would be invaluable, and may contribute towards decreasing the incidence of adverse pregnancy outcomes
The Effect of Calcium Supplementation on Body Weight Before and During Pregnancy in Women Enrolled in the WHO Calcium and Preeclampsia Trial
Get PDFIntroduction: Obesity is a major and challenging public health problem. The aim of this substudy is to evaluate the effect of calcium supplementation on body weight in women recruited in the Calcium and Preeclampsia trial. Methods: Women were recruited before pregnancy and randomized to receive a calcium supplement containing 500 mg of elemental calcium or placebo until 20 weeks’ gestation; all women received 1.5 g from 20 weeks until delivery. Results: A total of 630 women conceived during the study, 322 allocated to calcium and 308 to placebo. Among these, 230 allocated to calcium and 227 allocated to placebo had information on body weight at baseline and at 8 weeks' gestation. During the study period, women allocated to calcium had a mean weight increase of 1.1 (SD ±5.5) kg, whereas those allocated to placebo had a mean increase of 1.5 (SD ±6.1) kg, a mean difference of 0.4 kg (95% −0.4 (−1.4 to 0.6); P =.408). Women classified as obese at the start of the trial had a lower body weight gain at 8 weeks’ gestation (1.0 kg; 95% CI: −3.2 to 1.2; P =.330) and at 32 weeks’ gestation (2.1 kg; 95% CI: 5.6-1.3; P =.225) if they received calcium as compared to placebo. However, none of these differences were statistically significant. Conclusion: The smaller increase in body weight found in women supplemented with 500 mg elemental calcium daily is quantitatively consistent with previous studies. However, in this study, the difference was not statistically significant.Fil: Cormick, Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina. Universidad Nacional de La Matanza; Argentina. University of Cape Town; SudáfricaFil: Betrán, Ana Pilar. Organizacion Mundial de la Salud; ArgentinaFil: Harbron, Janetta. University of Cape Town; SudáfricaFil: Seuc, Armando. Instituto Nacional de Higiene; CubaFil: White, Cintia. Universidad Nacional de La Matanza; ArgentinaFil: Roberts, James M.. University of Pittsburgh; Estados UnidosFil: Belizan, Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Hofmeyr, G. Justus. University of the Witwatersrand; Sudáfric
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