1,721,004 research outputs found
The metabolic fate of dietary lipid in Human Immunodeficiency Virus : implications for the development of lipodystrophy
No full textDuring recent years, a HIV-associated lipodystrophy syndrome similar to Metabolic Syndrome X has been reported in HIV patients using highly active antiretroviral therapy (HAART). While the metabolic processes that appear to be dysregulated are similar to those of Metabolic Syndrome X (hyperlipidaemia and an altered insulin sensitivity), the changes appear to be more profound. While it is possible that HIV-associated lipodystrophy is related to the presence of infection plus genetic and environmental factors such as high saturated fat intakes, obesity, smoking and lack of exercise, there is a clear distinction between this and Metabolic Syndrome X as in HIV-associated lipodystrophy there is concurrent depot specific fat accumulation and fat wasting. This would suggest that use of HAART in HIV infection results in altered adipocyte metabolism. In order to investigate peripheral clearance and uptake of lipid from the circulation, stable isotope labelled fatty acids were given to healthy and HIV subjects with and without HAART and with lipodystrophy associated with specific drug combinations. The results suggest that while HIV infection is associated with delayed clearance of lipid from the circulation, the use of HAART exacerbates this process. In addition, it appears that while PI drugs may delay adipocyte clearance of triglyceride from the circulation, NRTI drugs may reduce adipocyte free fatty acid uptake. An audit of patients with more than six months exposure to HAART (n=545) showed that 25% of patients had elevated plasma lipid, 10% had elevated plasma glucose, but only 9% had both. While this data did not shown an association between specific drug classes and elevated plasma lipid or glucose, there was an association with the duration of therapy. Therefore, it is possible that HAART contributes to the development of HIV-lipodystrophy, but that the cause of this syndrome and the metabolic perturbations are multifactorial.</p
Comparing a range of potassium-enriched low sodium salt substitutes to common salt: results of taste and visual tests in South African adults
No full textBackground and aims: Potassium-enriched low sodium salt substitutes (LSSS), which replace a proportion of sodium chloride (NaCl) with potassium chloride (KCl), have been shown to reduce blood pressure and offer a potential solution to address the high burden of hypertension in South Africa. However, it is unknown which proportions of KCl in LSSS are acceptable. We compared the taste and visual acceptability of various LSSS in South African adults.Methods and results: Fifty-six adults underwent double-blind taste and visual tests of four LSSS (35%KCl/65%NaCl; 50%KCl/50%NaCl; 66%KCl/34%NaCl; 100%KCl) in comparison to 100%NaCl (common salt). Participants scored each product by taste ranking, taste perception and likeliness to use. Participants then visually inspected the five products and attempted to identify which was which. Almost half (45 %) of participants ranked the taste of 50%KCl/50 %NaCl as fantastic or really good. Furthermore, 62 % of participants liked and would be happy to use the 50 %KCl/50 %NaCl or felt this tasted like common salt. Only 12 % rated the 100%KCl highly for taste, and over half reported being unlikely to use this. Most participants (57.3 % and 36.4 %) were able to visually identify 100%NaCl and 100%KCl, while identification of other blends was generally poor. Responses were similar for 35%KCl/65%NaCl and 66%KCl/34%NaCl throughout.Conclusion: Our findings suggest that the taste of the 50%KCl salt substitute would be well tolerated by South African adults, most of which could not visually differentiate between this salt substitute and common salt
The paradox of improved antiretroviral therapy in HIV: potential for nutritional modulation?
No full textChronic infection with HIV type 1 is associated with alterations in macronutrient metabolism, specifically elevated plasma lipids, glucose and reduced insulin sensitivity. These alterations are most severe in patients at the later stages of AIDS, indicating a relationship with disease progression. Recently, a metabolic syndrome, termed lipodystrophy, has been described in successfully-treated HIV patients in whom the altered macronutrient metabolism of HIV infection appears to be amplified markedly, with concurrent alterations in adipose tissue patterning. This syndrome presents a paradox, as before the development of highly-active antiretroviral therapy (HAART) the most severe perturbations in metabolism were observed in the sickest patients. Now, the patients that respond well to therapy are showing metabolic perturbations much greater than those seen before. The implications of this syndrome are that, whilst life expectancy may be increased by reducing viral load, there are concomitant increases in the risk of cardiovascular disease, diabetes and pancreatitis within this patient population. The aetiology of the syndrome remains unclear. In a collaborative trial with the Chelsea and Westminster Hospital in London we have used stable-isotope-labelled fatty acids to examine the hypothesis that treatment with HAART causes a delayed clearance of dietary lipid from the circulation, resulting in the retention of lipid within plasma and the downstream changes in insulin and glucose homeostasis. This hypothesis would indicate a role for low-fat diets, exercise and drugs that reduce plasma lipid or insulin resistance, in modulating the response to antiretroviral therapy in HIV infection
Exploring health perceptions and priorities of South African youth: understanding what matters for health literacy interventions
No full textBackground and Objectives: Health literacy is a key factor underpinning health behaviours and effective use of health information. Optimising health literacy in adolescents and young adults (AYA) is critical as they transition from childhood to adulthood, changing health-related behaviours alongside physical, emotional, and cognitive change. In South African AYA, with unplanned pregnancy common, poor health literacy may impact multiple generations. Our aim was to explore health perceptions and priorities of South African AYA to inform contextually relevant health literacy intervention design. Materials and Methods: Through purposive sampling of youth registered at a youth development centre in Soweto, South Africa, AYA (n=39, 18-25y) were recruited to form an advisory Youth Health Council (YHC). Health literacy was assessed with the Health Literacy Test for Limited Literacy populations (HELTLL). Focus group discussions were recorded for inductive thematic analysis to inform AYA health literacy needs. Results: Most AYA (85%) had suboptimal health literacy. Analysis showed that AYA perceived ‘health’ as a complex mix of indicators (physical, emotional, mental, spiritual) that formed a holistic view of health. However, lack of funds and factors inherent in their local environment (food systems, family hierarchy, crime, vandalism, limited healthcare services) frequently challenged beneficial health behaviours. Stress was a common feature in the lives of AYA associated with multiple health domains. Conclusion: Stress-focused health literacy interventions are needed for youth in challenging environments. Understanding the complex constructions and the core tenets of health that young people hold can inform contextually relevant intervention co-creation for improved health literacy as youth transition into adulthoods.</p
Contextualising individual, household and community level factors associated with sugar-sweetened beverage intake and screen time in Soweto, South Africa
No full textThis study examined the relationship between individual, household, and community-level factors with obesity-related health behaviors. Households (n = 6110) were enumerated, and participants (>18 years) reported their screen time and how many sugar-sweetened beverages they consumed per day. Individuals from food insecure and higher SES households were more likely to report higher sugar-sweetened beverage consumption. Screen time was negatively associated with age (p < .01), and being female was associated with 35 minutes more screen time per day (p < .01). Community and household factors were independent drivers of behavior that need to be incorporated into individual level interventions, or considered in analyses.</p
Young women’s perceptions of life in urban South Africa:: Contextualising the preconception knowledge gap
Full text linkRaising awareness to support improved health and well-being of young women in sub-Saharan Africa is critical, particularly in the preconception period in order to achieve improved health for multiple generations. To inform messaging campaign on preconception health, we conducted eight focus group discussions (FGDs) with young women in Soweto to understand their perceptions and access to health messages. Preconception health was generally not a familiar topic for young women. Participants prioritised information seeking for other pressing challenges they faced such as poverty and unemployment. Within this context, mental health was viewed as important, while physical health only gained importance when illness was present or during pregnancy. Television, radio and community health workers were all viewed as useful communication channels for health messaging. Understanding the importance of preconception health of young adults to benefit from the triple dividend of better health now, better health for the future and for children is a critical knowledge gap for young women. Messages aimed to improve preconception physical and mental health could leverage significant health gains. Health messages should be contextualised within the experiences that young women face and should offer information to help young women cope with their challenges. (Afr J Reprod Health 2021; 25[2]: 39-49)
Exploring weight loss services in primary care and staff views on using a web-based programme
Full text linkBackground Demand is increasing for primary care to deliver effective weight management services to patients, but research suggests that staff feel inadequately resourced for such a role. Supporting service delivery with a free and effective web-based weight management programme could maximise primary care resource and provide cost-effective support for patients. However, integration of ehealth into primary care may face challenges.Objectives To explore primary care staff experiences of delivering weight management services and their perceptions of a web-based weight management programme to aid service delivery.Methods Focus groups were conducted with primary care physicians, nurses and healthcare assistants (n = 36) involved in delivering weight loss services. Data were analysed using inductive thematic analysis.Results Participants thought that primary care should be involved in delivering weight management, especially when weight was aggravating health problems. However, they felt under-resourced to deliver these services and unsure as to the effectiveness of their input, as routine services were not evaluated. Beliefs that current services were ineffective resulted in staff reluctance to allocate more resources. Participants were hopeful that supplementing practice with a web-based weight management programme would enhance patient services and promote service evaluation.Conclusions Although primary care staff felt they should deliver weight loss services, low levels of faith in the efficacy of current treatments resulted in provision of under-resourced and ‘ad hoc’ services. Integration of a web-based weight loss programme that promotes service evaluation and provides a cost-effective option for supporting patients may encourage practices to invest more in weight management services.</p
Barriers and facilitators of micronutrient supplementation among non-pregnant women of reproductive age in Johannesburg, South Africa
No full textThe prevalence of anaemia among South African women of reproductive age (WRA) remains high at 39%. Multiple micronutrient supplementation (MMS) may be an effective strategy in the prevention and management of anaemia. Our aim was to understand facilitators and barriers to preconception MMS adherence and to explore perceptions and beliefs of MMS in the prevention and treatment of anaemia among non-pregnant WRA. This qualitative study was embedded in a preconception MMS intervention trial of WRA and was conducted in two phases. Phase one assessed the barriers and facilitators of MMS adherence. Individual interviews were conducted with the community health workers (n = 7) administering MMS, and with non-pregnant WRA (n = 25) participating in the trial. Phase two included four focus groups with participating WRA (n = 26), which further explored participants’ perceptions and beliefs of MMS provision and adherence, and strategies to improve adherence. The reported facilitators to supplementation were family support, interaction with the community health workers, easy access to MMS, and experienced benefits of MMS. Barriers to preconception supplementation included the lack of family support, the link of supplements to antenatal care, and the perceived lack of benefits of MMS. Participants reported negative associations of supplements with medication, individual and societal stigma around medication and challenges around the supplementation schedule. For successful preconception MMS interventions, young women, their families, and communities need to be convinced of the value of supplementation. Public health interventions utilising preconception supplementation will require specialised training for health care providers, targeted counselling materials and community household suppor
Social vulnerability and its association with food insecurity in the South African population: findings from a National Survey
No full textSocial vulnerability refers to the attributes of society that make people and places susceptible to natural disasters, adverse health outcomes, and social inequalities. Using a social vulnerability index (SVI), we investigated social vulnerability prevalence and its relationship with food insecurity in South Africa (SA). In this nationally representative cross-sectional survey, we calculated SVI scores from 3402 respondents (median age, 35 (26–46) years) using an SVI developed by the United States (US) Centers for Disease Control and prevention (CDC) adapted for a South African context. We measured food insecurity using a modified Community Childhood Hunger Identification Project. Findings classified 20.6% and 20.4% of adults as socially vulnerable and food insecure, respectively. The risk of food insecurity was almost threefold higher in the social vulnerability group (OR 2.76, 95% CI 2.76–2.77, p < 0.001) compared to their counterparts. The SVI could be a useful tool to guide government and policymakers in the facilitation of social relief initiatives for those most vulnerable
Understanding attrition in the South African integrated intervention for diabetes risk after gestational diabetes (IINDIAGO) study: a qualitative study of postpartum lifestyle intervention disengagement
No full textBackground and aims: lifestyle interventions can benefit women with gestational diabetes (GDM) to manage the conditionduring pregnancy and reduce future health risks including the risk of progression to Type 2 diabetes (T2DM). However, future benefits may only be realised if women engage with the intervention (coaching, educational materials, ongoing risk assessment and monitoring) after the birth of the child. The aim of this study was to explore the factors influencing women's attrition froma lifestyle intervention study (IINDIAGO—Integrated Health System Intervention aimed at reducing Type 2 Diabetes risk inwomen after Gestational diabetes) in South Africa.Methods: this cross‐sectional exploratory descriptive qualitative study was conducted with women recruited from the intervention arm of the IINDIAGO study and living in a low‐income neighbourhood (Soweto). Participants were divided into two groups: Group A (n = 11 who remained engaged with the study and received ≥ 40% of the intervention) and Group B (n = 15who had disengaged from the study and received < 30% of the intervention). Semi‐structured interviews were conducted telephonically, with interviews recorded, transcribed, and analysed using inductive and deductive methods.Results: women who remained engaged (Group A) frequently reported the perceived intervention benefits including healtheducation, reduced diabetes risk, and positive relationships with the study team. In contrast, women in Group B who had disengaged highlighted multiple challenges and competing demands related to their personal situations, including the cost of travel to the study site and the impact of the COVID‐19 pandemic, that hindered their continued participation.Conclusions: successful implementation of postpartum lifestyle interventions for women who experience GDM and are at highrisk of converting to T2DM after the pregnancy are critical. However, interventions in the postnatal period must be tailored tothe contextual realities of new mothers facing multiple demands with limited resources to facilitate continued access andengagemen
- …
