Friede Wenhold

African leafy vegetables consumed by households in the Limpopo and KwaZulu-Natal provinces in South Africa

Abstract Objectives: The objectives of this study were to determine the availability of, access to and nutrition-related uses of African leafy vegetables in rural and urban households; and to determine the β-carotene content of the dominant African leafy vegetable. Design: The study consisted of a qualitative explorative phase (field walks, semi-structured interviews with key informants, focus group discussions) at two rural sites; and a quantitative household survey (questionnaire) at two rural and one urban site. Amaranth leaves were analysed for β-carotene content. Setting and subjects: The household survey included households at a rural site in Limpopo province (n = 100); and a rural (n = 101) and urban (n = 391) site in KwaZulu-Natal province, South Africa. Results: A variety of edible plants were identified during field walks at the two rural sites. Focus group discussions narrowed this down to ten plants at the rural Limpopo site and six at the rural KwaZulu-Natal site. The most popular leaves were amaranth (Amaranthus spp), spider plant (Cleome gynandra), wild watermelon (Citrullus lanatus) and blackjack (Bidens spinosa), consumed individually or mixed with other leaves. Rural households procured leaves mostly from the wild whereas urban households relied more on informal markets. In Limpopo, leaves were dried and stored for consumption during winter. KwaZulu-Natal households considered African leafy vegetables food for the poor. Leaves were boiled in salted water, or steamed and then fried in oil. Fried and boiled amaranth leaves contained 627 and 429 µg retinol activity equivalents/100 g respectively. Conclusions: Availability of, access to and nutrition-related uses of African leafy vegetables are context-specific, with inter- and intraprovincial rural/urban differences. Information collected during small studies within a specific area can therefore not be generalised for the overall South-African population. Amaranth can potentially contribute significantly to vitamin A requirements of nutritionally vulnerable communities.

Presentation and interpretation of food intake data: Factors affecting comparability across studies

Non-uniform, unclear, or incomplete presentation of food intake data limits interpretation, usefulness, and comparisons across studies. In this contribution, we discuss factors affecting uniform reporting of food intake across studies. The amount of food eaten can be reported as mean portion size, number of servings or total amount of food consumed per day; the absolute intake value for the specific study depends on the denominator used because food intake data can be presented as per capita intake or for consumers only. To identify the foods mostly consumed, foods are reported and ranked according to total number of times consumed, number of consumers, total intake, or nutrient contribution by individual foods or food groups. Presentation of food intake data primarily depends on a studys aim; reported data thus often are not comparable across studies. Food intake data further depend on the dietary assessment methodology used and foods in the database consulted; and are influenced by the inherent limitations of all dietary assessments. Intake data can be presented as either single foods or as clearly defined food groups. Mixed dishes, reported as such or in terms of ingredients and items added during food preparation remain challenging. Comparable presentation of food consumption data is not always possible; presenting sufficient information will assist valid interpretation and optimal use of the presented data. A checklist was developed to strengthen the reporting of food intake data in science communication.

Dietary Diversity and Vegetable and Fruit Consumption of Households in a Resource-Poor Peri-Urban South Africa Community Differ by Food Security Status

ABSTRACT Sociodemographic, living standard measure, consumption of vegetables and fruit, and dietary diversity in relation to household food security were assessed. Using a hunger score, households were categorized as food secure (n = 125) or food insecure (n = 273). Food secure respondents had a higher mean dietary diversity score (3.98; 95%CI [3.79, 4.18] versus 3.65; 95% [CI 3.53, 3.77]), were more likely to eat vitamin A–rich foods (OR 1.15; 95% CI [1.05, 1.26]), a more varied diet (DDS ≥ 4, OR 1.90; 95% CI [1.19, 3.13]), and vegetables daily (OR 3.37; 95% CI [2.00, 5.76]). Cost limited daily vegetable/fruit consumption in food insecure households. Respondents with ≥ 8 years of schooling were more likely (OR 2.07; 95% CI [1.22, 3.53]) and households receiving social grants were less likely (OR 0.37; 95% CI [0.19, 0.72]) to be food secure. Results highlight the association between dietary diversity and household food security.

Human milk fortification strategies for improved in-hospital growth of preterm infants

Human milk is the preferred feed for preterm infants, yet it may need to be fortified for optimal growth and development. Standard fortification of human milk seldom meets the recommended intake of protein, leading to inadequate post-natal growth. This article aims to critically review different human milk fortification strategies with a focus on in-hospital growth of premature infants in resource-limited settings. Super, adjustable and target fortification are compared to standard fortification. Different growth outcome parameters limit comparability of findings, but super fortification and adjustable fortification present opportunities to explore. More uniform growth outcome assessment is recommended. Practical implementation and cost-effectiveness in the local setting need to be investigated.

Strategies men use to cope with stress caused by severe obesity : a qualitative study

Abstract This qualitative study sought to explore and describe the coping strategies obese men use, as well as the lived experience of being obese. A phenomenological approach, symbolic interactionism and life course perspectives were used as theoretical points of departure. Experiences of being obese were described through three individual, in-depth, unstructured interviews. Emotion-focused coping strategies like blaming, denial and reappraisal, as well as avoidance were used while problem-focused coping strategies consisted of physical activity, weight loss diets and wearing appropriate clothes. Cognitive appraisals gave rise to certain emotions and feelings that their self and well-being were at risk and need to be dealt with. Along the life course they developed a specific coping trajectory. Identification of coping strategies and better awareness of the lived experience of obese men may enhance the knowledge of professionals, family members as well as parents who need to support them. It also provided tools to help vulnerable obese people deal with the consequences of stigma associated with it.

Screening for dietary fat intake of grade six children : self-assessment vs. maternal assessment

As part of justifiable nutrition promotion, this study aimed to determine internal consistency of a dietary fat screener and to compare self-assessment to maternal assessment of fat intake of grade six (about 12 years old) learners in a South African public primary school. The children completed in school a pictorial, quantitative food frequency-type screener consisting of 10 high-fat food categories; mothers individually completed a text version. Internal consistency was measured with item-total correlations, Cronbachs alpha and the split-half method. Child-mother comparison was based on kappa (κ) statistics, McNemars tests, Wilcoxon signed-rank test and the Bland-Altman method. In total, 101 (93.5%) children and 78 (72.2%) mothers responded. The screener was internally consistent, regardless of data source and statistical technique. For portion sizes and frequency of intake, children consistently reported higher intake than mothers. This resulted in systematic error, also evidenced by a significant difference from zero for the difference between childs and mothers final test scores for the whole group, and for boys and girls separately (always P < 0.001). In 76% of the pairs, classification into high fat or prudent intake was identical, yet the chance-corrected agreement was poor (κ = 0.16) and non-agreement was non-symmetrical (P = 0.001). Children and mothers reported high fat intakes (93% and 75%, respectively). It was concluded that the dietary fat screener was internally consistent, yet children and mothers did not agree in their assessment. The high fat intakes reported by children and mothers warrant measurement refinement and implementation of primary prevention programmes.