Janicke Visser

A systematic review and meta-analysis of the effect and safety of ginger in the treatment of pregnancy-associated nausea and vomiting

Background and objectivesNausea and vomiting during pregnancy (NVP) occur commonly. Possible harmful side-effects of conventional medicine to the fetus create the need for alternative options to relieve NVP. This systematic review (SR) investigated current evidence regarding orally administered ginger for the treatment of NVP. The primary objective was to assess the effectiveness of ginger in treating NVP. The secondary objective was to assess the safety of ginger during pregnancy.MethodsA comprehensive electronic bibliographic database search was carried out. Randomized controlled trials (RCTs) of the efficacy of orally administered ginger, as treatment for NVP in pregnant women at any stage of pregnancy, published in English, were included. Two researchers independently extracted data and assessed trial quality. RevMan5 software (Cochrane Collaboration) was used for data analysis. p < 0.05 was considered statistically significant.ResultsTwelve RCTs involving 1278 pregnant women were included. Ginger significantly improved the symptoms of nausea when compared to placebo (MD 1.20, 95% CI 0.56-1.84, p = 0.0002, I2 = 0%). Ginger did not significantly reduce the number of vomiting episodes during NVP, when compared to placebo, although there was a trend towards improvement (MD 0.72, 95% CI -0.03-1.46, p = 0.06, I2 = 71%). Subgroup analyses seemed to favor the lower daily dosage of <1500 mg ginger for nausea relief. Ginger did not pose a significant risk for spontaneous abortion compared to placebo (RR 3.14, 95% CI 0.65-15.11, p = 0.15; I2 = 0%), or to vitamin B6 (RR 0.49, 95% CI 0.17-1.42, p = 0.19, I2 = 40%). Similarly, ginger did not pose a significant risk for the side-effects of heartburn or drowsiness.ConclusionsThis review suggests potential benefits of ginger in reducing nausea symptoms in pregnancy (bearing in mind the limited number of studies, variable outcome reporting and low quality of evidence). Ginger did not significantly affect vomiting episodes, nor pose a risk for side-effects or adverse events during pregnancy. Based on evidence from this SR, ginger could be considered a harmless and possibly effective alternative option for women suffering from NVP.International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42011001237.

Micronutrient supplementation for critically ill adults: A systematic review and meta-analysis

OBJECTIVE This systematic review assessed the effects of micronutrient supplementation on adults recovering from critical illness. Primary outcomes included clinical endpoints (mortality, infectious complications, length of intensive care unit and of hospital stay). Secondary outcomes included descriptions of practice issues, micronutrient status, morbidity, course of the acute-phase response, and oxidative stress. METHODS Electronic bibliographic databases, bibliographies of retrieved articles, and personal files were searched and reviewed. Randomized controlled trials (RCTs) of micronutrient supplementation in adult critically ill patients administered enterally and/or parenterally in addition to their routine care were included. Two authors independently extracted data and assessed trial quality. The random-effects model was used to estimate overall relative risk (RR)/mean difference and effect size. P<0.05 was considered statistically significant. RESULTS Fifteen (n=1714) and 18 (n=1849) RCTs were included for the primary and secondary objectives, respectively. Fourteen trials (n=1468) showed a statistically significant decrease in overall mortality (RR 0.78, 95% confidence interval 0.67-0.90, I2=0%, P=0.0009). Six RCTs (n=1194) indicated a statistically significant decrease in 28-d mortality (RR 0.75, 95% confidence interval 0.63-0.88, I2=0%, P=0.0006). Micronutrient supplementation was not associated with a decrease in infectious complications, length of intensive care unit, or length of hospital stay. In subgroup analyses, a sensitivity analysis of combined micronutrients indicated a significant decrease in mortality (RR 0.69, 95% confidence interval 0.54-0.90, I2=2%, P=0.006). The secondary outcomes confirmed that timing, duration, and dosing appear to be key factors to ensure optimal clinical benefit. CONCLUSION This review does suggest a potential benefit of micronutrient supplementation in critically ill adults by possibly being associated with a decrease in mortality.

Randomized clinical trial: Effect of Lactobacillus plantarum 299 v on symptoms of irritable bowel syndrome

OBJECTIVES Irritable bowel syndrome (IBS) is a common diagnosis in gastroenterology. Its etiology is unknown and therapeutic options limited. Trials suggest probiotics may be beneficial. The aim of this study was to assess the symptomatic efficacy of Lactobacillus plantarum 299 v (L. plantarum 299 v) for the relief of abdominal pain in patients with IBS fulfilling Rome II criteria. METHODS This study was conducted in a referral hospital. Trial participants were randomized to receive either two capsules of L. plantarum 299 v at a dosage of 5 × 10(9) cfu per capsule or placebo daily for 8 wk. Severity of abdominal pain was assessed using a visual analog scale at each visit and a quality-of-life IBS (QoL-IBS) questionnaire was also completed. RESULTS There was no significant difference in abdominal pain relief between the study and placebo groups (P = 0.800). There was also no difference in QoL- IBS scores between the groups (P = 0.687). Both groups had a significant improvement in abdominal pain scores over the study period, from an average of 251.55 to 197.90 (P < 0.0001) indicating a large placebo effect. CONCLUSION An 8-wk treatment with L. plantarum 299 v did not provide symptomatic relief, particularly of abdominal pain and bloating, in patients fulfilling the Rome II criteria.

Anaemia in South Africa: the past, the present and the future

Despite some modest improvements described recently, 1 anaemia remains a significant global public health concern affecting both developed and developing countries. It affects a quarter of the global population, including 293-million (47%) children who are younger than five years of age. A prevalence of 42% and 30% has been described in pregnant and non-pregnant women, respectively. 2 Children and women of reproductive age are at high risk, partly because of physiological vulnerability, followed by the elderly. Africa and Asia are the most heavily affected regions, accounting for 85% of the absolute anaemia burden in high-risk groups. 3 According to the World Health Organization global database on anaemia (1993-2005), 3 this haematological disorder was considered to be a moderate public health problem at the time in South African preschool children, pregnant women and non-pregnant women of reproductive age.

Job satisfaction of South African registered dietitians

Abstract Objectives: The aim of this study was to determine the overall level of job satisfaction among South African registered dietitians and possible relationships between the influencing factors. Design: The design was a cross-sectional descriptive study. Setting and subjects: A national survey was carried out among all dietitians registered with the Health Professions Council of South Africa, excluding community service dietitians. Outcome measures: A two-part, self-administered, adapted job satisfaction survey questionnaire was used. Demographic data were collected. The questionnaire covered nine themes pertaining to job satisfaction: salary, promotion, knowledge and skills, professional colleagues, being a member of the multidisciplinary team, communication, the work environment, rewards of the job and nature of the work. Results: A final response rate of 22.5% (n = 340) was obtained. South African registered dietitians were only slightly satisfied (65.7%) with their current employment. There was no significant difference (p-value = 0.291) pertaining to overall job satisfaction between those working and living overseas and those working and living in South Africa. Primarily, lower levels of satisfaction were observed to be due to poor salaries, lack of promotion opportunities and a poor perception of professional image. Significant positive correlations were found between age (p-value = 0.036), professional experience (p-value = 0.035), area of expertise (p-value = 0.001), hours of work (p-value = 0.021) and location of work (p-value = 0.00001). Conclusion: Although overall job satisfaction scores indicated that South African registered dietitians are only slightly satisfied with their employment, registered dietitians reported that they love the nature of the work and what they do, tending towards confirmation of career satisfaction. Recommendations include re-evaluation of registered dietitian salary scales, career pathing with promotion opportunities, boosting the professional image and expanding the teaching of nondietetic skills to dietetic undergraduates.AbstractObjectives: The aim of this study was to determine the overall level of job satisfaction among South African registered dietitians and possible relationships between the influencing factors.Design: The design was a cross-sectional descriptive study.Setting and subjects: A national survey was carried out among all dietitians registered with the Health Professions Council of South Africa, excluding community service dietitians.Outcome measures: A two-part, self-administered, adapted job satisfaction survey questionnaire was used. Demographic data were collected. The questionnaire covered nine themes pertaining to job satisfaction: salary, promotion, knowledge and skills, professional colleagues, being a member of the multidisciplinary team, communication, the work environment, rewards of the job and nature of the work.Results: A final response rate of 22.5% (n = 340) was obtained. South African registered dietitians were only slightly satisfied (65.7%) with their current employment. There was no sig...

Micronutrients: do small things matter?

Abstract Despite the major developments on the importance of micronutrient status in health and disease, understanding of the exact role of the latter in critical illness remains elusive and ill defined, complicating decision-making on the part of the nutrition support practitioner. Micronutrient deficiencies in critically ill patients may occur as pre-existing conditions in patients with poor nutritional status prior to hospitalisation or as a result of severe illness or the injury itself. In practical terms it is clear that micronutrients should be provided at, at least, the current available recommended doses to prevent overt clinical deficiencies. For other claims/indications and higher doses the literature consistently indicate that the risk (adverse effects) to benefit (mortality) ratio may be favourable, and if such higher doses are used in practice it should be within the dose range that the current experience covers and for the clinical settings studied only.

Experiences and attitudes of dietitians during the first compulsory community service year (2003)

Abstract Objectives. This study was undertaken to investigate the experiences and attitudes of dietitians during the first compulsory community service (CS) year (2003), to determine their perception of the success of the year as a whole and to assess whether the knowledge and skills of graduates improved. Subjects and design. Data were collected by means of an anonymous questionnaire posted to the CS dietitians (N = 126). The questionnaire consisted of four sections: general information, demographic and logistical information, professional duties and competencies, and personal experience. Results. Ninety dietitians returned the completed questionnaire, giving a 71% response. Thirty-nine per cent of dietitians were placed during the first round of allocation, with 48% placed during the third round or after further deliberations. Eighty-eight per cent of the dietitians reported a safe working environment. Full competency was reported by 26% of dietitians for therapeutic nutrition, 47% for food service management and 30% for community nutrition. Only 7% of dietitians found it very difficult to execute their daily duties. At the outset, 55% of dietitians had a positive attitude regarding the year, with this percentage increasing to 67% towards the end of the year. Negative attitudes decreased from 17% to 15%. Ninety-one per cent of dietitians reported that their knowledge improved and 95% reported an improvement in skills. Most dietitians (92%) felt that the CS year was a successful institution. Conclusions. The majority of dietitians experienced the CS year positively and felt that their knowledge and skills improved. The vast majority of dietitians reported the CS year to be a successful institution.

Abnormal eating attitudes and weight-loss behaviour of adolescent girls attending a “traditional” Jewish high school in Johannesburg, South Africa

Abstract Objectives: This study aimed to determine the prevalence of abnormal eating attitudes and weight-loss behaviour in female Jewish adolescents. Teachers’ awareness of these factors and their attitudes towards a school programme to address these were also investigated. Design: A cross-sectional study was conducted. Subjects and setting: Female learners in grades 8-11 (n = 220), attending a “traditional” Jewish high school in Johannesburg were included. Teachers (n = 38) at the relevant school were also recruited. Outcome measures: A questionnaire consisting of the 26-item version of the Eating Attitudes Test (EAT-26) and a modified section of the USA Youth Risk Behavior Survey was completed by learners. Teachers completed a questionnaire designed by the researchers. Results: Twenty per cent of the learners (n = 43) achieved EAT-26 scores ≥ 20, suggestive of a possible eating disorder, while 30.2% (n = 65) required clinical evaluation for a potential eating disorder. Thirty-three per cent (n = 72) of the adolescent girls considered themselves to be overweight, while 64% (n = 139) were trying to lose weight at the time of the study. 19.1% (n = 42) had engaged in one or more extreme methods of weight loss in the past 12 months. Most teachers (81.6%, n = 29) underestimated the proportion of adolescent girls requiring clinical evaluation and 71.1% (n = 27) underestimated the extent of current weight-loss attempts. Almost all of the teachers (97.3%, n = 37) recognised the need to address disordered eating attitudes. However, only 34.2% of the teachers (n = 13) viewed the school as the appropriate place in which to do this, and were also prepared to participate in the programme and sacrifice class time. Conclusion: To date, no published South African literature documents the presence of abnormal eating attitudes in Jewish adolescent females in South Africa. The prevalence fell within the upper end of rates reported in studies on adolescent girls in South Africa and abroad. Teachers who participated in this study were not fully aware of the extent to which eating-related issues affected female learners. A qualitative exploration thereof could yield valuable insights.

Food avoidance in irritable bowel syndrome leads to a nutrition-deficient diet

Abstract Objective: The objective was to assess the dietary intake of subjects with irritable bowel syndrome (IBS) and to compare it to that of international recommendations. The hypothesising assumption of this study was that a situation in which subjects insist that diet or trigger foods play a part in symptom generation may lead to an unbalanced dietary intake. Design: This was a descriptive observational study, with an analytical component. Setting: A private, secondary care-level clinic in South Africa. Subjects: The study population comprised 122 participants. Each subject completed an estimated, three-day dietary record. The data were analysed using a computerised food analysis programme. The fructose intake was analysed semi-quantitatively. IBS subjects’ protein and carbohydrate intake were significantly higher than the recommended dietary allowance for protein and carbohydrate (p-values < 0.000 and < 0.000, respectively). Outcome measures: The identification of dietary risk factors that affect IBS. Results: The IBS subjects’ daily total dietary fibre (15.13 g ± 13.11) was significantly lower (p-value < 0.000) than the dietary reference intake (DRI) target intake of 24.76 g/day, and the intake of micronutrients,(calcium, iron and folate) was significantly less than the DRI. There was no significant difference in macronutrient intake between the diarrhoea-predominant IBS (D-IBS), constipation-predominant IBS (C-IBS) and the control groups. The total number of fructose serves per day was not statistically significant between the three groups (C-IBS 2.68 ± 1.68, D-IBS 2.15 ± 1.86, and controls 3.17 ± 2.39, p-value = 0.157). Conclusion: The IBS subjects in this study consumed diets that were deficient in key micronutrients and total fibre when judged against the recommended DRIs. Dietary adjustments may have been tailored by subjects to minimise symptom development and this led to nutritionally deficient diets.

An investigation into utilising gestational body mass index as a screening tool for adverse birth outcomes and maternal morbidities in a group of pregnant women in Khayelitsha

Abstract Objective: The aim of this study was to investigate the ability of the gestational body mass index (BMI) method to screen for adverse birth outcomes and maternal morbidities. Design: This was a substudy of a randomised controlled trial, the Philani Mentor Mothers’ study. Setting and subjects: The Philani Mentor Mothers’ study took place in a peri-urban settlement, Khayelitsha, between 2009 and 2010. Pregnant women living in the area in 2009-2010 were recruited for the study. Outcome measures: Maternal anthropometry (height and weight) and gestational weeks were obtained at baseline to calculate the gestational BMI, which is maternal BMI adjusted for gestational age. Participants were classified into four gestational BMI categories: underweight, normal, overweight and obese. Birth outcomes and maternal morbidities were obtained from clinic cards after the births. Results: Pregnant women were recruited into the study (n = 1 058). Significant differences were found between the different gestational BMI categories and the following birth outcomes: maternal (p-value = 0.019) infant hospital stay (p-value = 0.03), infants staying for over 24 hours in hospital (p-value = 0.001), delivery mode (p-value = 0.001), birthweight (p-value = 0.006), birth length (p-value = 0.007), birth head circumference (p-value = 0.007) and pregnancy-induced hypertension (p-value = 0.001). Conclusion: To the best of our knowledge, this is the first study that has used the gestational BMI method in a peri-urban South African pregnant population. Based on the findings that this method is able to identify unfavourable birth outcomes, it is recommended that it is implemented as a pilot study in selected rural, peri-urban and urban primary health clinics, and that its ease and effectiveness as a screening tool is evaluated. Appropriate medical and nutritional advice can then be given to pregnant women to improve both their own and their infants’ birth-related outcomes and maternal morbidities.