Mieke Faber

Atherogenic effects in a non-human primate of Fusarium moniliforme cultures added to a carbohydrate diet.

Adding less than 0.5% w/w of culture material of strain MRC 826 of the fungus Fusarium moniliforme to a carbohydrate diet low in fat resulted in an atherogenic plasma lipid profile in a non-human primate. Simultaneously increased plasma fibrinogen and activity of blood coagulation factor VII could enhance atherogenesis. This unique potential for promotion of atherosclerosis was probably secondary to chronic hepatotoxicity as indicated by liver fibrosis and elevated cholesterol, albumin and the enzymes AST, ALT, LD, GGT and ALP in serum. The cholesterol and enzymes responded in proportion to the calculated doses of fumonisin mycotoxins in the F. moniliforme MRC 826 cultures. Fumonisins are water soluble and heat stable. Thrombotic, hepatotoxic, carcinogenic and cerebral effects of MRC 826 culture material and fumonisins are well known in non-primates. The estimated fumonisin concentrations tested fall within a range due to natural contamination of human foods. The results suggest that all maize grain products should be analysed for fumonisins.

Increased vitamin A intake in children aged 2-5 years through targeted home-gardens in a rural South African community.

OBJECTIVES To determine vitamin A intake of children aged 2-5 years in a rural South African community one year after the implementation of a home-based food production programme targeting beta-carotene-rich fruits and vegetables. DESIGN Dietary intake of children aged 2-5 years was determined during a cross-sectional survey before and one year after the implementation of a home-based food production programme. SETTING A low socio-economic rural African community, approximately 60 km northwest of the coastal city of Durban in KwaZulu-Natal, South Africa. SUBJECTS Children aged 2-5 years (n = 100); 50 children from households with home-gardens producing beta-carotene fruits and vegetables (project gardens), and 50 children from households without project gardens. RESULTS As compared with baseline data, there was a significant increase in vitamin A intake in children from households with project gardens as well as in children from households without project gardens. However, children from households with project gardens had a significantly higher vitamin A intake than children from households without project gardens. The increased vitamin A intake in those children from households without project gardens can be attributed to the availability of butternuts in the local shop (as a result of the project), and because the mothers negotiated with project garden mothers to obtain these fruits and vegetables for their children. CONCLUSION A home-based food production programme targeting beta-carotene-rich fruits and vegetables can lead to an increase in vitamin A intake.

Complementary foods consumed by 6 – 12-month-old rural infants in South Africa are inadequate in micronutrients

OBJECTIVE To determine the nutrient composition of complementary foods consumed by 6-12-month-old South African infants. DESIGN Nutrient intake was determined for infants who were recruited to participate in a randomised controlled trial using a single 24-hour dietary recall. SETTING/SUBJECTS Infants aged 6-12 months (n=475) residing in The Valley of a Thousand Hills, a rural area in KwaZulu-Natal, South Africa. RESULTS Energy and protein intakes from complementary foods were adequate. Infants who consumed infant products (commercially available fortified infant cereals/ready-to-eat canned baby foods/formula milk powder) had significantly higher intakes of calcium, iron, zinc, vitamin A, thiamine, riboflavin, niacin, vitamin B6, vitamin B12 and vitamin C than infants who did not consume any infant products. For infants who consumed infant cereals (n=142), these cereals provided 51% of total iron intake. Infant cereals provided more than 25% of total intake for magnesium, thiamine, niacin and vitamin B12. For infants consuming ready-to-eat canned baby foods (n=77), these products contributed less than 15% of total intake for all the micronutrients. The nutrient density of the complementary diet was less than half the desired density for calcium, iron and zinc. Animal products were consumed by 17% of infants, 26% consumed dairy products and 18% consumed vitamin-A-rich fruit and vegetables during the 24-hour recall period. CONCLUSION The nutrient composition of complementary foods among rural South African infants was inadequate, especially for iron, zinc and calcium. Strategies should be developed to improve the nutritional quality of their diets.

Nutritional status and dietary intakes of children aged 2–5 years and their caregivers in a rural South African community

The objective of this study was to determine the nutritional status regarding vitamin A, iron and anthropometric indices and dietary intakes of children aged 2-5 years and their caregivers in a rural South African community. Micronutrient, haematological, anthropometric and dietary indicators were used to assess nutritional status during a cross-sectional survey. The setting was a low socioeconomic rural African community (Ndunakazi), approximately 60 km northwest of the coastal city of Durban in KwaZulu-Natal, South Africa. The subjects were children aged 2-5 years (n = 164), and their caregivers (n = 137). Of the preschool children, 50% had a low vitamin A status (serum retinol < 20 micrograms/dL), 54% were anaemic (Hb < 11 micrograms/dL), 33% had depleted iron stores (serum ferritin levels < 10 micrograms/L), and 21% were stunted (Z-score for height-for-age < -2SD). Of the caregivers, 30% had a low vitamin A status (serum retinol < 30 micrograms/dL), 44% were anaemic (Hb < 11 micrograms/dL), 19% had depleted iron stores (serum ferritin levels < 12 micrograms/L), and 40% and 26% were overweight (BMI > or = 24 and < 30) and obese (BMI > or = 30), respectively. The children and caregivers consumed a cereal-based diet, with phutu (a stiff porridge made with maize meal), rice and bread as staple foods. Quantitative dietary analysis showed that the dietary intakes were high in carbohydrates (approximately 70% of total energy), while fat intake was within the prudent dietary guideline of 30% of total energy intake. Median dietary intakes were below 50% of the RDA for calcium, zinc (children only), vitamin A, riboflavin, niacin (children only) and vitamin B12. These preschool children and their caregivers consumed a high carbohydrate diet deficient in most of the essential micronutrients. The poor quality of the diet was reflected in a poor vitamin A and iron status, and one-fifth of the children showed linear growth retardation. Nutrition education and intervention programmes should address micronutrient deficiencies, with the focus not only on quantity, but also quality of the diet.The objective of this study was to determine the nutritional status regarding vitamin A, iron and anthropometric indices and dietary intakes of children aged 2-5 years and their caregivers in a rural South African community. Micronutrient, haematological, anthropometric and dietary indicators were used to assess nutritional status during a cross-sectional survey. The setting was a low socioeconomic rural African community (Ndunakazi), approximately 60 km northwest of the coastal city of Durban in KwaZulu-Natal, South Africa. The subjects were children aged 2-5 years (n = 164), and their caregivers (n = 137). Of the preschool children, 50% had a low vitamin A status (serum retinol < 20 μ g/dL), 54% were anaemic (Hb < 11 μ g/dL), 33% had depleted iron stores (serum ferritin levels < 10 μ g/L), and 21% were stunted (Z-score for height-for-age < -2SD). Of the caregivers, 30% had a low vitamin A status (serum retinol < 30 μ g/dL), 44% were anaemic (Hb < 11 μ g/dL), 19% had depleted iron stores (serum ferritin levels <12 μ g/L), and 40% and 26% were overweight (BMI ≥ 24 and <30) and obese (BMI ≥ 30), respectively. The children and caregivers consumed a cereal-based diet, with phutu (a stiff porridge made with maize meal), rice and bread as staple foods. Quantitative dietary analysis showed that the dietary intakes were high in carbohydrates (~70% of total energy), while fat intake was within the prudent dietary guideline of 30% of total energy intake. Median dietary intakes were below 50% of the RDA for calcium, zinc (children only), vitamin A, riboflavin, niacin (children only) and vitamin B 12. These preschool children and their caregivers consumed a high carbohydrate diet deficient in most of the essential micronutrients. The poor quality of the diet was reflected in a poor vitamin A and iron status, and one-fifth of the children showed linear growth retardation. Nutrition education and intervention programmes should address micronutrient deficiencies, with the focus not only on quantity, but also quality of the diet.

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.

Nutritional status and dietary practices of 4-24-month-old children from a rural South African community.

OBJECTIVES To assess the nutritional status and dietary practices of 4-24-month-old children (under-twos) in a rural South African community. DESIGN Cross-sectional survey. SETTING A low socioeconomic rural African community (Ndunakazi), approximately 60 km north-west of Durban, KwaZulu-Natal, South Africa. SUBJECTS Children (n = 115), 4-24 months old who attended growth monitoring posts in the area. RESULTS Of these under-twos, 37.3% had low vitamin A status (serum retinol < 20 microg dl(-1)), 65.2% were anaemic, 43.2% had serum ferritin levels < 10 microg l(-1) (an indicator of low iron stores) and 15.3% were stunted. Breastfeeding was initiated by 99% of mothers. At the time of the survey, 80% of infants in the 4-12-month-old category and 56.9% of children in the 12-24-month-old category were being breastfed. Solid foods were introduced at 3.6 +/- 0.8 months. Food intake reflected a high intake of carbohydrate-rich foods, and irregular intakes of fruit and vegetables, especially those rich in vitamin A. Foods of animal origin were not consumed regularly. Of these under-twos, 15.9% experienced an episode of diarrhoea during 2 weeks prior to the survey. CONCLUSION These under-twos had a poor vitamin A and iron status. Nutrition education, intervention programmes and feeding schemes should address micronutrient deficiencies, with the focus on the quality of the diet, rather than quantity.

Dietary diversity in relation to other household food security indicators.

This article describes dietary diversity in relation to other food security indicators used in a cross-sectional livelihood survey that included 499 randomly selected households within five municipalities in Greater Sekhukhune, Limpopo Province, South Africa. Indicators calculated using data collected by questionnaire included household dietary diversity score (DDS), living standards measure, months of food shortages and household food insecurity and access scale (HFIAS). Households with DDS ≤ 4 (n = 267) and DDS > 4 (n = 232) were compared using analysis of variance and χ²-test. Spearman correlation analysis was done for HFIAS and DDS. Compared to households with a DDS > 4, households with a DDS ≤ 4 had fewer assets, experienced more food shortages and had a higher HFIAS (16.0, 95% confidence interval (CI) 15.0-17.0 vs. 9.8, 95% CI 8.8-10.9). An inverse correlation between HFIAS and dietary diversity (r = −0.450; p < 0.01) was observed. Therefore, dietary diversity is a promising indicator for food security.

The effect of a biscuit with red palm oil as a source of β-carotene on the vitamin A status of primary school children: a comparison with β-carotene from a synthetic source in a randomised controlled trial

Objective: To determine the effect of a biscuit with red palm oil as a source of β-carotene on the vitamin A status of primary school children and to compare this with the effect of a biscuit with β-carotene from a synthetic source.Design: Randomised controlled trial.Setting: A rural community in KwaZulu-Natal, South Africa.Subjects: A total of 437 primary school children, aged 5–11 y; 400 completed the study.Intervention: Subjects were randomly assigned to one of three groups, receiving, respectively: (i) a placebo biscuit; (ii) a biscuit with synthetic β-carotene as a vitamin A fortificant (SB); (iii) a biscuit with red palm oil as a source of β-carotene (PB); SB and PB supplied 30% of the RDA for vitamin A per serving of three biscuits. Biscuits were distributed daily during the school week; vitamin A status was assessed at baseline and after 3 months.Results: There was a significant improvement in serum retinol compared to the control group in both the SB and PB groups (P<0.005); the treatment effect for the two groups was equivalent (difference in treatment effect 0.62 µg/dl, with a 90% CI−0.33–1.57).Conclusions: A biscuit with red palm oil as a source of β-carotene is as effective as a biscuit with synthetic β-carotene in improving the vitamin A status of primary school children. The additional qualities of red palm oil (ie no trans fatty acids; rich source of antioxidants) make it an excellent alternative fortificant for addressing vitamin A deficiency.Sponsorship: Financial support from Palm Oil Research Institute of Malaysia (PORIM).European Journal of Clinical Nutrition (2001) 55, 657–662

Dietary intake of primary school children in relation to food production in a rural area in KwaZulu-Natal, South Africa.

The adequacy of food intake of primary school children living in a low socioeconomic rural area, +/- 60 km northwest of Durban, KwaZulu-Natal, South Africa was assessed in a cross-sectional study. Primary school children, 10 and 11 years old and in grades 5, 6 and 7, and their mothers/caretakers were interviewed. Dietary intake was assessed by a 24-h recall and an unquantified food frequency questionnaire. Local food production was assessed by questionnaire. The diet consumed by the children comprised a limited number of food items. Fruit and vegetable consumption was low, resulting in a poor intake of micronutrients. Despite the local production of some vitamin A rich food crops, the quantity grown and eaten was low. The long-term solutions for combatting micronutrient deficiencies in this rural area include targeted local food production accompanied by a nutrition education programme, to be initiated and monitored by a multi-sectoral team of agriculturists and health scientists.

Community-based agricultural interventions in the context of food and nutrition security in South Africa

Abstract Despite South Africa being a food-secure country in terms of aggregate food availability, it is listed by the World Health Organization as one of 36 high-burden countries, home to large numbers of stunted children. Recent findings, in the context of both over- and under-nutrition, have indicated that adult and child malnutrition rates have deteriorated in South Africa. The complementarities and synergies between food availability, access and utilisation need to be aligned in interventions used to address and strengthen food and nutrition security. This is particularly pertinent in the context of the widespread AIDS epidemic which interacts with food insecurity in complex ways. It is against this backdrop that home-grown or small-scale food production is explored as a feasible contributor to food and nutrition security for the rural poor with particular emphasis on contextual and technical factors. By illustrating a few successful models of home gardening, the evidence for addressing micronutrient deficiencies in these types of interventions is presented. The challenges to establish sustainable home gardening practices and the efforts needed to address gender-distinctive issues are discussed. The case is made for community-based agricultural interventions as a critical component of the various interventions used to address food and nutrition security at the household level.