Ramoteme L Mamabolo

Prevalence and determinants of stunting and overweight in 3-year-old black South African children residing in the Central Region of Limpopo Province, South Africa

OBJECTIVES To determine the prevalence of stunting, wasting and overweight and their determinants in 3-year-old children in the Central Region of Limpopo Province, South Africa. DESIGN Prospective cohort study. SETTING Rural villages in the Central Region of the Limpopo Province, South Africa. SUBJECTS One hundred and sixty-two children who were followed from birth were included in the study. Anthropometric measurements and sociodemographic characteristics of the children were recorded. RESULTS Height-for-age Z-scores were low, with a high prevalence of stunting (48%). The children also exhibited a high prevalence of overweight (22%) and obesity (24%). Thirty-one (19%) children were both stunted and overweight. Gaining more weight within the first year of life increased the risk of being overweight at 3 years by 2.39 times (95% confidence interval (CI) 1.96-4.18) while having a greater length at 1 year was protective against stunting (odds ratio (OR) 0.41; 95% CI 0.17-0.97). Having a mother as a student increased the risk for stunting at 3 years by 18.21 times (95% CI 9.46-34.74) while having a working mother increased the risk for overweight by 17.87 times (95% CI 8.24-38.78). All these factors also appeared as risks or as being protective in children who were both overweight and stunted, as did living in a household having nine or more persons (OR 5.72; 95% CI 2.7-12.10). CONCLUSION The results of this study highlight the importance of evaluating anthropometric status in terms of both stunting and overweight. Furthermore, it is important to realise the importance of normal length and weight being attained at 1 year of age, since these in turn predict nutritional status at 3 years of age.

Prevalence of gestational diabetes mellitus and the effect of weight on measures of insulin secretion and insulin resistance in third-trimester pregnant rural women residing in the Central Region of Limpopo Province, South Africa.

Aims  To examine the prevalence of gestational diabetes in third‐trimester pregnant women as well as to assess their insulin secretion and insulin resistance (IR).

Habitual physical activity and body composition of black township adolescents residing in the North West Province, South Africa

OBJECTIVE It is known that stunting and obesity affect a large proportion of children in the world, and these can be affected by the physical activity levels of the children. In the present study, we evaluated the association between physical activity, physical development and body composition in black adolescent children. DESIGN Cross-sectional study. SETTING Black township schools in the North West Province, South Africa. METHODS Three-hundred and thirteen grade 8 children were included in the Physical Activity in Youth study. Anthropometric measurements, body composition measures and maturity level as assessed by Tanner stages were determined in these children. In addition, Previous Day Physical Activity Recall questionnaires were administered on the children to record the various activities they undertake daily. RESULTS The demographic characteristics of the children showed a high level of homogeneity. A high prevalence of stunting (16.3%) was observed in the children, which was higher in boys than in girls (21.6 vs. 12.3%). Also prevalent was overweight/obesity (8.6%), but this was higher in girls than in boys (13.4 vs. 1.6%). The children also showed a reduction in levels of physical activity with advancement in maturity; furthermore, boys showed a more central form of fat deposition whilst girls showed more gynoid deposition. CONCLUSIONS The study revealed that physical activity plays a role in determining body composition, and further indicated that physical activity is associated with favourable body composition measures. Children who were more active were likely to have less fat deposits.

Point-of-use micronutrient fortification: lessons learned in implementing a preschool-based pilot trial in South Africa

This current pilot trial assessed the feasibility of implementing a point-of-use (PoU) micronutrient fortification in preschool settings. Preschool children (n = 151) aged 36–79 months were randomized into intervention (n = 76) and control (n = 75) groups, both receiving breakfast maize-porridge with added micronutrient or placebo powder for 52 school days. Process evaluation and early childhood development indicators were used to assess trial feasibility. Process evaluation results showed that the implementation components were feasible and could be delivered with high fidelity. The improvement in hemoglobin concentration in intervention and control groups were not significantly different (P = 0.250). There was medium likelihood for practical significance for the two global cognitive scores assessed: non-verbal index (intervention effects: 7.20; 95% confidence interval: 2.60, 11.81; P = 0.002, effect size: 0.55) and mental processing index (intervention effects: 2.73; 95% confidence interval: 0.25, 5.70; P = 0.072, effect size: 0.36) on the Kaufman Assessment Battery for Children, Second Edition. The lessons from this trial could help in planning/implementing future PoU micronutrient fortification trial among South African preschool children.

The relationship between indices of iron status and selected anthropometric cardiovascular disease risk markers in an African population: the THUSA study

Abstract There is evidence that certain indices of iron status are associated with anthropometric measures, which are used independently as markers of cardiovascular disease (CVD) risk. This study examined whether this association exists in an African population. The study was a cross-sectional comparative study that examined a total of 1 854 African participants. Ferritin was positively associated with body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), percentage body fat and subscapular skinfold thickness. Serum ferritin concentration was higher in the high-WHR category than the normal-WHR category for both genders. Additionally, WC and WHR increased with increasing ferritin concentrations in both genders. Serum iron was lower in the obese than the normal-weight and pre-obese women only. In this population-based study, increased serum ferritin concentrations associated positively with increased WHR and WC, indicating that individuals or populations at risk of iron overload as defined by high serum ferritin concentrations may be at a greater risk of developing CVD.There is evidence that certain indices of iron status are associated with anthropometric measures, which are used independently as markers of cardiovascular disease (CVD) risk. This study examined whether this association exists in an African population. The study was a cross-sectional comparative study that examined a total of 1 854 African participants. Ferritin was positively associated with body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), percentage body fat and subscapular skinfold thickness. Serum ferritin concentration was higher in the high-WHR category than the normal-WHR category for both genders. Additionally, WC and WHR increased with increasing ferritin concentrations in both genders. Serum iron was lower in the obese than the normal-weight and pre-obese women only. In this population-based study, increased serum ferritin concentrations associated positively with increased WHR and WC, indicating that individuals or populations at risk of iron overload as defined by high serum ferritin concentrations may be at a greater risk of developing CVD.

Folate and iron status of South African non-pregnant rural women of childbearing age, before and after fortification of foods

after fortification, none of the women had low serum folate. Low red cell folate (<164 ng/ml) was observed in 26.4% of subjects before fortification, and in 1.9% of subjects after fortification. The prevalence of vitamin B12 deficiency (<145 pg/ml) was 6.3% during phase 1 of the study and increased to 11.3% during phase 2. Low haemoglobin levels were present in 7.5% of women before fortification, and in 5% of women after fortification. The percentage of women with low ferritin levels was similar before and after fortification (25%). Conclusion. The study shows a significant improvement in folate status in women of childbearing age approximately 9 months after fortification of maize and wheat foodstuffs in South Africa, whereas no improvement in iron status as measured by serum ferritin was observed.

Can the high prevalence of micronutrient deficiencies, stunting and overweight in children at ages 1 and 3 years in the Central Region of Limpopo province be explained by diet?

Abstract Objective. To assess whether the high prevalence of stunting and overweight accompanied by serum deficiencies of iron, folate and vitamin B12 in children at ages 1 and 3 years, can be explained by their diet. Design. A prospective cohort study. Setting. Villages in the central region of Limpopo province, which are serviced by Mankweng Hospital. Subjects. A cohort of children (N = 219) followed from birth were included in the study. Of the original cohort, 156 and 162 could be traced and assessed at ages 1 and 3 years, respectively. Dietary intake of the children was assessed using a quantitative food frequency questionnaire and at 3 years a 24-hour recall questionnaire was also administered. Results. The children in this cohort consumed an energy-dense diet of poor quality as evidenced by insufficient intakes of iron, zinc, calcium and phosphates as well as folate, riboflavin, vitamin B6, niacin and vitamin A. Overall, nearly 70% of the energy intake of the diet came from carbohydrates while the contribution from fat was less than 20%. Average protein intake was adequate but comprised mainly protein from vegetable sources which are poor sources of iron and certain essential amino acids. Furthermore, the diet was judged to be high in phytates because of the high intake of cereals and this would have contributed to making iron and zinc less available for absorption. Low fruit and vegetable intake was the cause of the low intake of folate, vitamin A and vitamin C. The prevalence of micronutrient deficiencies was confirmed by the high prevalence of children with iron and folate biochemical deficiencies. Conclusion. The children’s diet was poor in several micronutrients which included iron, calcium, folate and vitamin A. Chronic energy deficiency, especially from animal sources, seems to be the factor contributing to the high levels of stunting observed.

Evaluation of the effectiveness of iron and folate supplementation during pregnancy in a rural area of Limpopo province.

Abstract Objective. To evaluate the effectiveness of iron and folate supplementation in antenatal clinics. Design. A cross-sectional analytical study. Setting. Villages in the central region of Limpopo province, which are serviced by Mankweng Hospital. Subjects. Third-trimester pregnant women (N = 262) attending antenatal clinics at eight local clinics inthe villages. Results. The prevalence of anaemia (haemoglobin < 10.5 g/dl) in this study population was 16.4%. The mean number of clinic visits during pregnancy was 4.1 (standard deviation (SD) 2.18). There were no differences in clinic attendance for the anaemic and non-anaemic participants. Maternal weight was found to be lower (p = 0.051) in the anaemic than the non-anaemic group. Iron, vitamin B12 and folate deficiencies are still common in this area, with 50.9%, 16.4% and 10.3% of the pregnant women respectively having biochemical evidence of these deficiencies. In the anaemic group iron deficiency was the most prevalent deficiency, with 62.8% of the women having iron deficiency (serum ferritin < 12 5g/ml). In the non-anaemic group there was a significant negative correlation between both serum and red cell folate and the time of first visit to the clinic, indicating that folate supplementation given by the clinics is effective in prevention of folate deficiency. Conclusion. Although both iron and folate supplements are issued at antenatal clinics in the central area of Limpopo province, iron deficiency and iron deficiency anaemia are still prevalent in pregnant women. However there has been a marked improvement in the prevalence of folate deficiency.

Iron status and cardiovascular disease risk in black South African women: the PURE study

Abstract Objective: To examine the associations between measures of iron status and cardiovascular disease (CVD) risk factors in South African women. Method: In a cross-sectional study, demographic information and health history were obtained during individual interviews using validated questionnaires in the North West Province, South Africa. Anthropometric indices, iron indices, blood pressure, blood glucose and lipid profiles were measured using standard procedures in 1 262 apparently healthy black South African women aged 35 years or older. Iron status was assessed using serum concentrations of ferritin, transferrin receptor (TfR) and TfR:ferritin ratio. Results: Associations between iron status parameters and CVD risk factors were generally weak (r < 0.3, p < 0.01) and were not retained when adjustment was made for age, body mass index, smoking, alcohol consumption and C-reactive protein in the analysis. Waist circumference (WC) and waist:hip ratio (WHR) were higher in the fourth quartile of serum ferritin than in the third quartile, and also in the third quartile compared to the second quartile (P < 0.05). Based on WC and WHR respectively, 31% and 52% of the women had excess abdominal obesity. The mean (95% confidence interval) serum TfR concentration was high, at 9.09 µg/ml (8.77, 9.44), indicating risk of iron deficiency. The mean (95% confidence interval) concentrations of lipids [total cholesterol 4.78 mmol/l (4.64, 4.93), high-density lipoprotein cholesterol 1.45 mmol/l (1.39, 1.52), low-density lipoprotein cholesterol 1.65 mmol/l (1.53, 1.78), triglyceride 1.12 mmol/l (1.07, 1.18)] were within reference ranges. Conclusion: No significant association was found between iron status parameters and established CVD risk factors. However, excessive abdominal adiposity indicated by high WC and WHR contributes significantly to increased serum ferritin concentration in this population.

Association between insulin-like growth factor-1, measures of overnutrition and undernutrition and insulin resistance in black adolescents living in the north-west province, South Africa

To determine if insulin‐like growth factor‐1 (IGF‐1) is a significant predictor of body fat percentage (%BF), lean body mass, and insulin resistance (IR) in black adolescents presenting with overnutrition and undernutrition.