Salome Kruger

Overfatness, stunting and physical inactivity are determinants of plasminogen activator inhibitor-1activity, fibrinogen and thrombin-antithrombin complex in African adolescents.

We examined fibrinogen, thrombin–antithrombin complex, factor VIIIc and plasminogen activator inhibitor-1 activity in African children in order to determine haemostatic profile patterning and to identify possible subdivisions at high risk for cardiovascular disease. In a cross-sectional analysis, a convenience sample of 117 girls and 78 boys (15.6 ± 1.35 years) in a South African township was investigated within the Physical Activity in Youth study. Haemostatic variables were investigated in the total group and subdivisions for physical activity levels, maturity (Tanner staging), sex, fat percentage and height for age. Overfatness (53.6%) coexisted with stunting (17.5%). Plasminogen activator inhibitor-1 activity differed significantly between the sexes after adjustments for fat percentage and physical activity levels. Sex explained 10% and muscle mass 1% of the variance in plasminogen activator inhibitor-1 activity. Fibrinogen was significantly higher in girls than in boys (before adjustment for fat percentage), in overfat than in lean children and in stunted than in the nonstunted children (even after adjustment for fat percentage). C-reactive protein, sex and height for age were predictors of fibrinogen. Thrombin–antithrombin complex was significantly higher in girls than in boys, but after separate adjustment for physical activity and fat percentage there were no significant differences. Fitness and muscle mass explained the variance in thrombin–antithrombin complex the best. No significant differences were seen between the groups for C-reactive protein and factor VIIIc. Overfatness, stunting and inactivity negatively influenced plasminogen activator inhibitor-1 activity, fibrinogen and thrombin–antithrombin complex possibly increased the risk for cardiovascular disease. These factors are modifiable through behavioural changes and optimal nutritional status throughout the early life.

The Relationship Between Iron Status and Adiposity in Women from Developing Countries: A Review

Scientific reports have shown that iron deficiency is positively associated with adiposity. With the high prevalence of iron deficiency and obesity in developing countries and women being particularly affected, this review was carried out with the aim of elucidating the link between iron status and adiposity in women from developing countries and to examine factors influencing this relationship. An extensive literature search was conducted using several search engines. A systematic approach with prespecified inclusion criteria was used in selecting relevant literature. Eight studies that met the inclusion criteria were selected for review. The relationship between iron status indices and adiposity in women in developing countries varied widely. While some studies observed negative relationships, some reported positive relationships, and others no significant relationships. Furthermore, other factors such as infection, alcohol consumption, type of diet, and genes were shown to affect the relationship between iron status and adiposity in women in developing countries. In conclusion, the possibility of iron status playing a role in adiposity in women from developing countries is likely, and it may be influenced by several other factors as described in the results. Thus, it is recommended that a special research effort should be directed toward this area.

The double burden of underweight and overweight in South African adolescents: a challenge and an opportunity for nutritionists and dietitians

The prevalence of obesity is increasing in paediatric populations in developed and developing countries. 1,2 During puberty, rapid and dynamic changes occur with respect to body composition and hormonal regulation, which may be associated with a future risk of disease. 3,4 The South African National Health and Examination Survey (SANHANES-1) reported on the anthropometric nutritional status of South African children and adolescents. 5 The results provided recent and clear evidence of the double burden of malnutrition in adolescents at national level, and confirmed that overweight and obesity in adolescent girls is of particular concern. 5,6

Deriving an optimal threshold of waist circumference for detecting cardiometabolic risk in sub-Saharan Africa

Background:Waist circumference (WC) thresholds derived from western populations continue to be used in sub-Saharan Africa (SSA) despite increasing evidence of ethnic variation in the association between adiposity and cardiometabolic disease and availability of data from African populations. We aimed to derive a SSA-specific optimal WC cut-point for identifying individuals at increased cardiometabolic risk.Methods:We used individual level cross-sectional data on 24 181 participants aged ⩾15 years from 17 studies conducted between 1990 and 2014 in eight countries in SSA. Receiver operating characteristic curves were used to derive optimal WC cut-points for detecting the presence of at least two components of metabolic syndrome (MS), excluding WC.Results:The optimal WC cut-point was 81.2 cm (95% CI 78.5–83.8 cm) and 81.0 cm (95% CI 79.2–82.8 cm) for men and women, respectively, with comparable accuracy in men and women. Sensitivity was higher in women (64%, 95% CI 63–65) than in men (53%, 95% CI 51–55), and increased with the prevalence of obesity. Having WC above the derived cut-point was associated with a twofold probability of having at least two components of MS (age-adjusted odds ratio 2.6, 95% CI 2.4–2.9, for men and 2.2, 95% CI 2.0–2.3, for women).Conclusion:The optimal WC cut-point for identifying men at increased cardiometabolic risk is lower (⩾81.2 cm) than current guidelines (⩾94.0 cm) recommend, and similar to that in women in SSA. Prospective studies are needed to confirm these cut-points based on cardiometabolic outcomes.

Nutritional environment at secondary schools in Bloemfontein, South Africa

References Objective: The objective was to determine the nutritional environment at secondary schools in Bloemfontein, Free State province. Design: This was a cross-sectional, descriptive study. Subjects and setting: The subjects were secondary school principals in Bloemfontein, Free State province, in 2006. Method: Principals of 10 secondary schools who were already participating in a larger study on 26 schools completed structured questionnaires on nutrition practices. Results: Four schools utilised nutrition education programmes. None had vending machines. Two schools sold dairy products. Biscuits and chocolates were sold at eight schools, and sweets, crisps and fast food at all of the schools. Conclusion: The nutrition environment at Bloemfontein secondary schools does not support healthy eating habits. Nutrition policies need to be introduced to improve the nutritional environment at schools as the available food for learners at the tuck shops and/or via the vendors was mostly unhealthy.

School environment, socioeconomic status and weight of children in Bloemfontein, South Africa.

Background The continued existence of undernutrition, associated with a steady increase in the prevalence of overweight and obesity in children and adolescents, necessitates identification of factors contributing to this double burden of disease, in order for effective treatment and prevention programmes to be planned. Aim To determine the nutritional status of 13–15-year-old children in Bloemfontein and its association with socioeconomic factors. Setting Bloemfontein, Free State Province, South Africa (2006). Methods This was a cross-sectional analytical study. Randomly selected children (n = 415) completed structured questionnaires on socioeconomic status. The childrens weight and height were measured and body mass index-for-age and height-for-age z-scores were computed according to World Health Organization growth standards in order to determine the prevalence of underweight, overweight, obesity and stunting. Waist circumference was measured to classify the children as having a high or very high risk for metabolic disease. Results Of the 415 children who consented to participate in the study, 14.9% were wasted and 3.4% were severely wasted. Only 6% of the children were overweight/obese. Significantly more boys (23.0%) were wasted than girls (10%) and severe stunting was also significantly higher in boys than in girls (10.3% and 4.2%, respectively). Children whose parents had graduate occupations were significantly more overweight/obese than those with parents working in skilled occupations. Stunting was significantly higher in low (31.4%) and medium (30.4%) socioeconomic groups compared to the high socioeconomic group (18.1%). Conclusion A coexistence of underweight and overweight was found and gender and parental occupation were identified as being predictors of nutritional status.

Do tuck shops contribute to an unhealthy, obesogenic lifestyle among schoolchildren?

The World Health Organization’s (WHO) projections indicate that noncommunicable diseases (NCDs) will be responsible for a significantly increased total number of deaths in the next decade. Africa is one of the regions where the greatest increase is expected. 1 Interventions to prevent NCDs on a populationwide basis are not only achievable, but also cost effective. 1 The WHO proposes “best buy” actions that should be undertaken immediately to accelerated progress in terms of lives saved, diseases prevented and healthcare costs saved. Nutritionrelated actions include reducing salt intake and replacing trans fat in food with polyunsaturated fat. There is also consistent evidence that the promotion of healthy eating in schools can reduce the risk for NCDs, hence the WHO policy on schoolbased interventions. Another cost-effective and population-wide intervention proposed by the WHO is restrictions on marketing of foods and beverages high in salt, fats and sugar, especially to children. 1

Potential health risks of folic acid supplementation of 5 mg per day during pregnancy

To the Editor: We would like to express our concern regarding current prescriptions for folic acid supplementation for pregnant women in state hospitals.