Susanna M. Hanekom

Effects of a high walnut and high cashew nut diet on selected markers of the metabolic syndrome: a controlled feeding trial.

We investigated the effects of a high walnut diet and a high unsalted cashew nut diet on selected markers of the metabolic syndrome. In a randomized, parallel, controlled study design, sixty-four subjects having the metabolic syndrome (twenty-nine men, thirty-five women) with a mean age of 45 (sd 10) years and who met the selection criteria were all fed a 3-week run-in control diet. Hereafter, participants were grouped according to gender and age and then randomized into three groups receiving a controlled feeding diet including walnuts, or unsalted cashew nuts or no nuts for 8 weeks. Subjects were required to have lunch at the metabolic ward of the Nutrition Department of the North-West University (Potchefstroom Campus). Both the walnut and the unsalted cashew nut intervention diets had no significant effect on the HDL-cholesterol, TAG, total cholesterol, LDL-cholesterol, serum fructosamine, serum high-sensitivity C-reactive protein, blood pressure and serum uric acid concentrations when compared to the control diet. Low baseline LDL-cholesterol concentrations in the cashew nut group may have masked a possible nut-related benefit. Plasma glucose concentrations increased significantly (P = 0.04) in the cashew nut group compared to the control group. By contrast, serum fructosamine was unchanged in the cashew nut group while the control group had significantly increased (P = 0.04) concentrations of this short-term marker of glycaemic control. Subjects displayed no improvement in the markers of the metabolic syndrome after following a walnut diet or a cashew nut diet compared to a control diet while maintaining body weight.

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.

Dietary assessment methodology for adolescents: a review of reproducibility and validation studies

Abstract Aim: The aim of this review is to explore the validity and/or reproducibility of dietary assessment methods used to assess food and nutrient intakes of adolescents. Method: A detailed literature search was undertaken to trace articles reporting on the validity and/or reproducibility of food records, food frequency questionnaires (FFQs) and 24-hour recalls for the dietary assessment of adolescents, especially among South Africans, in the following databases: Medline, Science Direct, Academic Search Premier, Health Source, PubMed and the South African e-publications database (SAE). Original studies published between 1990 and 2009, and relevant original articles published before 1990, were included. Of these, only three were South African-based studies reporting testing for reproducibility and/or validity. Results: Results indicated that adolescents comply better with estimated food records than with weighed food records. However, energy intake was underestimated in adolescents (by 18–42%) when using food record methods. The relative validity of FFQs among adolescents was moderate, with correlation coefficients of > 0.3 for most measured nutrients and food items. Reproducibility was fair to good among female adolescents (0.3–0.83) for most nutrients and foods, but was lower in a South African Tswana-speaking group. The 24-hour recall method showed the least over- and underestimation of all the reviewed methods. When comparing the 24-hour recall method to an observed intake method among adolescents, < 11% underestimation of energy intake was found, while < 4% underestimation was found when the 24-hour recall method was tested against the doubly labelled water method. Conclusion: Based on these outcomes it was concluded that FFQs and 24-hour recalls are valid and reproducible dietary assessment methods that can be used when collecting dietary data from adolescents. Factors to consider when choosing the best suitable method should include the gender and ethnicity of the population as well as the time frame for the collection of dietary data.

Clustering of haemostatic variables and the effect of high cashew and walnut diets on these variables in metabolic syndrome patients.

We investigated the effect of a high walnut and cashew diet on haemostatic variables in people with the metabolic syndrome. Factor analysis was used to determine how the haemostatic variables cluster with other components of the metabolic syndrome and multiple regression to determine possible predictors. This randomized, control, parallel, controlled-feeding trial included 68 subjects who complied with the Third National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol criteria. After a 3-week run-in following the control diet, subjects were divided into three groups receiving either walnuts or cashews (20 energy%) or a control diet for 8 weeks. The nut intervention had no significant effect on von Willebrand factor antigen, fibrinogen, factor VII coagulant activity, plasminogen activator inhibitor 1 activity, tissue plasminogen activator activity or thrombin activatable fibrinolysis inhibitor. Statistically, fibrinogen clustered with the body-mass-correlates and acute phase response factors, and factor VII coagulant activity clustered with high-density lipoprotein cholesterol (HDL-C). Tissue plasminogen activator activity, plasminogen activator inhibitor 1 activity and von Willebrand factor antigen clustered into a separate endothelial function factor. HDL-C and markers of obesity were the strongest predictors of the haemostatic variables. We conclude that high walnut and cashew diets did not influence haemostatic factors in this group of metabolic syndrome subjects. The HDL-C increase and weight loss may be the main focus of dietary intervention for the metabolic syndrome. Furthermore, diet composition may have only limited effects if weight loss is not achieved.

Low rates of exclusive breastfeeding are still evident in four South African provinces

Abstract Objectives: Breastfeeding is one of the primary strategies used to enhance infant nutrition and improving child survival worldwide. The intention of globally increasing the rate of exclusive breastfeeding (EBF) to at least 50% of infants in the first six months of life was stated in the 2014 International Conference on Nutrition Rome Declaration on Nutrition and the Post-2015 Development Agenda. This study aimed to explore the infant-feeding practices of mothers and caregivers of infants aged ≤ 6 months in four provinces in South Africa. Setting and subjects: This cross-sectional study was conducted in four provinces in South Africa. In total, 40 health facilities were randomly selected in the four provinces and visited, including metropolitan and non-metropolitan health facilities over the geographical area of the provinces. The sample size comprised mothers and/or caregivers of babies aged ≤ 6 months. Design: Fixed-format interviews were used in this cross-sectional study on 580 mothers and/or caregivers. The mothers completed 24-hour recall based on the Food and Agriculture Organization of the United Nations dietary diversity list, consisting of 12 different food groups, to assess dietary intake and diversity. Results: The EBF rate for infants up to the age of six months was 12%. Mothers who delivered full-term babies were most likely to initiate breastfeeding within the first hour of delivery. More than a third of the mothers had ceased breastfeeding by one month (40%, n = 23). The introduction of complementary food took place in 17% of infants during this first month. The minimum standards of dietary diversity were met by one infant only. Different reasons found to influence mothers’ feeding practices included needing to return to work (29%) or their studies (12%), the mothers’ health status (25%), and perceptions of an “insufficient” milk supply (13%). Conclusion: Therefore, new strategies should address these gaps in knowledge with key breastfeeding awareness messages and a special focus on community involvement and participation. There is also a need for the whole nutrition fraternity, including government, academia and development industries, to intervene by developing more innovative approaches to increase the rate of EBF in South Africa.

Describing a design thinking methodology to develop sustainable physical activity and nutrition interventions in low resourced settings

The objective of the study is to describe how design thinking as a participatory process can be applied in determining how sustainable physical activity and nutrition interventions should be implemented in a low resourced community in South Africa. Physical inactivity is the 4th leading cause of mortality world-wide. Associated with inactivity, a high prevalence of obesity is reported. Evidence based research indicate that sustainable physical activity and nutrition interventions will reduce the burden of physical inactivity and obesity. Poverty, and its inherent lack of food security, further impacts the health of people living marginalized, increasingly urban lifestyles. The intent of the project is to change attitudes and behavior towards physical activity participation and nutrition choices. Design Thinking is typically implemented using a five-step process where the community is engaged with presenting the problem they experience, defining the problem, presenting solutions to the problem and finally developing a prototype in solving the problem they experience. The principle of the Design Thinking process is that the low resourced community holds part of the answer to the problem and has a desire to change their health. The proposed solutions, coming directly from the participants, are therefore considered viable. Once a desired prototype is developed and tested in the community, feasibility can be determined. The presence of these three factors, is expected to result in an innovation.

Reproducibility of two, three, four and five 24-hour recalls in peri-urban African adolescents in the North West province

Abstract Background: The objective was to determine the reproducibility of two, three, four and five repeated 24-hour recalls among peri-urban African adolescents. Method: A prospective study design was used within the multidisciplinary PhysicaL Activity in the Young (PLAY) study. Eighty-seven Grade 9 learners (59 girls and 28 boys, aged 10–18 years) with a mean age of 14.7 ± 1.5 years, who had completed five 24-hour recalls, were investigated. The learners were from Seiphemelo Secondary School in Ikageng, a peri-urban area in the North West province of South Africa. Reproducibility coefficients (RCs) and 95% confidence intervals (CIs) were calculated, using the intraclass correlation coefficient formula for transformed values of selected nutrients and food groups, for two, three, four and five repeated 24-hour recalls. The RCs and 95% CIs were compared in order to identify the optimum number of 24-hour recalls to give the best reproducibility results. Results: The RCs were nutrient- and food-group sensitive and ranged from 0.25 (riboflavin) to 0.6 (carbohydrate). Although differences were not statistically significant, RCs for four and five 24-hour recalls were higher than those obtained for two and three 24-hour recalls. For most nutrients and food groups, four 24-hour recalls gave the highest RCs, with non-significant differences overall between the four and five 24-hour recalls. Conclusion: The results suggest that four 24-hour recalls would be sufficient to provide acceptable reproducibility of reported food group and nutrient intakes among peri-urban African adolescents.