South African Journal of Clinical Nutrition

Nutrition support in critical care: How does a South African unit measure up against the suggested guidelines and against the world?

Anna-Lena du Toit — 2023-07-24

No abstract

Nutritional support practices at an intensive care unit in Johannesburg, South Africa

Abdullah E Lahera — 2023-07-24

Objectives: Nutritional support is a fundamental component of holistic patient care in the intensive care unit (ICU). There is a paucity of local data pertaining to nutritional support practices at ICUs in South Africa. The aim of this study was to determine nutritional support practices at an academic hospital ICU in Johannesburg, South Africa.
Methods: In this cross-sectional, descriptive and retrospective study, a simple random sampling method was utilised to select
50 data collection days from a three-month period (1 August–31 October 2018). Data relevant to the study were extracted from the ICU charts of patients who received formulae-based enteral and/or parenteral nutrition on the selected days. Charts were categorised into acute phase days (≤ 72 hours from ICU admission) and recovery phase days (> 72 hours from ICU admission).
Results: A total of 387 ICU charts were included in the final sample, comprising 114 acute phase and 273 recovery phase days. Overall, enteral nutrition was prescribed on 296 (76.5%) chart days while parenteral nutrition was prescribed on 111 (28.7%) chart days. The median daily fluid balance was approximately 600 ml positive. Target protein and calorie intake was achieved on 67 (17.3%) and 110 (28.4%) chart days respectively.
Conclusion: Although protein and calorie intake was suboptimal in comparison with the recommended targets, it is in keeping with general international trends. Regular audits, training of staff, attention to minimising feeding interruptions and encouraging the timely initiation of enteral nutrition are recommended interventions that may be useful in achieving
nutritional targets.

Exploring the prevalence of multiple forms of malnutrition in children 6–18 years living in the Eastern Cape, South Africa

Gugulethu T Moyoa — 2023-07-24

Background: The existence of multiple forms of malnutrition is a growing problem in developing countries. Children living in the Eastern Cape have a relatively high prevalence of cardiovascular disease (CVD) risk factors and food insecurity, suggesting the possibility of the several coexisting forms of malnutrition. Due to the negative long-term consequences of undernutrition, overnutrition and, to a greater extent, a combination of both, it is important for this issue to be identified early in children and addressed.
Aim: This study was undertaken to investigate the prevalence of the different forms of malnutrition in children living in the Eastern Cape province.
Methods: Secondary analysis of a cross-sectional sample of 237 school-aged children, aged 6–18 years, in the Eastern Cape province of South Africa was conducted. The variables included in the analysis were the demographic data, anthropometric data and biochemical data, specifically blood profiles related to micronutrient deficiencies and CVD risk factors. Fisher’s exact test was used to compare the prevalence rates of several coexisting forms of malnutrition in the children. All data analysis was conducted in R version 4.0.3 and statistical significance was set at 0.05.
Results: In children with overweight/obesity, 13.6% had a micronutrient deficiency, while 37.71% of the children within the normal weight range had coexisting micronutrient deficiencies and CVD risk factors. The prevalence of folate deficiency was 73.0%, iron deficiency 6.3%, and hyperglycaemia was at 10.6%. Fisher’s exact test was used to compare the prevalence rates between genders and no statistically significant differences were observed.
Conclusion: Further research is needed to understand the relatively high prevalence of CVD risk factors in these children within the normal weight range and to investigate how dietary intake contributes to the overall double burden of malnutrition in children.

The relationships between socioeconomic status, dietary knowledge and patterns, and physical activity with adiposity in urban South African women

Gudani Mukoma — 2023-07-24

Background: This cross-sectional study examined the relationship between socioeconomic status (SES), dietary knowledge and patterns, and physical activity level with body mass index of urban South African young women.
Methods: Data were collected on 160 black South African women (aged 18–24 years) and included household SES, food frequency and nutritional knowledge questionnaires, self-reported physical activity and anthropometry. To assess household SES index, 1–7 assets were categorised as a lower household SES and those with 8–13 assets as a higher household SES. Structural equation modelling analysis was used to determine the direct, indirect and total effects on adiposity of household SES, age, education, nutrition knowledge score, dietary patterns and physical activity.
Results: The prevalence of overweight and obesity was similar among women from high SES households compared with their low SES peers (48.4 vs. 44.8%). More than half (53%) of the women had poor dietary knowledge. Women from low SES households spent more time in moderate to vigorous intensity exercise (MVPA) compared with their high SES counterparts. Two distinct dietary patterns (Western and mixed) were identified. SEM results show that a unit increase in adherence to the ‘Mixed’ dietary pattern compared with ‘Western’ was associated with a 0.81 lower BMI kg/m² (95% CI −1.54; −0.08), while ≥ 150 minutes’ MVPA per week was associated with a 1.94 lower BMI kg/m2 (95% CI −3.48; −0.41).
Conclusion: The associations of SES, diet and physical activity on BMI must be taken into account when developing and designing interventions that target improvement in young women’s health.

Assessment of knowledge, attitude and practice of nurses regarding enteral nutrition at a military hospital

Londolani Ramuadaa — 2023-07-24

Background and objectives: Enteral nutrition (EN) support plays a vital role in reducing malnutrition in hospitalised patients, and its provision is primarily a nurse’s role. Therefore, nurses need to have adequate knowledge and a positive attitude regarding EN. This study aimed to determine the knowledge, attitudes and practices (KAPs) regarding enteral nutrition of nursing personnel at 1 Military Hospital and to determine the need for updated in-service training.
Method: A descriptive, cross-sectional study with an analytical component was used to collect data from military nurses through a validated self-administered questionnaire. A score of 80% and above was rated as adequate knowledge. Descriptive statistics were employed to describe the results and correlations were used to determine relationships between continuous variables.
Results: In total, 207 (86.2% response rate) questionnaires were completed. The median knowledge score was 46.3% (mean 45.8 ± 13.7%, range 6.3–81.2%). Only one participant achieved the target score of ≥ 80%, and 16.3% scored ≥ 60%. No significant differences were found between knowledge and professional rank (p = 0.14) and knowledge and years of working experience (r = −0.01; p = 0.85). A positive attitude towards EN was found and 96.1% of participants expressed the need for additional in-service training.
Conclusion: The nursing personnel have inadequate EN knowledge, irrespective of their professional rank and experience. However, they are perceived to have positive attitudes towards the importance and administration of EN. Therefore, inservice training should be conducted regularly to mitigate the gap in knowledge.

Perception of proposed preliminary food-based dietary guidelines for Lake Victoria region of Kenya: findings from a qualitative study among adult community members

EC Korira — 2023-07-24

Background: Diets in the Lake Victoria region of Kenya have been described as monotonous, consisting chiefly of starchy staple
foods, accompanied by green vegetables and oil. To promote healthy eating in the region, 11 food-based dietary guidelines (FBDGs) were proposed.
Objective: This study was designed to assess perception of the proposed FBDGs amongst consumers in Lake Victoria region.
Design and setting: A qualitative, descriptive cross-sectional design was used to collect data from 36 focus-group discussions
(FGD) among adult males (18) and females (18) in Kisumu and Homa Bay Counties.
Subjects: A total of 207 adult males (26–74 years) and 211 females (18–71 years) participated in this study. Data collection and analysis: Proposed FBDGs were printed on posters and presented to FGD participants. Proceedings were audio-taped, transcribed, translated and analysed based on themes.
Results: The proposed FBDGs were perceived as promoting the consumption of a balanced diet. As a concept, a balanced diet was misrepresented as composed of only three nutrients: carbohydrates, proteins and vitamins. There was no mention of fats/ oils and minerals as other significant nutrient constituents of a balanced diet. Other concepts, which included ‘three regular meals’, ‘snacks’, ‘food variety’, ‘healthy and physically active lifestyle’, were polysemous.
Conclusion: The findings provide insight to guide the adaptation of the national FBDGs. The findings also provide a basis for nutrition advocacy programmes and a rationale for the revision of nutrition education materials, including the school curriculum, to align content with current evidence-based information.

Nutritional interventions and outcomes of children with short bowel syndrome in a tertiary hospital setting in South Africa

BD Saaymana — 2023-07-24

Objectives: To describe the impact of nutritional interventions on the outcomes of children with short bowel syndrome (SBS).
Design: This was a retrospective descriptive observational review where data were obtained from the patient’s medical records.
Subjects and setting: Children with SBS between the ages of 0 and 24 months who obtained this diagnosis between January 2005 and December 2015 at a tertiary paediatric hospital in Cape Town were investigated.
Results: There were 46 patients (62% male, 38% female) included in the study. The median duration of parenteral nutrition (PN) support was one month (0.6, 2.2 months), after which 83% of patients were weaned from PN. Enteral nutrition was commenced in 96% of patients, with the majority (n = 36; 82%) starting on day six (±6; range 1–29 days) postoperatively and 80% of patients attaining full feeds at median 1.2 months (0.2, 36 months). Patients displayed a mean weight and length gain of 15 g/day (±4; range 19–92 g) and 2 cm/month (±1.4; range 0.25–4 cm) respectively. The main complications were PN-associated cholestasis (n = 17), fat malabsorption (n = 13) and vitamin D deficiency/insufficiency (n = 5).
Conclusion: This study showed that early initiation of PN support was attained, and that most patients were able to achieve enteral autonomy.