South African Journal of Clinical Nutrition <ol> <li class="show">The Journal accepts articles from all basic and applied areas of dietetics and human nutrition, including clinical nutrition, community nutrition, food science, food policy, food service management, nutrition policy and public health nutrition.</li> <li class="show">The Journal has a broad interpretation of the field of nutrition and recognizes that there are many factors that determine nutritional status and that need to be the subject of scientific investigation and reported in the Journal.</li> <li class="show">The Journal seeks to serve a broad readership and to provide information that will be useful to the scientific community, the academic community, government and non-government stakeholders in the nutrition field, policy makers and industry.</li> <li class="show">The Journal encourages articles from all investigators in the field of dietetics, food, nutrition and related areas. In particular young researchers and researchers from historically disadvantaged backgrounds will be encouraged and supported to submit their research work for publication.</li> <li class="show">The Journal is based in South Africa and encourages articles from other African countries to act as a forum for the discussion of African nutritional issues.</li> <li class="show">The Journal is committed to high scientific and ethical standards.</li> <li class="show">The Journal will accept letters for publication, which are relevant to the Journal.</li> <li class="show">The Journal provides a forum for publication of congress abstracts, supplements, short communications and policy statements with their technical support papers.</li> <li class="show">The views expressed in the Journal are those of the authors and not necessarily those of the Editorial Board.</li> <li class="show">The Journal will be managed by an Editor and Editorial Board with the following responsibilities:</li> <ul> <li class="show">Maintenance of scientific standards of the articles published and appointment of a review Panel of experts for the peer review process</li> <li class="show">Maintenance of ethical standards of the articles published</li> Encouragement and support of authors <li class="show">Promotion of the readership</li> <li class="show">Ensuring the spread of articles published</li> </ul> <li class="show">Maintenance of ethical standards with regard to sponsorship and advertisements</li> <li class="show">The Editorial Board of the SAJCN recognises the important role that advertisements and sponsorships play in meeting the costs of the publication and in ensuring the continued existence of the Journal. The SAJCN welcomes advertising or funding from all possible sources, provided the advertisements or funding arrangements are supportive of the objectives of the Journal and do not conflict with the mission, vision and values statements of ADSA, NSSA and SASPEN. The following guidelines shall be implemented for sponsorship and advertising:</li> <ul> <li class="show">The Jakarta Declaration, which clearly stipulates that “both the public and the private sector should promote health by pursuing policies and practices that ….. restrict production and trade in inherently harmful goods and substances such as tobacco and armaments, as well as unhealthy practices?</li> <li class="show">Advertisements/sponsorships should not conflict with the South African Code of Ethics for the Marketing of Breastmilk Substitutes. The updated code will be used as soon as it is formally released.</li> <li class="show">The Journal will accept advertisements for infant-feeds, which are therapeutic in nature, for example lactose free feeds, breast milk fortifiers, hypo-allergic feeds and feeds designed for tube feeding. Any such advertisements shall include a phrase that normally exclusive breast milk feeding is the best food for babies.</li> <li class="show">There shall be full disclosure at all times of funding sources</li> <li class="show">The decision to reject an advertisement / sponsorship rests with the Editorial Board and should be recorded, so that further investigations can be conducted if required</li> <li class="show">Non-designated support will be accepted from interested organisations and shall be acknowledged in the Journal</li> <li class="show">The allocated editorial space for advertisements should not normally exceed 40% of the total editorial space in any one issue of the Journal; however, the costs of publication of the Journal should always be borne in mind in any one given situation</li> <li class="show">The Editor, in consultation with the Editorial Board as appropriate, will be responsible for the final acceptance of any advertorial material</li> </ul> </ol> <p>Other websites related to this journal:<br>NISC <a href="" target="_blank" rel="noopener" data-saferedirecturl=";source=gmail&amp;ust=1684568969944000&amp;usg=AOvVaw2GsR7m5wTo6_bDIrFD3goH"><wbr>products/77/journals/south-<wbr>african-journal-of-clinical-<wbr>nutrition</a><br>T&amp;F <a href="" target="_blank" rel="noopener" data-saferedirecturl=";source=gmail&amp;ust=1684568969944000&amp;usg=AOvVaw16BF1kchMr8VCJE98Bl9Kt"><wbr>journals/ojcn20</a><br>SAJCN website <a href="" target="_blank" rel="noopener" data-saferedirecturl=";source=gmail&amp;ust=1684568969944000&amp;usg=AOvVaw2d88QwEyiZWfXx_CYQVUAl"><wbr>php/SAJCN</a>)</p> <p>The <em>South African Journal of Clinical Nutrition</em> (SAJCN) is also Accredited with the <strong>DHET (SAPSE)</strong> and now on the <strong>DOAJ</strong>.</p> en-US <p>Material submitted for publication in the South African Journal of Clinical Nutrition (SAJCN) is accepted provided it has not been published elsewhere. Copyright forms will be sent with acknowledgement of receipt and the SAJCN reserves copyright of the material published.</p><p>The SAJCN does not hold itself responsible for statements made by the authors.</p> (Prof D. Labadarios) (Ms Robyn Marais (Title coordinator)) Mon, 15 Apr 2024 10:23:13 +0000 OJS 60 Urgent call for awareness and education about donor breastmilk <p>No Abstract</p> Lisanne M. du Plessis, Mantji A. Mahlatjie Copyright (c) 2024 Mon, 15 Apr 2024 00:00:00 +0000 Knowledge, attitudes and awareness regarding donor breast milk: a crosssectional study of mothers in a high HIV-prevalent area <p><strong>Background</strong>: The use of donated expressed breast milk (DBM) is encouraged in South Africa, with donor milk banks and legislated&nbsp; policies and programmes available in hospitals serving populations with a high HIV prevalence. Concerns over poor attitudes amongst&nbsp; mothers towards DBM seem to persist.</p> <p><strong>Methods</strong>: A cross-sectional mixed-methods approach was used in a cohort of mothers of neonates in a regional hospital. Between April&nbsp; 2021 and January 2022, survey data on knowledge, awareness and attitudes towards DBM was collected. Qualitative data from open- ended questions were thematically analysed. Comparative analysis using independent sample t-tests and logistic regression to&nbsp; determine differences in variables and to understand associations related to knowledge was conducted.</p> <p><strong>Results</strong>: A total of 163 mothers with a mean (SD) age of 27.1 ± 6.3 years were included; 49.7% of mothers had post-high-school qualifications, 82.8% were unemployed and 87.0% received social security. Some 64.4% had inadequate knowledge of DBM. Awareness of&nbsp; DBM had the strongest association with better knowledge concerning DBM and AdjOR (25.25 95% CI 10.60– 68.40; p &lt; 0.001). Negative&nbsp; attitudes towards DBM were largely driven by a lack of knowledge regarding human immunodeficiency virus (HIV) screening of donor&nbsp; mothers and fears of HIV transmission when using DBM.</p> <p><strong>Conclusion</strong>: Lack of awareness concerning DBM was associated with poor&nbsp; knowledge of DBM, which may drive poor uptake of this critical nutritional source for at-risk neonates. Implementing targeted awareness&nbsp; programmes on DBM, which begin in the antenatal period and specifically address HIV screening of donor mothers, could&nbsp; address the poor uptake of DBM.</p> Hadebe Thobeka Zamahlubi, Kimesh L. Naidoo, Fharnisa Khana, Refiloe Masekela Copyright (c) 2024 Mon, 15 Apr 2024 00:00:00 +0000 Associations between nutrition knowledge and obesity-related attitudes and physical activity among young adults from Kenya, South Africa, and the United Kingdom <p><strong>Objective</strong>: This study’s aim was to test associations between nutrition knowledge and obesity-related attitudes and physical activity (PA)&nbsp; among 3000 18–35-year-old men and women from Kenya, South Africa (SA), and the United Kingdom (UK).</p> <p><strong>Methods</strong>: A cross-sectional online survey was conducted in April 2022. To estimate nutrition knowledge, dietary recommendation&nbsp; knowledge score was computed using the standard General Nutrition Knowledge questionnaire. Obesityrelated attitudes were from the&nbsp; British Social Attitudes Survey. Self-reported days of vigorous and moderate PAs and walking were used. Ordinal logistic regression was&nbsp; employed to test all associations, while adjusting for age group, gender and a household asset score. Using simple mediation, testing&nbsp; was also done to ascertain whether obesity-related attitudes mediated associations between nutrition knowledge and PA.</p> <p><strong>Results</strong>:&nbsp; Consistently, better nutrition knowledge was associated with disagreeing that ‘There is no reason to worry about obesity’ (ORs ≥ 1.09),&nbsp; but lower odds of being against ‘Providing free weight management courses’ and ‘Creating/improving cycle paths and pavements to&nbsp; encourage PA’ (ORs ≤ 0.90). Better nutrition knowledge was also associated with higher vigorous PA in SA (OR = 1.09), and moderate PA&nbsp; (OR = 1.04) and walking (OR = 1.12) in the UK. In the combined sample, associations of nutrition knowledge with vigorous PA were fully&nbsp; mediated by believing that ‘Obesity results from not exercising enough’ (11.1% mediated). Likewise, associations of nutrition knowledge&nbsp; with moderate PA were fully mediated by attitude towards ‘Creating or improving cycle paths and pavements to encourage PA’ in the UK&nbsp; (38.9% mediated).</p> <p><strong>Conclusions</strong>: Nutrition knowledge is associated with obesity-related attitudes and PA among young adults, but some relationships are country-specific. Interventions based on findings from high-income countries should be evaluated before being&nbsp; implemented in low-resource settings.&nbsp;</p> Siphiwe N. Dlamini, Asanda Mtintsilana, Witness Mapanga, Ashleigh Craig, Shane A. Norris Copyright (c) 2024 Mon, 15 Apr 2024 00:00:00 +0000 Agreement between measured energy expenditure and predictive energy equations in paediatric oncology <p><strong>Purpose</strong>: Optimal nutritional support in childhood cancer relies on the adequate provision of energy. This study investigated the impact&nbsp; of chemotherapy on resting energy expenditure (REE) during the first six months of treatment and the accuracy of predictive equations in calculating said requirements of newly diagnosed children with cancer.<br><strong>Methods</strong>: REE was measured at diagnosis utilising a validated bioelectrical impedance analysis (BIA) mobile unit and compared with&nbsp; three predictive equations (Schofield 1985, World Health Organization [WHO] 1985 and the Recommended Dietary Allowance [RDA]&nbsp; 1989). Agreement and accuracy of these equations were tested by determining bias and agreement rates and displayed using the Bland– Altman plot. Baseline values were plotted against monthly follow-up measurements over time. Statistical significance was 5% and a priori limits of agreement set between 90% and 110% of measured REE.<br><strong>Results</strong>: Forty-three newly diagnosed children with median age 4 years (IQR 2.0–7.6) were measured prior to chemotherapy initiation.&nbsp; Compared with measured REE (mean ± SD) 719.53 ± 206.29 kcal/day, all predictive equations significantly overestimated REE: WHO 1985&nbsp; (889.75 ± 323.31 kcal/day; 23% overestimation), Schofield 1985 (899.62 ± 336.10 kcal/day; 25% overestimation) and RDA (1647.67 ± 481.06&nbsp; kcal/day; 129% overestimation) (p &lt; 0.001). Despite significant proportionate bias in all three equations (p &lt; 0.001), the intra-class&nbsp; consistency coefficient showed good reliability for the Schofield 1985 (0.864) and WHO 1985 (0.849) equations. Though statistically&nbsp; significant (chi-square = 23.11, p &lt; 0.003), the overall 1 kcal/kg (1.3%) increase for all cancer types at six months may not be clinically&nbsp; significant.<br><strong>Conclusion</strong>: Existing predictive equations are unable to calculate REE accurately at childhood cancer diagnosis, highlighting the need for&nbsp; future investigations into the development of cancer-specific equations.</p> I. Kellerman, M. Kruger, J. Schoeman, R. Blaauw Copyright (c) 2024 Mon, 15 Apr 2024 00:00:00 +0000 Non-nutritive sweeteners: consumer awareness and inclusion in food and beverage products in South Africa <p><strong>Background</strong>: The widespread use of non-nutritive sweeteners (NNSs) in the food and beverage industry has become a global trend.</p> <p><strong>Objective</strong>: A study was undertaken to assess the level of awareness of South Africans of NNSs and to create a scientific product database&nbsp; of NNSs in a sample of packaged products in South Africa.</p> <p><strong>Design</strong>: A cross-sectional survey design was chosen.</p> <p><strong>Setting</strong>: The study was&nbsp; carried out online in South Africa.</p> <p><strong>Subjects</strong>: The study participants were South African adults (n = 388).</p> <p><strong>Outcome measures</strong>: A consumer&nbsp; awareness survey on NNSs and a scientific product database were created to identify products formulated with NNSs.</p> <p><strong>Results</strong>:&nbsp; A large proportion of participants were unfamiliar with most NNSs by name; however, a significant 61% (n = 238) (p &lt; 0.001) of&nbsp; participants were most aware of xylitol, and 45% (n = 174) were aware of aspartame. Despite this, a significant number of participants&nbsp; consumed products labelled ‘sugar-free’ and/or ‘diet’ (p &lt; 0.001). Participants were aware of health concerns and health benefits&nbsp; associated with the consumption of NNSs. A scientific product database consisting of 419 products containing NNSs was created during&nbsp; the study. A combination of NNSs was used in the formulations of 65% (n = 273) of the products, while 35% (n = 146) of the products were&nbsp; formulated with a single NNS.</p> <p><strong>Conclusion</strong>: The outcome of this research highlights key consumer insights into NNSs and their&nbsp; widespread use in product formulations in South Africa. The outcome of this study shows the need for continuous monitoring of the&nbsp; effects of the increasing use of NNSs in product formulation and their impact on health and diet. Consumer education would advance consumer awareness of NNSs.&nbsp; </p> Shakun Naicker, Ashika Naicker, Evonne Singh Copyright (c) 2024 Mon, 15 Apr 2024 00:00:00 +0000 Job satisfaction and perception of workloads among dietitians and nutritionists registered in South Africa <p><strong>Background</strong>: Personal perspective concerning work demands directly impacts quality health care and patient satisfaction. Little is known&nbsp; about job satisfaction amongst dietitians and nutritionist, while workload has not previously been studied in this population.</p> <p><strong>Methods</strong>: A descriptive cross-sectional study was performed using an online questionnaire. Data were collected on sociodemography.&nbsp; Job satisfaction was measured with Spector’s Job Satisfaction Survey (JSS) (including an added subscore for resource availability) and&nbsp; workload with the National Aeronautics and Space Administration Task Load Index (NASA-TLX).</p> <p><strong>Results</strong>: Respondents (n = 238) had a&nbsp; median age of 32.0 years (IQR: 27−39 years); 92.4% were female; 95.7% were dietitians, 2.4% were nutritionists and 18.9% had a&nbsp; postgraduate degree. Respondents had practised the profession for a median of 8 years (IQR 3−15 years), and 225 were in dietetic and&nbsp; nutrition-related jobs. Median scores indicated that they were slightly satisfied with their jobs (n = 224) and experienced slightly high&nbsp; workload (n = 224). Most respondents were moderately satisfied with the nature of their work and found it rewarding. The median scores&nbsp; for salaries, promotion opportunities, work environment and availability of resources were low. Total JSS was higher in older and more experienced dietitians and nutritionists than in younger ones (p &lt; 0.05). Those employed in the government sector (n = 100) experienced&nbsp; higher physical demands and levels of frustration, and had lower JJS than those employed elsewhere (n = 124), particularly regarding&nbsp; promotion opportunities and resources availability.</p> <p><strong>Conclusion</strong>: Despite being generally positive towards practising their profession,&nbsp; South African dietitians and nutritionists, particularly in the public health sector, experienced only slight job satisfaction, related to salary&nbsp; and promotion issues and lack of resources, and were slightly overworked. Understanding the factors that shape perceptions of work&nbsp; within nutrition and dietetics may assist managers in recruiting and retaining a highly skilled workforce, particularly in developing&nbsp; countries with overburdened healthcare systems.&nbsp;</p> Louise van den Berg, Sindi-marie de Beer, Talitha Claassen, Jemima Meyer, Ingrid Strydom, Cornelius van Rooyen, Hermina Spies Copyright (c) 2024 Mon, 15 Apr 2024 00:00:00 +0000 Integration of nutrition support using the FIGO nutrition checklist in the <i>Bukhali</i> trial: a dietitian’s perspective <p>The burden of malnutrition experienced globally, coupled with the increasing rate of micronutrient deficiencies, compromises the health&nbsp; and well-being of women during their reproductive years. Obesity places young South African women at particular risk during pregnancy,&nbsp; and increases obesity risk for their offspring. To address these risks, the Bukhali trial is being implemented in Soweto, South&nbsp; Africa with 18–28-year-old women, as part of the Healthy Lifestyle Trajectory Initiative. A dietitian is part of the Bukhali intervention team&nbsp; (community health workers) to provide nutritional support for overweight/obese trial participants, making use of the International Federation of Gynaecology and Obstetrics (FIGO) Nutrition Checklist. This paper reflects on the experiences and lessons learned by the&nbsp; Bukhali dietitian, including the use of the FIGO Nutrition Checklist and Healthy Conversation Skills to facilitate conversations about&nbsp; making healthy dietary behaviour changes. Identified challenges that influence nutrition and behaviour are discussed, including lack of&nbsp; food affordability, cultural and social influences on healthy food choices, unsupportive environments and food insecurity. Strategies to optimise this nutritional support are also mentioned. The Bukhali trial is showing that introducing additional nutrition support by a&nbsp; dietitian for at-risk participants has the potential to encourage young women to prioritise nutrition and health, even in the midst of&nbsp; contextual challenges to both nutrition and health.&nbsp;</p> Lethabo Mogasho, Shane A. Norris, Khuthala Mabetha, Larske Soepnel, Catherine E. Draper Copyright (c) 2024 Mon, 15 Apr 2024 00:00:00 +0000