Objective: The aim of the National Food Consumption Survey (NFCS) in South Africa was to determine the nutrient intakes and anthropometric status of children (1 -9 years old), as well as factors that influence their dietary intake. Design: This was a cross-sectional survey of a nationally representative sample of all children aged 1-9 years in South Africa. A nationally representative sample with provincial representation was selected using 1996 Census information. Subjects: Of the 3120 children who were originally sampled data were obtained from 2894, a response rate of 93%. Methods: The sociodemographic status of each household was assessed by a questionnaire. Dietary intake was assessed by means of a 24-hour recall and a foodfrequency questionnaire from the caregivers of the children. Food purchasing practices were determined by means of a food procurement questionnaire. Hunger was assessed by a modified hunger scale questionnaire. Nutritional status was determined by means of anthropometric measurements: height, weight, head circumference and arm circumference. Results: At the national level, stunting (height-for-age below minus two standard deviations (,22SD) from the reference median) was by far the most common nutritional disorder, affecting nearly one in five children. The children least affected (17%) were those living in urban areas. Even with regard to the latter, however, children living in informal urban areas were more severely affected (20%) compared with those living in formal urban areas (16%). A similar pattern emerged for the prevalence of underweight (weight-for-age ,22SD), with one in 10 children being affected at the national level. Furthermore, one in 10 (13%) and one in four (26%) children aged 1-3 years had an energy intake less than half and less than two-thirds of their daily energy needs, respectively. For South African children as a whole, the intakes of energy, calcium, iron, zinc, selenium, vitamins A, D, C and E, riboflavin, niacin, vitamin B 6 and folic acid were below two-thirds of the Recommended Dietary Allowances. At the national level, data from the 24-hour recalls indicated that the most commonly consumed food items were maize, sugar, tea, whole milk and brown bread. For South African children overall, one in two households (52%) experienced hunger, one in four (23%) were at risk of hunger and only one in four households (25%) appeared food-secure. Conclusion: The NFCS indicated that a large majority of households were foodinsecure and that energy deficit and micronutrient deficiencies were common, resulting in a high prevalence of stunting. These results were used as motivation for the introduction of mandatory fortification in South Africa.

The effects of two low-energy diets on serum insulin concentrations and weight loss in obese hyperinsulinemic females were compared during a 12-wk period. The first diet (n = 15) was designed to evoke a low insulin response (ID), and the second (n = 15) was a conventionally balanced diet (ND). After a 12-wk washout period, seven and nine subjects who had been on the ID and ND, respectively, changed to the alternative diet for 12 wk. Variables studied were basal and 30- and 120-min concentrations of blood glucose, insulin, and C-peptide after an oral glucose load; body weight; and energy intake. Mean (+/- SD) weight was significantly reduced after ID and ND (9.35 +/- 2.49 and 7.41 +/- 4.23, respectively). The mean weight loss was more after ID. Fasting insulin concentrations decreased more after ID compared with ND (91.3 +/- 61.8 vs 21.0 +/- 71.5 pmol/L; P < 0.05). We conclude that ID significantly reduces serum insulin concentrations and weight in obese hyperinsulinemic females.

BackgroundHealth care workers need to be equipped to deal with the increasing obesity and obesity-related morbidity occurring in developing countries.ObjectivesTo assess weight status, eating practices and nutritional knowledge amongst nursing students at the University of Fort Hare, Eastern Cape.MethodA cross-sectional descriptive survey was conducted on 161 undergraduate (51 male and 110 female) students of the Department of Nursing Sciences at the University of Fort Hare. Body mass index, waist and hip circumferences and waist hip ratio were determined. Nutritional knowledge and eating practices were investigated by structured interviewer-administered questionnaires.ResultsStatically, 49.7% were overweight or obese (58.2% of the females; 31.4% of the males) and 65.2% had waist circumferences putting them at risk for non-communicable diseases. Most did not meet the recommendations for intakes from the vegetable group (97.5% ate <3 servings per day), the fruit group (42.2% ate <2 servings per day), and the dairy group (92.6% ate <2 servings per day); whilst 78.3% ate ≥4 serving per day of sugar or sweets. Most consumed margarine, oil or fat (68.3%), sugar (59.0%) and bread (55.9%) daily, but few reported daily intakes of vegetables (12.4%), fruit (23.6%), fruit juice (21.2%) and milk (15.6%). Fewer than 50% knew the recommended intakes for vegetables, fruit, dairy, starchy foods and meat or meat alternatives.ConclusionsThese nursing students had a high prevalence of overweight and obesity, poor eating habits and inadequate knowledge on key nutrition issues, which may impact negatively on their efficacy as future health ambassadors to the public.

Objective: To determine the nutritional status and household resources of preschool children. Design: A cross-sectional survey. Setting: Two informal settlement areas, Joe Slovo (JS) and JB Mafora (JBM) in Mangaung, near Bloemfontein, South Africa. Subjects: Preschool children (,72 months) of a randomly selected sample of households in JS (experimental) (n = 162) and JBM (control) (n = 186) were included. Standard methods were used to obtain household and care-giver particulars, weight and height measurements, blood and stool samples, and 24-hour dietary recalls. Results: Breast-feeding and dietary intake in the two areas were nearly similar; breastfeeding was continued for 12 months and longer. Although the children's total protein intake was suf®cient, their energy intake was low. A low median intake of micronutrients prevailed, including iron, zinc, calcium, niacin, ribo¯avin, thiamine and vitamins C, B 6 , A and D. The prevalence of being underweight (JS = 19.8%; JBM = 18.8%), stunted (JS = 29%; JBM = 21.5%) and wasted (JS = 6.5%; JBM = 3.7%) were fairly similar in both areas, as well as the prevalence of marginal vitamin A de®ciency, anaemia, iron de®ciency and parasite infestations. No signi®cant associations could be found between household and nutritional status indicators, probably due to the small number of well-nourished children and the generally poor household situation of the participants. Conclusions: The generally poor nutritional status and environmental conditions emphasize the urgency of intervention for these children.

Objective: The study determined the impact of a community-based nutrition education programme, using trained community nutrition advisors, on the anthropometric nutritional status of mixed-race children aged between 2 and 5 years. Design and setting: The programme was implemented over two years in four study areas in the Free State and Northern Cape Provinces. Two control areas were included to differentiate between the effect of the education programme and a food aid programme that were implemented simultaneously. Weight-for-age, height-forage and weight-for-height were summarised using standard deviations from the NCHS reference median. For each of the indicators, the difference in the percentage of children below minus two standard deviations from the reference NCHS median in the initial and follow-up surveys was determined. Subjects: Initially 536 children were measured and, after two years of intervention, 815. Results: Weight-for-age improved in all areas, but only significantly in boys and girls in the urban study area, and in boys in one rural study area. No significant improvement in height-for-age occurred in any area. Weight-for-height improved significantly in the urban study area. Conclusion: The education programme in combination with food aid succeeded in improving the weight status of children, but was unable to facilitate catch-up growth in stunted children after two years of intervention.

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Objective: To evaluate the nutritional intake and status of HIV-1 seropositive patients, as well as the relationship between malnutrition and disease stage. Design: A cross-sectional study. Settings: The Immunology Clinic at the Pelonomi Hospital in Bloemfontein, South Africa. Subjects: Eighty-one HIVaAIDS patients in different stages of disease were recruited consecutively from January to May 1995. Eleven of these patients were followed in 1997. Main outcome measures: Anthropometric data including current weight, height, triceps skinfold thickness, midupper-arm circumference, body mass index and bone-free arm muscle area were collected. Nutrient intake was estimated using a diet history in combination with a standardised food frequency questionnaire. The patients were divided into 3 groups according to their CD4 T cell counts. Results: The men were leaner (BMI 18.9) than the women (BMI 22.7) and patients with a CD4T cell count`200 (stage III) tended to have the lowest median values for all anthropometric measurements. More than half the patients had a low intake (`67% of the recommended dietary allowances) of vitamin C, vitamin B 6 , vitamin D, vitamin A, calcium, iron and zinc. Conclusions: The results con®rms that HIVaAIDS patients from this population are malnourished. There was, however, no association between disease stage and nutritional status. Nutritional supplementation of HIVaAIDS patients should be considered, as this might lead to improved immune function in these patients.