IntroductionNutrient profiling is defined as the science of categorising foods based on their nutrient composition. The Choices Programme is a nutrient profile system with criteria that determine whether foods are eligible to carry a “healthier option” stamp. The Daily Menu Method which has been developed to evaluate these criteria is described here. This method simulates the change in calculated nutrient intakes which would be the result of consumers changing their diets in favour of food products that comply with the criteria.MethodsAverage intakes of energy, trans fatty acids (TFA), saturated fatty acids (SAFA), sodium, added sugar and fibre were derived from dietary intake studies and food consumption surveys of 7 countries: The Netherlands, Greece, Spain, the USA, Israel, China and South Africa. For each of the key nutrients, these average intakes were translated into three Typical Daily Menus per country. Average intakes based on these three menus were compared with average intakes from three Choices Daily Menus. To compose the Choices Menus, foods from the Typical Menus that did not comply with the Choices criteria were replaced with foods that did comply and are available on the market.ResultsComparison of intakes from the Choices Menus with the survey data showed that calculated intakes of energy, SAFA, TFA, sodium and added sugar were reduced. Fibre intakes were increased. The size of the effect differed per country.ConclusionThe Daily Menu Method is a useful means to predict the potential effects of nutrient profiles such as the Choices criteria, on daily nutrient intakes. The method can be applied internationally and confirms that the criteria of the Choices Programme are in line with the aim of the programme: to improve nutrient intakes in the direction of the recommendations.

Infant health and nutrition in South Africa are a priority, as evidenced by the political commitment and policy development history of the last 25 years. Current efforts focus on improving breastfeeding rates, but the action plan for complementary feeding receives less attention and resourcing. A thorough analysis of the current infant feeding situation is required to assist with policy and targeted programmes associated with complementary feeding. Aim: The aim of this review was to identify and collate all published research in South Africa on the complementary feeding practices of infants and young children, aged 0-24 months. Methodology: Searches included English-language research published between 2006 and 2017, within PubMed, Scopus, Web of Science and Google Scholar. All papers included in the review had to meet defined eligibility criteria. Papers older than 11 years were excluded. In total 34 papers relevant to South Africa were identified and included in this review. Main findings: Early introduction of foods and liquids other than breast milk is a common practice. Maize porridge is a common first food for infants, but there is also a high reliance on commercial infant cereal. Water and other liquids (e.g. tea, herbal mixtures) are commonly given to infants younger than six months. There is little information on the number of meals per day. The diets of many older infants do not meet the criteria for a minimally acceptable diet. Few animal source foods are used in complementary feeding. There are indications that processed meats, soft drinks, sweets and salty crisps are given regularly to older infants between six months and one year. Conclusion: Complementary feeding practices in South Africa are suboptimal and appropriate action is needed to improve this situation. Further investigation is needed on whether older infants and young children can achieve their required dietary intakes from the food that is available to them. If a change in older infant and young child feeding behaviour is desired, then existing methods and approaches need to change.

Pretoria South Africa 0002 riette.dekock@up.ac.za +27 12 420 3238 Highlights New consumer-focused behaviour insights for salt reduction of meals. Unexpected similarities in liking for chicken meals with varying levels of salt. A gradual reduction of salt in chicken stews resulted in a reduced salt intake. 19% consumers added salt back to reduced-salt meals, up to full compensation. AbstractThis study investigated the impact of salt reduction on liking, salt taste perception, and use of table salt when consuming chicken stew in light of South Africa"s new salt recommendations. In total, 432 South-African consumers (aged 35.2 ± 12.3 years) consumed a full portion of a chicken stew meal once at a central location. Four stock cube powders varying in salt content were used to prepare chicken stews: 1) no reduction -2013 Na level; regular salt level as currently available on the South African market (24473 mg Na/100g), 2) salt reduction smaller than 2016 level, i.e. 10%-reduced (22025 mg Na/100g), 3) 2016 salt level, as per regulatory prescriptions (18000 mg Na/100g), 4) 2019 salt level, as per regulatory prescriptions (13000 mg Na/100g). Consumers were randomly allocated to consume one of the four meals.Liking, salt taste perception, and use of table salt and pepper were measured. 1Chicken stews prepared with reduced-salt stock powders were equally well-liked as chicken stews with the current salt level. Moreover, a gradual reduction of the salt in the chicken stews resulted in a reduced salt intake, up to an average of 19% for the total group compared to the benchmark 2013 Na level stew. However, 19% of consumers compensated by adding salt back to full compensation in some cases.More salt was added with increased reductions of salt in the meals, even to the point of full compensation. Further investigation into the impacts of nutrition communication and education about salt reduction on salt taste perception and use is needed. This research provides new consumer insights on salt use and emphasises the need for consumer-focused behaviour change approaches, in addition to reformulation of products.

The impact that the COVID-19 pandemic has had, and will continue to have, on food security and child health is especially concerning. A rapid, Short Message Service (SMS) Maternal and Child Health survey was conducted in South Africa in June 2020 (n = 3140), with a follow-up in July 2020 (n = 2287). This was a national cross-sectional survey conducted among pregnant women and mothers registered with the MomConnect mhealth platform. Logistic regression was conducted to explore the associations between breastfeeding, maternal depressive symptoms, and hunger in the household. High breastfeeding initiation rates and the early introduction of other foods or mixed milk feeding were found. The prevalence of depressive symptoms in this survey sample was 26.95%, but there was no association between breastfeeding behaviour and depressive symptom scores (OR = 0.89; 95% CI: 0.63, 1.27). A positive correlation was found between not breastfeeding and not going to the health clinic. The odds of hungry mothers breastfeeding were significantly lower (OR = 0.66; p = 0.045). This result also holds in a multivariate framework, including covariates such as depressive symptoms, attendance of a PHC facility, and whether the infant was older than 3 months. Support for breastfeeding must include support, such as economic support, for breastfeeding mothers, to enable them to access nutritious diets. Mothers also need reassurance on the quality of their breastmilk and their ability to breastfeed and should be encouraged to continue to attend the health clinic regularly.

The objectives of this study were to ascertain whether the nutrient requirements of 6-11-month-old infants can be met with a food-based approach, and to identify the nutrients of which it is difficult to achieve adequate intakes. Design, setting and subjects: A cross-sectional survey and interviews with mothers and caregivers from the KwaMashu Community Health Centre were conducted. One hundred and thirty-four interviews were completed. This information provided the food consumption input for the model using Optifood software. Results: The results revealed that with the current food pattern of infants from the study group in KwaMashu, iron, zinc and calcium are nutrients whose requirements are likely not to be met in the diet. The percentage RNI (recommended nutrient intake) for iron was 25.2%, zinc 51.3% and calcium 77%. Nutrient intakes for these nutrients of concern improved in the 'No pattern' diet but iron and zinc intakes remained below the RNI. According to the best diets modelled by Optifood, it appears that infants in KwaMashu would be able to achieve the recommended intakes of energy, protein, and 8 of the 11 micronutrients, as long as breastfeeding on demand continues during the complementary feeding phase.Conclusions: This study calls into question the continued food-based focus to ensure nutrient adequacy in infants. In conjunction with efforts to improve household food security and continued support and promotion of breastfeeding for the first 2 years of life, targeted micronutrient supplementation may be needed to ensure the optimal growth and development of infants in South Africa.

There are growing concerns on the impact of COVID-19 on food security and child health in South Africa. A rapid SMS Maternal and Child Health survey was conducted in South Africa in June (n=3140) with a follow up in July (n=2287). Breastfeeding practices found in this survey confirmed findings from other studies: with high breastfeeding initiation rates and early introduction of other foods/mixed milk feeding. Logistic regression was conducted to explore the associations between breastfeeding, maternal depression and hunger in the household. The odds of hungry mothers breastfeeding were significantly lower (OR = 0.66; 95% CI: 0.44, 0.99). The prevalence of depression in this survey sample was 26.95%, but there was no association between breastfeeding behaviour and depression scores (OR = 0.89; 95% CI: 0.63, 1.27). A positive correlation was found between not breastfeeding and not going to the health clinic. Breastfeeding needs to be protected, promoted and supported; and mothers should be encouraged to continue to attend the health clinic. Further to communication to communities, supporting the breastfeeding mother to enable her to breastfeed and feel competent to do so is a critical gap that needs to be addressed. This support could include economic support to enable her to access a nutritious diet. Mothers also need reassurance on the quality of their breastmilk and their ability to breastfeed. Aside from the nutritional superiority, the safety and immune benefits of breastmilk may need to be asserted to counter concerns during the COVID-19 pandemic.