No abstract

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.

Full funding sources listed at the end of the paper (see Acknowledgments).

Among patients with tuberculosis, rifampin plasma concentrations and sputum conversion rates have been reported to be lower in Africans. Rifampin is a substrate of P-glycoprotein (coded for by the ABCB1 gene) and organic anion-transporting polypeptide 1B1 (coded for by SLCO1B1). The objectives were to identify genetic polymorphisms of drug transporters and the transcriptional regulators pregnane X receptor (PXR) and constitutive androstane receptor (CAR) with an impact on rifampin pharmacokinetics in South Africans. Fifty-seven patients with tuberculosis from Cape Town underwent pharmacokinetic sampling during treatment with rifampin, pyrazinamide, isoniazid, and ethambutol. DNA was genotyped for ABCB1, SLCO1B1, PXR, and CAR polymorphisms by using real-time PCR. NONMEM was used for data analysis. The allele frequency of the SLCO1B1 rs4149032 polymorphism was 0.70. Patients heterozygous and homozygous for this polymorphism had reductions in the bioavailability (and, thus, the area under the curve [AUC]) of rifampin of 18% and 28%, respectively. Simulations showed that increasing the daily rifampin dose by 150 mg in patients with the polymorphism would result in plasma concentrations similar to those of wild-type individuals and reduce the percentage of patients with peak plasma concentrations (C max ) below 8 mg/liter from 63% to 31%. ABCB1, PXR, and CAR polymorphisms were not associated with differences in rifampin pharmacokinetics. SLCO1B1 rs4149032 was present in most patients and was associated with substantially reduced rifampin exposure. These data suggest that the standard recommended dose of rifampin should be reconsidered for South Africans.

In an article that forms part of the PLoS Medicine series on Big Food, Corinna Hawkes and colleagues provide a perspective from South Africa on the rise of multinational and domestic food companies, and argue that government should act urgently through education about the health risks of unhealthy diets, regulation of Big Food, and support for healthy foods.

Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, Canadian Institutes of Health Research Strategy for Patient Oriented Research through the Ontario SPOR Support Unit, the Ontario Ministry of Health and Long-Term Care, pharmaceutical companies (with major contributions from AstraZeneca [Canada], Sanofi Aventis [France and Canada], Boehringer Ingelheim [Germany amd Canada], Servier, and GlaxoSmithKline), Novartis and King Pharma, and national or local organisations in participating countries.

Full funding sources listed at the end of the paper (see Acknowledgments).

Summary The Healthy Food Environment Policy Index (Food‐EPI) aims to assess the extent of implementation of recommended food environment policies by governments compared with international best practices and prioritize actions to fill implementation gaps. The Food‐EPI was applied in 11 countries across six regions (2015‐2018). National public health nutrition panels (n = 11‐101 experts) rated the extent of implementation of 47 policy and infrastructure support good practice indicators by their government(s) against best practices, using an evidence document verified by government officials. Experts identified and prioritized actions to address implementation gaps. The proportion of indicators at “very low if any,” “low,” “medium,” and “high” implementation, overall Food‐EPI scores, and priority action areas were compared across countries. Inter‐rater reliability was good (GwetAC2 = 0.6‐0.8). Chile had the highest proportion of policies (13%) rated at “high” implementation, while Guatemala had the highest proportion of policies (83%) rated at “very low if any” implementation. The overall Food‐EPI score was “medium” for Australia, England, Chile, and Singapore, while “very low if any” for Guatemala. Policy areas most frequently prioritized included taxes on unhealthy foods, restricting unhealthy food promotion and front‐of‐pack labelling. The Food‐EPI was found to be a robust tool and process to benchmark governments' progress to create healthy food environments.