Objectives: The objective of the study was to describe wasting and stunting in children aged 12-60 months, admitted to targeted supplementary feeding programmes for the treatment of moderate acute malnutrition (MAM) in South Africa.Design: A cross-sectional, descriptive study was performed.Subjects and setting: Children with MAM, managed as outpatients at primary healthcare facilities in three provinces, were included in the study conducted between September 2012 and August 2013.Outcome measures: Weight, height and mid-upper-arm circumference (MUAC) measurements were collected to classify the children as moderately or severely stunted or wasted.Results: Of the total sample (n = 225), 13% (n = 30) were diagnosed as wasted, 58% (n = 131) as stunted, and 21% (n = 47) as both wasted and stunted. MUAC was significantly associated with wasting. However, an association was not found between MUAC and stunting. Of the sample, 32% (n = 72) presented with severe stunting, and 29% (n = 65) with moderate wasting. Food insecurity was associated with wasting, but not with stunting. Conclusion:A low weight-for-age z-score resulted more from stunting than from wasting in this study. Severe stunting presented as a greater health concern than moderate wasting. Without scrutinising wasting and stunting, healthcare professionals may remain unaware of the drivers of underweight for age in children treated at South African primary healthcare facilities. Following this study's outcomes, the sensitivity of MUAC in screening for moderate malnutrition in South African settings with a high prevalence of stunting is questionable. It is recommended that current nutritional interventions are revisited to explore the efficacy of treating children with wasting, stunting or both.Peer reviewed.

BackgroundA strong relationship exists between hypertension and body weight. Research has linked both higher blood pressure and body weight with lower vitamin D status.ObjectiveThis study assessed the vitamin D status of a low-income, urban, black community in South Africa, to examine whether serum levels of 25-hydroxy vitamin D [25(OH)D] are associated with hypertension and body mass index (BMI).MethodsData collected from 339 adults (25–64 years) from the Assuring Health for All in the Free State (AHA-FS) study were analysed. Variables measured include serum 25(OH)D, blood pressure, weight and height to determine BMI, and HIV status.ResultsMean 25(OH)D level was 38.4 ± 11.2 ng/mL for the group; 43.5 ± 11.8 ng/mL and 37.0 ± 10.6 ng/mL for males and females, respectively. Approximately 40% of the participants were HIV-positive and 63.4% hypertensive. Based on BMI, 11.8% were underweight, 33.0% normal weight, 23.0% overweight and 32.1% obese. HIV status showed no correlation with 25(OH)D levels when controlling for BMI. Poor inverse relationships were found between BMI and 25(OH)D (p = 0.01), and between mean arterial blood pressure and 25(OH)D (p = 0.05). When controlling for BMI, no correlation was found between 25(OH)D and the prevalence of hypertension or mean arterial blood pressure.ConclusionApproximately 96% of participants had an adequate vitamin D status, which could be attributed to latitude, sunny conditions and expected high levels of sun exposure because of living conditions. Results confirmed a poor inverse relationship between vitamin D status and hypertension, which seems to be dependent on BMI.

BackgroundNon-communicable diseases, including hypertension, are increasing rapidly in resource-poor, developing countries amongst populations transitioning from traditional to westernised lifestyles; and are associated with excess weight.AimTo investigate the relationship between hypertension and various indices of body adiposity in a transitioning, urban, black population.SettingThree hundred and thirty-nine adults (25–64 years) from a larger cross-sectional study (Assuring Health for All in the Free State) conducted in Mangaung, South Africa, were included.MethodsStandard techniques were used to determine blood pressure, HIV status, body mass index (BMI), waist-to-height ratio (WHtR) and body adiposity index (BAI).ResultsApproximately 40% of the sample was HIV-positive and 63.4% hypertensive, with the greatest risk of hypertension being amongst older men. Based on BMI, 23.0% were overweight and 32.1% obese. Waist-to-height ratio showed that 58.6% had increased cardiovascular risk. Mean BAI was 34.1%, whilst 76.3% had a body fat percentage in the overweight/obese category. Waist circumference representing increased cardiovascular risk was found in 44.3% of women and 3.9% of men. Significant positive correlations between mean arterial blood pressure and BMI (r = 0.261; p < 0.001), WHtR (r = 0.357; p < 0.001) and BAI (r = 0.245; p < 0.001) were found. WHtR was a stronger predictor of mean arterial pressure than BMI or BAI. HIV status showed an inverse correlation with all adiposity indices (p < 0.001).ConclusionOur findings promote WHtR as a practical screening tool for increased hypertension risk in populations undergoing westernisation, and support weight loss as a first-line intervention for the prevention and management of hypertension.

Objective: To describe catch-up growth in children with moderate acute malnutrition (MAM) on targeted supplementation using Ready-to-Use Supplementary Food (RUSF). Methods: An impact study was done to determine anthropometric changes in children aged 12-60 months who received RUSF (175 kcal/kg/day) for six weeks, managed as outpatients and followed up for 12 weeks until a final assessment. Results: Default rates were high, with 30% of children returning to the primary healthcare facility for follow-up only once or twice. Despite significant improvement in height-for-age Z-score (HAZ), weight-for-age Z-score (WAZ), weight-for-height Z-score (WHZ) and mid-upper arm circumference (MUAC), 70.5% of the sample remained in the same malnutrition classification and only 26% recovered. The growth velocity of children with a lower initial WHZ was significantly higher (r = -0.15, p < 0.05) than those with less wasting, but only 20% grew at a rate to achieve catch-up growth. The mean growth velocity decreased as the intervention period continued. Conclusion: All median anthropometric indicators improved with RUSF supplementation. However, catch-up growth or recovery occurred in only 20-25% of children included in the study. These findings create questions about the value of supplementation in the absence of blanket food distribution or other interventions to address food security.

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