OBJECTIVE: To develop and test a book of photographs of commonly eaten foods to be used as a visual aid in the description of portion sizes in a large cross-sectional study on the health profile of Africans in transition (THUSA - Transition, Health and Urbanization in South Africa). SETTING: Clinics in the North West Province of South Africa. PARTICIPANTS: One hundred and sixty-nine adult African volunteers DESIGN: Data on commonly eaten foods, preparation methods, recipes and portion sizes were collected in a pilot study. Colour photographs, taken of foods prepared by the researchers and measured into three or four portion sizes, were enlarged and put together in a book. The food portion photograph book (FPPB) was tested by presenting subjects with a portion of real food and asking them to estimate the portion size by matching it with one of the portion photographs. MAIN RESULTS: Of 2959 portions tested, 68% were accurately estimated (estimated weight within 10% of actual weight). Clearly defined solid foods were better estimated than foods that had an amorphous appearance. Accuracy of estimation was not affected by gender, age or education. CONCLUSION: The FPPB was accepted as a useful and convenient visual aid to estimate portion sizes in the cross-sectional dietary intake study.

Smaller households, inactivity and increasing age for girls were found to be determinants that influence the development of overweight/obesity, while female gender and age post-menarche were identified as determinants of higher body fat content. For overweight/obesity prevention, the focus should be on pre-menarcheal girls, aged 10-13 years, using these determinants to identify overweight/obesity risk. Preventive programmes should aim to increase the physical activity of children to improve their current and future weight status.

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Objective: To determine the relative validity of the culture-sensitive quantitative food frequency questionnaire (QFFQ) developed for the Transition, Health and Urbanisation in South Africa (THUSA) study by 7-day weighed food records, urinary nitrogen excretion and basal metabolic rate (BMR). Design: A cross-sectional study. Setting: A community-based study in a population strati®ed according to level of urbanization. Subjects: Residents of the North West Province, South Africa, aged between 15 and 65 years. The weighed food record study comprised 74 participants while 104 participants collected 24-hour urine samples. Methods: All participants were interviewed using the QFFQ. For the weighed food record study, participants kept detailed weighed food diaries for seven consecutive days. For the urinary nitrogen study, participants made one 24-hour urine collection. Completeness of the urine collections was checked against 240 mg para-aminobenzoic acid. BMR was estimated by the Scho®eld equations. Results: Spearman rank correlation coef®cients between the QFFQ and weighed food record ranged between 0.14 (®bre) and 0.59 (vitamin C). The QFFQ tended to underestimate intakes compared with the weighed records. Quintile distributions were similar for both methods. The correlation between urinary nitrogen excretion and dietary intake was poor. Possible underreporting was identi®ed for 43% of the participants with the QFFQ and 28% with the weighed food record. Conclusions: The QFFQ appeared to be a relatively valid instrument for the assessment of dietary intakes of the population of the North West Province. The use of biomarkers in this population was dif®cult and needs further investigation.

Objective: To develop and assess the reproducibility of a quantitative food frequency questionnaire (QFFQ) sensitive to the culture of the African population of the North West Province, South Africa. Design: A cross-sectional study. Setting: A community-based ®eld study in a population strati®ed according to level of urbanization from deep rural to urban upper class. Subjects: A total of 144 (99 women and 45 men) residents of the North West Province, aged between 15 and 65 years, participated in the study. Methods: A culture-sensitive, 145-item interviewer-administered QFFQ was designed to cover the whole diet. Portion sizes were estimated from a food portion photograph book (FPPB) showing foods in three portion sizes. The QFFQ was administered twice, 6±12 weeks apart. Results: Spearman rank correlation coef®cients between the two administrations varied from 0.14 for calcium to 0.75 for alcohol. The mean percentage difference between intakes was 8.5 (standard deviation = 9.9). Energy, protein, carbohydrate and calcium gave differences within 10%. Few signi®cant differences among correlation coef®cients or percentage difference for gender, age group or strata of urbanization were present. Bland±Altman plots showed signi®cant proportional bias for protein, ®bre and vitamin C. More than 70% of the participants were classi®ed into adjacent quintiles for all nutrients. For food groups, correlation coef®cients ranged from 0.25 for milk to 0.45 for vegetable and maize meal groups and 80% of participants were classi®ed into adjacent quintiles. Conclusions: The QFFQ appeared to be a reproducible dietary intake assessment instrument.

Background: Evaluating the impact of a nutrition education program could provide insight into the effectiveness of an intervention. Researchers tested the hypothesis that a theory-based contextual nutrition education program (NEP) would improve the nutrition knowledge, attitudes, and dietary practices (KAP) of teachers and learners.Methods: Twenty three teachers who taught nutrition in Grades 4–7 (treatment school, n = 12) and 681 learners (treatment school, n = 350) participated in the study. In this quasi-experimental study, two primary schools were randomly selected to implement a contextual NEP. The nutrition KAP were assessed using previously validated questionnaires. The treatment school teachers taught nutrition using a developed nutrition education manual, while the control school teachers taught nutrition in the usual manner. Random effects Generalized Least Squares regression estimated the difference in the teachers' and learners' KAP for the treatment and control schools; p = 0.025 for a one-tailed test.Results: At post-implementation, the treatment school teachers' had higher total nutrition knowledge mean score (85.5% ± 8.2, p = 0.003) compared to the control school. Within the treatment school, total nutrition knowledge mean score of the teachers improved by 14.1%, p ≤ 0.001. Learners in the treatment school had higher total nutrition knowledge (53.2% ± 16.9, p = 0.002) and nutrition attitude (63.9% ± 19.7, p = 0.001) scores compared to learners in the control school. Within the treatment school, learners' total nutrition knowledge and nutrition attitudes scores increased by 4.9%, p ≤ 0.001 and 6.9%, p ≤ 0.001, respectively. The dietary practices of the teachers and the learners, and the nutrition attitudes of the teachers in the treatment school showed no significant within school improvement or in comparison with the control school (p > 0.025).Conclusions: The NEP led to the improvement in the teachers' and the learners' nutrition knowledge and the learners' nutrition attitudes. However, no significant improvement in the dietary practices of either teachers or learners was found.

Although total inpatient costs did not differ significantly between the rotavirus-negative and -positive patients, costs for the rotavirus-negative patients tended to be higher. Although a rotavirus vaccine will reduce the burden of diarrheal disease, it is imperative that measures for reducing the incidence and severity of diarrheal disease due to other pathogens are strengthened.

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