A review of adolescent nutrition in South Africa: transforming adolescent lives through nutrition initiative

Abstract

In South Africa, urbanisation is associated with substantial burdens of adolescent overweight and obesity, making teenagers vulnerable to longer-term non-communicable diseases. In addition, as potential future parents, the nutritional status of adolescents is increasingly recognised as a key driver of health and well-being in the next generation. This review reported on the available literature examining nutritional status and dietary intakes and practices, as well as their determinants, in South African adolescents. Study design and methods: Medline (Pubmed), Web of Science and EMBASE were searched for relevant articles published between 1994 and May 2018. Applicable search terms and phrases were identified in study titles and/or abstracts and fulltext articles were reviewed according to inclusion/exclusion criteria. Data were extracted according to specific review objectives. Results: A total of 67 relevant studies were identified. Only one study used a biochemical marker to describe adolescent nutritional status (vitamin D status; 25(OH)D). Overweight and obesity prevalence increased in South African adolescents over the reference period, with national increases of 6% in boys and 7% in girls between 2002 and 2008. Girls and urbandwellers were particularly vulnerable to excess adiposity. Dietary intakes demonstrated a transition towards energy-dense, processed foods high in sugar and fat, but low in essential micronutrients. Food choices were driven by the adoption of obesogenic behaviours in the teenage years, including irregular breakfast consumption and fewer family meals, increased snacking and low levels of physical activity. Conclusion: South African adolescents-particularly girls-are increasingly burdened by obesity as a result of urbanisationassociated shifts in dietary intake and eating behaviours. However, the implications for micronutrient status and long-term nutritional health are not known. Additionally, more data on the clustering of diet, activity and sedentary behaviours in adolescent boys and girls is needed, as well as on behaviour patterns to facilitate healthy growth and reduced adiposity.

An Umbrella Review of Systematic Reviews on Food Choice and Nutrition Published between 2017 and-2019

“…Social support, whether from peers or family members, can have both positive or adverse effects on dietary behaviours and eventual onset of overweight/obesity. Family members and sharing meals with the larger family was associated with better eating habits in early adolescence, but not in older ages [26,47]. Particularly, the presence of grandparents at home might contribute to a healthier weight status among mobile/migrated families but not in societies with little geographic mobility [22].…”

“…Qualitative research or mixed methods papers provided deeper insights into determinants of food choices [25,26,29,34,35,42], while quantitative papers provided more measurable effect sizes [24,40,41,44] useful, e.g., for future sample size calculations. Systematic reviews are not yet a cross-disciplinary accepted methodology as the authors of the reviews come mainly from health/nutrition and life science arenas [22,26,30,32,33,39,40,41]. It is underscored that some of the reviews are by authors from business economics [38], food science [36], sensory science [31] and marketing [29], highlighting the potential for cross-disciplinary collaboration.…”

“…The strategies for addressing child eating behaviours reported earlier are in agreement with a review by Scaglioni et al [62] that highlighted the effectiveness of covert control, avoidance of food rewards, promoting self-regulation, a more authoritative parenting style, family meals, and highlighted ways in which parents can contribute to making the family environment [21,39] conducive to a healthier lifestyle for the child. Eating meals with the family and thus more traditional food consumption is part of an overall support system that allows children to make a better selection of foods (fewer fast-foods and snacks) [26,47], as well as to maintain a healthier weight status [22].…”

Dietary Practices and Adolescent Obesity in Secondary School Learners at Disadvantaged Schools in South Africa: Urban–Rural and Gender Differences

“…In the South African Health and Nutrition Examination Study (SANHANES) of 2012 [5], the combined prevalence of overweight and obesity was 26.8% in 15 to 17-year-old females and 48.8% in 18 to 24 year-old females, implying an even greater increase. A recent review of cross-sectional studies undertaken on South African adolescents in urban and rural settings showed an overall increase in the combined prevalence of overweight and obesity with age in adolescents from age 10 to 20-years, mostly because of an increase in obesity in females [6]. Briefel and Johnson (2004), evaluating secular trends in dietary intake in the United States over 30 years, found that in children 1 to 19-years-old energy intake had increased little except in adolescent females [7].…”

“…Adolescents experience more time away from the family than younger children and hence are exposed to many foods which may not be the norm at home. Growing levels of independence make adolescents more susceptible to the development of obesogenic behaviors which increases the risk of obesity [6]. Numerous studies have examined sedentary behaviors in adolescents, especially television (TV) watching and/or excessive screen time, and found them to be associated with a less healthful diet [8][9][10][11][12].…”