South African Food-based Dietary Guidelines Research Articles

Adherence to the South African food based dietary guidelines may reduce breast cancer risk in black South African women: the South African Breast Cancer (SABC) study.

To determine the level of adherence and to assess the association between higher adherence to the South African food based dietary guidelines (SAFBDG) and breast cancer risk. Population-based, case-control study (the South African Breast Cancer study) matched on age and demographic settings. Validated questionnaires were used to collect dietary and epidemiological data. To assess adherence to the SAFBDG, a nine-point adherence score (out of eleven guidelines) was developed, using suggested adherence cut-points for scoring each recommendation (0 and 1). When the association between higher adherence to the SAFBDG and breast cancer risk was assessed, data-driven tertiles among controls were used as cut-points for scoring each recommendation (0, 0·5 and 1). OR and 95 % CI were estimated using multivariate logistic regression models. Soweto, South Africa. Black urban women, 396 breast cancer cases and 396 controls. After adjusting for potential confounders, higher adherence (>5·0) to the SAFBDG v. lower adherence (<3·5) was statistically significantly inversely associated with breast cancer risk overall (OR = 0·56, 95 % CI 0·38, 0·85), among postmenopausal women (OR = 0·64, 95 % CI 0·40, 0·97) as well as for oestrogen-positive breast cancers (OR = 0·51, 95 % CI 0·32, 0·89). Only 32·3 % of cases and 39·1 % of controls adhered to at least half (a score >4·5) of the SAFBDG. Higher adherence to the SAFBDG may reduce breast cancer risk in this population. The concerning low levels of adherence to the SAFBDG emphasise the need for education campaigns and to create healthy food environments in South Africa to increase adherence to the SAFBDG.

Identifying Nutrient Patterns in South African Foods to Support National Nutrition Guidelines and Policies.

Food composition databases (FCDBs) provide the nutritional content of foods and are essential for developing nutrition guidance and effective intervention programs to improve nutrition of a population. In public and nutritional health research studies, FCDBs are used in the estimation of nutrient intake profiles at the population levels. However, such studies investigating nutrient co-occurrence and profile patterns within the African context are very rare. This study aimed to identify nutrient co-occurrence patterns within the South African FCDB (SAFCDB). A principal component analysis (PCA) was applied to 28 nutrients and 971 foods in the South African FCDB to determine compositionally similar food items. A second principal component analysis was applied to the food items for validation. Eight nutrient patterns (NPs) explaining 73.4% of the nutrient variation among foods were identified: (1) high magnesium and manganese; (2) high copper and vitamin B12; (3) high animal protein, niacin, and vitamin B6; (4) high fatty acids and vitamin E; (5) high calcium, phosphorous and sodium; (6) low moisture and high available carbohydrate; (7) high cholesterol and vitamin D; and (8) low zinc and high vitamin C. Similar food patterns (FPs) were identified from a PCA on food items, yielding subgroups such as dark-green, leafy vegetables and, orange-coloured fruit and vegetables. One food pattern was associated with high sodium levels and contained bread, processed meat and seafood, canned vegetables, and sauces. The data-driven nutrient and food patterns found in this study were consistent with and support the South African food-based dietary guidelines and the national salt regulations.

The Food and Nutrition Environment at Secondary Schools in the Eastern Cape, South Africa as Reported by Learners.

Overweight and obesity are growing concerns in adolescents, particularly in females in South Africa. The aim of this study was to evaluate the food and nutrition environment in terms of government policy programs, nutrition education provided, and foods sold at secondary schools in the Eastern Cape province. Sixteen schools and grade 8–12 learners (N = 1360) were randomly selected from three health districts comprising poor disadvantaged communities. Based on age and sex specific body mass index (BMI) cut-off values, 13.3% of males and 5.5% of females were underweight, while 9.9% of males and 36.1% of females were overweight or obese. The main food items purchased at school were unhealthy energy-dense items such as fried flour dough balls, chocolates, candies, and crisps/chips. Nutrition knowledge scores based on the South African food-based dietary guidelines (FBDGs) were poor for 52% to 23.4% learners in Grades 8 to 12, respectively. Female learners generally had significantly higher nutrition knowledge scores compared to their male counterparts (p = 0.016). Questions poorly answered by more than 60% of learners, included the number of fruit and vegetable portions required daily, food to eat when overweight, foods containing fiber, and importance of legumes. It was noted that the majority of teachers who taught nutrition had no formal nutrition training and their responses to knowledge questions were poor indicating that they were not familiar with the FBDGs, which are part of the curriculum. Nutrition assessment as part of the Integrated School Health Program was done on few learners. Overall however, despite some challenges the government national school meal program provided meals daily to 96% of learners. In general, the school food and nutrition environment was not conducive for promoting healthy eating.

The role of traditional foods in food-based dietary guidelines – A South African case study on maas (cultured milk)

With the revision of the South African food-based dietary guidelines (FBDGs) a new guideline specifically recommending the daily consumption of dairy products including maas (cultured milk) was introduced. This paper aims to evaluate the relevance of including maas as a traditional food product in the FBDGs. It was found that maas is a culturally relevant and traditional food product in South Africa. The nutrient profile of maas has changed notably over time since the first nutrient analysis was performed in 1995. The health benefits of maas, together with its popularity and its cultural relevance as part of the South African diet, make maas a suitable traditional food product to be included in the South African FBDGs.

Challenges to implementing the food-based dietary guidelines in the South African primary school curriculum: a qualitative study exploring the perceptions of principals and curriculum advisors

Objectives: The South African food-based dietary guidelines (FBDG) were developed and implemented to promote healthy lifestyles in the population along with preventing non-communicable diseases and other forms of diet-related illness. The FBDG were recommended for implementation within the national school curriculum. The objective of this study was to explore perceived challenges to successful implementation of these guidelines in the primary school curriculum.Design: This qualitative study gathered data via semi-structured individual interviews. Data were transcribed and analysed with ATLAS.ti software, using a thematic approach.Setting: Public primary schools located in three education districts in the Western Cape, South Africa.Subjects: Principals at twelve schools from communities with different socioeconomic statuses, and five curriculum advisors of relevant subjects from provincial and district levels.Outcomes measures: Perceived barriers to implementing FBDG in the primary school curriculum.Results: A lack of knowledge and/or expertise related to the FBDG by educators, time constraints within the teaching programme and lifestyle related factors of educators, parents and learners emerged as the three main challenge themes from the interviews. A lack of resources was identified as an additional theme.Conclusions: The principals and curriculum advisors anticipated many barriers to the success of implementing nutrition education using the FBDG in the primary school curriculum. Adequately addressing such barriers through improved awareness and knowledge of the FBDG by school staff could improve the potential of using the FBDG as a nutrition education tool in primary schools in South Africa.

Primary School Children's Nutrition Knowledge, Self-Efficacy, and Behavior, after a Three-Year Healthy Lifestyle Intervention (HealthKick).

This study aimed to evaluate the effects of HealthKick(HK), a healthy lifestyle intervention, on nutrition knowledge, behavior, and dietary self-efficacy of school children in the Western Cape Province of South Africa. A three-year cluster randomized control trial at primary schools in low socioeconomic settings with a baseline study in 2009 and follow-up in 2010 and 2011. Participants were Grade four children (n=500) at eight schools in the intervention group and at eight schools in the control group (n=498). An action planning process was followed with educators whereby they identified their own school health priorities and ways to address them. Schools were provided with nutrition resources, including curriculum guidelines and the South African food-based dietary guidelines. Children completed a questionnaire comprising nutrition knowledge, self-efficacy and behavioral items. The intervention significantly improved the knowledge of the intervention group at the first (mean difference =1.88, 95%CI: .32 to 3.43, P=.021) and second follow-up (mean difference=1.92, 95%CI: .24 to 3.60, P=.031) compared with the control group. The intervention effect for self-efficacy was not significant at the first follow-up (mean difference=.32, 95%CI: -.029 to .94, P=.281) whereas a significant effect was observed at the second follow-up (mean difference=.71, 95%CI: .04 to 1.38, P=.039). There were no significant differences between the intervention and control groups for nutritional behavior scores at any of the follow-up time points. The HK intervention improved nutrition knowledge and self-efficacy significantly in primary schoolchildren; however, it did not improve their eating behavior.

Nutrition Knowledge and Dietary Intake of Adolescents in Cofimvaba, Eastern Cape, South Africa

The aim of the study was to assess the nutrition knowledge, nutrient intakes, and association between nutrition knowledge and dietary intakes of 98 adolescents attending five schools in rural Cofimvaba, South Africa. Measures included a socioeconomic questionnaire, two 24-hour-recall questionnaires, and food-frequency and nutrition knowledge questionnaires. The overall score for the multiple-choice section on general nutrition and the South African Food-Based Dietary Guidelines was 72.9%; 75.4% for correct identification of food groups; and 41.3% for correct identification of food portions/serving sizes. Median nutrient intakes, measured by 24-hour recall, failed to meet average requirements, with the exception of protein, carbohydrates, chromium, riboflavin, pantothenate, and vitamin K among girls. A similar trend was observed for boys. Lower total carbohydrate and fat and higher protein intakes were associated with a higher quartile score for nutrition knowledge. The study provided a valuable understanding of the association between nutrition knowledge and dietary intakes of adolescents.

The feasibility of implementing food-based dietary guidelines in the South African primary-school curriculum.

To explore the perceptions of educators from the Western Cape Province about the feasibility of implementing South African food-based dietary guidelines (FBDG) in the national curriculum of primary schools. Combined quantitative and qualitative methods. We report on the quantitative component. Twelve public primary schools of different socio-economic status in three education districts of the Western Cape: Metro Central, Metro East and Cape Winelands. Educators (n 256) participated in the self-completed questionnaire survey. Educators assessed that FBDG were appropriate to South African schoolchildren (94%), could be used as an education tool (97%) and fill gaps in the current curriculum about healthy dietary habits (91%). Besides Life Orientation, FBDG could be taught in other learning areas from grades 3 to 7 (9-13 years old). Important barriers to implementing FBDG in the curriculum were educators' workload (61%), insufficient time (46%), learners' disadvantaged background (43%) and educators' lack of knowledge (33%). Other approaches to teach children about FBDG included linking these to the National School Nutrition Programme (82%), school tuck shops (79%), parent meetings (75%), school nutrition policy (73%) and school assembly (57%). Educators in high-income schools perceived that learners' lifestyle was significantly worse (P < 0·001) and that tuck shops and the school assembly were the best means to teach pupils about FBDG (P < 0·001 and P < 0·05). Implementing FBDG in the national school curriculum is seen as important together with optimizing the school physical environment. Key factors required for successful implementation in the curriculum are sufficient educational materials, adequate time allocation and appropriate educator training.

Do Food Quality and Food Quantity Talk the Same? Lesson From Household Food Security Study in Embo, South Africa

Objectives: Relating food diversity, quality, and intake is one of the key aspects in understanding household food security. This paper aimed at marying food intake and quality, both being measurement for food security. Methods: A household food consumption survey (n = 200) exploring food diversity, quality of foods, and their relation to food intake in Embo, a poor farming community in rural KwaZulu-Natal was carried out in November 2004 (period of insufficiency) and repeated in March 2005 (period of plenty). Household food intake strata were developed using matrices obtained from the Household Food Intake Index and nutritional adequacy ratios. Food quality was measured using food count and later using 5 food groups, namely, starches, vegetables and fruits,animal sourced foods, fats, and legumes. Results: Single food count showed dietary diversity to be significantly different across households with different food intake during the period of plenty (P ≤ 0.000). During the period of plenty, vegetable and fruits contributed significantly different proportions of energy (P ≤ 0.000), protein (P ≤ 0.006), iron (P ≤ 0.020), and vitamin E (P ≤ 0.006) to household food intake strata. Intake of vitamin A was more elastic as its intake variation from legumes, fats, and animal sourced foods was (P ≤ 0.000), from starches (P ≤ 0.008) and from vegetable and fruits (P ≤ 0.064) during the second round. Starches are the most important food group to the community, whereas fats and animal sourced food groups are less important. Conclusions: The current study has been able to include food quality in food security studies. Seasonality accounts for variation in food quality. The South African food-based dietary guidelines are relevant to the Embo community.

Experiences in Developing and Implementing Health Clubs to Reduce Hypertension Risk among Adults in a South African Population in Transition

Chronic noncommunicable diseases (NCDs) are increasing substantially as a cause of death and disability in all strata of the South African society, particularly among the urbanised poor. Hypertension is a risk factor for many of these diseases and becoming a burden in a growing population in a Cape Town township, Khayelitsha. To alleviate healthcare demands at clinics in this area, a health club was initiated and community health workers (CHWs) were trained to empower community members about NCDs and create public awareness. After training, a health club was initiated. Three months after initiation of the health club, 76 participants had been recruited of whom 22 were regular attenders. New members joined the health club weekly. Anthropometric and blood pressure measurements were taken, and various hypertension topics were covered at the club meetings which included healthy behaviours, such as the benefits of being physically active and eating healthy. Nutrition education sessions based on the South African food-based dietary guidelines were also held. Consequent to the initial group that was established, two more clubs were formed in the area. Health clubs are sustainable and culturally appropriate when facilitated by local people who have an insight and deeper understanding of the culture and environment of the people they serve.

Are South African women willing and able to apply the new food-based dietary guidelines? Lessons for nutrition educators

BackgroundConsumer testing was a prime consideration in developing specific South African food-based dietary guidelines (FBDGs) which were nationally adopted in 2003.ObjectivesThis study aimed to determine the consumer’s ability to apply the Fbdgs Appropriately, in terms of identifying foods/drinks according to the FBDG food categories; perceived importance of and barriers to applying each FBDG; and planning a typical day’s meals to reflect the FBDGs.DesignA cross-sectional study of 333 women from different cultural and socio-economic backgrounds.SettingKwaZulu-Natal, South Africa.MethodsData collection comprised focus-group discussions (n = 103) and structured individual interviews (n = 230).ResultsThe identification of foods/drinks according to the FBDG food categories reflected a high level of comprehension by participants of these food categories. Participants from all study samples endorsed the importance of applying the FBDGs, predominantly for health reasons. Participants cited barriers to the application of the FBDGs as affordability, availability, household taste preferences, routine food-purchasing habits, time constraints, traditional/ habitual food-preparation methods, and persistent attitudes. Only three FBDGs were mentioned as difficult to apply, namely, “fruits/vegetables”, “foods from animals” and “legumes”. Meal plans did reflect the FBDGs, illustrating the flexibility of their use across cultural and socio-economic differences.ConclusionsConsumer testing of the FBDGs was mainly positive. The study has highlighted areas of confusion regarding certain concepts, terminology and misconceptions, and has identified barriers to application. These concerns can be addressed through the reformulation and retesting of certain dietary guidelines, and the provision of explanatory consumer information and health-worker training materials.

An assessment of preliminary food-based dietary guidelines for infants 6–12 months of age in the Little Karoo area of the Western Cape Province of South Africa

This study aimed to assess mother's/caregiver's understanding, practical application and cultural acceptability of a preliminary set of South African food-based dietary guidelines (FBDGs) for children aged 6-12 months living in the Little Karoo area of the Western Cape Province. An observational, descriptive and cross-sectional study design was followed. Focus group interviews, recorded on videotape, were analysed for qualitative data. Quantitative questionnaires measured knowledge and comprehension of guidelines, perceived constraints to compliance with and importance of guidelines as well as socio demographic data prior to the focus group interviews. Afrikaans-, English- and Xhosa-speaking communities of the Little Karoo area of the Western Cape Province of South Africa, including the urban areas of Oudtshoorn, Bongulethu, Bridgton, Toekomsrus and the adjacent rural areas of Dysselsdorp, Calitzdorp, Uniondale, Ladismith and Zoar. Sixty-four mothers or caregivers to infants 6-12 months of age were included in the sample. Information obtained through the questionnaires supported what was said during discussions. Although perceived as important by the majority of respondents, some of the guidelines were not well understood without prior explanation. Such guidelines were those pertaining to meal frequency and cup feeding, while application of the guideline to prolonged breast-feeding seemed the most problematic. The FBDGs for this age group will have to be supported by extensive and appropriate educational material to be effective when introduced to the public. The fact that the applicability of the guideline to prolonged breast-feeding seemed to be the most problematic is a cause for concern.