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Development of Food-Based Dietary Guidelines for South Africa – the process

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Abstract

One of the goals of the World Declaration and Plan of Action for Nutrition adopted at the 1992 FAO/WHO International Conference on Nutrition in Rome is the global elimination or substantial reduction of malnutrition, micronutrient malnutrition and diet-related communicable and non-communicable disease. 1 A strategy identified to accomplish this goal is the promotion of appropriate nutritional intake and healthy lifestyles. 1 The failure of nutrient-based guidelines to substantially influence dietary patterns of different populations stimulated another FAO/WHO initiative to establish the scientific basis for developing and using food-based dietary guidelines relating to practices and prevailing nutrition-related public health problems. 2 There has therefore been a change in focus from the traditional attention to nutrients to locally available foods. Existing guidelines in South Africa are either nutrient-based 3 or aimed only at a population eating a typical Western diet. 4 Motivated by the FAO/WHO initiatives, the Nutrition Society of South Africa (NSSA) decided to form a focus or working group (WG) that could start the process of developing Food-Based Dietary Guidelines (FBDGs), and asked Professor H H Vorster to initiate the process. In a newsletter of the NSSA published in the South African Journal of Food Science and Nutrition, 5 volunteers were invited to serve on the WG to develop FBDGs that would be appropriate for the whole South African population.

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... The NEIP was based on the SA foodbased dietary guidelines (FBDG) [15] and SA paediatric FBDG. [16] Mypyramid for children [17] and dietary guidelines for children [18] were also used. ...
... FBDG are practical and simple messages that inform the general public on which foods and eating habits will provide the nutrients they need to promote overall health and prevent chronic diseases. [15] In SA, the FBDG were developed based on affordable, available foods that are widely consumed. [15] In addition, the FBDG were compatible with different cultures and eating patterns of the target population. ...
... [15] In SA, the FBDG were developed based on affordable, available foods that are widely consumed. [15] In addition, the FBDG were compatible with different cultures and eating patterns of the target population. [15] Implementation of the NEIP The NEIP comprised 10 topics, namely: enjoying a variety of foods; guidelines for feeding children 3 years and older; hygiene and sanitation; making starchy foods the basis of most meals; eating plenty of vegetables and fruits every day; eating dry beans, split peas, lentils and soya; recommending that chicken, fish, meat, milk or eggs be eaten daily; using salt sparingly; eating fats sparingly; and using food and drinks containing sugar sparingly and not between meals. ...
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Background. Globally, the prevalence of chronic and acute malnutrition and micronutrient deficiency is high in young children, especially in developing countries. Nutrition education is an important intervention to address these challenges. Objective. To determine the nutritional (anthropometric and micronutrient) status of children aged 3 - 5 years at baseline and post intervention. Methods. A pre-test–post-test control group design was chosen, which included eight villages (four villages in the experimental group (E); four villages in the control group (C)). The Nutrition Education Intervention Programme (NEIP) comprised ten topics emphasising healthy eating, hygiene and sanitation. Results. At baseline, 15% (E) - 22.4% (C) of children were stunted. Very few children were underweight in both groups (E = 2.5%; C = 8.2%) and only 2.5% of children were wasted in the E group at baseline. At baseline, about a third of children in both groups (E = 38.5%; C = 30.8%) had marginal vitamin A status (100 - 199.9 μg/L), while <10% in the E group (E = 7.7%) had vitamin A deficiency (<100 μg/L). According to the categories for indicators of iron status, the number of children who were in the ‘adequate’ category for serum iron, serum ferritin, serum transferrin and percentage transferrin saturation did not change in both groups at postintervention assessment. In both groups, nutritional status of children (both anthropometric and blood variables) did not change significantly following intervention. Conclusion. The nutrition intervention did not have a significant effect on indicators of nutritional status, possibly owing to its short duration (12 months) and the fact that food supplementation was not included. © 2015, Health and Medical Publishing Group. All rights Reserved.
... The NEIP was based on the SA foodbased dietary guidelines (FBDG) [15] and SA paediatric FBDG. [16] Mypyramid for children [17] and dietary guidelines for children [18] were also used. ...
... FBDG are practical and simple messages that inform the general public on which foods and eating habits will provide the nutrients they need to promote overall health and prevent chronic diseases. [15] In SA, the FBDG were developed based on affordable, available foods that are widely consumed. [15] In addition, the FBDG were compatible with different cultures and eating patterns of the target population. ...
... [15] In SA, the FBDG were developed based on affordable, available foods that are widely consumed. [15] In addition, the FBDG were compatible with different cultures and eating patterns of the target population. [15] Implementation of the NEIP The NEIP comprised 10 topics, namely: enjoying a variety of foods; guidelines for feeding children 3 years and older; hygiene and sanitation; making starchy foods the basis of most meals; eating plenty of vegetables and fruits every day; eating dry beans, split peas, lentils and soya; recommending that chicken, fish, meat, milk or eggs be eaten daily; using salt sparingly; eating fats sparingly; and using food and drinks containing sugar sparingly and not between meals. ...
... 1 The South African Food Based Dietary Guidelines recommend that either chicken, fish, meat, milk or eggs should be eaten daily. 28 Consistent with studies indicating that meat consumption has increased in South Africa, 2,6 FAOSTAT FBS data (Table 1) indicate that South Africans consumed 18 kg of meat per annum more in 2009 than they did in 1994. This increase is mainly as a result of significant increases of 109% and 119% from 2009 to 1994 in consumption of poultry meat and pig meat respectively, with beef, mutton and goat meat consumption remaining relatively stable. ...
... Fruit and vegetable consumption plays a vital role in providing a micronutrient dense diet 30 and South Africa's Food Based Dietary Guidelines recommend eating plenty of fruits and vegetables every day and dry beans, peas, lentils and soya regularly. 28 However, the recent SANHANES-1 study revealed a low intake of fruits and vegetables (two or fewer portions per day) for 25.6% of South Africans and that people in formal urban areas appeared to consume the most fruit and vegetables. 9 This result may be linked to cost and availability. ...
... [36][37][38] Fats South Africa's Food Based Dietary Guidelines recommend eating fats sparingly. 28 However, as with studies indicating increases in fats and oils consumption in South African and other developing countries, 1,23,39 both FAOSTAT FBS and Euromonitor PFBC data indicated increasing trends (Table 5). Increases were greater than 28.5% according to both FAOSTAT FBS and Euromonitor PFBC data ( Table 5). ...
Article
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Food consumption patterns in South Africa have changed dramatically over the past decades and likely will continue to change over the coming decades. Various food-related studies conducted over the last few decades indicate that food consumption shifts in South Africa have been towards a more Western-orientated diet, with nutritional consequences contributing to increased obesity and other non-communicable diseases. Several sources of data may be used to examine patterns in food consumption over time. Each of these methods has its own merits depending on the desired outcome, but are difficult to compare as each measures different levels of dietary information. As a result of the lack of regular national or comparable food consumption data in South Africa, the objective of this study was to establish, through the use of databases (FAOSTAT food balance sheets and Euromonitor International© Passport), the broad food and beverage consumption shifts in South Africa since 1994. Our findings indicate that food consumption shifts have been towards an overall increase in daily kilojoules consumed, a diet of sugar-sweetened beverages, an increase in the proportion of processed and packaged food including edible vegetable oils, increased intake of animal source foods, and added caloric sweeteners, and a shift away from vegetables. The largest shifts in food consumption were observed for soft drinks, sauces, dressings and condiments, sweet and savoury snacks, meat, and fats and oils. Convenience, health and nutrition, and indulgence were the main drivers of the increase in consumption of packaged foods and beverages. These shifts in food consumption are concerning as relates to their fat, sugar and salt composition and potential effect on public health.
... In 1997, the Nutrition Society of South Africa (NSSA) formed a working group to start developing South African food-based dietary guidelines (FBDGs) to address existing nutrient deficiencies and excesses and their resulting nutrition related-public health problems (Vorster et al., 2001). The mandate of this working group was to develop a core set of guidelines to promote health for South Africans older than 5years-old, taking into account affordability, availability, cultural sensitivity, and sustainability and environmental impact of the food items . ...
... Further, the recent salt legislation aimed at reducing the amount of salt added to processed foods emanated from evidence that the bulk of salt intake among most of the population comes from processed foods such as bread, breakfast cereals, butter and spreads, and processed meats (RSA, 2013). (Vorster, et al., 2001, Vorster, et al., 2013. Recently, public media has increasingly criticised the relations between ADSA, NSSA and the food industry and the extent to which they may impact on the kind of dietary advice provided by nutrition professionals in the country. ...
... In 1997, the Nutrition Society of South Africa (NSSA) formed a working group to start developing South African food-based dietary guidelines (FBDGs) to address existing nutrient deficiencies and excesses and their resulting nutrition related-public health problems (Vorster et al., 2001). The mandate of this working group was to develop a core set of guidelines to promote health for South Africans older than 5years-old, taking into account affordability, availability, cultural sensitivity, and sustainability and environmental impact of the food items . ...
... Further, the recent salt legislation aimed at reducing the amount of salt added to processed foods emanated from evidence that the bulk of salt intake among most of the population comes from processed foods such as bread, breakfast cereals, butter and spreads, and processed meats (RSA, 2013). (Vorster, et al., 2001, Vorster, et al., 2013. Recently, public media has increasingly criticised the relations between ADSA, NSSA and the food industry and the extent to which they may impact on the kind of dietary advice provided by nutrition professionals in the country. ...
... In 1997, the Nutrition Society of South Africa (NSSA) formed a working group to start developing South African food-based dietary guidelines (FBDGs) to address existing nutrient deficiencies and excesses and their resulting nutrition related-public health problems (Vorster et al., 2001). The mandate of this working group was to develop a core set of guidelines to promote health for South Africans older than 5years-old, taking into account affordability, availability, cultural sensitivity, and sustainability and environmental impact of the food items . ...
... Further, the recent salt legislation aimed at reducing the amount of salt added to processed foods emanated from evidence that the bulk of salt intake among most of the population comes from processed foods such as bread, breakfast cereals, butter and spreads, and processed meats (RSA, 2013). (Vorster, et al., 2001, Vorster, et al., 2013. Recently, public media has increasingly criticised the relations between ADSA, NSSA and the food industry and the extent to which they may impact on the kind of dietary advice provided by nutrition professionals in the country. ...
... A nutrition knowledge questionnaire (NKQ) was developed to assess existing knowledge and the impact of a classroom-based Grade R NEP in the experimental (EG) and control groups (CG). To improve nutrition knowledge and reduce malnutrition the NEP developed for Grade R incorporated the 2003 FBDGs (Vorster, 2001) and the 2007 SA Paediatric Food-Based Dietary Guidelines (PFBDGs) (Bourne, 2007). Besides the FBDGs the nutrient-based food groups were included in the NEP to help prevent the occurrence of nutrition-related diseases, as advocated by Hendricks at al. (2007). ...
... An eighthour, eight-week Grade R NEP was created by the researcher in consultation with the foundation phase educator recruited to conduct the NEP. The content of the programme was aligned to the 2003 FBDGs (Vorster, 2001) and the 2007 PFBDGs (Bourne, 2007): enjoy a variety of foods; be active every day; make starchy foods the basis of a child"s main meal; eat plenty of fruit and vegetables every day; drink milk every day; eat chicken, fish, meat, eggs, soya or peanut butter every day; drink clean safe water regularly; eat fats sparingly; the use of salt; if children have sweets or drinks, offer small amounts with meals; feed children regular meals (Vorster et al., 2013) and the five nutrient-based food groups. The NETs consisted of a food group plate puzzle, NEP "My Little Books", NEP card games and the "Good for you, not good for you" board game and the HEAB (Oldewage-Theron and Napier, 2011). ...
Article
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The aim was to determine the effect of a nutrition education programme (NEP) on the nutrition knowledge of Grade R learners. The study was conducted in four phases. Grade R educators (n=20) from randomly selected urban government and private schools in Durban completed a nutrition education questionnaire (NEQ) to identify activities and visuals suitable for this age group (Phase 1). Consequently, a classroom-based NEP was developed by the researcher in consultation with the foundation phase teacher recruited to teach the NEP. The participating schools were randomly selected from the 20 that had participated in the NEQ. A nutrition knowledge questionnaire (NKQ) was developed and tested. Fieldworkers and educators were sourced and trained (Phase 2). The intervention involved 120 Grade R learners in three schools: a government school (Experimental group – EGG) (n=37), a private school (Experimental group – EPG) (n=40) and one Control group (CG) (n=43), a private school. The same foundation phase teacher implemented the eight-hour (eight-week) NEP to Grade R learners in each experimental group (EG); the CG did not receive any nutrition education (NE) (Phase 3). Pre- and post-test knowledge was assessed using a validated NKQ (Phase 4). The educators‟ NEQ results confirmed the need for NE with suitable activities. For the NKQ the Cronbach Alpha score at 0.532 was achieved and the questionnaire was accepted as valid and reliable. For the intervention, One-way ANOVA was used to determine the total group‟s correct answers between pre-and post-test between the three schools. Statistical significant differences between two schools were observed using Independent t-test. The NEP pre- implementation test score indicated similar correct answers and not statistically significant between the three groups (EGG 72.43%, EPG 70.83% and CG 69.15%), with the EGG boys most knowledgeable (73.32%). For the whole test, it was the EGG (88.30%) that achieved a marginally higher percentage of correct answers post-test than the EPG (87.50%) with a significant (p=0.035) post-test difference between EGG (83.30) and CG (71.47). The NEP post-test results indicated that the EG girls (EGG 89.62% and EPG 87.50%) were more knowledgeable than the boys (EGG 87.00%), an insignificant difference. The study concludes that a resource-dense NEP with children actively involved in a non-threatening environment will increase nutrition knowledge.
... Nutrition science that includes clinical nutrition, food and nutrition management, public health nutrition, personalized nutrition, etc., has its foundation in the biological, chemical, and medical sciences, with a focus on nutrient/non-nutrient function and metabolism. One of the main objectives of the nutrition science is to establish food-based dietary guidelines (FBDGs) to achieve optimum health, and treatment or prevention of disease conditions as well as food production and safety [1]. FBDGs are simple advices on healthy eating, aimed at the general public, which give an indication as to what a person (an individual member of the general public) should be eating in terms of foods, and provide a basic framework to apply when making healthy dietary choices and planning meals. ...
... Finally, the ranks to the sets, Φ f , need to be assigned and organized into an w × 1 vector Rank s . For the set with the lowest average value, M ean i [1], the rank is defined as ...
... Advertisements were further analyzed by 2 nutrition experts who placed the advertised food into either recommended or nonrecommended groups based on the South African food-based dietary guidelines. 28,35 Key features of these guidelines include a recommendation for making the following foods a major part of the diet: starchy foods; dry beans, peas, lentils, and soy; chicken, fish, and meat; and vegetables and fruit. The guidelines also recommend that salt, fats, and sugar be used sparingly. ...
... 26 With respect to magazines these claims were seen most often with advertisements for milk and dairy products, starchy foods, and meat/chicken/fish. Though the great majority of these health/ nutrition claims were honest and accurate (i.e., were consistent with the South African food-based dietary guidelines), 28 we did see numerous cases of misleading statements. For example, some advertisements emphasized the positive nutritional features of the food (such as its content of vitamins or dietary fiber) but ignored the negative features (a high content of undesirable substances). ...
Article
Little is known about food advertising in the print media in South Africa or other developing countries. We investigated the extent to which different ethnic population groups of South Africa are exposed to magazine advertising for food and beverages. Five different magazines (n = 162 issues) with the most adult readers were assessed. We identified 959 food-related advertisements. These were for food and beverages (80.9%), dietary supplements (10.4%), and slimming products (8.7%). Of the 658 advertisements for specific food and beverages, most (59.3%) were for unhealthy foods. Numerous cases of misleading health/nutrition claims were seen. Government interventions are required to reduce the advertising of unhealthy food-related products and to curb misleading advertising.
... HK intervention behavioural outcomes leading to a healthy diet and physical activity were developed using the intervention mapping (IM) approach [15]. This process was closely aligned with the South African food-based dietary guidelines [16,17] and physical activity guidelines for schools to ensure compliance with national dietary and physical activity objectives for South Africans. During the IM process, different aspects that were identified as priorities to address in the intervention are summarised in Fig. 1, while behaviour outcomes for the children are shown in Fig. 2. The APP based on Action Schools British Colombia (AS! BC) Planning Guide for Schools [18,19] and the Centres for Disease Control's School Health Index [20] formed the basis of the HK programme, of which the development is described in greater detail elsewhere [13]. ...
... Barriers mentioned could possibly have contributed to school staff perceiving problems as insurmountable. A lack of time, finances and resources have also been described as problematic to various degrees in other school interventions in South Africa and elsewhere [16,17]. The lack of planning in the physical activity action area could be related to the inability to address the school physical environment and perceived lack of resources in the particular sample as it has been shown that it is feasible to successfully implement a physical activity intervention in a lowincome school setting in South Africa [23]. ...
Article
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The HealthKick intervention, introduced at eight primary schools in low-income settings in the Western Cape Province, South Africa, aimed to promote healthy lifestyles among learners, their families and school staff. Eight schools from similar settings without any active intervention served as controls. The Action Planning Process (APP) guided school staff through a process that enabled them to assess areas for action; identify specific priorities; and set their own goals regarding nutrition and physical activity at their schools. Educators were introduced to the APP and trained to undertake this at their schools by holding workshops. Four action areas were covered, which included the school nutrition environment; physical activity and sport environment; staff health; and chronic disease and diabetes awareness. Intervention schools also received a toolkit comprising an educator's manual containing planning guides, printed resource materials and a container with physical activity equipment. To facilitate the APP, a champion was identified at each school to drive the APP and liaise with the project team. Over the three-years a record was kept of activities planned and those accomplished. At the end of the intervention, focus group discussions were held with school staff at each school to capture perceptions about the APP and intervention activities. Overall uptake of events offered by the research team was 65.6 % in 2009, 75 % in 2010 and 62.5 % in 2011. Over the three-year intervention, the school food and nutrition environment action area scored the highest, with 55.5 % of planned actions being undertaken. In the chronic disease and diabetes awareness area 54.2 % actions were completed, while in the school physical activity and sport environment and staff health activity areas 25.9 and 20 % were completed respectively. According to educators, the low level of implementation of APP activities was because of a lack of parental involvement, time and available resources, poor physical environment at schools and socio-economic considerations. The implementation of the HealthKick intervention was not as successful as anticipated. Actions required for future interventions include increased parental involvement, greater support from the Department of Basic Education and assurance of sufficient motivation and 'buy-in' from schools.
... A working group, representative of nutrition professionals in South Africa, recently formulated a basic set of food-based dietary guidelines (FBDG) that can be used in nutrition education and recommendations to consumers of all ethnic groups. 2 One of these guidelines is to 'eat fats sparingly'. In their excellent technical support paper motivating this guideline, Wolmarans and Oosthuizen 3 show how the guideline embodies the principles that fat should be eaten because it provides essential, important and needed fatty acids and energy, but that it should be eaten 'sparingly' because overconsumption is associated with obesity and other non-communicable chronic diseases of lifestyle (NCDs). ...
... The FBDG directive to 'eat fat sparingly' is a good starting point, indicating that fats should be eaten, but that overconsumption should be avoided. 2,3 However, the guideline should be accompanied by practical advice on which foods and products to choose. 3 The joint expert consultation of the FAO/WHO 10 on fats and oils in human nutrition pointed out that responsible, evidence-based recommendations are needed because of the wide-ranging implications for consumers, health care providers, nutrition educators, food producers, processors and distributors. ...
Article
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This paper briefly reviews the role of dietary fats (lipids) in human nutrition, summarises the contribution to the symposium on fats and oils during the 2000 South African Nutrition Congress, and examines the present recommendations and controversies regarding fat intake, in order to examine whether in a developing country such as South Africa, dietary fat recommendations to consumers should be more explicit, specific and detailed. It is concluded that to reach 'optimal' intakes, some groups in South Africa (e.g. rural blacks) should increase intakes, while those at risk for cardiovascular disease should lower intakes. It is suggested that all South Africans over the age of 2 years should aim for an intake in which fat provides approximately 30% of total energy. To meet the guidelines that more omega-3 (ω-3), proportionally more monounsaturated fatty acids and less trans and saturated fatty acids should be eaten, alternative sources of and for these fatty acids in the South African diet should be promoted. Both consumers and the food industry should be targeted with information and advice to make healthier but affordable choices possible. Only then will dietary advice on the quality of fat (less saturated and trans fatty acids and more monounsaturated and (ω3 fatty acids) be practical and meaningful.
... 14 Unlike other types of recommendations, FBDGs are framed in terms of the food being consumed and not individual nutrients, making the message easy for the consumer to conceptualise and understand. 12 FBDGs are intended to be used in health promotion, nutrition education and dietary guidance for the general public and therefore should be culturally sensitive and take into consideration appropriate customary dietary patterns for various population groups. These guidelines should further address public health concerns (such as those described above) in specific population groups 14 such as the elderly. ...
... Vorster et al. 12 recommended the development of FBDGs for vulnerable groups in SA. A working group was assembled in 2012 to develop FBDGs for elderly South Africans. ...
Article
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Food-based dietary guidelines (FBDGs) are not a new concept and are being used in many countries to promote healthy eating and the prevention of diet-related chronic diseases. The Food and Agriculture Organization (FAO) recommended FBDGs as an approach to prevent malnutrition and promote healthy dietary behaviours in populations, taking into consideration local conditions, traditional dietary practices and socioeconomic and cultural factors whilst at the same time using evidence-based scientific principles. South Africa (SA) currently has two sets of guidelines, namely the paediatric food-based dietary guidelines and the South African FBDGs for the population aged seven years and older. The recognition that elderly malnutrition remains a major public health concern in SA led to the formulation of a specific set of guidelines for this vulnerable population group based on existing nutrition-related health issues, local dietary habits and barriers to food intake experienced by those aged 60 and above. This introductory paper on the development of the elderly food-based dietary guidelines (EFBDGs) will be followed by six technical papers motivating why these guidelines are suited to address nutrition-related issues among the elderly in SA.
... In 1997 the South African FBDG Work Group was founded and set about proposing and consumer testing a set of FBDG for healthy adults (aged seven years and older). 4 This set of 11 guidelines was accepted as policy by the South African Department of Health, Nutrition Directorate (June 2003). It was further decided to compile FBDG for groups with specific needs, including children, and a PFBDG Work Group was formed in 2000. ...
Article
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Aim: To determine the comprehensibility of the preliminary paediatric food-based dietary guidelines (PFBDG) for infants younger than 6 months in South Africa. Methods: This qualitative study used focus group discussions held in the Western Cape to evaluate the comprehensibility and the understandability of the preliminary PFBDG. Groups were convened according to area of residence (rural, urban formal and urban informal) and ethnicity (white, coloured and black) to reflect the Western Cape population. Focus group discussions were conducted in the participant’s home language, namely Afrikaans, English or Xhosa. The purposive sample included 89 women with infants younger than 6 months divided in 20 groups. Results: In general, mothers understood the guidelines and could reportedly implement them, but constraints such as having to go back to work, being tired and not having enough breast-milk were volunteered. There were very few problems regarding the PFBDG terminology except with the word ‘regularly’ in the context of the oral hygiene guideline. With regard to the breast-feeding guideline there was some confusion over whether other foods could be included while breast-feeding. Suggestions were made to include ‘only’ in the breast-feeding guideline. Some of the participants did not know anything about cleaning the infant’s mouth, and suggested it be changed to the overall hygiene of the infant. Conclusion: The findings from this study indicate that it may be possible to use one set of dietary guidelines for infants younger than 6 months for all ethnic groups living in the Western Cape, provided that these guidelines are accompanied by supportive documentation citing examples and reasons for the implementation of the guidelines. Recommendations were made for the PFBDG Work Group to revise the preliminary PFBDG for infants younger than 6 months for implementation and further action.
... Food-based dietary guidelines (FBDGs) are simple advices on healthy eating, aimed at the general public (Vorster et al., 2001). They give an indication of what a person (an individual member of the general public) should be eating in terms of foods, and provide a basic framework to apply when making healthy dietary choices and planning meals. ...
Conference Paper
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In order to help people to follow the new knowledge about healthy diet that comes rapidly each day with the new published scientific reports, a grammar and dictionary based named-entity linking method is presented that can be used for knowledge extraction of evidence-based dietary recommendations. The method consists of two phases. The first one is a mix of entity detection and determination of a set of candidates for each entity, and the second one is a candidate selection. We evaluate our method using a corpus from dietary recommendations presented in one sentence provided by theWorld Health Organization and the U.S. National Library of Medicine. The corpus consists of 50 dietary recommendations and 10 sentences that are not related with dietary recommendations. For 47 out of 50 dietary recommendations the proposed method extract all the useful knowledge, and for remaining 3 only the information for one entity is missing. Due to the 10 sentences that are not dietary recommendation the method does not extract any entities, as expected.
... 3 South Africa currently has two sets of FBDGs, one for children and adults (Table I) and another for infants and preschool children, which is still being tested. 4 In this study we determined which foods and beverages were major sources of essential nutrients and then compared these food intakes with the FBDGs aimed at promoting a healthy diet in children and adults. The 2001 FBDGs for South Africans aged 7 years and older are primarily used as a basis for comparison in the discussion. ...
Article
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Objective. The aim of this study was to determine which foods and beverages contribute most ( ≥ 5% of total) to energy, macronutrient and micronutrient intakes of South African children aged 12 - 108 months. It was also our intention to evaluate the dietary content according to the Food-Based Dietary Guidelines (FBDGs) (2001) for South Africans aged 7 years and older. Low energy and micronutrient intakes are widespread in South Africa and it is important to examine which foods are currently contributing to nutrient intake in order to make appropriate suggestions regarding dietary improvements. Methods. The National Food Consumption Survey was undertaken in 1999 on a representative sample of children aged 12 - 108 months (N = 2 818). Dietary intake of each participant was determined by means of a 24-hour recall undertaken with the primary caregiver of the child. Dietary aids were used to assist in the determination of portion sizes of foods and drinks consumed. The FoodFinder database was used to determine the dietary composition of the dietary intake according to local food tables. Statistical analyses involved calculating the percentage contribution of different food items towards total intake of each specific nutrient. Results. Only a few food items contributed significantly to the intakes of many nutrients. Maize porridge and bread contributed 27% and 14.8% to total energy, 19.1% and 15.7% to protein and 40% and 17.2% to carbohydrate intake, respectively. In terms of micronutrients, maize porridge and bread contributed 10.9% and 15.6% to iron, 14.9% and 16.9% to zinc, 9.8% and 19.5% to niacin and 37.6% and 15.6% to thiamin intake. In terms of the FBDGs, guidelines not being met were those aimed at improving variety of foods eaten, increasing fruit and vegetable intake, increasing legume intake, and eating more animal foods. Ones that were being met were making starches the basis of most meals, and using fats sparingly. Conclusion. Maize and bread contributed significantly to macronutrients and most micronutrients, with the exception of calcium. Food fortification of these items will increase these values significantly. The diet of children in South Africa (12 - 108 months) in 1999 was found to have little variety, was low in fat and animal foods, particularly dairy foods, and contained a low intake of legumes, fruit and vegetables.
... FBDGs guidelines are intended to be used as an effective nutrition education tool for promoting the importance of nutrition to combat the growing burden of chronic diseases as well as existing nutritional disorders associated with poverty and undernutrition. The guidelines will form the core of Governments nutrition education messages with a view of promoting healthy lifestyles among all South Africans (Vorster, Love & Browne, 2001). The first three of the eleven FBDGs provide general health messages to promote a healthy lifestyle and include: Enjoy a variety of foods, Be active, and Drink lots of clean, safe water. ...
Article
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Insufficient and imbalanced nutrition is prevalent within the developing world and negatively affects people's health, productivity, sense of hope and overall well-being. Despite economic development moving South Africa from a developing to an emerging economy, micronutrient deficiencies are prevalent and primarily affect vulnerable groups such as women and children. Many children consume a low quality diet poor in good quality protein and micronutrient density. Collectively, micronutrient deficiencies contribute to growth retardation, brain damage, diminished cognitive function and diminished working capacity in children and adults as well as increased susceptibility and severity of infections, and mortality. While undernutrition remains a problem among children, overnutrition with obesity and associated non-communicable diseases traditionally a problem of affluent countries, are now increasingly prevalent amongst all population groups in South Africa. Obese individuals are at a health and social disadvantage, and are often discriminated against in employment opportunities. Hunger, poverty and disease are interlinked, and in South Africa, malnutrition alone causes the loss of between 86 400 and 136 000 disability adjusted life years causing reduced work capacity. Decreases in labour productivity and creativity, increased health costs and the spill over welfare costs reinforce poverty levels. Malnutrition causes a generational cycle of low productivity and poverty, as malnourished parents bear underweight, malnourished children; and malnourished children are likely to be intellectually impaired, with diminished productive and creative capacities. Good nutrition is an important foundation for poverty alleviation, and for meeting many of the Millennium Development Goals. The paradox of over and under nutrition, as well as the range of micronutrient deficiencies of public health significance, requires complementing strategies and an integrated approach to ensure optimal nutrition for all South Africans. To successfully combat malnutrition, short-term interventions and proper feeding in infancy must be supported by long-term sustainable solutions concentrating on whole diets. Increasing the efficacious nutrient supply, by using food-based approaches can control micronutrient deficiencies. Food-based interventions are viewed as those most likely to be sustained, provided the culture and ecology of the foods is addressed in programs based on agriculture, food processing, social marketing and public health education.
... Source: Adapted from Vorster et al., 2001;48 Department of Health, 2004. 47 Health service management of non-communicable diseases Table 2. Working closely with schools and the Department of Education, Woolworths in conjunction with SSISA, has developed the 'Making the Difference through Nutrition Programme'. ...
... The nutrition education tools used were developed in English for primary school children in the Vaal region and were based on the SAFBDGs. 19,20 The nutrition education tools that were developed included a text and activity book containing colouring-in activities, word searches and crossword puzzles. A card and a board game, as well as a food puzzle, supplemented the activity book. ...
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Objective: The aim of this study was to improve the dietary intake patterns and food choices of children aged 9-13 years in a periurban community. Methods: Two schools were randomly selected from within this periurban community. A nutrition education programme was implemented over one school term, with the testing of nutrition knowledge occurring pre- and post-intervention, and in the long term, with the experimental group only. A validated 24-hour recall questionnaire was completed pre- and post-intervention by both the control (n = 91) and experimental groups (n = 81), and in the long term, by the experimental group. Food models were used to assist in the estimation of portion sizes and identification of food items. The questionnaire was analysed using the computer software programme Food Finder 3, with means and standard deviations calculated for macro- and micronutrients, and comparisons made with dietary reference intakes for specific age groups. A list was drawn up of the 20 most commonly consumed food items, based on weights consumed. Paired t-tests were conducted to assess significance in dietary intake and food choices after the intervention. Correlations between knowledge and dietary choices were determined among the experimental group in the long-term measurements. Results: Correlations linked protein intake to knowledge of proteins, and vitamin C intake to knowledge of fruit and vegetables. Fruit and vegetable intake remained very low. Refined sugars and fat were still consumed among the experimental group. The diet for both groups was based on carbohydrates. Conclusions: The objective of changing the dietary intake patterns of the children was not achieved. The intake of legumes, fruit and vegetables remained low. The lack of variety in intake results in a diet that does not meet the daily requirements of children.
... According to the South African Department of Health 'sensible drinking' is defined as three or two standard drinks per day for men and women respectively, where a standard drink is defined as a can of beer, one tot of spirits, one glass of wine or one small glass of sherry (Vorster, 2001). Serfontein et al. (2009) conducted a sample study of the African population in the North West province of South Africa. ...
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The Sunday Times Discovery Healthiest Company Index Survey collected a dataset of 13 578 responses from corporate employees in 101 companies. This dataset has been used to assess the prevalence of self-reported modifiable health-risk factors and the association with chronic conditions. The analysis indicates that there is a greater likelihood of an individual reporting achronic condition where their lifestyle risk factors are outside of the healthy range. This suggests that there are opportunities to manage the costs of health insurance, medical expenses and productivity losses by applying risk management tools aimed at addressing modifiable risk factors.KEYWORDS: Chronic condition, disease management programme, modifiable health risk factors
... Using the Intervention Mapping approach (Bartholomew, Parcel, Kok & Gottlieb, 2006), HK activities were developed and closely aligned with specific South African FBDG (Vorster, 2001), which formed the HK Behavioural Outcomes relating to healthy nutrition and PA behaviour. ...
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This study explores the feasibility of implementing the curriculum and action-planning components of the HealthKick (HK) intervention in eight low-resourced schools in the Western Cape, South Africa. Process evaluation comprising workshops and personal interactions with teachers and principals were followed up with semi-structured interviews and focus group discussions, along with a questionnaire and evaluation sheet, during three implementation phases. Since promoting healthy habits during the early formative years is of key importance, the research team actively intervened to ensure successful implementation of the curriculum component. Time constraints, teachers' heavy workload, and their reluctance to become involved in non-compulsory activities, were the main reasons for non-compliance in using the curriculum document. Furthermore, the priorities of the teachers were not necessarily those of the researchers. However, findings indicate that with an appropriate introduction and continued interaction and support, the integration of specific healthy lifestyle outcomes into a curriculum can be sustainable if teachers are well informed and motivated.
... Information on the understanding of diet and adherence was generated by asking patients what they had been taught or knew about diet and their current dietary practices. All the focus groups seemed to be aware of most dietary recommendations, as per the South African national guidelines for diabetes (Department of Health 2005) and the Food Based Dietary Guidelines (Vorster 2001), as indicated by the following comments: 'We are not supposed to eat oily and fatty foods; we may eat fruits, beans and vegetables' (Gp 2, P2/10). ...
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Diabetes self-management education is crucial in diabetes care. Education that is tailored to the needs of the patient is considered the most effective in improving health outcomes. Diet, a critical element of diabetes treatment, is reported as the most difficult to adhere to by both patients and health professionals. Tailored nutrition education (NE) could benefit diabetic individuals with low socio-economic status, who are amongst those noted to have poor health outcomes. This qualitative interpretive phenomenological study aimed to explore and describe the NE needs of adults with type 2 diabetes mellitus to guide development of a tailored NE programme for resource-poor settings. Participants were 31 non-insulin-dependent type 2 diabetic patients (convenience sample) and 10 health professionals. Focus group discussions using semi-structured questions were held with the diabetics, and open-ended self-administered questionnaires were used with the health professionals. Data analysis was done using Krueger's framework approach. Disease-related knowledge deficits and inappropriate self-reported dietary practices, including intake of unbalanced meals, problems with food portion control and unsatisfactory intake of fruits and vegetables, were observed. Recommendations for the NE programme included topics related to the disease and others related to diet. Group education at the clinic, a competent educator and comprehensive education were indicated by the patients. Participation of family and provision of pamphlets were aspects recommended by patients and health professionals. Barriers that could impact the NE included financial constraints, food insecurity, conflict in family meal arrangements and access to appropriate foods. Support from family and health professionals and empowerment through education were identified as facilitators to following dietary recommendations by both groups of participants. Knowledge deficits, inappropriate dietary practices and barriers are issues that need addressing in an NE programme, whilst the suggestions for an NE programme and facilitators to dietary compliance need to be incorporated.
... 43 The South African FBDGs were developed to encourage undernourished persons to choose a more adequate diet and over-nourished persons a more prudent diet. 44 The dietary guidelines of "eating plenty of fruit and vegetables", 6 "eating dry beans, peas, lentils and soya often", 11 "making starchy foods the basis of most meals", while eating more of the cereals and grains in an unprocessed or minimally processed form 7 and "drinking lots of clean, safe water" (that may be taken in the form of beverages such as tea) 13 can support achieving the suggested daily dietary TAC. Due to widespread household food insecurity in SA, 42 nutrition messages should incorporate the recommendation of whole grains as three servings 12 and to wait at least one hour after eating before drinking tea, or drinking tea between meals. ...
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Objective: In this exploratory study, the average adult South African dietary total antioxidant capacity (TAC) was estimated using secondary data and was evaluated against that determined for dietary intake recommendations. Design: The average adult South African dietary TAC was estimated using a report published by the Department of Health that summarises food consumption studies conducted in South Africa between 1983 and 2000. This estimated adult South African dietary TAC was evaluated against that determined for dietary intake recommendations incorporating the five-a-day concept and the basic food groups and beverages (tea and coffee). Results: The average adult South African dietary TAC was estimated as 11 433 micromoles (µmoles) Trolox equivalents (TE)/person/day, with beverages (tea) being the main contributor (38.5%). The dietary TAC based on the recommended five-a-day concept and other dietary intake recommendations was 20 513 µmoles TE/person/day, with beverages again being the main contributor (47.8%). Conclusions: Compared to the TAC of the five-a-day concept and other dietary intake recommendations, the South African population consumes about half of this estimated TAC per day. It is especially in the vegetable group and beverages where actual consumption is well below the coupled TAC. Grains are the only food group where consumption is above the coupled TAC. The five-a-day concept is only the aim for minimum intake and not the ultimate goal. An increase in these foods, along with beverages (tea) and whole grains to the recommended servings, can uphold the dietary TAC and health benefits.
... 6 The Department of Health (DoH) and academic institutions anticipated the FBDG to form the basis of nutrition education in schools in South Africa. 6,7 Furthermore, nutrition education is one of the key pillars of the NSNP (now one of the flagship programmes of the National Department of Basic Education [DBE]) and, as such, must be reinforced in the curriculum in accordance to the DBE. 4 It is, however, not clear to what extent schools implement this important component of the NSNP. ...
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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.
... Finally, revisions are made based on the comments received, and finalising, adapting, and disseminating the final FBDGs. Dietary guidelines should be expressed through short, clear, and specific messages that provide guidance and promote good health among populations [55]. To be culturally acceptable, the choice of foods and colours used in illustrations should be culturally appropriate, be sensitive to religious and other cultural considerations, especially those of minority groups. ...
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Food-based dietary guidelines (FBDGs) are important tools for promoting healthy eating and nutrition education at the population level. Currently, more than 100 countries worldwide have developed FBDGs with majority of existing FBDGs in high-income countries. However, there are a few countries in Africa which have developed FBDGs. This review describes and compares the characteristics of existing FBDGs in Africa. Data were extracted from all existing FBDGs from African countries which have been archived in the Food and Agriculture Organization's (FAO) online repository of FBDGs. In addition, supporting documentation from other sources linked to the identified FBDGs were also reviewed. Extracted data were coded and synthesized to describe the purpose of the FBDGs, the process for developing the FBDGs, and how healthy diets were expressed in the FBDGs. In addition, the FBDGs were examined for content on considerations for planetary health, and non-dietary recommendations. A checklist was used to extract the evidence in the identified documents. Of the 47 African countries in the WHO Africa region, only eight FBDGs were identified from seven countries. South Africa had two FBDGs (including a FBDG for young children). Multidisciplinary technical working groups were convened in developing majority of the FBDGs. The working groups utilised scientific evidence on diet-related diseases and nutrient requirements as a basis for recommendations. All the FBDGs were intended as a tool for promoting healthy diets among the lay population. The FBDGs that were reviewed included between six and sixteen dietary messages. Diet diversification was promoted as the most common recommendation across African country FBDGs. The recommendations often promoted consumption of four to six food groups communicated using text as well as images (food guide). Local availability and cultural acceptability were important values promoted as part of an optimal diet in some of the countries. However, none of the recommendations addressed environmental sustainability. Apart from South Africa, none of the FBDGs had been evaluated or revised. Across Africa, there is a need for increased focus on developing new FBDGs or revising existing ones as a tool for meeting the dietary information needs of populations at risk of malnutrition in all its forms.
... The South African FBDG were developed based on an analysis of the dietary habits of South Africans, their nutritional status and the disease patterns in South Africa. The South African FBDG aimed to address both over-and under-nutrition and to provide nutrition education for all populations and sectors of South African society (Vorster et al., 2001). In total eleven guidelines were formulated for South Africans over the age of 7 years. ...
Article
In this paper the current and potential utilisation of crops (bought and home produce) in diets in South Africa is reviewed. Available data shows that at all levels, national, household and individual, the amounts of fruits and vegetables available and consumed are about half the WHO (2003) recommendations of at least 400g per day. To counteract this, the South African Food Based Dietary Guidelines promote fruit and vegetable consumption. The 1999 National Food Consumption Survey (NFCS), showed that in South Africa, nationally, 17% of the sample produced crops only, 9% produced crops and livestock and 8% produced livestock only. Median intakes of nutrients such asenergy, vitamin A and calcium for children in rural households with crop and livestock production, although raised, were still below requirements. However, evaluation of an intervention which combined production of vitamin A rich crops in home gardens with nutrition education and growth monitoring, showed vitamin A intakes increased above required levels. Another possible approach is the promotion of the consumption of indigenous vegetables, which are rich sources of several micronutrients. The 1999 NFCS data showed that ten percent of the children in rural areas consumed wild leaves/spinach. In conclusion, the traditions of crop production and indigenous vegetable consumption can be built on, by the combined efforts of agriculturalists and nutritionists. The increased utilisation of indigenous crops in the South African diet would contribute to combating both under-nutrition and over-nutrition.
... Epidemiological studies often discuss morbidity along broad racial categories, but increasingly dietary advice should be personalised rather than assume that individuals have a set of food practices based on their racial background. We expect the need for dietary recommendations to be sensitive to inter-cultural food practices will be increasingly relevant to cosmopolitan settings in different parts of the world, as we join other scholars (Ayala, Baquero, & Klinger, 2008;Curry, 2000;Liu, Berhane, & Tseng, 2010;Vorster et al., 2001) in advocating for more flexible and tailored interventions in multicultural societies. Food was also perceived to serve a healing purpose for many participants in our study based on traditional health beliefs. ...
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The choice of food practices can be influenced by one's identity in many societies, but has mostly been evaluated in light of the maintenance of cultural identity in migrant populations. This study focused on understanding the influence of identity on food practices among individuals in multicultural societies. We conducted 18 focus group discussions (n = 130) among Indian, Chinese and Malay women in Singapore. Focus group transcripts were analysed using Thematic Analysis both inductively and deductively. Deductive analysis was framed within a Social Representations Approach, a social psychological theory that allows a deeper understanding of the contextual aspects of identity. Participants highlighted the central position of food in social events, cultural celebrations, and persistent traditional beliefs about health (such as 'hot-cold balance'). These beliefs extended to the perception of certain traditional foods possessing medicinal properties. Importantly, the consumption of these traditional foods was accepted as necessary for the maintenance of health by the women. We propose that while cultural food practices are integral to identity preservation and identity continuity for Singaporean women from all three racial groups, this is different to other multicultural societies such as Canada where communities preserve their cultural food practices, in part, due to fear of cultural identity loss. In addition, cross-cultural food practices are readily adopted in participants' daily lives for a number of reasons such as the promotion of health, convenience, and variety. At times, this adoption blurred boundaries between different cultural cuisines. Food practices in multicultural societies like Singapore are thus a reflection of everyday multiculturalism, multicultural social policies and attitudes towards traditional healthful food practices, and these aspects need to be considered in the development of public health policies and interventions.
... Nutritional sciences, such as clinical nutrition, food and nutrition management, public health nutrition, etc., combine a strong foundation in the biological, chemical and medical sciences, with a focus on nutrient/non-nutrient function and metabolism. The main objective of nutritional sciences is to establish food-based dietary guidelines (FBDGs) to achieve optimum health and the treatment or prevention of disease conditions as well as food production and safety [1]. Even though FBDGs are simple messages, we must be aware that they are based on complex scientific facts, which include dietary reference values (DRVs). ...
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Evidence-based dietary information represented as unstructured text is a crucial information that needs to be accessed in order to help dietitians follow the new knowledge arrives daily with newly published scientific reports. Different named-entity recognition (NER) methods have been introduced previously to extract useful information from the biomedical literature. They are focused on, for example extracting gene mentions, proteins mentions, relationships between genes and proteins, chemical concepts and relationships between drugs and diseases. In this paper, we present a novel NER method, called drNER, for knowledge extraction of evidence-based dietary information. To the best of our knowledge this is the first attempt at extracting dietary concepts. DrNER is a rule-based NER that consists of two phases. The first one involves the detection and determination of the entities mention, and the second one involves the selection and extraction of the entities. We evaluate the method by using text corpora from heterogeneous sources, including text from several scientifically validated web sites and text from scientific publications. Evaluation of the method showed that drNER gives good results and can be used for knowledge extraction of evidence-based dietary recommendations.
... 3 Food and Agriculture Organization (FAO) and World Health Organization (WHO) has thus supported the development of guidelines formulated on scientific basis to fight against dietrelated public health problems. 4 The treatment and management of these non communicable diseases seems easy and approachable i.e. through dietary modification but literature review on dietary patterns in relation to nutrient adequacy, demographic variables and health outcome 5 reveal that this task is not as uncomplicated as it seems. Planning a healthful diet is not simple as it not only involves the principles of a healthy diet, but also takes into consideration factors influencing food choices which include personal preferences, habits, ethnic heritage and tradition. ...
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This review focuses at highlighting the importance of Food Exchange List in cultural perspective, as an effective dietary tool to help individuals’ manage their dietary modifications in relation to non communicable diseases whilst specifying measures that can help improve the quality of Food Exchange Lists for combating various non communicable diseases and addressing adherence related issues to specialized diets. A search was done using PubMed & Google Scholar till June 2016. Search terms used were food exchange list AND disease, diet AND non-communicable diseases. We included only studies that discussed Food Exchange List (FEL) in relation to non-communicable diseases; in addition to factors like cultural relevance and adherence. Out of the 837 papers accessed 57 were identified as relevant to the Food Exchange List, out of which 39 papers were focused to the concept and development of the Food Exchange List. Only 18 discussed FEL in relation to non communicable diseases and were thus included in the review. Food exchange list is a user friendly tool for dietary modification due to disease. This tool may help to customize meals for people as it provides information regarding various food items in different groups. This tool is helpful in reducing blood & plasma glucose levels, maintaining lipid profile & effectively combating other diet related diseases & those ailments in which diet plays a significant role in maintenance & prevention from reoccurrences. However, better management and adherence to modified diets for non communicable diseases can be ensured by keeping cultural relevance under consideration before using Food Exchange Lists for such diseases.
... The guidelines were supported by technical papers and were consumer tested for understanding. 6 They should be the basis of public health nutrition communication for the promotion of optimal nutrition; they are health promoting and contribute to the prevention of disease. The 2002 guidelines were updated in 2013, incorporated recent research findings and reflected on the ongoing relevance of each message. ...
... 124 Research has identified demographic factors as barriers associated with low milk and milk-product intake including ethnicity, low socioeconomic status, increased bodyweight and older age. 8,150 Nutrition education material for the consumer should include guidance on low-fat and salt options in this food group, specifically cheese for the elderly. ...
Article
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Studies have shown that the elderly are at a higher risk of developing malnutrition due to physiological and pathological changes. Several studies have confirmed that older South Africans have insufficient dietary diversity, resulting in nutritional deficiencies. Furthermore, poor and uninformed dietary choices are associated with the development of several diseases and increased mortality. Following the Elderly Food Based Dietary Guidelines (EFBDGs) related to promoting elderly health could ensure that the elderly have an adequate intake of nutritious foods. This paper provides an overview of six FBDGs relating to promoting health and is based on the South African Food Based Dietary Guidelines.
... In other counties, this advice was the result of a strategy to provide only positively formulated FBDG recommendations, even in the difficult case of food from animals (e.g. Vorster et al., 2001). Recently, some countries with a high and largely animal-based protein supply (i.e. ...
Article
– A shift to a healthy and sustainable diet (as recommended by the EAT Lancet Commission) needs to have a strong societal legitimation. This makes it relevant to investigate to what extent countries are using their Food-Based Dietary Guidelines (FBDGs) in ways that can stimulate such a shift.. – Given the pivotal role of protein, we examined what patterns of protein-related recommendations are used to guide consumers and how these patterns are related to specific contexts and societal priorities of the countries. The analysis of data from 93 countries worldwide revealed two emerging patterns of recommendations. One pattern (found in a cluster of 23% of the countries) combined positive advice about key protein sources with limiting messages to reduce (or replace) the consumption of animal protein. The other pattern (found in a cluster of 24%) encouraged both animal and plant protein, thereby diversifying the set of protein sources, without negative advice on animal-based food sources. The two patterns of recommendations were differently associated with health and nutrition variables, including the countries’ level of animal protein supply (in particular, dairy) and the prevalence of overweight among adult men. For all stakeholders, it is of crucial importance to realize that an increasing number of countries in the world are moving into the direction of acknowledging and addressing the diet-health-environment nexus by adapting their patterns of recommendations for key protein sources. This study is the first that reveals patterns in recommendations with respect to protein sources by different nations worldwide
... This was done in partnership with the Department of Health, Directorate Nutrition, the Medical Research Council (MRC) of South Africa, the Association for Dietetics in South Africa (ADSA) and several other stakeholders from the United Nations' agencies and food-producer organisations in South Africa. 9 In 2003 the South Africa FBDG for adults and children over the age of seven years were published and adopted by the Department of Health. 8 In 2007, technical support papers for proposed South African Paediatric FBDGs (SA-PFBDGs) were published, 10 but the guidelines were not adopted by the Department of Health due to insufficient national field testing, and a lack of research resources and capacity. ...
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Background: This paper provides an overview of a series of studies undertaken to assess the appropriateness and understanding of the revised, draft South African Paediatric Food-Based Dietary Guidelines (SA-PFBDGs) amongst mothers/caregivers of children aged 0–5 years. Previous exposure to guidelines with similar messages, barriers and enablers to following the guidelines were also assessed. Design: Qualitative methods were used to collect data from 38 focus-group discussions (isiXhosa = 11, Afrikaans = 11, English = 10 and siSwati = 6) resulting in 268 participants. Setting: Breede Valley sub-district (Worcester), Stellenbosch Municipality (Stellenbosch, Pniel and Franschhoek) and Northern Metropole (Atlantis, Witsand, Du Noon and Blouberg), City of Cape Town, Western Cape province, as well as Ehlanzeni District (Kabokweni) in Mpumalanga province. Subjects: Mothers/caregivers older than 18 years who provided informed consent to participate. Results: The majority of participants had previous exposure to guidelines with similar messages to the SA-PFBDGs. Information sources included nurses, local clinics, family, friends and media. Possible barriers to following the guidelines included limited physical and financial access to resources; cultural/family practices, poor social support and time constraints. Outdated information, misconceptions, inconsistent messages and contrasting beliefs were evident. The vocabulary of some messages was not well understood. Education on infant and young child feeding and visual portrayal of the guidelines could aid understanding. Conclusion: A degree of rewording should be considered for improved understanding of the revised, draft SA-PFBDGs. Once adopted, the guidelines can be used to educate various stakeholders, including parents, caregivers, healthcare providers and educators, on the correct nutritional advice for children aged 0–5 years ensuring the healthy growth and development of young children in South Africa.
... The EDI of PFAS through the consumption of dairy milk (Table 8) in this study is much lower than EDIs reported for other parts of the world, mainly because of the overall low daily consumption of dairy milk by South Africans. This low consumption (Table 4) fell well below the 625 mL, 375 mL and 732 mL recommended daily intake for toddlers, adolescents and adults, respectively; was chiefly attributed to the lack of affordability by the larger part of the population and the general lactose intolerance among Africans (Vorster et al., 2001;MacIntyre et al., 2002;Steyn, 2006;Vorster et al., 2013). The result indicates that toddlers had the highest total intake of PFAS in both urban and rural populations of 20.41 ngkg −1 BWday −1 and 14.17 ngkg −1 BWday −1 respectively, compared to adolescents and adults (Table 8). ...
Article
Dairy milk and infant formula play important roles in the diet of adolescents, adults and infants, respectively, in the South African population. However, data on the occurrence of legacy and emerging contaminants such as PFAS in these important food sources is lacking. In this study, the concentration of fifteen PFAS were measured in 23 pooled retail dairy milk and 7 pooled infant formulas by means of an ultrahigh performance liquid chromatography tandem mass spectrometric method. The concentrations of Σ15PFAS ranged from 0.08–15.51 ng mL⁻¹ and 0.42–5.74 ng mL⁻¹ in dairy milk and infant formulas, respectively. PFBA, PFPeA, PFuDA, PFTrDA and PFDoA were the most prevalent PFAS in both matrices with detection frequency > 96%. Highest PFAS concentrations of 2.02 ng ml⁻¹ and 2.76 ng ml⁻¹ were recorded for PFDoA in infant formulas and dairy milk, respectively. The concentrations of legacy PFAS –PFOA and PFOS, shows resemblance with global data, however, elevated concentrations of long chain C9 – C14 PFAS were observed in this study. Though, higher concentrations of PFAS were measured in full cream dairy milk, no statistical significant difference (P = 0.546) was observed for the various classes of dairy milk. The EDI of Σ15PFAS through infant formulas were 184.92, 329.47 and 166 ngkg⁻¹BWday⁻¹ for partially breastfed, exclusively formula fed and older infants, respectively. Similarly, the EDI of PFAS through dairy milk for toddlers, adolescents, female and male adults for the rural population were 14.17, 1.09, 2.59 and 3.16 ngkg⁻¹BWday⁻¹ respectively while they were 20.41, 3.84, 4.13 and 4.26 ngkg⁻¹BWday⁻¹ respectively in the urban population. Although, the EDI of PFAS through the consumption of infant formulas and dairy milk are lower than the daily tolerable limits, the relative importance of long-term exposure and the cumulative effects of multiple exposure pathways cannot be overemphasized.
... However, there is no biofortification programme for maize in South Africa (Figure 2). In contrast, there is commercial fortification of maize [72,73], which may not be affordable or sustainable for the rural and urban poor in South Africa. It is promising that the government of South Africa is promoting research on the biofortification of maize to implement it at a level that can alleviate VAD [74][75][76]. ...
Article
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In many poorer parts of the world, biofortification is a strategy that increases the concentration of target nutrients in staple food crops, mainly by genetic manipulation, to alleviate prevalent nutrient deficiencies. We reviewed the (i) prevalence of vitamin A, iron (Fe) and zinc (Zn) deficiencies; (ii) availability of vitamin A, iron and Zn biofortified crops, and their acceptability in South Africa. The incidence of vitamin A and iron deficiency among children below five years old is 43.6% and 11%, respectively, while the risk of Zn deficiency is 45.3% among children aged 1 to 9 years. Despite several strategies being implemented to address the problem, including supplementation and commercial fortification, the prevalence of micronutrient deficiencies is still high. Biofortification has resulted in the large-scale availability of βcarotene-rich orange-fleshed sweet potatoes (OFSP), while provitamin A biofortified maize and Zn and/or iron biofortified common beans are at development stages. Agronomic biofortification is being investigated to enhance yields and concentrations of target nutrients in crops grown in agriculturally marginal environments. The consumer acceptability of OFSP and provitamin A biofortified maize were higher among children compared to adults. Accelerating the development of other biofortified staple crops to increase their availability, especially to the target population groups, is essential. Nutrition education should be integrated with community health programmes to improve the consumption of the biofortified crops, coupled with further research to develop suitable recipes/formulations for biofortified foods.
... Furthermore, nutritional benefits were considered. The 82 beneficial health effects of the incorporation of probiotics in fermented milk can play an essential role 83 in improving lipid profiles, the lower pH of fermented milk can delay gastric emptying which can result 84 in appetite regulation, and the low sodium-to-potassium ratio is considered to be beneficial for the 85 prevention of cardiovascular disease and hypertension were recognised (Vorster et al., 2013 1).Vorster et al., 2001;2 )Beukes et al. 2001;Panesar, 2011). The product is thick in consistency, ...
Article
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.
... The South African FBDG were developed based on an analysis of the dietary habits of South Africans, their nutritional status and the disease patterns in South Africa. The South African FBDG aimed to address both over-and under-nutrition and to provide nutrition education for all populations and sectors of South African society (Vorster et al., 2001). In total eleven guidelines were formulated for South Africans over the age of 7 years. ...
Article
Full-text available
The Department of Basic Education (DBE) has not given nutrition education the necessary emphasis that it needs, despite its importance in South African schools. Nutrition is included as only one of many topics forming part of the Life Orientation syllabus. Educators are role models for learners in making healthy food choices, however, studies have shown that major gaps exist in the health and nutrition-related knowledge and behaviour of educators. The objective of this research was to undertake a pilot study to determine the impact of a nutrition education programme (NEP) on the nutrition knowledge of Life Orientation educators in public schools in South Africa (SA). An exploratory baseline survey, to determine the nutrition education practices in 45 purposively selected public schools, was carried out before the experimental nutrition education intervention study. A nutrition knowledge questionnaire was completed by 24 purposively selected educators, representing all nine provinces in SA, before and after a three-day NEP. Pre and post-NEP data were analysed on the Statistical Package for Social Sciences (SPSS) for a Windows program version 17.0 for descriptive statistics, version 17.0. Paired t-tests measured statistically significant differences (p < 0.05) before and after the NEP. The knowledge of the respondents improved significantly after the NEP as the mean±s.d. score of correctly answered questions (n = 59) improved from 63.3±30.2% before to 80.6±21.1% after the NEP. The results proved that nutrition knowledge of Life Orientation educators in primary schools is not optimal, but can be improved by NEP.
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As the population of elderly individuals in South Africa (SA) grows, there is a need to promote the continued health of these persons as they progress through the life cycle. Food Based Dietary Guidelines (FBDGs) for the SA elderly were developed to address this need. These thirteen guidelines for the elderly collectively offer a basis of health practices that the elderly can follow to ensure that they are taking the right steps toward maintaining their health. While the guideline ‘Eat clean and safe food’ is not included in the current SA FBDGs, this recommendation is of particular importance to the elderly, who face a much higher risk of foodborne illness than most of the general population due to a number of factors. Reduced immunity and other physiological changes are a result of ageing, malnutrition, diseases and and/or medication side effects. All these factors play a role in the elderly’s risk of foodborne illness. Increased susceptibility to certain pathogens also causes higher rates of foodborne illness infection. Lastly, elderly people’s food safety knowledge and pre-established beliefs and practices regarding food handling and preparation can be influential in their sensitivity to foodborne disease. These risk factors, coupled with the heavy burden of foodborne illness and existing gaps in food safety policy, practices and education in SA, substantiate the need for a dietary guideline to address the importance of clean and safe food consumption among the elderly in SA.
Article
INTRODUCTION: South African adolescents consume relatively low fruit and vegetables in spite of the development of food-based dietary guidelines for South Africa. AIMS AND OBJECTIVES:The aims and objectives of the present study were to investigate parents' perception of their role in the prevention of the health compromising behaviour of inadequate consumption of fruit and vegetables among adolescents in South Africa. DESIGN: The study design was qualitative and exploratory and the research strategy used was inductive, deductive and abductive. METHODS: Using a guiding question schedule data were collected from Ave focus group interviews. A non-probability purposive theoretical sampling method was utilized and the sample size of 37 determined by theoretical saturation. Data analysis was performed using the grounded theory approach. RESULTS: The findings of the study suggest that children should be introduced to fruit and vegetables as early as possible. CONCLUSION: The study recommends that infants should be exposed to the taste of locally available fruit and vegetables followed by the gradual introduction of fruit and vegetables into their diet together with a variety of other nutrient-dense foods when solid foods are being introduced.
Article
Objective To assess knowledge of dietary and behaviour-related determinants of non-communicable disease (NCD) of urban Senegalese women. Design A cross-sectional, population study using an interviewer-administered knowledge questionnaire, developed and validated for this study. The questionnaire consisted of 24 items with six scores measuring knowledge of: (1) diet- and behaviour-related causes of NCD; (2) diet quality–NCD relationship; (3) fruit and vegetable link with NCD; (4) health consequences of obesity; (5) causes of cardiovascular disease (CVD); and (6) causes of certain cancers. Subjects A random sample of 301 women aged 20–50 years. Results The knowledge scores developed suggest that the health consequences of obesity (mean score of 65.4%) were best understood followed by causes of CVD (mean score of 60.6%), because obesity, smoking, high blood cholesterol and dietary fat were well recognised as risk factors for CVD. Subjects scored least for their knowledge of the protective effect of fruit and vegetables (mean score of 19.9%). Knowledge of causes of certain cancers (mean score of 36.1%) was also low. Women who worked outside the home had better knowledge for two scores but otherwise no relationship was found between knowledge and literacy, formal education or body mass index. Conclusions Findings suggest reasonable overall knowledge concerning diet and behaviour with NCD, especially given the relatively new context of the obesity epidemic in Senegal. However, there was poor knowledge of the benefit of eating fruit and vegetables and other preventable causes of certain cancers. Education targeting the benefits of vegetables and fruit may have the greatest impact on NCD prevention.
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Dietary choices drive both health and environmental outcomes. Information on diets come from many sources, with nationally recommended diets (NRDs) by governmental or similar advisory bodies the most authoritative. Little or no attention is placed on the environmental impacts within NRDs. Here we quantify the impact of nation-specific NRDs, compared with an average diet in 37 nations, representing 64% of global population. We focus on greenhouse gases (GHGs), eutrophication, and land use because these have impacts reaching or exceeding planetary boundaries. We show that compared with average diets, NRDs in high-income nations are associated with reductions in GHG, eutrophication, and land use from 13.0 to 24.8%, 9.8 to 21.3%, and 5.7 to 17.6%, respectively. In upper-middle–income nations, NRDs are associated with slight decrease in impacts of 0.8–12.2%, 7.7–19.4%, and 7.2–18.6%. In poorer middle-income nations, impacts increase by 12.4–17.0%, 24.5–31.9%, and 8.8–14.8%. The reduced environmental impact in high-income countries is driven by reductions in calories (∼54% of effect) and a change in composition (∼46%). The increased environmental impacts of NRDs in low- and middle-income nations are associated with increased intake in animal products. Uniform adoption of NRDs across these nations would result in reductions of 0.19–0.53 Gt CO2 eq⋅a⁻¹, 4.32–10.6 Gt PO 4 3 − PO43− eq⋅a⁻¹, and 1.5–2.8 million km², while providing the health cobenefits of adopting an NRD. As a small number of dietary guidelines are beginning to incorporate more general environmental concerns, we anticipate that this work will provide a standardized baseline for future work to optimize recommended diets further.
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Background: Consumer testing was a prime consideration in developing specific South African food-based dietary guidelines (FBDGs) which were nationally adopted in 2003. Objectives: This 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. Design: A cross-sectional study of 333 women from different cultural and socio-economic backgrounds. Setting: KwaZulu-Natal, South Africa. Methods: Data collection comprised focus-group discussions (n = 103) and structured individual interviews (n = 230). Results: The 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. Conclusions: Consumer 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.
Article
The aim of the study was to investigate gaps in nutrition knowledge and the relationship between nutrition knowledge and sociodemographic characteristics in an urban black and white South African population. The sample included 90 blacks and and 90 whites living in former white and black urban areas in the Limpopo Province of South Africa, chosen by systematic random sampling via a telephone survey. Measures used included a general nutrition knowledge questionnaire. Results indicate that both blacks and whites seem to have a reasonable knowledge of dietary recommendations and sources of nutrients but have less knowledge on the diet-disease relationship, particularly with regard to choosing everyday foods that are healthier. Whites have sianificantly more general nutrition knowledge than blacks. Although there was no significant difference when comparing black and white men on general nutrition knowledge, black women had significantly lower nutrition knowledge than white women.
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Objectives: To determine the prevalence of food insecurity and related factors among undergraduate recipients of financial aid at the University of KwaZulu-Natal, Pietermaritzburg Campus (UKZN- PMB) and whether there is a relationship between food security status and academic performance. Design: A cross-sectional descriptive survey was conducted assessing the food security status and related factors of students on financial aid. Setting: UKZN-PMB campus, situated in Scottsville, Pietermaritzburg, with a student population of 9 785. Subjects: A sample of 268 students on financial aid was randomly selected. First year and post graduate level students were excluded. Outcome measures: A self-administered questionnaire consisting of the four main sections, including: anthropometric status and socio-demographic information, food frequency questionnaire (FFQ), household food insecurity access scale (HFIAS), nutrition knowledge questionnaire (NKQ) and combined performance index (CPI) scores. Results: The mean BMI of the study sample was 24.4 ± 4.7 kg/m2 . A fifth (21.4%) of the sample was overweight and a tenth (12.4%) was obese. An increase in BMI was associated with an increase in food insecurity. The foods consumed „more than once a day‟, included the starch group, fats and coffee and tea. Just over half (53.0%) of the sample received no additional allowance apart from financial aid. The majority (82.4%) of the sample spent most of their money on food. The mean amount of monthly food expenditure was R558.40 ± R211.12. Over a third (34.7%) of the sample was food insecure with another third (33.6 %) being at risk of food insecurity. Almost a tenth (9.7%) of the sample was severely food insecure and just over a fifth (22%) was food secure. The main coping strategy adopted was seeking assistance from friends. The mean NKQ score of the sample was 18.8 ± 3.8 (58.6%) which fell within the “average” range. Food insecure students had a lower mean CPI score than those who are food secure. Conclusion: There was a high prevalence of food insecurity and obesity among the study sample. The diets lacked diversity with a low consumption of fruit and vegetables. Nutrition iv knowledge seems to have no impact on food choice. Food insecurity impacted negatively on academic performance.
Article
In its different forms, malnutrition is said to be one of the greatest, and at the same time, one of the most preventable obstacles in terms of fulfillment of human potential and health status. It also places a significant burden on individuals, households and the national health system, as well as the entire cultural, social and economic make-up of a nation. Compared to the cost of treating and dealing with the different effects of malnutrition, its prevention is much more economical and also has a positive impact on productivity and economic growth, education, intellectual capacity and social development. 1
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Noncommunicable diseases (NCDs) impose a growing burden on the health, economy, and development of South Africa. According to the World Health Organization, four risk factors, tobacco use, alcohol consumption, unhealthy diets, and physical inactivity, account for a significant proportion of major NCDs. We analyze the role of tobacco, alcohol, and food corporations in promoting NCD risk and unhealthy lifestyles in South Africa and in exacerbating inequities in NCD distribution among populations. Through their business practices such as product design, marketing, retail distribution, and pricing and their business practices such as lobbying, public relations, philanthropy, and sponsored research, national and transnational corporations in South Africa shape the social and physical environments that structure opportunities for NCD risk behavior. Since the election of a democratic government in 1994, the South African government and civil society groups have used regulation, public education, health services, and community mobilization to modify corporate practices that increase NCD risk. By expanding the practice of health education to include activities that seek to modify the practices of corporations as well as individuals, South Africa can reduce the growing burden of NCDs.
Article
This article discusses the first two years of implementation of the Healthy, Hunger-Free Kids Act of 2010 in the United States Department of Agriculture’s (USDA) core child nutrition programs—the National School Lunch Program and the School Breakfast Program. As child nutrition professionals work toward compliance with these new guidelines, they are engaging in ongoing discussions on the USDA’s Mealtalk listserv. The purpose of this study was to identify critical themes emerging from these discussions. This study takes a stakeholder perspective and evaluates Mealtalk discussions from the points-of-view of the organization (schools), foodservice unit, and customers (students). Study results show the most frequently cited themes and child nutrition professionals’ efforts to overcome initial challenges and obstacles in implementing the new guidelines.
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Recent studies suggest that chronic diseases of lifestyle account for 28.5% of deaths of all South Africans between the ages of 35 and 64 years and that more than 56% of all South Africans between the ages of 15 and 64 have at least one modifiable risk factor for chronic disease of lifestyle. The main aim of the study was to assess the dietary patterns, dietary diversity and body mass index (BMI) of adult rural women in Greater Letaba Municipality, Limpopo province, using the South African food-based dietary guidelines (SAFBDGs). The study design was a descriptive and correlational cross-sectional survey with an analytic component. The sample consisted of 160 randomly selected women aged 19–45 years. Demographic, socioeconomic and dietary-pattern data were collected using a researcher-administered questionnaire during home visits. Dietary variety and availability was determined by direct observation and questioning and weight and height were measured to determine the BMI. Data were analysed using SPSS 18.0. Descriptive statistics and chi square tests were used to explore relationships between variables. The majority of women (51%) were either overweight or obese. Their dietary patterns only complied with three of the eleven SAFDBGs messages and dietary diversity was low.
Article
Objective: To determine the impact of nutrition education on feeding practices of caregivers with children aged 3 to 5 years at baseline and post intervention. Methodology: A pre-test–post-test control group design was chosen using eight villages (four villages in the experimental group (E) and four villages in the control group (C)). The nutrition education intervention programme (NEIP) comprised ten topics emphasising healthy eating, hygiene and sanitation. Results: Majority of children in both the experimental and control groups were given three meals or more per day, including starchy and protein rich foods at baseline and post intervention. The median carbohydrates and protein intake in both groups was adequate when compared to the Estimated Average Requirements/Recommended Dietary Allowance (EAR/RDA), though median energy intake was inadequate. Even before intervention, the majority of children ate indigenous foods. Despite this, the intake of some indigenous foods did improve significantly in the experimental group, but not in the control group (termites; mopani worms; indigenous vegetables including black jack, spider flower and wild jute; and, indigenous fruits including baobab fruit and pawpaw). On the other hand, the intake of mixed traditional dishes as well as the intake of the indigenous foods, stinging nettle, meldar, wild peach, pineapple, dovhi, tshigume and thophi, increased significantly in both the experimental and control groups. Conclusion: Due to the fact that most children in both groups consumed most food items, including indigenous foods, before the intervention, improvements were only seen in a few feeding practices in the experimental group after the NEIP.
Article
Aims: To synthesise peer-reviewed literature that investigates the dietary intake by food group of individuals with type 2 diabetes mellitus (T2DM) and compare intakes to national and international dietary guidelines. Methods: Four electronic databases (MEDLINE, EMBASE, CINAHL and Web of Sciences) were searched for studies that investigated the dietary intake of adults (≥18 years) with T2DM using the five main food groups (fruit, vegetables, dairy, grains and meat/meat alternatives). Food group intake in serves was compared against national guidelines and fruit and vegetable intake in grams was compared against the World Health Organization (WHO) guidelines. Results: After screening 13 662 publications, 11 studies were included. All reported cross-sectional data. Majority of participants were consuming less than the recommended serves of fruit, vegetables, grains and dairy and were meeting or exceeding the recommended serves for meat/meat alternatives. Two of six studies reported fruit and vegetable recommendations were being met, two reported dairy recommendations were being met and two reported grain recommendations were being met. Of the five studies reporting intake in grams, four met the WHO minimum intake for fruit and vegetables. Conclusions: Individuals with T2DM do not comply with food group recommendations; particularly for fruit, vegetables, dairy and grains. Longitudinal research is required to better understand how food group intake changes over time after diagnosis.
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The Food-Based Dietary Guidelines (FBDGs) have been developed with the aim of making evidence-based nutrition and lifestyle messages to the public accessible, understandable, generalisable, acceptable in a cross-cultural context, and feasible. Furthermore, these messages are formulated to be positive rather than punitive or negative. One of the more important and widely understood messages is encouragement to participate in regular, lifestyle physical activity. The guideline 'Be active' is based on the now well-established link between physical activity and lowered risk of all-cause mortality, as well as mortality and morbidity associated with many chronic diseases of lifestyle. The American College of Sports Medicine (ACSM) and the United States Centers for Disease Control (CDC) now recommend that individuals should attempt 'to accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the week'. 1 The salient part of these ACSM/CDC recommendations is the concept 'to accumulate', which indicates that the exercise dose may consist of physical activity 'taken' in smaller units of time; yet a similar health risk reduction may be expected. 2 In addition, this message is compatible with an increasing focus on lifestyle or habitual physical activity, structured around household and gardening activities, transport and leisure-time. The guideline 'Be active' is important, firstly, because there is a substantial and increasing burden of chronic disease in the South African population. Secondly, there is evidence that although South Africa is a 'sporting nation', reported levels of physical activity in urban populations are comparable with those of more developed countries. The focus of this document is: (i) to examine the burden of chronic disease and associated risk factors in the 'target' population; (ii) to provide the evidence base for the efficacy and effectiveness of physical activity in changing this disease burden; and (iii) to highlight the challenges and opportunities for implementing this guideline at individual, group, and population-based levels.
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Objective. This paper reviews the scientific merit and feasibility of the Food-Based Dietary Guideline (FBDG) 'Eat dry beans, peas, lentils and soy regularly'. Beans, peas and lentils are also known as 'pulses'. In this review, legumes refer to pulses and soybeans (which are classified as oilseeds). Composition and nutrient content. Legumes are rich and economical dietary sources of good quality protein, carbohydrates, soluble and insoluble dietary fibre components and a variety of minerals and vitamins. Pulses have a low energy, fat and sodium content. Although full-fat soy foods are relatively high in fat, they may contribute significantly to polyunsaturated fatty acid intake, including α-linolenic acid, an n-3 fatty acid not commonly found in plant foods.
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Aim. To assess the appropriateness of the preliminary South African food-based dietary guidelines (FBDGs) as a nutrition education tool for women in KwaZulu-Natal (KZN) and the Western Cape (WC) in terms of comprehension, interpretation and implementation. Methods. This was a qualitative study using focus group discussions. Focus groups were held in five magisterial districts within KZN, and the Cape Town metropolitan area of the WC, to evaluate the comprehensibility and applicability of the FBDGs. Groups were randomly selected according to settlement type (non-urban, urban informal, urban formal) and ethnicity (black, coloured (of mixed origin), Indian, white) to reflect the KZN and WC population. Focus groups were conducted in the home language of the participants, namely, English, Zulu, Xhosa and Afrikaans. Participants included 137 women aged 19 - 63 years, with no formal nutrition training and who were responsible for food purchasing and food preparation decisions in the household. Results. In general, women understood many of the FBDGs and the suggested food categories, and could construct a day's meals using the FBDGs. Areas of confusion were identified regarding certain terminology and concepts, such as the terms 'legumes', 'foods from animals', and 'healthier snacks'. Primary constraints to implementation of the FBDGs included cost and availability of food, household taste preferences, routine food purchasing habits, habitual or traditional food preparation and cooking methods, time constraints, accessibility (primarily transport difficulties) and underlying attitudes towards health and nutrition. Conclusion. The findings from this study have been used to revise the preliminary FBDGs, in order to provide an appropriate tool for effective nutrition education, for the purpose of improving nutrition knowledge, attitudes and dietary behaviours of South Africans.
Article
Under federal law, the Dietary Guidelines for Americans are to be published by the US Departments of Agriculture (USDA) and Health and Human Services (DHHS) every five years. This document serves both departments as a nutrition education tool for the general public and serves as a policy statement with which all other federal policy to the general public must be consistent. An external, expert advisory panel was selected to review the edition of the guidelines. The committee's report offers specific language for each guideline, explanatory text for the guidelines booklet, and the scientific rationale behind the changes they recommended. The overriding issue is the growing problem of obesity in the US. The committee is likely to recommend more emphasis on physical activity and maintaining a healthy weight. At the same time, the committee recommended changes in other guidelines aimed at helping the consumer avoid a positive energy balance. It also placed considerable emphasis on making the guidelines easy for consumers to implement. There will be a brief public comment period prior to the finalisation and release of the fifth edition of the guidelines.
Article
There are several diet-related public health concerns in South Africa. Food-Based Dietary Guidelines (FBDGs) have been proposed to attempt to resolve many of these public health problems. 1 As outlined in the introductory paper 1 South Africa is a society in transition with a double burden of diseases related to both under-and overnutrition. Poorer populations have problems of stunting, micronutrient deficiencies and a greater risk of infectious disease, while both richer and poorer populations are more prone to obesity and chronic degenerative diseases. 'Enjoy a variety of foods' is the first of the ten FBDGs. This guideline attempts to focus on some of the consequences arising from a lack of dietary variety. Results of the 1999 National Food Consumption Survey in South Africa showed that the diets of many households, particularly lower income households, have low dietary variety. 2 The aim of this guideline is to encourage people to change their diets where necessary so as to increase the variety of foods eaten and to enjoy their food. The guideline needs to be understood in the context of the other FBDGs and to be applied with the assistance of a food guide. The aim of this paper is to discuss the rationale and scientific background for the recommendation to enjoy a variety of foods. It should be noted that the FBDGs are for children aged 5 years and older and for all 'healthy' South African adults (excluding pregnant and lactating women).
Article
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