Browsing by Author "Jaffer, Nasreen"

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    Comparison of the dietary intake of the urban black population in Cape Town in 1990 with 2009
    (Stellenbosch : Stellenbosch University, 2017-03) Jaffer, Nasreen; Steyn, Nelia P. (Nelia Patricia); Herselman, Marietjie; Peer, Nasheeta; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.
    ENGLISH SUMMARY : Background: In 1990 the BRISK was undertaken in the black population in five townships in Cape Town, Langa, Gugulethu, Khayalitsha, Nyanga, and Crossroads. The prevalence of noncommunicable diseases (diabetes and heart disease) and their risk factors, including dietary intake were investigated. Aim: To determine the dietary intake of the urban black population (25–64 years) of Cape Town in 2009 and compare these findings with a similar sample examined in the same townships in 1990. Study design and sample: A cross-sectional survey including a representative sample of 392 males and 707 females (n=1099) was drawn from the same townships as in 1990. Methods: Socio-demographic data were collected by trained field workers. Weight, height, and waist and hip circumference were measured. Body mass index (BMI), and waist- hip ratio (WHR) were calculated. Dietary intake data (macro- and micronutrients, mean adequacy ratio (MAR), food groups and portion sizes) were calculated using the MRC FoodFinder program and compared with the dietary reference intakes. The MAR was calculated for each participant. Data analyses: Anthropometric and dietary data are presented as means and standard deviations by age, level education, type of housing, degree of urbanisation and asset index (proxy for socioeconomic status). Associations of dietary data with anthropometric and biochemistry data (TC, HDLC, LDL-C, and glucose), blood pressure, asset index, and degree of urbanisation were assessed. A linear regression model was computed using MAR as the dependent variable and adding age, gender, urbanisation, asset index and other variables to the model. Correlations between the asset index and urbanisation duration were done with energy and nutrient intakes using Pearson’s correlations. Regressions were done to test the significance of various variables. Results: Most of the adults had an education of at least 8–12 years, though 60% of the males and 58.3% of females were unemployed, and 13.8% were pensioners. Twenty-one per cent lived in formal houses, 35.4% in council houses or hostels, and 43.6% in shacks. Only 12.1% of adults had spent less than 20% of their life in an urban area. Thirty three per cent were classified as falling within the poorest tertile of the asset index. The percentage of adults with a BMI greater than 30 kg/m2 was 63.3% in females and 12% in males. Males had a WC and WHR of 85.7 cm and 0.89 and females 97.5 cm and 0.85, respectively. Analysis of the 24-hour dietary recall data showed very low mean energy intakes [M 6516 (2929); F 5760 (2446) kJ]. These results did not support the high prevalence of obesity, particularly in females, and also in four other studies among urban black populations. Hence the Goldberg equation was used to remove under-reporters. The remaining sample comprised 544 (214 males and 330 females) participants residing in Khayelitsha (42.4%), Langa (31.4%), Gugulethu (15.3%), and less than 10% in Crossroads and Nyanga. After removal of the under-reporters, mean energy intakes were similar to those of the 1990 study and in 25–44-year-old males were 8557 kJ compared to 8500 kJ in 1990. In females they were 7619 kJ compared with 6400 kJ in 1990. Fat intakes were highest in 25–44-year-old males (32% energy [E]) and females (33.4% E) in 2009 compared to 1990 (males: 25.9% E, females: 27.0% E). Carbohydrate intakes were lower in 2009 (males 53.2% E, females: 55.5% E) than in 1990 (males: 61.3% E; females: 62% E), while sugar intake increased significantly (p <0.01) in females. There were significant positive correlations between urbanisation and total fat (p=0.016), saturated fat (p=0.001), monounsaturated fat (p=0.002) and fat as a %E intake (p=0.046). Urbanisation was inversely associated with intake of carbohydrate %E (p <0.001). Overall micronutrient intakes improved significantly compared to 1990 with the exception of calcium intake. This is thought to be due to the national fortification of maize and wheat flour. Of note is that energy and macronutrient intakes were all significant in a linear regression model using the MAR, as was duration of urbanisation. The higher fat and lower carbohydrate %E intakes in this population demonstrate a transition to a more urbanised diet over the two decades. Forward regression was done to identify the significant variables which were then entered into a linear regression model. In males, BMI was significantly associated with protein intake, while in females BMI was related to saturated fat, saturated fat %E, carbohydrate, and carbohydrate %E. In terms of the duration of urbanisation it can be noted that carbohydrate %E, total fat %E energy, calcium, animal protein and total cholesterol were significant in males. In females, protein %E, carbohydrate %E, fat %E were significantly associated with greater urbanisation. In the 2009 study, milk products, the meat group, legumes, SF and brick margarine in males and females were found to be statistically lower than those in the 1990 study. This was also found in the cereal group, but only for the males. Despite this, the 2009 study for the males and females, showed significantly higher intakes of eggs, vitamin C rich fruits and vegetables and PUFA sources compared to the 1990 group. This was also found in the cereal group for females. The percentage consumers for red meat, white meat, eggs, vegetables and fruit, and cereals increased from 1990 to 2009. For the dairy and fat groups, the percentage consumers decreased. Conclusion: The nutrient intakes demonstrate that while certain changes have taken place between 1990 and 2009, the dietary pattern regarding foods eaten remains poor. The diet has become more urbanised and atherogenic with regard to fat distribution and carbohydrate intake, while the consumption of certain food groups has remained low, such as the poor consumption of dairy products and low intake of fruit and vegetables. However, overall mean micronutrient intakes increased to above the dietary reference intakes with the exception of calcium intake. Recommendation: Interventions are urgently needed to combat the shift towards a continuing atherogenic diet and to improving the consumption of priority food groups, such as dairy products, and fruit and vegetables.
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    Dietary intake of the urban Black population of Cape Town : the cardiovascular risk in black South Africans (CRIBSA) study
    (MDPI, 2016) Steyn, Nelia P.; Jaffer, Nasreen; Nel, Johanna; Levitt, Naomi; Steyn, Krisela; Lombard, Carl; Peer, Nasheeta
    Introduction: To determine dietary intake of 19 to 64 years old urban Africans in Cape Town in 2009 and examine the changes between 1990 and 2009. Methods: A representative cross-sectional sample (n = 544), stratified by gender and age was randomly selected in 2009 from the same areas sampled in 1990. Socio-demographic data and a 24-h dietary recall were obtained by trained field workers. The associations of dietary data with an asset index and degree of urbanization were assessed. Results: Fat intakes were higher in 19–44-year-old men (32% energy (E)) and women (33.4%E) in 2009 compared with 1990 (men: 25.9%E, women: 27.0%E) while carbohydrate intakes were lower in 2009 (men 53.2%E, women: 55.5%E) than in 1990 (men: 61.3%E; women: 62%E) while sugar intake increased significantly (p < 0.01) in women. There were significant positive correlations between urbanization and total fat (p = 0.016), saturated fat (p = 0.001), monounsaturated fat (p = 0.002) and fat as a %E intake (p = 0.046). Urbanization was inversely associated with intake of carbohydrate %E (p < 0.001). Overall micronutrient intakes improved significantly compared with 1990. It should also be noted that energy and macronutrient intakes were all significant in a linear regression model using mean adequacy ratio (MAR) as a measure of dietary quality in 2009, as was duration of urbanization. Discussion: The higher fat and lower carbohydrate %E intakes in this population demonstrate a transition to a more urbanized diet over last two decades. These dietary changes reflect the nutrition transitions that typically occur as a longer time is spent in urban centers.