Research Articles (Human Nutrition)
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- ItemPerceptions of dietitians and key role players regarding their role in reporting food labelling transgressions in South Africa(Taylor & Francis Group, 2024-05-16) Profe-Fuchsloch, Mikayla; Koen, N.; Wicks, M.Objectives: A study was undertaken to describe South African dietitians and key role players’ perceptions regarding their role in reporting food labelling legislation transgressions. Design: A multimethod study design was employed to explore a previously unstudied topic. Setting: Dietitians registered with the Health Professions Council of South Africa (HPCSA) together with key role players in food labelling in South Africa. Methods: Quantitative data were collected using a self-administered electronic questionnaire and qualitative data using a semi-structured interview guide. Quantitative data were analysed using Microsoft Excel and qualitative data using ATLAS.ti software. Data were analysed independently in the results section but integrated for interpretation of the findings. Results: In total, only 6% (n = 7) of the included dietitians (n = 126) reported food labelling transgressions, and 12% (n = 15) believed dietitians have a role to play in reporting transgressions. Interestingly, half of the included dietitians (50%, n = 63) stated they would report an identified transgression. Dietitians demonstrated a lack of awareness of the current food labelling regulations, with 43% wrongly identifying the draft regulation to consult. Almost all (99%, n = 125) of the included dietitians reported that their transgression reporting practices would improve if a clear guideline from the Department of Health: Directorate Food Control (DoH DFC) was available. Key role players (n = 8) cited enforcement issues and a perceived gap in dietitians’ understanding of legislation and reporting processes as barriers to reporting non-compliance. Key role players identified enablers such as awareness of regulations, contacts within the DoH DFC and familiarity with the reporting process for transgressions. They also provided insight on the proper procedure for reporting food labelling transgressions. Conclusion: The low prevalence of food labelling transgression reporting by dietitians stems from several barriers, including a perceived lack of confidence regarding the current regulation, awareness of the applicable legislation, uncertainty regarding the correct reporting procedure and scepticism that transgression reports will be acted upon. Regular communication regarding food and nutrition regulations and the development of an easy-to-use transgression reporting framework could support the implementation and impact of food labelling regulations in South Africa.
- ItemThe effect of ß-glucan prebiotic on kidney function, uremic toxins and gut microbiome in stage 3 to 5 chronic kidney disease (CKD) predialysis participants : a randomized controlled trial(MDPI, 2022-02-14) Ebrahim, Zarina; Proost, Sebastian; Tito, Raul Yhossef; Raes, Jeroen; Glorieux, Griet; Moosa, Mohammed Rafique; Blaauw, ReneeThere is growing evidence that gut dysbiosis contributes to the progression of chronic kidney disease (CKD) owing to several mechanisms, including microbiota-derived uremic toxins, diet and immune-mediated factors. The aim of this study was to investigate the effect of a ß-glucan prebiotic on kidney function, uremic toxins and the gut microbiome in stage 3 to 5 CKD participants. Fifty-nine participants were randomized to either the ß-glucan prebiotic intervention group (n = 30) or the control group (n = 29). The primary outcomes were to assess kidney function (urea, creatinine and glomerular filtration rate), plasma levels of total and free levels of uremic toxins (p-cresyl sulfate (pCS), indoxyl-sulfate (IxS), p-cresyl glucuronide (pCG) and indoxyl 3-acetic acid (IAA) and gut microbiota using 16S rRNA sequencing at baseline, week 8 and week 14. The intervention group (age 40.6 ± 11.4 y) and the control group (age 41.3 ± 12.0 y) did not differ in age or any other socio-demographic variables at baseline. There were no significant changes in kidney function over 14 weeks. There was a significant reduction in uremic toxin levels at different time points, in free IxS at 8 weeks (p = 0.003) and 14 weeks (p < 0.001), free pCS (p = 0.006) at 14 weeks and total and free pCG (p < 0.001, p < 0.001, respectively) and at 14 weeks. There were no differences in relative abundances of genera between groups. Enterotyping revealed that the population consisted of only two of the four enterotypes: Bacteroides 2 and Prevotella. The redundancy analysis showed a few factors significantly affected the gut microbiome: these included triglyceride levels (p < 0.001), body mass index (p = 0.002), high- density lipoprotein (p < 0.001) and the prebiotic intervention (p = 0.002). The ß-glucan prebiotic significantly altered uremic toxin levels of intestinal origin and favorably affected the gut microbiome.
- ItemAssessment of the realisation of the right to adequate food in the Blue Crane Route (Eastern Cape, South Africa)(Taylor & Francis, 2022-08-26) Marais, M. L.; Lessing, E.; Frank, T.Objectives: To assess whether the right to adequate food (RtF) is realised by children and primary caregivers and what actions are required to fully realise this right. Design: A cross-sectional, descriptive study was undertaken using a mixed-methods approach. Setting and subjects: Rural and urban primary caregivers of children (one to five years old) were recruited if they had resided in the Blue Crane Route (Eastern Cape) for at least six months. Purposefully selected key informants (KIs) involved in nutrition and food security, health or governance participated in in-depth interviews. Outcome measures: Primary caregivers responded to interviewer-administered questionnaires (IAQ) (N = 161), which investigated various indicators supporting the realisation of the RtF. Statistical analysis of quantitative data examined relationships between urban and rural participants. Significance was considered at p < 0.05. In-depth interviews with key informants (KIs) examined the perceptions of 11 prominent community leaders. Qualitative data were coded deductively and common themes identified. Results: Based on the IAQ, half (51%) of the caregivers had experienced risk of, or food insecurity in the past month. Common themes indicative of suboptimal realisation of the RtF included insufficient employment opportunities, inadequate policies and programme implementation, and inadequate agrarian practices, while the child support grant partially supported the realisation of the RtF. Caregivers felt disempowered by a sense of inability to realise the right themselves without government assistance but KIs suggested that caregivers needed to take responsibility. Conclusion: The RtF of children and their caregivers is not fully realised in the Blue Crane Route. Concerted, multidisciplinary approaches using a rights-based approach to implement policies and programmes are needed, together with the empowerment of the community with necessary skills and resources to further the realisation of the RtF.
- ItemEffect of simplified dietary advice on nutritional status and uremic toxins in chronic kidney disease participants(Taylor & Francis, 2022-11-29) Ebrahim, Zarina; Glorieux, Griet; Moosa, Rafique M.; Blaauw, RenéeBackground: Traditional chronic kidney disease (CKD) dietary advice is challenging with many restrictions, consequently adherence to the CKD diet is low. Recent literature has proposed less restrictive dietary guidelines in CKD to improve dietary adherence and outcomes; however, limited evidence of its implementation exists. Objectives: This study (trial number: PACTR202002892187265) investigated the effect of simplified dietary advice on nutritional outcomes and adherence after four weeks of dietary advice. Design: A before-and-after study was conducted. Outcome measures: Sociodemographic, clinical and biochemical information was collected and anthropometric measurements performed on Stage 3–5 CKD participants attending a pre-dialysis clinic. Uremic toxins were quantified by UPLC/fluorescence detection. Dietary intake was assessed using a quantified food frequency questionnaire (QFFQ). Participants were educated by the study dietitian on simplified dietary advice using an infographic. A diet-adherence score sheet monitored adherence. All outcomes were measured at baseline and four weeks after the diet was advised. IBM SPSS® version 27 was used for statistical analysis. Results: Fifty-nine participants, mean age 41.0 ± 11.6 years, completed the study. After four weeks, significant improvements were found in body mass index (p < 0.006), waist circumference (p < 0.001), mid-upper arm circumference (p < 0.001), serum total cholesterol (p < 0.045), serum triglycerides (p < 0.017), energy (p < 0.001), protein (p < 0.001) and most dietary intake variables. Overweight and obesity prevalence was high at 68%. Uremic toxin concentrations remained stable. Dietary adherence was 88.6%. Conclusion: The simplified dietary advice suggests improved nutritional outcomes in CKD patients who were predominantly overweight and obese, without compromising kidney function. This study highlights the importance and feasibility of simplified nutrition education in CKD.
- ItemGastrointestinal symptoms in HIV-positive kidney transplant candidates and recipients from an HIV-positive donor(Nature, 2021-06) Martin, C. J.; Veldman, F. J.; Labadarios, Demetre; Ebrahim, Z.; Muller, E.; Kassier, S. M.Gastrointestinal symptoms (GIS) are common in kidney transplant candidates and recipients and may be worsened by HIV. Objective: To determine the frequency and severity of GIS in HIV-positive kidney transplant recipients from HIV-positive donors, and those waiting to receive one. A GIS rating scale (GSRS) was completed by 76 participants at baseline and at 6 months. GIS frequency was defined as having at least one symptom (GSRS > 1). Severity was indicated by the GSRS score. Transplant candidates: GIS frequency was 88.9% and 86.3% at baseline and 6 months respectively. Indigestion was the most frequent (79.6% and 66.7% at baseline and 6 months), and severe GIS (GSRS 2.3). Women reported global mean (p = 0.030) severity significantly more than men. Transplant recipients: GIS frequency was 95.2% and 76.2% at baseline and 6 months respectively. At both assessment points, indigestion occurred most frequently (85.7% and 61.9% respectively). Highest GSRS was reported for indigestion at baseline (2.33) and at 6 months (1.33). Waist circumference (WC) was positively associated with the severity of constipation GSRS. GIS are common in both groups, especially indigestions. WC in transplant recipients should be monitored.