Janet Adede Carboo

Introduction: Neonatal size and body composition, including fat mass and fat-free mass, are influenced by maternal nutritional status, lifestyle and overall health during pregnancy. Paternal health and household factors may also be contributory to neonatal body composition and subsequent growth trajectories. Neonatal anthropometry and body composition are important predictors of early morbidity, growth faltering, stunting and childhood adiposity and long-term risk of obesity and non-communicable diseases (NCDs). In South Africa, 28% of children under 5 years are stunted, alongside a growing overweight and obesity prevalence and NCD risk in children. Limited evidence exists regarding the maternal and paternal determinants of neonatal body composition in this setting. Methods and analysis: This prospective cohort study aims to investigate maternal and paternal nutritional, health, body composition and lifestyle factors that influence neonatal size and body composition in Bloemfontein. The study will enrol 200 mother–neonate pairs at birth from Universitas Academic Hospital and follow them to 6 weeks postpartum. Maternal assessments at enrolment include anthropometry, body composition (using bioimpedance analysis), dietary intake, medical history, mental health, household food security and socio-economic and lifestyle factors. Neonatal measurements include birth weight and length, gestational age and body composition (using air displacement plethysmography). Paternal data include anthropometry, body composition, dietary intake, chronic disease risk and lifestyle factors, including alcohol use and smoking. At 6 weeks postpartum, infant feeding practices, growth and body composition are assessed. Multiple linear and logistic regression models will be used to assess the relationships between maternal and paternal factors and neonatal outcomes. Ethics and dissemination: This study is approved by the Health Sciences Research Ethics Committee of the University of the Free State and the Free State Department of Health. Findings of this study will be published as scientific articles in peer-reviewed journals, presented at scientific conferences and workshops and disseminated at hospital staff forums and in local media.

Vitamin A deficiency (VAD) is common among pregnant women (PW) and has been associated with anaemia and adverse birth outcomes. However, in the Free State Province of South Africa, evidence regarding this is limited. Hence, this cross-sectional study investigated the vitamin A (vitA) intake and status of PW in Bloemfontein and its association with anaemia, iron status and birth outcomes. Blood was taken from 427 PW to assess the status of vitA (retinol-binding protein 4 (RBP4)), iron (ferritin, soluble transferrin receptor (sTfR)) and anaemia (Hb). Sociodemographic, HIV, birth outcomes (birthweight and gestational age) and dietary vitA intake data were obtained using a questionnaire in an interview and medical records. Descriptive statistics and linear regression were used to describe variables and the association between vitA and iron status and birth outcomes. Median vitA intake was 1007 µgRAE/d with 19 % of participants’ intake below the estimated average requirement of 550 µgRAE/d. Median (IQR) RBP4 was 1·51 (0·78) µmol/l. Insufficient vitA status and VAD prevalence were 12·2 % and 1·2 %, respectively. VitA intake was positively associated with RBP4 ( β = 0·068; 95 % CI 0·020, 0·116; P = 0·006). RBP4 was positively associated with Hb ( β = 0·363; 95 % CI 0·186, 0·539; P < 0·001) and ferritin ( β = 0·359; 95 % CI 0·139, 0·579; P = 0·001) but negatively with sTfR ( β = −0·125; 95 % CI −0·246, −0·005; P = 0·041). No significant association between plasma RBP4 and birth weight, as well as preterm birth, was observed. There was a low prevalence of VAD in the study population. Nonetheless, the positive association between RBP4 and Hb and ferritin highlights the importance of optimal vitA status in preventing anaemia in pregnancy.

Objective: To describe the nutritional intake and status of pregnant women in Bloemfontein and compare across different household food security categories. Design: Cross-sectional. Setting: Pelonomi Tertiary Hospital. Participants: 427 pregnant women were interviewed using a standard questionnaire and a quantitative FFQ to collect socio-demographic, HIV status, household food security, supplement and dietary intake data. Weight and height were measured using standard anthropometric techniques and capillary blood taken by finger-prick for anaemia, Fe and inflammation status assessment. Results: 26·7 % of participants were food secure, while 11·5 %, 32·1 % and 29·5 % experienced mild, moderate and severe food insecurity, respectively. 54·5 %, 41·7 % and 31·1 % were obese, anaemic and Fe deficient. Median energy intake was 8808 (6978–9223) KJ/d, with no significant differences between the food security groups (P = 0·517). Based on the dietary reference intakes, 98·1 % met the estimated average requirement (EAR) for carbohydrates, but the majority had sub-optimal intake of protein (58·3 %), fibre (60·9 %), pantothenic acid (67·0 %), vitamins C (65·6 %), D (68·4 %), E (59·0 %) and K (61·8 %), potassium (99·8 %), dietary Ca (95·8 %) and Fe (80·8 %). Compared with the moderately and severely food-insecure counterparts, food-secure participants had a higher intake of animal protein (P < 0·001), total fat (P = 0·014), monounsaturated fat (P = 0·002), vitamins B₁₂ (P = 0·014), C (P < 0·001) and D (P = 0·003) and dietary Ca (P = 0·001). Dietary folate intake was below the EAR in 69·9 %, but was higher among severely food-insecure participants (463·94 (327·39, 609·71) µg than food secure (378·49 (265·99, 496·15) µg, P = 0·007)). Conclusion: The findings show widespread inadequate nutrient intake among pregnant women in Bloemfontein, with food-insecure women showing significantly lower intake of specific nutrients.

Westernization of traditional diets has been implicated in the rising burden of overweight/obesity and type 2 diabetes, especially in developing countries. In recent times, diet therapy is increasingly being recognized as an essential component of diabetes care. This study assessed the effect of diet therapy on body composition, antioxidant nutrient intake, and glycemic status in individuals living with type 2 diabetes (ILWT2D). In this prospective observational cohort study, 45 ILWT2D who were receiving diet therapy (personalized dietary counseling) in addition to standard medical treatment (intervention group) were compared with 45 ILWT2D receiving only standard medical treatment (comparator group). Antioxidant micronutrient intake was assessed using a 24-h dietary recall. Body composition indices, including body mass index (BMI), percentage body fat (%BF), and visceral fat (VF), were assessed. Participants’ fasting blood glucose (FBG), glycated hemoglobin (HbA1C) levels, and blood pressure (BP) were measured. All measurements were performed before and after a three-month period. There were significant improvements in BMI (27.8 ± 6.0 kg/m² vs. 26.9 ± 5.5 kg/m², p = 0.003), %BF (37.8 ± 11.9% vs. 35.5 ± 10.5%, p < 0.001), visceral fat (9.8 ± 3.4 vs. 9.1 ± 3.2, p < 0.001), systolic BP (136.9 ± 19.9 mmHg vs. 124.6 ± 13.0 mmHg, p < 0.001), FBG (8.8 ± 2.8 mmol/L vs. 6.7 ± 1.5 mmol/L, p < 0.001), and HbA1c (7.3 ± 1.0% vs. 6.4 ± 0.8%, p < 0.001) in the intervention group from baseline to endline, but not in the comparator group. In contrast, %BF increased within the comparator group (39.9 ± 7.8 vs. 40.7 ± 7.4; p = 0.029). Vitamin A intake increased significantly (227.5 ± 184.3 µg vs. 318.8 ± 274.7 µg, p = 0.038) within the intervention group but not in the comparator group (174.9 ± 154.3 µg, 193.7 ± 101.4 µg, p = 0.54). There were no significant changes in zinc, copper, selenium, and vitamin C intakes (p > 0.05) in the intervention group from the baseline to endline, unlike those in the comparator group who showed a significant increase in the intake of these nutrients. There was a significant increase in vitamin A intake among the ILWT2D who received dietary counseling as an intervention compared to those who did not. Additionally, the ILWT2D who received dietary counseling had significant improvements in their body composition (BMI, body fat, and visceral fat) and systolic blood pressure, compared to those who did not. The ILWT2D who received the intervention had significantly better glycemic control (FBG and HbA1c) than their counterparts who did not. Thus, this study suggests the potential of diet therapy as a viable non-pharmacological treatment approach for individuals living with type 2 diabetes.

Despite routine iron supplementation for pregnant women in South Africa, anaemia and iron deficiency (ID) in pregnancy remain a public health concern. To determine the associations between iron status and birth outcomes of pregnant women attending antenatal clinic at a regional hospital in Bloemfontein. In this cross-sectional study of 427 pregnant women, blood was taken to analyze biomarkers of anaemia (haemoglobin), iron status (ferritin and soluble transferrin receptor) and inflammation (C-reactive protein and α-1-acid glycoprotein). A questionnaire was used to collect information about birth outcomes (birth weight and gestational age at birth), HIV exposure, sociodemographics, iron supplement intake, and maternal dietary iron intake using a validated quantified food frequency questionnaire. The median (Q1, Q3) weeks of gestation of participants was 32 (26, 36) at enrolment. Anaemia, iron deficiency (ID), ID anaemia (IDA) and ID erythropoiesis (IDE) were present in 42%, 31%, 19% and 9.8% of participants, respectively. Median (Q1, Q3) dietary and supplemental iron intake during pregnancy was 16.8 (12.7, 20.5) mg/d and 65 (65, 65) mg/d, respectively. The median (max-min) total iron intake (diet and supplements) was 81 (8.8-101.8) mg/d, with 88% of participants having a daily intake above the tolerable upper intake level of 45 mg/d. No significant associations of anaemia and iron status with low birth weight and prematurity were observed. However, infants born to participants in the third hemoglobin (Hb) quartile (Hb > 11.3–12.2 g/dL) had a shorter gestation by 1 week than those in the fourth Hb quartile (Hb > 12.2 g/dL) (p = 0.009). Compared to pregnant women without HIV, women with HIV had increased odds of being anaemic (OR:2.14, 95%CI: 1.41, 3.247), having ID (OR:2.19, 95%CI: 1.42, 3.37), IDA (OR:2.23, 95%CI: 1.36, 3.67), IDE (OR:2.22, 95%CI: 1.16, 4.22) and delivering prematurely (OR:2.39, 95%CI: 1.01, 5.64). In conclusion, anaemia, ID, and IDA were prevalent in this sample of pregnant women, despite the reported intake of prescribed iron supplements, with HIV-infected participants more likely to be iron deficient and anaemic. Research focusing on the best formulation and dosage of iron supplementation to enhance iron absorption and status, and compliance to supplementation is recommended, especially for those living with HIV infection.

In 2013, the World Health Organisation (WHO) updated the recommendations for micronutrient deficiency correction in hospitalised under‐5 children with complicated severe acute malnutrition (SAM). This study aimed to describe the micronutrient deficiency correction practices in relation to WHO 2013 recommendations. Data from medical records of under‐5 children admitted for SAM management at two hospitals in South Africa and three tertiary hospitals in Ghana were extracted. Micronutrient correction practices were compared to the WHO 2013 recommendations by considering the dosage, timing of micronutrient supplementation (vitamin A, iron and folic acid) and therapeutic feeds administered. In total, 723 medical records were included. Nearly half (48.3%) of the children received at least one of the studied micronutrients as a supplement. Vitamin A was supplemented in 27.4% of the children, while iron and folic acid were supplemented in 9.5% and 34.9%, respectively. Among the children who received vitamin A, 60.1% received the first dose on Day 1 of admission. Also, 46.4% of the iron‐supplemented children received iron within the first week of admission. Vitamin A, iron and folic acid were administered within the dose range of 100,000–180,000 IU, 3.1–7.7 mg per kg per day, and 3–5 mg per day, respectively. Additionally, 71.7% of the children reportedly received therapeutic feeds that met WHO recommendations. The micronutrient deficiency correction practices regarding dose and timing differed from the 2013 WHO guidelines. Qualitative studies investigating the reasons for the disparities are recommended.