Nutritional support practices at an intensive care unit in Johannesburg, South Africa
Nutritional support is a fundamental component of holistic patient care in the intensive care unit (ICU) and therefore warrants diligent consideration. Various factors including patient pathophysiology, underlying comorbidities, baseline nutritional status, genetic factors and severity of illness may influence nutritional requirements. Both under- as well as overfeeding have been associated with adverse patient outcomes in the ICU. Underfeeding occurs in approximately half of ICU patients and has been associated with a loss of muscle mass, an increase in hospital length of stay and an increase in overall mortality. Approximately one-fifth of patients in the ICU are overfed. Overfeeding has been associated with azotaemia, metabolic acidosis, hypercapnia, hypertonic dehydration, hyperglycaemia, hyperlipidaemia, increased infection risk, hepatic steatosis and an increase in mortality.
Exploring the prevalence of multiple forms of malnutrition in children 6–18 years living in the Eastern Cape, South Africa
A major challenge in developing countries is the coexistence of multiple forms of malnutrition such as undernutrition (micronutrient deficiencies, stunting, wasting, underweight), overweight, obesity and the rising prevalence of noncommunicable diseases (NCDs). The State of Food Security and Nutrition in the World Report has listed several potential causes for the multiple burden of malnutrition, including food insecurity, stress, the body’s adaptation to lack of food and poor diet quality. In children, the consequences of this include a combination of the detrimental aspects of undernutrition, such as reduced cognitive development and academic performance, combined with the negative health aspects associated with overnutrition such as the development of NCDs. Overnutrition is associated with an increase in cardiovascular disease (CVD) risk factors, which include dyslipidaemia, an abnormal concentration of cholesterol and lipids in the bloodstream. Other metabolic markers include hyperglycaemia and hypertension, deficiencies of folate, vitamin B6 and vitamin B12, and increased levels of inflammatory markers such as high-sensitivity C-reactive protein (hs-CRP), which has been linked to several NCDs and recommended for the assessment of CVD risk. There are also economic implications related to increased frequency of hospitalisations, reduced earning potential and ultimately reduced quality of life. Thus the coexistence of multiple forms of malnutrition presents a unique challenge for healthcare professionals and creates a need for appropriate and effective interventions and policies.
The relationships between socioeconomic status, dietary knowledge and patterns, and physical activity with adiposity in urban South African women
The obesity epidemic continues to rise rapidly in low- and middle-income countries, particularly in Africa, despite the high prevalence of food insecurity and undernutrition. Currently, South Africa has the highest obesity prevalence in sub-Saharan Africa (SSA), with the latest national survey reporting a 68% prevalence of overweight and obesity in adult women, and 40% in young women between 15 and 24 years. Using data from the Birth to Twenty Plus cohort in Soweto, Nyati et al. also report this rise in combined prevalence from 11 years of age, reaching 46.5% in the 21+ years of age in urban young women. Alongside this, poor nutritional knowledge has also been reported in young South African women.
Assessment of knowledge, attitude and practice of nurses regarding enteral nutrition at a military hospital
Malnutrition is a debilitating and highly prevalent condition in hospital settings. Globally, malnutrition prevalence in hospitalised patients ranges between 13% and 69%. In Australia, 17% of patients were malnourished on admission to hospital. Those that developed malnutrition during hospitalisation stayed on average 26 days longer compared with well-nourished patients. In Africa, at-riskformalnutrition on admission to hospital was diagnosed in 61% of adult patients and increased to 71% on discharge. Of these, only 18.8% were referred for specialised nutrition support during hospitalisation. In South Africa, 21.8% of adult patients admitted to hospital were classified as malnourished.
Perception of proposed preliminary food-based dietary guidelines for Lake Victoria region of Kenya: findings from a qualitative study among adult community members
Almost half of the world’s population eats low-quality diets. Analysis of the diet showed that suboptimal diets were the leading global dietary risk factors for mortality in 2017. Non-optimal intake of wholegrains, fruits and sodium accounted for more than 50% of 11 million global deaths in the year. Generally, diets in low- and middle-income countries (LMICs), including those in sub-Saharan Africa (SSA), are characterised by high proportions of starchy foods, and are low in animal proteins, and low in fruits and vegetables. Persistent prevalence of underweight (24.1%), a rise in non-communicable diseases (from 18.6% in 1990 to 29.8% in 2017) in association with nutrition transition and co-occurring micronutrient malnutrition are issues of public health concern in the region.
Nutritional interventions and outcomes of children with short bowel syndrome in a tertiary hospital setting in South Africa
Short bowel syndrome (SBS) is defined in the literature as a malabsorption disorder that occurs because of extensive resection of the small bowel. The diagnosis of SBS is routinely made when more than 70 cm (approximately 23%) of small bowel length is lost and/or the patient remains dependent on parenteral nutrition support for more than six weeks. Small bowel length has been reported to be approximately 150–300 cm in term neonates. Although emphasis is placed on the length of bowel it is important to note that SBS is the loss of small bowel function rather than a small bowel anatomical disorder. Other factors that are relevant to the development of SBS include the functionality of the residual bowel, the underlying diagnosis, the type of bowel segments that remain, the presence of the ileo-caecal valve (ICV), presence and location of the stoma and the functionality of the remaining colon. All these aspects will influence bowel adaptation, which further impacts on the functionality of the gastrointestinal system and feeding options.