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and Nutrition
Collaborative Projects with UWC’s Department of Dietetics and Nutrition
SOPH collaborates with the UWC Department of Dietetics and Nutrition and the DSI/NRF Centre of Excellence in Food Security on a range projects led by Prof Rina Swart. They have been grouped as follows • Food and nutrition security • Food consumption patterns • The food environment, focusing on obesity prevention strategies Those participating in the research are drawn from a range of organisations, and are listed here. The SOPH also provides administrative support for these projects.
FOOD AND NUTRITION SECURITY
Student food security
UWC Dietetics & Nutrition: Rina Swart, Ernie Kunneke UWC Social Work: Rinie Schenck UWC students: Nolukholo Mabharwana, Morongoa Tlhako In our 2017 exploration of food and nutrition security among UWC students, food insecurity was reported by 28% of respondents, with 22% regularly going to bed hungry and 11% reporting severe food insecurity (regularly going without food for more than 24 hours). Two students continue to explore this topic under the supervision of Rina Swart. A review was done of all programmes on campus that support students who are food insecure – from individual departmental initiatives during examination periods to the programme that provides food parcels to students in need run by the institution. Another on-line survey of food insecurity of students at the four public universities in the Western Cape will be conducted in 2021.
young adults not employed and not in education and training (NEET)
UWC Dietetics & Nutrition: Rina Swart, Ernie Kunneke UWC Social Work: Rinie Schenck UWC, Institute for Social Development: students North West University In 2018 a study was begun to explore the food and nutrition security of young adults (aged 18-25 years) who were not employed and were not engaged in education and training (NEETs) and who lived in Langa or Fisantekraal (Western Cape province) or Ikageng (North West province). A standardised survey instrument and anthropometric measurements were used with 300 participants in Langa and Ijkaneneg – while in Fisantekraal, the dietary intake, anthropometric status and food acquisition patterns of young adults 18-24 years was taken. In all three sites the qualitative component, intended to explore the young adults’ perceptions of food environments in more depth, were prevented by COVID-19 restrictions. The project is being undertaken in collaboration with North West University, and includes support for postgraduate students from the Institute for Social Development at UWC.
FOOD CONSUMPTION PATTERNS
Maternal health and nutritional status of mothers
UWC Dietetics & Nutrition: Rina Swart UWC SOPH: Nazeeia Sayed (post-doctoral fellow) Stellenbosch University: Ronelle Burger Wits: Abigail Harper This project has supported a post-doctoral fellow to complete descriptive and inferential analyses regarding the maternal health and nutritional status of mothers, using the General Household Surveys, the Income and Expenditure Surveys, the National Income Dynamic Survey and the South African National Health and Nutrition Examination Survey (SAN HANES); and, in particular, the 2016 Demographic and Health Survey data. During the COVID-19 lockdowns in 2020, data collected through momconnect were analysed to explore associations between breastfeeding and hunger as well as mental health and hunger during the hard lockdown period in 2020. The project is funded through the DSI/NRF Centre of Excellence in Food Security.
Dr Nazeeia Sayed
Dr Nazeeia Sayed is a registered dietician – and post-doctoral fellow at the SOPH. Her PhD assessed complementary feeding practices using nutrition modelling software and found iron, zinc and calcium as nutrients of concern in 6-11 month-old breastfed infants in KwaMashu, KwaZulu-Natal. Findings of focus group discussions supported the inclusion of grandmothers in efforts to improve infant feeding. Since October 2020 Nazeeia has been working with Prof. Rina Swart and supporting the National Dietary Intake Survey. Her current research focus is on food environments and drivers of food choice. Nazeeia’s experience includes working in the areas of food composition, teaching community nutrition, project technical nutrition support, project management, partnerships, and communication development. From 2017-2019 she was an executive and management member of the Association for Dietetics in South Africa.
National dietary intake study
UWC Dietetics & Nutrition: Rina Swart, Ernie Kunneke UWC SOPH: Zandile Mchiza, Nazeeia Sayed (post-doc) UWC COE Food Security: Julian May No national data on dietary intake of adults are currently available and the National Food Consumption Survey which documents the dietary intake of children 1-9 years is 20 years old. While the Third National Risk survey documented adolescent risk behaviour including food consumption, adequacy of nutrient intake was not included. Commissioned by the National Department of Health, this research seeks to document the food consumption patterns and nutrient intake of South Africans in order to provide nationally and provincially representative data on the diets of South Africans and factors affecting their food choices. A desk top review has been conducted on foods procured, nutritional status and dietary intake of people living in South Africa. It includes a summary of available literature (1997-2019) as well as foods produced and food retail in South Africa (2005-2019). A survey will be implemented in 2021. UWC leads a consortium of 11 South African higher education institutions who will assist with management of data collection, quality assurance and final reporting on the findings. They are Departments of Dietetics or Nutrition at the universities of Stellenbosch, Free State, Pretoria, Zululand, Limpopo, Venda, South Africa, the Western Cape and the Sefako Makgato University, Nelson Mandela University and North West University.
Gendered aspects of food consumption
UWC Dietetics & Nutrition: Rina Swart UWC SOPH: Michelle de Jong KNUST: Reggie Anan, Charles Apprey The nutrition needs and consumption patterns of men and women are not only different, but they also have different views, different roles as well as strategies towards food and nutrition security. This study focuses on exploring the gender roles and views towards food and nutrition security - the gendered roles and views of what people eat, what influences their choices of what they eat, how they access what they eat, how often they have access to what they eat, as well as their perceptions and coping strategies with regards to these aspects. The study will supplement metadata analyses with key informant and focus group interviews in six communities in South Africa – Mt Frere, Khayelitsha, Langa, Fisantekraal, Ikageng and the Witzenberg municipality – and Ahodwa and Erutiye in Ghana. While the data analyses have been completed, focus group discussions have been delayed given COVID-19. This study is also linked to the national dietary intake survey (see above). The project is funded through the DSI/NRF Centre of Excellence in Food Security.
Food consumption, gut microbiome and chronic disease in disadvantaged urban and rural communities
UWC Dietetics & Nutrition: Rina Swart UWC SOPH: Sikhumbule Joni UWC student: Denise Stokell Stellenbosch University, African Microbiome Institute: Stephen OKeefe, Matsepa Ramaboli & Lucky Nesengani This study is exploring the relation between composition of the diet, gut microbiome and lifetime risk profile for cardio-vascular disease among a sub-sample of participants in the PURE study (see pg 46 above). The dietary intake component of the project is funded through the DSI/NRF Centre of Excellence in Food Security whilst AMI funders are responsible for support of the gut-microbiome component of the study.
This work is supported by the Gillings School of Public Health at the University of North Carolina (UNC) and the Bloomberg Foundation.
Evaluation of the implementation of the health promotion levy
UWC Dietetics & Nutrition: Rina Swart UWC SOPH: David Sanders, Tamryn Jenkings UNC: Shu Wen Ng, Barry Popkin, Mike Essman The purpose of this project was to provide evidence to guide policy actions aimed at promoting healthy diets. The research begun in 2018 with baseline data on food and beverage consumption collected from 2,500 households and individuals in Langa, Cape Town, prior to the implementation of the legislated tax (‘sugar tax’) on sugary beverages (SSBs). A repeat survey was undertaken six months later, while a one-year follow-up was undertaken in early 2019. Data analyses will begin to assess any changes in consumption of taxed beverages over time, as well as the contribution of these beverages to total nutrient intake (especially energy). Knowledge, attitudes and perceptions of SSBs and links to obesity and non-communicable diseases will also be collected during each round of the survey. In addition, prices of all beverages (taxed and nontaxed), as well as any reformulation of the size of units of beverages, is being collected from six supermarket groups and from all spaza shops in Langa on a threemonthly basis to monitor price changes. Large reductions in taxed SSB intake was found, separating the effects of behavioural change from reformulation. This reduction was partially compensated by an increase in sugar and energy from untaxed beverages. Because policies such as taxes can incentivise reformulation, our use of an up-to-date Food
Composition Table that reflects a rapidly changing food supply is novel and important for evaluating policy effects on intake. Most behavioural drivers were not strongly linked to taxed beverage intake. However, participants expressing an intention to reduce SSB intake had a greater reduction in volume consumption than those who did not intend to do so. Fieldworkers who contributed to data collection were: Dietary intake and anthropometry collection: Chuma Maqina, Kelly Leman Scott, Sarona Munyai, Sikhumbule Joni, Lamla Sajini, Sisa Honesi Martins, Olwethu Mateta, Siyabulela Mditshwa, Andiswa Magwaza, Abongwe Benge, Ayakha Sigwabe, Masingita Nyalungu, Namhla Baskiti, Andisiwe Siramza, Siphesihle Thotsho, Nomhle Poni, Ntombizodwa Nako Household questionnaires: Mawande Nelani, Pamela Magubane, Emmanuel Obasa, Zukiswa Mfinyongo, Ziyanda Lufele, Zikhona Lobola, Asisipho Majongile, Nqabakazi Majeke, Yanga Gadu, Busiswa Mqhayi, Priscilla Nkhensani, Thandokazi Magqaza, Onele Maqambayi, Nonelwa Ngcingane, Tembakazi Msutwana, Sisipho Mabaso, Chumani Matiwane, Akhona Rasmeni, Sisipho Mngqnge
Nutrition facts panel data
UWC Dietetics & Nutrition: Rina Swart UWC SOPH: David Sanders, Tamryn Jenkings Univ Limpopo, Human Nutrition and Dietetics: Makoma Bopape UNC: Jessica Ostrowski, Bridget Hollingsworth The South African law (Act 54 of 1972) requires that the labels of packaged food should display basic information regarding the producer/manufacturer of the product, the ingredients used and, if a health or nutrition claim is made, detailed information on the nutrient composition of the food product. Many products now provide the latter. In support of, and to monitor, potential reformulation of food products following policy action, this project collects photographic information of all packaged food products from food retailers (supermarkets) in the Western Cape, particularly in Langa (in support of the project on the health promotion levy) and Khayelitsha (in support of the project on researching obesogenic food environments). All supermarkets in Durbanville have been included as an additional site. Information from the photographic evidence is captured digitally. This data will support the health promotion levy project by monitoring any reformulation of products pre- and post-tax. It will also provide information for the implementation planning of the proposed nutrition information label for South Africa and will subsequently translate into food labelling and marketing regulations. Findings related to child-directed marketing of breakfast cereals and nutritional composition of snack foods are expected to be published in 2021. Research Assistants and fieldworkers who contributed to data collection were: Luchrechia Afrika, Vashika Chibba, Lisa Deyce, Alice Khan, Thandokazi Mahuzi, Kholiswa Manisi, Tyler Coats, Valentine Khumalo, Aneeqah Latief, Zintle Phekana, Stephanie Röhrs, Sharna Solomons and Morongoa Tlhako.
Evaluation of a simplified nutrition information label for packaged food in South Africa
UWC Dietetics & Nutrition: Rina Swart UWC SOPH: David Sanders, Tamryn Jenkings Univ Limpopo, Human Nutrition & Dietetics: Makoma Bopape Wits: Safura Abdool Karim Vital Strategies: Nandita Marukutla, Luyanda Majija UNC: Lindsey Smith Tallie, Emily Busey This project aims to develop a suitable nutrient profiling model for packaged food in South Africa to identify foods high in critical nutrients. A stepwise process has been used to develop a model, following Rayner’s internationally used approach. Together with another three models purposefully selected from other countries, this model is being applied to the food supply information collected in the nutrition facts panel project in order to validate the model. The number and proportion of foods falling into either the compliant or non-compliant categories are being used to identify the ability of the nutrient profiling model to identify products that contain high levels of critical nutrients. The mean content of critical nutrients will be calculated. Differences between models regarding the proportion of foods identified as compliant will be explored by using tests of proportions. Following the development of the nutrient profiling model, a warning label to inform consumers of foods high in the nutrients of concern was developed through four stages. Recommendations on the most effective front of pack label to inform consumers on high levels of critical nutrients as well as the unhealthiness of packaged foods have been made to the National Department of Health.
