http://sajcn.co.za/index.php/SAJCN <p>The South African Journal of Clinical Nutrition (SAJCN) is an Open Access journal that publishes research on dietetics and human nutrition. Topics addressed include clinical nutrition, community nutrition, food science, food service management, nutrition policy and public health nutrition. The SAJCN is the official joint publication of the Association for Dietetics in South Africa, the Nutrition Society of South Africa and the South African Society of Parenteral and Enteral Nutrition.</p> MISC (Pty) Ltd en-US South African Journal of Clinical Nutrition 1607-0658 Material submitted for publication in the South African Journal of Clinical Nutrition (SAJCN) is accepted provided it has not been published elsewhere. Copyright forms will be sent with acknowledgement of receipt and the SAJCN reserves copyright of the material published. <p> The SAJCN does not hold itself responsible for statements made by the authors. <p> http://sajcn.co.za/index.php/SAJCN/article/view/1722 <p>none</p> M Faber ##submission.copyrightStatement## 2024-10-02 2024-10-02 37 3 i ii http://sajcn.co.za/index.php/SAJCN/article/view/1723 <p><strong>Objectives</strong>: This study investigated to what extent South African dietitians make use of social media and electronic communication and their compliance with the ethical guidelines set by the Health Professions Council of South Africa (HPCSA). <br><strong>Design</strong>: Cross-sectional descriptive design.<br><strong>Setting</strong>: South Africa.<br><strong>Subjects</strong>: Registered South African dietitians.<br><strong>Methods</strong>: Data were collected using an online survey (<em>N&nbsp;</em>= 125) and an observational checklist for selected digital platforms (<em>N&nbsp;</em>= 135). Both parts assessed demographic characteristics, usage of digital platforms and awareness or adherence to ethical guidelines.<br><strong>Results</strong>: Most participants used Instagram (45.5%) and Facebook (31.6%) as these platforms were regarded as user friendly, quick and suitable for their target audiences. Barriers to social media usage included time constraints (53.0%) and being unfamiliar with some platforms (37.3%). Enablers to social media usage included better reach of target population (61.4%) and ease of use (56.6%). The majority of survey participants were aware of the HPCSA Ethical Guidelines for Good Practice (<em>n</em> = 68/75, 90.7%). Overall compliance with the HPCSA guidelines was observed, yet nearly half (37/89, 41.6%) of the dietitians who shared information on digital platforms never provided references. Forms of touting/canvassing were observed on 20.7% (<em>n</em> = 28/135) of the platforms, while 15.6% of dietitians (<em>n</em> = 21) sold products on their websites, mostly meal-plans and supplements.<br><strong>Conclusion</strong>: South African dietitians actively engage with digital platforms to a varied extent, highlighting the importance of being cognisant of, and applying, the HPCSA Ethical Guidelines for Good Practice. The study can be useful in guiding future research on this unexplored, emerging topic.<br><strong>Keywords</strong>: social media; electronic communication; dietitian; ethical guidelines; South Africa</p> J Visser E van Niekerk ML Marais N Koen ##submission.copyrightStatement## 2024-09-17 2024-09-17 37 3 97 105 http://sajcn.co.za/index.php/SAJCN/article/view/1724 <p><strong>Objective</strong>: A study was undertaken to explore the portion size estimation accuracy of bean bags as low-cost volumetric portion size estimation aids for amorphous foods.<br><strong>Designs</strong>: Three observational, cross-sectional and three experimental/quasi-experimental developmental evaluation sub-studies were carried out.<br><strong>Settings</strong>: Observational, cross-sectional: one retirement village and four schools. Experimental/quasi-experimental: one South African university.<br><strong>Participants</strong>: Observational, cross-sectional: elderly persons, adult women (school educators), school children.<br><strong>Experimental/quasi-experimental</strong>: university students. In total<em> N</em> = 541; &gt; 3 800 observations.<br><strong>Variables measured</strong>: Using a standardised set of bean bags (test object; volume range: 60–625 ml), volumes of different amorphous foods (reference objects: actual foods or representations) in varying portion sizes had to be estimated. Accuracy (outcome measure) was perfect if volumes of test and reference object were identical. Acceptable estimation accuracy allowed for misestimation by one bean bag size. Test–retest reproducibility was also assessed.<br><strong>Analysis</strong>: Descriptive statistics (proportions perfect and acceptable accuracy).<br><strong>Results</strong>: Across the sub-studies, perfect accuracy ranged from 22–65% depending on participants, reference food and portion size. Irrespective thereof, acceptable accuracy was noted in &gt; 70% of observations. Reproducibility varied (range: 28–67% agreement).<br><strong>Conclusions and implications</strong>: Perfect portion size estimation of amorphous foods remains challenging. When misestimation by 60–125 ml still serves the purpose of a dietary assessment, bean bags show promise for cost-effective food volume quantification, especially on group level in resource-limited settings.<br><strong>Keywords</strong>: dietary assessment, portion size estimation, portion size estimation aids, accuracy, amorphous foods, bean</p> FAM Wenhold UE Maclntyre ##submission.copyrightStatement## 2024-09-19 2024-09-19 37 3 106 115 http://sajcn.co.za/index.php/SAJCN/article/view/1725 <p><strong>Objectives</strong>: A study was undertaken to describe South African dietitians and key role players’ perceptions regarding their role in reporting food labelling legislation transgressions.<br><strong>Design</strong>: A multimethod study design was employed to explore a previously unstudied topic.<br><strong>Setting</strong>: Dietitians registered with the Health Professions Council of South Africa (HPCSA) together with key role players in food labelling in South Africa.<br><strong>Methods</strong>: 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.<br><strong>Results</strong>: In total, only 6% (<em>n</em> = 7) of the included dietitians (<em>n</em> = 126) reported food labelling transgressions, and 12% (<em>n</em> = 15) believed dietitians have a role to play in reporting transgressions. Interestingly, half of the included dietitians (50%, <em>n</em> = 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%,<em> n</em> = 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 (<em>n</em> = 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.<br><strong>Conclusion</strong>: 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.<br><strong>Keywords</strong>: dietitian, food labelling, food industry, legislation, transgression</p> M Profe-fuchsloch N Koen M Wicks ##submission.copyrightStatement## 2024-09-17 2024-09-17 37 3 116 124 http://sajcn.co.za/index.php/SAJCN/article/view/1726 <p><strong>Objectives</strong>: Monitoring muscle mass (cross-sectional area [CSA]) and quality (echogenicity) using ultrasound may help optimise nutrition support in the critically ill. However, to date, ultrasound imaging has not been included in the undergraduate training of dietitians, who are mostly responsible for the nutrition care of critically ill patients. This study assessed the accuracy and reliability of bedside imaging performed by a dietitian trained according to standardised methodology, followed by blinded analyses.<br><strong>Methods</strong>: Two operators (a trainer and dietitian trainee) performed B-mode ultrasonography of the rectus femoris quadriceps muscle. For inter-rater accuracy, imaging was performed independently on 32 subjects by both operators, and for intra-rater reliability both obtained a second image on 15 subjects. A blinded assessor performed analyses (CSA and echogenicity) on all images. In a subset of 11 subjects, a musculoskeletal sonographer repeated all measurements. Inter- and intra-rater reliability were determined by calculating intraclass correlation coefficients (ICC), based on an absolute-agreement, 2-way mixed-effects model. An ICC &gt; 0.75 was classified as good and &gt; 0.90 as excellent.<br><strong>Results</strong>: Intra- (ICC = 0.9–0.94) and inter-rater (ICC = 0.85–0.95) reliability of the imaging performed was good to excellent. No statistically significant differences were found between the two operators (mean difference for CSA = 0.18 cm², 95% CI = −0.38–0.03,<em> p</em> = 0.08; mean difference for echogenicity = 6.88, CI = −0.71–14.78, <em>p</em> = 0.07). Inter-rater reliability for image analyses was excellent (ICC = 0.97–1.0).<br><strong>Conclusion</strong>: Bedside ultrasound performed by a dietitian trained according to standardised methodology shows good to excellent reliability and reproducibility. Training dietitians to perform bedside ultrasound may help to monitor muscle mass and quality in the critically ill.<br><strong>Keywords</strong>: critical illness, ICU, muscle mass, muscle quality, bedside ultrasound, nutrition, ICU recovery</p> L Veldsman A Lupton-Smith GA Richards R Blaauw ##submission.copyrightStatement## 2024-09-17 2024-09-17 37 3 125 130 http://sajcn.co.za/index.php/SAJCN/article/view/1727 <p><strong>Background</strong>: Non-communicable diseases (NCDs) are an important problem in South Africa; they account for 60% of all deaths. Early screening could help lower NCD incidences and long-term consequences.<br><strong>Objective</strong>: The study aimed to profile NCD risk factors among insourced support staff at the University of Pretoria in 2018.<br><strong>Design</strong>: A cross-sectional, descriptive study was conducted at the University of Pretoria, Hatfield Campus. The World Health Organization (WHO) STEPwise approach to chronic disease risk factor surveillance (STEPS) questionnaire was administered to collect data in three steps. The participants’ behavioural risk profiles were gathered using the face-to-face interview technique (STEP I), followed by their physical risk profile using anthropometric and blood pressure measurements (STEP II). Last was the biochemical risk profile, including finger-prick blood glucose and cholesterol measurement (STEP III). Data were analysed using Epi-Info, version 3.54.<br><strong>Subjects</strong>: A convenient sample of participants aged 18–64 years from the Departments of Industrial Hygiene and Building Services, Landscape Services, Sports Fields Management, and Security Services (<em>n</em> = 146, 60% were females) took part in the study.<br><strong>Results</strong>: Most participants (97.8%) had low daily fruit and vegetable intake. Some 80% of the study population always or often added salt to their food when cooking. Daily alcohol consumption was reported by a quarter of the sample. More than two-thirds of all the participants were overweight or obese and 61% had central obesity.<br><strong>Conclusion</strong>: The study identified a high prevalence of several NCD risk factors. Tailored nutrition education and monitoring are needed to lower the elevated risk.<br><strong>Keywords</strong>: non-communicable diseases (NCDs), NCD risk factors, STEPS survey</p> SN Mathunjwa TB Mohlala HM Legodi ##submission.copyrightStatement## 2024-09-17 2024-09-17 37 3 131 139 http://sajcn.co.za/index.php/SAJCN/article/view/1728 <p><strong>Background</strong>: Advances in neonatal medicine, resulting in improved survival, have brought the concept of extra-uterine growth restriction (EUGR), defined as postnatal growth failure secondary to protein and energy deficits, to the forefront as an important cause of morbidity, particularly in very low birthweight (VLBW) neonates.<br><strong>Objectives</strong>: This study’s main objective was to determine the prevalence of EUGR in Steve Biko Academic Hospital in VLBW infants.<br><strong>Methods</strong>: This was a pre- (epoch 1) and post- (epoch 2) intervention study. The intervention was the introduction of a written nutritional protocol in the neonatal unit in mid-November 2017. Three definitions were used to identify EUGR, namely: (1) discharge weight &lt; 10th percentile, (2) a change by −1.28 <em>z</em>-score in weight at discharge, and (3) the discharge weight percentile below the nadir percentile.<br><strong>Results</strong>: The prevalence of EUGR in epoch 1 was 85.7%, 63.5%, and 88.0% using the above definitions, respectively. The prevalence of EUGR in epoch 2 was 73.9%, 65.8%, and 89.4% using the above definitions, respectively. EUGR using the three definitions combined was present in 95.2% and 92.8% of infants in epochs 1 and 2, respectively. None of the differences in EUGR prevalence between the two epochs were significant.<br><strong>Conclusion</strong>: The prevalence of EUGR was not significantly different between the two epochs, although it had been proposed that the introduction of a written nutritional protocol would have decreased the prevalence of EUGR in epoch 2. One of the reasons proposed for this finding was poor adherence to the nutritional protocol during epoch 2.<br><strong>Keywords</strong>: postnatal growth failure, extra-uterine growth restriction, EUGR, very low birthweight, VLBW, premature, prematurity</p> LND Mosidi A van Niekerk M Coetzee ##submission.copyrightStatement## 2024-09-17 2024-09-17 37 3 140 147 http://sajcn.co.za/index.php/SAJCN/article/view/1729 <p>none</p> T Cohen ##submission.copyrightStatement## 2024-09-17 2024-09-17 37 3 148 154 http://sajcn.co.za/index.php/SAJCN/article/view/1732 <p>See pdf for questionnaire</p> SAJCN Office ##submission.copyrightStatement## 2024-09-27 2024-09-27 37 3 http://sajcn.co.za/index.php/SAJCN/article/view/1733 <p>See pdf for questionnaire</p> SAJCN Office ##submission.copyrightStatement## 2024-09-27 2024-09-27 37 3 http://sajcn.co.za/index.php/SAJCN/article/view/1720 <p>none</p> SAJCN Office ##submission.copyrightStatement## 2024-09-16 2024-09-16 37 3 http://sajcn.co.za/index.php/SAJCN/article/view/1730 SAJCN Office ##submission.copyrightStatement## 2024-09-27 2024-09-27 37 3 http://sajcn.co.za/index.php/SAJCN/article/view/1731 SAJCN Office ##submission.copyrightStatement## 2024-09-27 2024-09-27 37 3 http://sajcn.co.za/index.php/SAJCN/article/view/1734 SAJCN Office ##submission.copyrightStatement## 2024-09-27 2024-09-27 37 3