Nutritional Intervention Research Unit

Current projects

Food-based approaches for addressing Nutritional imbalances
Food fortification

The effect of a low-cost micronutrient fortified cereal on the nutritional status of infants
The aim of this study is to evaluate the efficacy of a low-cost high-quality fortified cereal on the vitamin A and iron status of infants of low socio-economic background, through a placebo-controlled trial. The study is being conducted in a rural area in KwaZulu-Natal in South Africa. After completion of the study the formulation of the product will be licenced to ensure quality control. Collaboration with the marketing department of food companies involved will ensure sound nutritional messages used in the marketing campaign and on the packaging. Commercialisation of such a low-cost scientifically tested fortified product could potentially impact on the nutritional status, growth and development of infants in developing countries, thus enabling them to reach their full potential. This study is being carried out in collaboration with the food industry and The Valley Trust, and is funded by the Thrasher Research Fund.
Project leader: Ms M. Faber

Evaluation of the short-, medium- and long-term effectiveness of introducing mandatory iodisation at an elevated concentration on the iodine and goitre status of children with endemic goitre
In this study baseline measurements of iodine and goitre status of primary school children were made in four communities in the Langkloof area of the Eastern Cape shortly before the introduction of mandatory iodisation in South Africa, and again after 1, 3 and 5 years. The iodine status improved rapidly after one year, but it is taking longer for the goitres to regress.
Project leader: Dr P.L. Jooste

Evaluation of the short-, medium- and long-term effectiveness of introducing mandatory iodisation at an elevated concentration on the iodine concentration of retailer salt
Iodised salt samples for iodine analysis were obtained from 50 food stores situated in 3 of the 9 provinces before the introduction of mandatory iodisation and again after 1, 3 and 5 years. The mean iodine content more than doubled within one year and then increased further to the level required by law. However, considerable variation in the iodine content of table salt is observed in this study.
Project leader: Dr P.L. Jooste

A national survey of the iodine content of household salt in South Africa
A salt sample was obtained from a national sample of 2 043 households representing all the residential categories, and therefore of all socio-economic strata in the population, and analysed for the iodine concentration. The results indicate that although the national mean and median iodine concentrations are acceptable, significant geographical variation in iodine concentration was observed, and only 62,4% of households used adequately iodised salt, sufficient to eliminate iodine deficiency and its consequences.
Project leader: Dr P.L. Jooste

An investigation of the iodine content of iodised salt at the production level in South Africa, of the salt producers' knowledge regarding the prevention and control of iodine deficiency disorders, and the quality control systems used by salt producers to ensure the production of salt iodised according to the legal requirements
This study will form the basis for the design of a national monitoring system to ensure the production of table salt containing sufficient amounts of iodine for the sustainable elimination of iodine deficiency in the country.
Project leader: Dr P.L. Jooste

The effect of fortifying the diet of 6-12-month-old disadvantaged South African infants on micronutrient status, linear growth and mental and motor development
The age of introduction of complementary food in the diet of infants has often been implicated in the onset of micronutrient deficiencies and linear growth retardation. The study looked at the effect of fortifying a commonly used complementary food on the micronutrient status, linear growth and mental and motor development of infants in two communities. The results may yield important information for policy-makers regarding the national fortification of food products aimed at addressing the prevalence of micronutrient deficiency and linear growth retardation.
Project leader: Dr A. Oelofse

The effect of an iron, iodine and ß-carotene fortified biscuit on the micronutrient status, morbidity and cognitive function of primary school children
In order to address micronutrient deficiencies in primary school children (from a low socio-economic community) a shortbread-based biscuit, fortified with iron, iodine and ß-carotene, was developed in collaboration with the food industry and evaluated in a randomised controlled trial over a period of one year. Results showed this biscuit to be a feasible, practical and effective way of improving the micronutrient status of primary school children. Morbidity and cognitive function were also favourably affected. In follow-up trials the long-term effects of this biscuit are being examined (over a period of +-4 years), as well as alternative compounds to be used as fortificants, eg EDTA iron, ferrous bisglycinate and red palm oil (a rich natural source of ß-carotene and vitamin E).
Project leader: Ms M.E. van Stuijvenberg

Supplementation

International research on infant supplementation (IRIS) study
In many countries populations suffer simultaneously from different micronutrient deficiencies and often supplementation programmes for different single micronutrients are implemented at the same time. Since operational strategies and distribution systems can be similar for each micronutrient, efforts and resources are duplicated and cost-effectiveness is therefore reduced. To overcome these problems, multi-micronutrient supplementation in different age groups has been suggested. Several studies have been conducted to test the efficacy in schoolchildren, adolescents and adults. However, little is known about the efficacy of multi-micronutrient supplementation in infants (6-12 months). It is this age group which is mostly affected by these deficiencies. This multicentre study looks at the efficacy of such a supplementation programme in different ethnic groups and is conducted in Vietnam, Indonesia, Peru and South Africa. The study targeted communities where babies have a prevalence of vitamin A deficiency and anaemia of more than 30%. The study is evaluated after six months of supplementation. UNICEF financially supports the study.
Project leader: Dr C.M. Smuts

Food diversification

The effectiveness of a home-based beta-carotene-rich food garden programme to improve household food security and undernutrition with special reference to micronutrient deficiencies in mothers and their children
A home-garden programme was integrated with a primary health care activity, namely a community-based growth monitoring system, in a rural village in KwaZulu-Natal, South Africa. The aim of the garden programme is to promote the production and consumption of yellow fruits and vegetables and dark-green leafy vegetables at household level, in order to address the vitamin A deficiency prevalent in the area. The community-based growth monitoring system provides the infrastructure that is needed for relevant nutrition education, home-gardening promotion, and training of agricultural activities. This study is done in collaboration with the Agricultural Research Council and the Ndunakazi community, and is funded by the Thrasher Research Fund.
Project leader: Ms M. Faber

Food Composition

Food composition database
The nutrient composition of foods in our country is unique due to the climate, specific plant cultivars and animal breeds, agricultural practices and manufacturing procedures. Each country needs to have its own food composition database reflecting the food consumed by people in that country. Currently, 41% of the foods in the South African Food Composition Database (SAFOODS) is of true South African content, a figure that needs to be increased in future.
Project leader: Ms N Danster

Dietary software
FoodFinderTM2 is a new software program specially developed for South Africans who are interested in the analysis of the food intake of individuals or groups of individuals.
Project leader: Dr P. Wolmarans

Hard copies of the Food Composition Tables and Dietary software analysis programs, can be ordered from the Nutritional Intervention Research Unit upon fax request to (021) 938-0321.

Nutrition status surveys/surveillance

The nutritional status of 6-71-month-old preschool children living in the City of Kimberley, Northern Cape Province: An anthropometric, micronutrient and socio-demographic survey
The Health Department of Kimberley invited the MRC to conduct a nutritional status survey of preschool children, after a preliminary study showed that the prevalence of chronic and acute undernutrition among preschoolers in Kimberley was higher than expected. An anthropometric, socio-demographic haematological and micronutrient status survey will be done on children aged 6-71 months. Based on the results of the initial cross-sectional study, an intervention programme will be planned in conjunction with the municipality and the community.
The MRC will also assist with the collection of baseline health and nutrition information on the San community in Schmidtsdrift before they are resettled in the Kimberley district.
Project leader: Dr M.A. Dhansay

A model for a community-based growth monitoring system
In 1995 the lack of health facilities within a rural village in KwaZulu-Natal prompted the establishment of a community-based growth-monitoring programme for preschool children. The programme is run by nutrition monitors (local people specifically trained for the project) through home-based centres (called Isizinda) within the community. As part of their contribution towards the programme, families make their homes available on a voluntary basis, once a month, to serve as growth monitoring points. The various aspects of the programme are managed and coordinated by the headmaster of the local primary school. Activities at the Isizinda include monthly growth monitoring, nutrition education, and recording of morbidity and mortality data. Children who are in need of medical treatment or who show growth faltering are referred to the nearest clinic and followed up by the nutrition monitors.
Project leader: Ms M. Faber

The nutritional status of the care-giver as indicator of the nutritional status of the preschool child
A recent study in a rural village in KwaZulu-Natal showed that the caring capacity of the care-giver was associated with the nutritional status of the child. The caring capacity of the care-giver can potentially be influenced not only by socio-economic or living conditions, but also by her health and nutritional status. In this study we will determine whether the nutritional status of the care-giver can be used as an indicator for the nutritional status of the child. This study is funded by the South African Sugar Association.
Project leader: Ms M. Faber

Dietary practices of normal weight, overweight and obese rural South African women
Obesity is common in South African women. In a rural village in KwaZulu-Natal more than 75% of women were shown to be either overweight or obese. The aim of this study is to look at dietary practices of normal weight, overweight and obese women in rural women with similar socio-economic backgrounds, and all with access to the same limited number of food items. This study is funded by the South African Sugar Association.
Project leader: Ms M. Faber

A study of the iodine and goitre status of primary school children near Worcester in the Western Cape
During the national survey of the prevalence of iodine deficiency disorders conducted in 1998, mild iodine deficiency was found in children attending a primary school near Worcester. Follow-up measures were required to decide whether or not iodine intervention was required over and above the iodisation of salt. Ultrasonography was used for the first time in South Africa to determine the size of the thyroids of these children.
Project leader: Dr P.L. Jooste

Langebaan nutrition surveillance study
The Unit facilitated the establishment of a nutritional surveillance system in an urban area through a community-based and community-driven growth monitoring system. The model has been adopted by the local Municipality and has sustained representative coverage of preschool children for growth monitoring and improved targeting of preschool children for 6-monthly deworming and other essential health and nutrition interventions.
Project leader: Ms S.E. Schoeman

Western Cape - Health facility-based nutrition programme evaluation
The main objective of the study is to evaluate the current process of targeting at-risk preschool children for nutrition intervention at primary health care facilities. The study will determine whether current practices at health facilities are effective in identifying nutritionally at-risk preschool children, whether nurses have been trained and have knowledge regarding targeting nutritionally at-risk groups, and whether nutrition guidelines are available and applied in targeting nutritionally at-risk groups.
Project leader: Ms S.E. Schoeman

Iron status of women working in a fruit packaging factory
The aims of this cross-sectional study were to determine the iron status and the risk factors for low iron status in adult women working in a fruit packaging factory. The study was undertaken on women between 18 and 55 years of age. A blood sample was analysed for haemoglobin, serum ferritin, serum iron, total iron binding capacity, and vitamin A concentrations. Body mass and height were measured. Demographic data were collected by a questionnaire. This study showed that iron deficiency and iron deficiency anaemia were not major problems, but the prevalence of overweight and obesity was high.
Project leader: Dr P. Wolmarans

Experimental - Clinical Research

Atherosclerosis studies in the vervet model
The vervet monkey, Cercopithecus aethiops, develops and models human atherosclerosis lesion types I to VIII within at least 18 months when fed Western-type diets high in cholesterol and fat content. Thus, the progression of atherosclerosis or anti-atherogenic efficacy of a variety of dietary components, eg natural occurring antioxidants, can be demonstrated in this non-human primate model of accelerated atherogenesis. It is also a good model for studying the changes in plasma lipoproteins found in response to dietary cholesterol and type of fat in humans. The objective of the current study is to determine the effect of palm oil on the metabolism of plasma lipoproteins and atherosclerosis in African vervet monkeys consuming high or moderate fat diets.
Project leader: Dr P.J. van Jaarsveld

Collaborative Research
NIRU collaborates extensively with several national and international universities, institutions, non-governmental organisations and industries.