Objectives: The objective of this study was to determine and compare the nutritional status of the elderly in two long-term care facilities - one situated in a higher socio-economic area and one in a lower socio-economic area. Design: A cross-sectional study was undertaken. Setting: The study setting comprised two urban areas of Bloemfontein, Free State province, South Africa. Subjects: Sixty-two elderly residing in a long-term care facility from both the higher and lower socio-economic areas agreed to participate and met inclusion criteria (N = 124). Outcome measures: The nutritional status of participants was assessed using the Mini Nutritional Assessment (MNA^®) questionnaire. Indicators of nutritional status that were assessed as part of the validated MNA^® included anthropometry, a global assessment, dietary assessment and subjective assessment. A total score of 24 or more points was interpreted as being well-nourished. Results: Malnutrition was identified in 3.2% of participants from the long-term care facility situated in the higher socio-economic area and 11.3% from the lower socio-economic area. A significantly higher percentage of participants from the lower socio-economic area were found to be at risk of malnutrition than those from the higher socio-economic area (74.2% vs. 37.1%) [95% CI 19.8%; 51.4%]. Participants from the higher socio-economic area consumed significantly more fluid and protein rich foods than their counterparts. Conclusion: Elderly participants from the lower socio-economic area were more likely to have a poor nutritional status and be at risk of malnutrition. The findings highlight the need to focus on screening for malnutrition in order to promote health and prevent the possible development of nutrition-related co-morbidities in the elderly.

Aims: High diet quality is related to better health outcomes in general. During pregnancy, a high-quality diet is of paramount importance to promote optimal maternal and neonatal outcomes. This is a scoping review of research available on diet quality indexes (DQIs) for use during pregnancy that summarizes the DQIs in terms of development, country of origin, population used, components, scoring and weighting of components, and evaluation. Furthermore, the DQIs are discussed narratively to inform and direct the development of improved and country-specific DQIs for pregnancy. Methods: The EBSCOhost database was used to identify English-language, peer-reviewed articles published between 2000 and 2023, from which 11 publications were identified that describe the development of pregnancy-specific DQIs. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews model. Results: Almost all DQIs (n = 9 of 11) were developed in high-income countries, using dietary intake data from food frequency questionnaires. Several DQIs (n = 5 of 11) used the US Healthy Eating Index as basis and modified it in various ways. Almost all DQIs included both foods and nutrients as components (n = 9 of 11), with vegetables being the most commonly included component alone (n = 8 of 11) or combined with fruit (n = 2 of 11). Conclusion: Because most DQIs were developed using dietary guidelines, recommendations, and dietary intake data from high-income countries, it is recommended that pregnancy-specific DQIs be developed and validated to reflect the nutrition guidelines for lower-income and culturally diverse countries.

Objectives: The objective of this study was to determine the knowledge, perceptions and practices of HIV-infected mothers regarding human immunodeficiency virus (HIV) and infant feeding. Design: A cross-sectional study design was applied. Setting: The study was undertaken at a regional hospital in Bloemfontein. Subjects: A total of 100 mother–infant pairs that were still in hospital after the delivery of the baby were included. All mothers were HIV-infected. Outcome measures: Sociodemographic information, medical history, and knowledge, perceptions and practices related to infant feeding in the context of HIV were noted. Results: The median age of mothers was 31 years, and most mothers reported anti-retroviral therapy (ART) use (93.0%). The median CD4 cell count was 383 cells/mm³, and median haemoglobin level was 11.4 g/dl. Most mothers planned to breastfeed their infant(s) (70.0%). A large percentage of the mothers reported that they did not know or were not aware of the fact that HIV can be transmitted to an infant via breastfeeding (43.0%). Only half of the mothers had been shown how to either breastfeed or formula feed by healthcare staff (depending on their choice). Conclusion: The knowledge, perceptions and practices related to infant feeding were inadequate in mothers included in this study. Providing scientifically based, unbiased information is fundamental during counselling on infant feeding to ensure the success of prevention of mother-to-child transmission (PMTCT) programmes. If women feel confident in their acquired knowledge, they are more likely to be self-empowered and make informed decisions related to infant feeding.

Poor birth outcomes such as low birth weight, low birth length and short gestational age, are public health concern issues in South Africa (SA). This study utilized structural equation modeling (SEM) to explore how nutritional and social factors contribute to favorable fetal growth conditions (FFGC) in pregnant women living with and without human immunodeficiency virus (HIV), in the Free State Province of SA. Sociodemographic characteristics, stress, health and nutrition-related information, and birth outcomes data were collected and analyzed from a subsample of 305 women enrolled in a cohort study from 2018–2020. Descriptive statistics were analyzed in R version 4.1.2 and SEM was conducted in Lavaan version 0.6–5. Higher gestational body mass index (GBMI) and income levels were associated with higher FFGC (p < 0.05). Household incomes were positively associated with dietary micronutrient quality (p = 0.002), GBMI (p = 0.012) and food security (p = 0.001). Low incomes (p = 0.004) and food insecurity (p < 0.001) were associated with higher stress, while social support was positively associated with food security status (p = 0.008). These findings highlight the complex interconnections between the social and nutritional factors that are associated with fetal growth conditions. Multisectoral community-based programs may be a useful strategy to address these challenges.

Background: Diet quality indexes (DQIs) consist of combinations of foods and/or nutrient components that represent adherence to dietary guidelines. A high-quality diet during pregnancy contributes to optimal birth outcomes. Objective: We developed and validated the first DQI for pregnancy for South African women. Methods: The South African Food Based Dietary Guidelines and pregnancy dietary guidelines were used as theoretical basis for the a priori development of the South African Diet Quality Index for Pregnancy (SA-DQI-P). To validate the SA-DQI-P, we applied it to data collected for the Nutritional status of Expectant Mothers and their newborn Infants (NuEMI) study ( N = 682). We determined the associations between SA-DQI-P scores in tertiles with nutrient intakes, sociodemographic factors, household food security level, and biochemical values. Results: A lower household density ratio, household access to a toilet, refrigerator, and microwave, a higher educational level, being employed and being food secure were significantly associated with a higher score. After correcting for energy intake, higher scores were significantly associated with higher intakes of protein, total fat, saturated fat, cholesterol, calcium, vitamin A, vitamin E, folic acid, vitamin B12, and vitamin C. Significantly more participants who were vitamin A deficient scored in the lowest tertile than those in higher tertiles. Conclusion: The SA-DQI-P is the first DQI developed for a South African population and has proven to be valid in ranking diet quality in pregnant women in our sample. Information regarding diet quality of this vulnerable group can assist with planning nutrition intervention programs to improve nutritional status.

Background: The health and well-being of pregnant women can influence pregnancy outcomes and are closely associated with social support and experiences of stress. Poor nutrition predisposes to poor health with choline intake affecting pregnancy outcome. This study determined reported health, social support, and stress and how these factors are associated with choline intake in pregnancy. Methods: A cross sectional study was performed. Pregnant women in their second and third trimesters attending a high-risk antenatal clinic at a regional hospital in Bloemfontein, South Africa, were included. Trained fieldworkers obtained information during structured interviews using standardised questionnaires. Logistic regression with backward selection (p < 0.05) was used to select significant independent factors associated with choline intake. Variables with a p-value < 0.15 in bivariate analysis were considered for inclusion in the model. Results: Median age and gestation in the sample (N = 682) were 31.8 years and 32.0 weeks, respectively. Most participants (84.7%) consumed less than the adequate intake (AI) of 450 mg of choline per day. Most participants (69.0%) were either overweight or obese. One in eight participants (12.6%) reported not having anyone that could help them in times of need, more than one third (36.0%) reported having unpayable debt and one in twelve (8.4%) reported experiencing physical abuse by their partners. Normotensive participants and those using anti-retroviral therapy (ART) (thus HIV-infected), were more likely to consume choline in amounts below the AI (p = 0.042 and p = 0.011, respectively). Logistic regression analysis showed that the odds of consuming choline in amounts below the AI were lower for participants that were not using ART versus those using ART, with an odds ratio of 0.53. Conclusion: HIV-infected participants were more likely to consume choline in levels below the AI. This vulnerable group should be the focus of targeted efforts to improve choline intake.