Optimal Nutrition for South Africans

Leave a comment April 29, 2015 nutritionadsa

It is very important to differentiate between public health messages and those that are tailored to meet the specific needs of individual members of the public. Public health messages are intended for the general public, and can be communicated as “blanket” evidence-based messages based on proven public health problems in a population and based on the profile of the majority of the population. Messages to individual members of the public should be interpreted as a one-on-one consultation with a qualified healthcare worker, based on scientific reasoning and motivation for deviation from the public health message, if needed and appropriate.

The primary aim of any dietary strategy is to provide optimal nutrition for energy, growth and health throughout the life course, while secondary aims include prevention or management of a range of chronic medical conditions. Any diet that is promoted should be healthy, easy to follow and maintain, and should also be sustainable. Food and dietary choices can have an impact on the environment in many ways, such as climate change, land, water and energy use, and biodiversity. Healthy diets include the concept of enviromental sustainability [1, 2]. Sustainable diets are those diets with low environmental impacts that contribute to food and nutrition security and to healthy life for present and future generations. Sustainable diets are nutritionally adequate, safe and healthy; protective and respectful of biodiversity and ecosystems, culturally acceptable, accessible, economically fair and affordable; while optimizing natural and human resources [3].

Dietary strategies do not act in isolation and an individualised approach should be encouraged. Unique biological and metabolic profiles, as well as external factors such as a person’s health/disease status, physical activity levels, diet quantity (amounts consumed) and quality (e.g. types of fat and fatty acids, protein and carbohydrate consumed, as well as alcohol intake), stress levels, attitude towards food and eating, and motivation should be considered, as well as affordability and socio-economic factors; and may affect the positive outcome of any dietary strategy.

Overall, the combination of foods and nutrients we eat (our dietary pattern) influence our health, not any single food, nutrient or food group on its own.

Most foods consist of more than one nutrient. Full cream milk, for example, contains 20% protein, 30% carbohydrate and 50% fat of total energy; and also contains calcium, magnesium, B vitamins and other micronutrients. We can vary the intake of one component in our diet and not alter diet quality or health. A healthy dietary pattern, (as described below) has been linked consistently with reduced risk of disease [4, 5], demonstrating how foods and nutrients work together for health. An example of this is the Mediterranean dietary pattern [6, 7].

Healthy dietary patterns emphasise quality food choices, and are explained in the South African Food Based Dietary Guidelines (FBDGs) [8]. These guidelines were developed to address existing public health problems in South Africa (that affect the majority of the population) and are in line with current evidence on eating for health. The FBDGs [8] encourage us to eat a variety of foods, plenty of vegetables and fruit, choose unrefined starchy foods, eat beans, peas and lentils regularly, have dairy products every day and use vegetable fats rather than hard fats. Fish, chicken, lean meat or eggs can be eaten daily. Sugar, salt and foods high in these should be used sparingly. This includes highly processed foods such as biscuits, cakes, pastries, chips, snack bars, ready-to-eat savoury or sweet snacks and sweetened drinks.

ADSA supports current evidence that supports a balanced dietary approach that neither favours fat or carbohydrate, but rather focuses on whole grain and high-fibre sources of carbohydrate, dietary fats that are rich in omega-3 and mono-unsaturated fatty acids; and encourages moderate intake of low fat protein sources, especially fish. The intake of highly refined carbohydrates, free sugars and trans fatty acids should be discouraged; while intake of saturated fat and sodium should be reduce. [8-12]

References:

1. United States Department of Health and Human Services; Dietary Guidelines Advisory Committee 2015. Scientific Report of the 2015 Dietary Guidelines Advisory Committee. United States Department of Health and Human Services, United States Department of Agriculture, 2015.
2. NNR 2012 Working Group. Nordic Nutrition Recommendations NNR 2012. Nordic Council of Ministers,  Nordic Committee of Senior Officials for Food Issues, 2013.
3. Burlingame B, Dernini S, eds. Sustainable diets and biodiversity: directions and solutions for policy, research and action. Proceedings of the International Scientific Symposium. Biodiversity and sustainable diets united against hunger; 3–5 Nov 2010; Rome, Italy. Rome, Italy: Food and Agriculture Organization, 2012.
4. Alhazmi A, Stojanovski E, McEvoy M, Garg ML: The association between dietary patterns and type 2 diabetes: a systematic review and meta-analysis of cohort studies. J Hum Nutr Diet 2014, 27(3):251-260.
5. Esposito K, Chiodini P, Maiorino M, Bellastella G, Panagiotakos D, Giugliano D: Which diet for prevention of type 2 diabetes? A meta-analysis of prospective studies. Endocrine 2014:1-10.
6. Rees K, Hartley L, Flowers N, Clarke A, Hooper L, Thorogood M, Stranges S: ‘Mediterranean’ dietary pattern for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev 2013, 8:CD009825.
7. Sofi F, Abbate R, Gensini GF, Casini A: Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr 2010, 92(5):1189-1196.
8. Vorster HH, Badham JB, Venter CS: An introduction to the revised food-based dietary guidelines for South Africa. S Afr J Clin Nutr 2013, 26(3 (Supplement)):S5-S12. http://sajcn.co.za/index.php/SAJCN/issue/view/67/showToc
9. Nordic Council of Ministers. Nordic Nutrition Recommendations 2012: integrating nutrition and physical activity, 5th edition. Copenhagen: Nordic Council of Ministers, 2014
10. US Department of Agriculture. A series of systematic reviews on the relationship between dietary patterns and health outcomes. March, 2014. http://www.nel.gov/vault/2440/web/fi les/DietaryPatterns/DPRptFullFinal. pdf (accessed Sept 22, 2014).

11. Schwab U, Lauritzen L, Tholstrup T, et al. Eff ect of the amount and type of dietary fat on cardiometabolic risk factors and risk of developing type 2 diabetes, cardiovascular diseases, and cancer: a systematic review. Food Nutr Res 2014; 58: 25145.
12. Jakobsen MU, O’Reilly EJ, Heitmann BL, et al. Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies. Am J Clin Nutr 2009; 89: 1425–

Basic Nutrition Guidelines and Needs of Infants

2 Comments April 27, 2015 nutritionadsa

There is global recognition that the first 1,000 days of life (from conception to two years of age) is a key window of opportunity for improving health outcomes during childhood and into adulthood. Optimal infant and young child feeding is defined by the World Health Organisation (WHO) as exclusive breastfeeding from birth to six months and continued breastfeeding to two years and beyond along with complementary feeding from the age of six months (World Health Organisation, 2003). South Africa has adopted these recommendations.

Babies should be given only, where possible, breast milk from birth until the age of six months. Following the 6 month period, small amounts of food introduced into a baby’s diet, called complementary foods, should be safe, available, affordable, appropriate and culturally acceptable. Breastfeeding should continue while complementary foods are introduced, for up to two years of age and beyond.

The principle of responsive feeding, (i.e. when a child communicates feelings of hunger and satiety through verbal or non-verbal cues and the mother/caregiver responds appropriately) should guide the amount of complementary food that is offered. Since each child’s needs differ, each child consumes different quantities of breast milk and complementary foods, and each child grows differently, the amount of complementary foods should not be overly prescriptive.

The WHO and the Institute of Medicine (IOM) (IOM, Dietary Reference values 2006) recommend that an infant’s energy (which is provided by breast milk and complementary foods) should come from about 30 – 45% of total fat, 6 – 7% of protein with the remainder from carbohydrates. This is very much in line with the composition of breast milk at that age. It is also recommended that infant diets do not contain more than 15% of energy from protein, until more is known on the effect of protein on obesity later on in life (Michaelsen & Greer 2014). Major expert paediatric committees such as the The European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN), American Academy of Paediatrics (AAP) and Canadian Paediatric Society (CPG) support these guidelines, until more research becomes available on the matter.

High nutrient needs, due to babies’ rapid growth and development in the first two years of life, coupled with the relatively small amounts of complementary foods eaten in this period, means that the nutrient density in complementary foods must be very high. Gradually increase the amount of food, number of feeds and food variety as your child gets older.

Guidelines on suitable complementary foods                                   (Du Plessis, et al., 2013)

• Provide a variety of foods to ensure that nutrient needs are met. This includes vegetables, fruit, whole grains, meat and meat alternatives (meat, poultry, fish, eggs, legumes, nuts, seeds and nut butters) and dairy products (from the age of 12 month and in addition to, but not replacing breast milk).
• Foods from animals (meat, poultry, fish or egg) should be eaten daily, or as often as possible to meet protein and iron needs. In infants and young children, vegetarian diets cannot meet nutrient needs, unless nutrient supplements or fortified products are used.
• Dark green leafy vegetables and orange coloured vegetables and fruit rich in Vitamin A (e.g. sweet potato, carrot, pumpkin, broccoli and spinach, mango, peaches, apricot, paw-paw) should be eaten daily.
• Provide diets with an adequate fat content (from plant foods e.g. vegetable oils, avocado, nut butters and foods from animals, listed above, and also including breast milk).
• Use fortified complementary foods or vitamin-mineral supplements for infants, as needed or prescribed.

Low nutrient-dense liquids, such as tea and coffee, energy-dense sugar-sweetened drinks, an excessive intake of fruit juice, high-fat and salty snacks, and highly refined starchy carbohydrates worsen poor nutrient intake and displace healthy food in the diet, and are therefore not recommended for complementary feeding.

When considering nutrition guidelines and dietary advice, it is very important to differentiate between public health messages and those that are tailored to meet the specific needs of individual members of the public. Public health messages are intended for the general public, and can be communicated as “blanket” evidence-based messages based on proven public health problems in a population and based on the profile of the majority of the population. Messages to individual members of the public should be interpreted following a one-on-one consultation with a qualified healthcare worker, based on scientific reasoning and motivation for deviation from the public health message, if needed and appropriate.

Restrictive diets for infants should only be followed in specific medical conditions and under strict medical supervision.

Sources:

1. Du Plessis LM, Kruger S, Sweet L. Complementary feeding: a critical window of opportunity from six months onwards. South African Journal of Clinical Nutrition 2013;26(3)(Supplement):S129-S140 Available at http://sajcn.co.za/index.php/SAJCN/issue/view/67/showToc (Accessed 25 April 2015)
2. Pan American Health Organization PAHO/World Health Organization (2003) Guiding Principles for Complementary Feeding of the Breastfed Child. Available at http://whqlibdoc.who.int/paho/2003/a85622.pdf (Accessed 15 April 2015)
3. World Health Organization (2003) Global Strategy for Infant and Young Child Feeding. WHO: Geneva.
4. Institute of Medicine (IOM). Dietary Reference Intakes Essential Guide Nutrient Requirements. 2006.
5. Michaelsen KF, Greer FR. Protein needs early in life and long-term health. Am J Clin Nutr 2014 Jan, 99(suppl):718S-22S.
6. Agostoni C, Desci T, Fewtrell M et al. Medical position paper on complementary feeding: a commentary by ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutri, 2008; 46(1): 99-110.
7. Handbook of Paediatric Nutrition, 3^rd Edition, American Academy of Paediatrics, 2005.
8. Grueger B; Canadian Paediatric Society. Weaning from the breast. Paediatr Child Health 2013;18(4):210

For more information, contact the Association for Dietetics in South Africa +27 (0)82 376 4446

Quinoa & Fig Salad

1 Comment April 24, 2015 nutritionadsa

With beautiful weather forecast for most of the country for the long weekend, our latest NutritionConfidence recipe “Quinoa & Fig Salad” is the perfect meal. We love the combination of sweet, salty and sour in this recipe. A lovely vegan main meal containing a good combination of protein, carbohydrate and healthy mono-unsaturated fats. Also perfect as a side salad for a braai this weekend!

Our Dietitians Say

Quinoa is a good source of fibre, folate, magnesium, manganese, phosphorus and B vitamins. It has an amino acid score of 106, which indicates a complete high-quality protein. Quinoa is also a good source of carbohydrate and contains roughly the same amount of carbohydrate than a 100 g portion of cooked brown rice.

And importantly, figs are currently in season here in South Africa and available at most grocery stores.

RECIPE

Serves 4

Ingredients

1 cup white quinoa

2 cups water

8 purple figs, cut into quarters

100 g walnuts, raw & unsalted

200 g mixed salad greens (rocket, baby spinach, watercress)

1/2 cucumber

120 ml extra virgin olive oil

50 ml white wine vinegar

1 tablespoon honey

1 teaspoon smooth Dijon mustard

How to make it

– Preheat the oven to 150 deg C.

– Put the quinoa & water into a medium saucepan on a medium heat. Cook the quinoa for about 20 minutes until it expands and opens slightly. Cook with the lid on. Remove from the heat and strain the excess water from the quinoa. Season with a pinch of salt and leave the quinoa to cool.

– Roast the walnuts on an oven proof tray for about 10 minutes, check on the walnuts now and then to make sure they don’t burn. Remove the nuts from the oven and leave to cool.

– Using a peeler, peel the cucumber to make long thin ribbons. Peel around the cucumber using only the firm outside parts. Discard the middle part of the cucumber with the seeds or eat as a snack.

– To make the dressing: whisk the vinegar, honey & mustard in a mixing bowl. Slowly drizzle the olive oil into the bowl, while continuously whisking to combine.

– Assemble the salad greens on a large plate or platter. Sprinkle the cooled quinoa over the salad leaves. Arrange the figs and cucumber ribbons on top of the salad. Sprinkle the roasted walnuts over the salad and drizzle with the dressing.

– Serve as a light main course or as a healthy side salad to your favourite dish.

The Nutritional Value serves 4

Energy: 2689 kJ

Protein: 11.3 g

Carbohydrate: 51.3 g

Total Fat: 44 g

Dietary Fibre: 41 g

Sodium: 8 mg

Gluten & Sugar Free Brownies

Leave a comment April 10, 2015 nutritionadsa

This month seems to be all about chocolate, so we thought we’d share a recipe that is all about chocolate, but a much better alternative to other sugar-laden chocolate treats (and because the recipe contains no flour it is perfect for anyone who is gluten intolerant). Chef Vanessa Marx created the most delicious Gluten & Sugar Free Brownies, our latest NutritionConfidence Recipe.

Our Dietitians say: 

Historical evidence shows that cocoa has been used in a medicinal capacity for over two thousand years (since the time of the ancient Mayan and Aztec civilisations and following its introduction to Europe in the Middle Ages).

A large Harvard study showed that cocoa consumption is associated with decreased blood pressure, improved blood vessel health, and improvement in cholesterol levels, among other benefits.

The cocoa bean’s therapeutic properties can be attributed to certain constituent compounds, known as flavonoids.

RECIPE

Makes 48

Ingredients

200 g raw cocoa paste (solid)

375 g ground almonds

6 whole free-range eggs

250 g xylitol

300 g cocoa butter

50 g desiccated coconut

3 tablespoons cocoa powder

1 teaspoon baking powder

How to make it

– Preheat the oven to 160 C

– Grind together the cocoa paste, ground almonds, coconut, cocoa powder & baking powder.

– Whisk together the eggs and xylitol until light and fluffy and the xylitol is dissolved.

– Melt the cocoa butter.

– In a large bowl, fold together the ground cocoa mixture & the egg mixture until combined.

– Fold the warm cocoa butter into the mixture until all combined.

– Pour the batter into a greased baking dish and bake for 30-40min until set.

– Leave to cool a pond then slice into squares

The nutritional value serves 48:

Energy: 572 kJ

Protein: 2 g

Carbohydrate: 6 g

Total fat: 12 g

Fibre: 1.7 g

Sodium: 13.5 mg

Enjoy! If you want to download the recipe card visit: http://www.adsa.org.za/Public/Recipes.aspx

Liquid Assets

Leave a comment April 9, 2015 nutritionadsa

Considering a juice fast? Read this first. Lauren Shapiro from My Kitchen magazine chatted to ADSA spokesperson and Registered Dietitian Nathalie Mat to find out if this is just another fad diet or if there is more to it:

http://www.tfgclub.co.za/mykitchen