INTRODUCTION, THE PROBLEM AND STUDY SETTING ............... 1-10
Statement of the problem
The aim of this study was to determine the prevalence of overweight and obesity among grade 2 learners in Pietermaritzburg, and whether dietary calcium from their dairy intake and/or their total dairy intake had any impact on their BMI. Furthermore, this study determined whether grade 2 learners in Pietermaritzburg meet their calcium and dairy needs (assuming they receive calcium from other, non-dairy sources), and if not, what barriers exist to obtaining an adequate dairy intake .
Research objectives
To determine (among other things): . 1) the state of health of children under the age of five 2) the state of health of. Where studies have examined the effect of milk measured as 'one cup', the quantity of milk is also indicated.
Hypothesis
Inclusion and exclusion criteria
All quintile 5 schools in Pietermaritzburg that fell under the Msunduzi municipality were included in this study. Eligible quintile 5 schools were representative of all South African racial groups (Black African, White, Colored and Indian).
Definition of terms
Schools where all four major South African race groups were not represented in the eligible school. It is based on the sum of the triceps and subscapular skinfold thicknesses ≥ 85th percentile (overfat) (Frisancho 1990).
Abbreviations
Assumptions
Summary
Dissertation overview
Referencing style
Milk and dairy products are reviewed, with particular attention paid to the beneficial role they play in contributing to good health in children. International pediatric studies on the effect of milk and dairy products on weight and body fat are reviewed.
A background to the global problem of malnutrition
Children from developing countries have not been immune to the rapid dietary changes and increasingly sedentary lifestyle observed in many countries, with childhood obesity recorded at 41.8% in Mexico, 22.1% in Brazil, 22% in India and 19.3% in Argentina (Gupta). , Goel, Shah & Misra 2012). Investing in nutrition should be seen as a way to improve economic growth, in contrast to the current way of thinking where economic growth will lead to good nutrition (International Food Policy Research Institute 2016).
Overweight and obesity in South Africa
To determine the prevalence of overweight and obesity in a sample of South African children aged 6 to 13 years. The causes of overweight and obesity among South African children are explained in the next section.
Aetiology of overweight and obesity
- Dietary intake
- Nutrition Transition
- Physical activity
- Socioeconomic status
- Culture
- Gender
- Stress
Because of the fast-paced lifestyles of many parents, there is a heavy reliance on low-cost, processed convenience foods for the main meal of the day. By watching television, children are also more likely to be exposed to marketing of the Western lifestyle and diet.
Encouraging a healthy diet in South Africa
In South Africa, the recommended number of servings of milk and milk per day for children aged 4 to 8 years is 3 cups, or equivalent servings, which provides approximately 900 mg of calcium (Milk SA Consumer Education Project 2013). If South African children aged 4 to 8 years consumed the recommended three servings of milk and/or milk products per day (750 ml), it would be possible for them to meet the VER for calcium of 800 mg per day and up to 50% of their potassium requirements.
The benefits of milk and dairy products
- The cardiovascular system
- The immune system
- The gastrointestinal system
- The nervous system
Peptides are also involved in the regulation of hyperglycaemia (Luhovyy et al 2007) and contribute to satiety by aiding in the release of cholecystokinin, a hormone involved in the control of food intake and digestion (Korhonen & Pihlanto 2006). Opioid receptors are found in the nervous, endocrine, immune and gastrointestinal systems (Korhonen & Pihlanto 2006).
Barriers towards milk and dairy intake
In South Africa, the consumption of milk and dairy products is dependent on the price of the product, as can be demonstrated by the sale of fresh, pasteurized milk versus Ultra Heat Treated (UHT) milk. A 14.4% increase in sales of long-life UHT milk in South Africa was recorded in 2015, and was directly related to the reduced cost of the product.
Dairy intake and obesity
The studies reviewed differed in several ways, and it was impossible to demonstrate a definitive outcome, with no clear consensus on the relationship between dairy products and BMI being reached. Forshee & Storey (2003), Moreira et al (2005) and Abreu et al (2012) only showed an inverse relationship between dietary calcium and BMI in girls.
Summary
METHODOLOGY ......................................................................................... 55-76
Background information to the study area
Design of study
- Cross sectional study
The situation may then arise where the study is no longer representative of a cross-section of the population (Sedgwick 2014). Another disadvantage of this type of study is that since the data is collected only once, no trends or causal relationships can be inferred from the study.
Study population and sample selection
All eight quintile 5 schools that met the criteria were invited to participate in the study. Seven of the eight schools that met the criteria responded positively to the researcher's invitation, after an appointment with the school principal/head of department.
Measurement of dietary intake
- Weighted food record
- Food frequency questionnaire
- Literature supporting the semi-quantitative FFQ
Their results showed that dietary calcium intake obtained by FFQ was significantly higher than calcium from 24-hour recall. From the literature reviewed, the FFQ has been shown to be a good tool in assessing calcium intake.
Study method and data collection
As the FFQ was intended to be self-administered, clear instructions were given on how to complete it and closed questions were asked to minimize errors. In order to preserve the integrity of the larger sample size, it was decided not to use a 24-hour recall.
Measuring instruments used
- Anthropometric measurements
- Semi-quantitative FFQ
The student was asked to step onto the stadiometer and turn to face the field worker. The student was asked to breathe deeply and hold their breath while the measurement was taken.
Fieldworker recruitment and training
Pilot study
The researcher's contact information was also provided in the informed consent letter to allow parents/guardians to clarify any questions. It was then decided that an incentive should be offered to potentially increase participation in the main study.
Data collection
As the parents/guardians were informed that participation was voluntary and they can withdraw from the study at any time without incurring any penalties, the researcher will.
Data capturing and processing
Statistical analysis of data
Regression analysis was used to determine whether a significant difference existed between the two sexes' BMI and FFQ calcium. A Pearson correlation analysis was performed to determine whether a relationship existed between dairy intake and SSBs.
Reliability and validity of data
Reduction of bias
The FFQ provided clear instructions that were simply worded so as not to mislead or confuse respondents. The mall voucher lucky draw prize was selected at random and not based on responses to the FFQ.
Ethical considerations
The researcher informed the parents/guardians in the informed consent letter (Appendix G, p. 161) that there were no "right" or "wrong" answers to the questions they were asked, potentially reducing bias and unfairness. The questions in the FFQ were formulated in a neutral way, with no positive or negative wording used (Schriesheim & Hill 1981).
Summary
RESULTS .................................................................................................... 77-89
The prevalence of overweight and obesity amongst Grade 2 learners in Pietermaritzburg, as
The students' BMI measurements are shown as a distribution curve in Figure 4.1, with the two blue lines indicating the recommended range for a normal BMI, according to the WHO (2007) for that gender. According to the Kruskal Wallis test, no significant differences between age and BMI were found in students of different gender and race.
The daily calcium and dairy intake of Grade 2 learners in Pietermaritzburg
There are few studies available on the calcium and dairy intake of the pediatric population in South Africa. The questionnaire will consist of approximately 38 questions related to the dairy intake of the grade 2 learners' diet.
The Grade 2 learners’ dietary calcium from dairy products, compared to the EAR for calcium
The Grade 2 learners dairy intake compared to the recommended dairy intake
The relationship between the Grade 2 learners’ calcium and total dairy intake, and their BMI
The dairy product most commonly consumed, and its effect on the Grade 2 learners’ BMI
The dairy product that contributed the most calcium to the Grade 2 learners’ diet, and its
Barriers that prevented the Grade 2 learners from consuming an adequate dairy intake
- The relationship between dairy products and sugar sweetened beverages
With literature expressing concerns that reduced levels of milk intake are associated with greater increases in SSB consumption, a Pearson correlation analysis was performed to determine whether such a relationship existed between milk intake and SSB. When all SSBs were analyzed together, there was still no significant correlation between milk intake and SSBs (p = 0.82), indicating that those students who drank less dairy products did not necessarily drink more SSBs.
Summary of results
The results of this study showed lower levels of overweight and obesity when consulting the IOTF classification compared to the WHO classification. As a result, the IOTF results for overweight and obesity are considered more severe (Cole et al 2000).
The daily calcium and dairy intake of Grade 2 learners in Pietermaritzburg
As part of the NutriGo study, Theron et al (2007) measured calcium intake in 12- to 24-month-old children from poor socioeconomic backgrounds in Gauteng and Limpopo. Calcium intake increased by approximately 100 mg per day in both groups when breast milk was included in the analysis.
Grade 2 learners dietary calcium intake from dairy products, compared to the EAR for
Due to the current cost of dairy products and their need for refrigeration, it can be assumed that students from quintile 1-4 schools may have even less access to dairy products and therefore much lower dairy and calcium intake than the students in this study. It is therefore essential that primary school children are encouraged to increase their dairy intake, and subsequent calcium intake, to maximize these opportunities.
The Grade 2 learners dairy intake compared to the recommended dairy intake
Dairy, specifically milk and yogurt, can be used as a good indicator of the quality of a diet due to the nutritional density of these foods (Weaver 2014). In diets where milk consumption was low, the nutritional profile of the diet was found to be lacking in several vital nutrients; Few people are able to meet all their nutritional requirements.
The relationship between the Grade 2 learners’ calcium and total dairy intake, and their BMI
Many of the studies differed in terms of their subject demographics, study design, methodology, type of dairy products and their portion sizes, follow-up duration and anthropometric measurement outcomes, and it is therefore impossible to compare them. Furthermore, the majority of studies indicated that full cream milk may be more beneficial than low-fat milk (Louie et al 2011), but most of the learners preferred full cream milk (54.9%) compared to all other types of milk and dairy products, and there was no association with their weight not observed.
Barriers affecting dairy intake
The second most commonly cited reason for reduced dairy intake was taste preference, with 17.6% (n=16) agreeing and 4.4% (n=4) strongly agreeing that the "learner doesn't like dairy". Another potential barrier was "no fridge at home", with 4.4% (n=4) agreeing and 5.5% (n=5) strongly agreeing that this was a barrier for their learner s dairy intake.
Summary
With Zemel et al (2000) demonstrating a link between calcium intake and adipose tissue in adults, several international studies have been conducted on the link between milk and/or dairy intake and BMI in children, with mixed results. Although this study did not find a correlation between calcium intake or dairy intake and the students' BMI, the students were able to do so.
CONCLUSION AND RECOMMENDATIONS ..................................... 104-109
Objective 1: To determine the incidence of overweight and obesity amongst Grade 2
Objective 2: To determine the calcium intake from dairy and the total dairy intake in
Objective 3: To determine the contribution that dairy products make towards meeting the
Objective 4: To determine the relationship between the dietary calcium (from dairy)
Objective 5: To determine possible barriers to dairy intake in Grade 2 learners in
Limitations
Although BMI's ability to accurately determine overweight and obesity has been recognized, it is not approved to measure body fat. Future research could isolate students into those consuming "low-fat" versus "high-fat" dairy products, and "low-sugar" versus "high-sugar" dairy products to provide a more accurate reflection of whether the energy value of those consumed dairy products affect students' BMI.
Recommendations
- Recommendations for dietetic practice
- Recommendations for the government
- Recommendations for future research
Role of parents in determining children's food preferences and the development of obesity. If you answered “yes” to question 25, what type of yogurt does he/she drink most?
