1
|
Middelkoop K, Micklesfield LK, Walker N, Stewart J, Delport C, Jolliffe DA, Mendham AE, Coussens AK, van Graan A, Nuttall J, Tang JCY, Fraser WD, Cooper C, Harvey NC, Hooper RL, Wilkinson RJ, Bekker LG, Martineau AR. Influence of vitamin D supplementation on bone mineral content, bone turnover markers, and fracture risk in South African schoolchildren: multicenter double-blind randomized placebo-controlled trial (ViDiKids). J Bone Miner Res 2024; 39:211-221. [PMID: 38477739 DOI: 10.1093/jbmr/zjae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/27/2023] [Accepted: 01/05/2024] [Indexed: 03/14/2024]
Abstract
Randomized controlled trials (RCTs) to determine the influence of vitamin D on BMC and fracture risk in children of Black African ancestry are lacking. We conducted a sub-study (n = 450) nested within a phase 3 RCT of weekly oral supplementation with 10 000 IU vitamin D3 vs placebo for 3 yr in HIV-uninfected Cape Town schoolchildren aged 6-11 yr. Outcomes were BMC at the whole body less head (WBLH) and LS and serum 25-hydroxyvitamin D3 (25(OH)D3), PTH, alkaline phosphatase, C-terminal telopeptide, and PINP. Incidence of fractures was a secondary outcome of the main trial (n = 1682). At baseline, mean serum 25(OH)D3 concentration was 70.0 nmol/L (SD 13.5), and 5.8% of participants had serum 25(OH)D3 concentrations <50 nmol/L. Among sub-study participants, end-trial serum 25(OH)D3 concentrations were higher for participants allocated to vitamin D vs placebo (adjusted mean difference [aMD] 39.9 nmol/L, 95% CI, 36.1 to 43.6) and serum PTH concentrations were lower (aMD -0.55 pmol/L, 95% CI, -0.94 to -0.17). However, no interarm differences were seen for WBLH BMC (aMD -8.0 g, 95% CI, -30.7 to 14.7) or LS BMC (aMD -0.3 g, 95% CI, -1.3 to 0.8) or serum concentrations of bone turnover markers. Fractures were rare among participants in the main trial randomized to vitamin D vs placebo (7/755 vs 10/758 attending at least 1 follow-up; adjusted odds ratio 0.70, 95% CI, 0.27 to 1.85). In conclusion, a 3-yr course of weekly oral vitamin D supplementation elevated serum 25(OH)D3 concentrations and suppressed serum PTH concentrations in HIV-uninfected South African schoolchildren of Black African ancestry but did not influence BMC or serum concentrations of bone turnover markers. Fracture incidence was low, limiting power to detect an effect of vitamin D on this outcome.
Collapse
Affiliation(s)
- Keren Middelkoop
- Desmond Tutu HIV Centre, Institute of Infectious Diseases & Molecular Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
- Department of Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
| | - Lisa K Micklesfield
- Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), University of Cape Town, Newlands, Cape Town 7700, Western Cape, South Africa
- Department of Paediatrics, SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg 2193, Gauteng, South Africa
| | - Neil Walker
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, United Kingdom
| | - Justine Stewart
- Desmond Tutu HIV Centre, Institute of Infectious Diseases & Molecular Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
- Department of Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
| | - Carmen Delport
- Desmond Tutu HIV Centre, Institute of Infectious Diseases & Molecular Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
| | - David A Jolliffe
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, United Kingdom
| | - Amy E Mendham
- Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), University of Cape Town, Newlands, Cape Town 7700, Western Cape, South Africa
- Department of Paediatrics, SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg 2193, Gauteng, South Africa
| | - Anna K Coussens
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3052, Australia
| | - Averalda van Graan
- Biostatistics Unit, SAFOODS Division, South African Medical Research Council, Tygerberg, Cape Town 7505, Western Cape, South Africa
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town 7505, Western Cape, South Africa
| | - James Nuttall
- Department of Paediatrics and Child Health, Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town 7700, Western Cape, South Africa
| | - Jonathan C Y Tang
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom
- Departments of Laboratory Medicine, Clinical Biochemistry and Departments of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich NR4 7UY, United Kingdom
| | - William D Fraser
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom
- Departments of Laboratory Medicine, Clinical Biochemistry and Departments of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich NR4 7UY, United Kingdom
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
- University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
- University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
| | - Richard L Hooper
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, United Kingdom
| | - Robert J Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
- The Francis Crick Institute, London NW1 1AT, United Kingdom
- Imperial College London, London W12 0NN, United Kingdom
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, Institute of Infectious Diseases & Molecular Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
- Department of Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
| | - Adrian R Martineau
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, United Kingdom
| |
Collapse
|
2
|
Balakrishna Y, Manda S, Mwambi H, van Graan A. Determining classes of food items for health requirements and nutrition guidelines using Gaussian mixture models. Front Nutr 2023; 10:1186221. [PMID: 37899829 PMCID: PMC10611470 DOI: 10.3389/fnut.2023.1186221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction The identification of classes of nutritionally similar food items is important for creating food exchange lists to meet health requirements and for informing nutrition guidelines and campaigns. Cluster analysis methods can assign food items into classes based on the similarity in their nutrient contents. Finite mixture models use probabilistic classification with the advantage of taking into account the uncertainty of class thresholds. Methods This paper uses univariate Gaussian mixture models to determine the probabilistic classification of food items in the South African Food Composition Database (SAFCDB) based on nutrient content. Results Classifying food items by animal protein, fatty acid, available carbohydrate, total fibre, sodium, iron, vitamin A, thiamin and riboflavin contents produced data-driven classes with differing means and estimates of variability and could be clearly ranked on a low to high nutrient contents scale. Classifying food items by their sodium content resulted in five classes with the class means ranging from 1.57 to 706.27 mg per 100 g. Four classes were identified based on available carbohydrate content with the highest carbohydrate class having a mean content of 59.15 g per 100 g. Food items clustered into two classes when examining their fatty acid content. Foods with a high iron content had a mean of 1.46 mg per 100 g and was one of three classes identified for iron. Classes containing nutrient-rich food items that exhibited extreme nutrient values were also identified for several vitamins and minerals. Discussion The overlap between classes was evident and supports the use of probabilistic classification methods. Food items in each of the identified classes were comparable to allowed food lists developed for therapeutic diets. This data-driven ranking of nutritionally similar classes could be considered for diet planning for medical conditions and individuals with dietary restrictions.
Collapse
Affiliation(s)
- Yusentha Balakrishna
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Samuel Manda
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
- Department of Statistics, University of Pretoria, Pretoria, South Africa
| | - Henry Mwambi
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Averalda van Graan
- Biostatistics Research Unit, SAFOODS Division, South African Medical Research Council, Cape Town, South Africa
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
3
|
Jumat M, Duodu KG, van Graan A. Systematic Review of the Literature to Inform the Development of a South African Dietary Polyphenol Composition Database. Nutrients 2023; 15:nu15112426. [PMID: 37299389 DOI: 10.3390/nu15112426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023] Open
Abstract
Comprehensively compiled dietary polyphenol data is required to compare polyphenol content between foods, calculate polyphenol intake and study its association with health and disease. The purpose of this review was to identify data on the presence and content of polyphenolic components in South African foods, with the aim of compiling the data into a database. An electronic literature search was conducted up until January 2020 using multiple databases. Additional literature was sourced from South African university repositories. A total of 7051 potentially eligible references were identified, of which 384 met the inclusion criteria. These studies provided information on food item name, geographical distribution, polyphenol type, quantity, and quantification method. Data for 1070 foods were identified, amounting to 4994 polyphenols. Spectrophotometry was the main method used for quantification of gross phenolic content in various assays such as total phenolic content (Folin-Ciocalteu assay), total flavonoid content (AlCl3 assay) and condensed tannin content (vanillin-HCl assay). Phenolic acids and flavonoids were the main polyphenol classes identified. This review highlights that South Africa has abundant information on the polyphenol content of foods, which could be utilised within a food composition database for the estimation of polyphenol intake for South Africa.
Collapse
Affiliation(s)
- Malory Jumat
- Biostatistics Research Unit, South African Food Data System (SAFOODS) Division, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Tygerberg 7505, Cape Town P.O. Box 19070, South Africa
- Department of Consumer and Food Sciences, University of Pretoria, Private Bag X20, Hatfield 0028, South Africa
| | - Kwaku Gyebi Duodu
- Department of Consumer and Food Sciences, University of Pretoria, Private Bag X20, Hatfield 0028, South Africa
| | - Averalda van Graan
- Biostatistics Research Unit, South African Food Data System (SAFOODS) Division, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Tygerberg 7505, Cape Town P.O. Box 19070, South Africa
- Department of Global Health, Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg 7505, Cape Town P.O. Box 19063, South Africa
| |
Collapse
|
4
|
Balakrishna Y, Manda S, Mwambi H, van Graan A. Statistical Methods for the Analysis of Food Composition Databases: A Review. Nutrients 2022; 14:nu14112193. [PMID: 35683993 PMCID: PMC9182527 DOI: 10.3390/nu14112193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/19/2022] [Accepted: 05/22/2022] [Indexed: 11/16/2022] Open
Abstract
Evidence-based knowledge of the relationship between foods and nutrients is needed to inform dietary-based guidelines and policy. Proper and tailored statistical methods to analyse food composition databases (FCDBs) could assist in this regard. This review aims to collate the existing literature that used any statistical method to analyse FCDBs, to identify key trends and research gaps. The search strategy yielded 4238 references from electronic databases of which 24 fulfilled our inclusion criteria. Information on the objectives, statistical methods, and results was extracted. Statistical methods were mostly applied to group similar food items (37.5%). Other aims and objectives included determining associations between the nutrient content and known food characteristics (25.0%), determining nutrient co-occurrence (20.8%), evaluating nutrient changes over time (16.7%), and addressing the accuracy and completeness of databases (16.7%). Standard statistical tests (33.3%) were the most utilised followed by clustering (29.1%), other methods (16.7%), regression methods (12.5%), and dimension reduction techniques (8.3%). Nutrient data has unique characteristics such as correlated components, natural groupings, and a compositional nature. Statistical methods used for analysis need to account for this data structure. Our summary of the literature provides a reference for researchers looking to expand into this area.
Collapse
Affiliation(s)
- Yusentha Balakrishna
- Biostatistics Research Unit, South African Medical Research Council, Durban 4001, South Africa
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg 3201, South Africa; (S.M.); (H.M.)
- Correspondence: ; Tel.: +27-31-203-4855
| | - Samuel Manda
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg 3201, South Africa; (S.M.); (H.M.)
- Department of Statistics, University of Pretoria, Pretoria 0028, South Africa
| | - Henry Mwambi
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg 3201, South Africa; (S.M.); (H.M.)
| | - Averalda van Graan
- Biostatistics Research Unit, SAFOODS Division, South African Medical Research Council, Cape Town 8001, South Africa;
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Cape Town 8001, South Africa
| |
Collapse
|
5
|
Balakrishna Y, Manda S, Mwambi H, van Graan A. Identifying Nutrient Patterns in South African Foods to Support National Nutrition Guidelines and Policies. Nutrients 2021; 13:nu13093194. [PMID: 34579071 PMCID: PMC8465156 DOI: 10.3390/nu13093194] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/09/2021] [Accepted: 09/11/2021] [Indexed: 01/18/2023] Open
Abstract
Food composition databases (FCDBs) provide the nutritional content of foods and are essential for developing nutrition guidance and effective intervention programs to improve nutrition of a population. In public and nutritional health research studies, FCDBs are used in the estimation of nutrient intake profiles at the population levels. However, such studies investigating nutrient co-occurrence and profile patterns within the African context are very rare. This study aimed to identify nutrient co-occurrence patterns within the South African FCDB (SAFCDB). A principal component analysis (PCA) was applied to 28 nutrients and 971 foods in the South African FCDB to determine compositionally similar food items. A second principal component analysis was applied to the food items for validation. Eight nutrient patterns (NPs) explaining 73.4% of the nutrient variation among foods were identified: (1) high magnesium and manganese; (2) high copper and vitamin B12; (3) high animal protein, niacin, and vitamin B6; (4) high fatty acids and vitamin E; (5) high calcium, phosphorous and sodium; (6) low moisture and high available carbohydrate; (7) high cholesterol and vitamin D; and (8) low zinc and high vitamin C. Similar food patterns (FPs) were identified from a PCA on food items, yielding subgroups such as dark-green, leafy vegetables and, orange-coloured fruit and vegetables. One food pattern was associated with high sodium levels and contained bread, processed meat and seafood, canned vegetables, and sauces. The data-driven nutrient and food patterns found in this study were consistent with and support the South African food-based dietary guidelines and the national salt regulations.
Collapse
Affiliation(s)
- Yusentha Balakrishna
- Biostatistics Research Unit, South African Medical Research Council, Durban 4001, South Africa
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg 3201, South Africa; (S.M.); (H.M.)
- Correspondence: ; Tel.: +27-31-203-4855
| | - Samuel Manda
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg 3201, South Africa; (S.M.); (H.M.)
- Biostatistics Research Unit, South African Medical Research Council, Pretoria 0001, South Africa
- Department of Statistics, University of Pretoria, Pretoria 0001, South Africa
| | - Henry Mwambi
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg 3201, South Africa; (S.M.); (H.M.)
| | - Averalda van Graan
- Biostatistics Research Unit, SAFOODS Division, South African Medical Research Council, Cape Town 8001, South Africa;
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Cape Town 8001, South Africa
| |
Collapse
|