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The nutrition and health transition in the North West Province of South Africa: a review of the THUSA (Transition and Health during Urbanisation of South Africans) study

Published online by Cambridge University Press:  02 January 2007

Hester H Vorster ,
Christina S Venter ,
Marié P Wissing  and
Barrie M Margetts
Hester H Vorster*
Affiliation:
School of Physiology and Nutrition, North-West University (Potchefstroom Campus), Private Bag X6001, Potchefstroom, 2520, Republic of South Africa
Christina S Venter
Affiliation:
School of Physiology and Nutrition, North-West University (Potchefstroom Campus), Private Bag X6001, Potchefstroom, 2520, Republic of South Africa
Marié P Wissing
Affiliation:
School of Psycho-Social and Behavioural Sciences, North-West University (Potchefstroom Campus), Potchefstroom, Republic of South Africa
Barrie M Margetts
Affiliation:
School of Physiology and Nutrition, North-West University (Potchefstroom Campus), Private Bag X6001, Potchefstroom, 2520, Republic of South Africa
*
*Corresponding author: Email [email protected]
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Abstract

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Objective

To describe how urbanisation influences the nutrition and health transition in South Africa by using data from the THUSA (Transition and Health during Urbanisation of South Africans) study.

Design

The THUSA study was a cross-sectional, comparative, population-based survey.

Setting

The North West Province of South Africa.

Subjects

In total, 1854 apparently healthy volunteers, men and women aged 15 years and older, from 37 randomly selected sites. Pregnant and lactating women, those with diagnosed chronic diseases and taking medication, with acute infections or inebriated were excluded but screened for hypertension and diabetes mellitus. Subjects were stratified into five groups representing different levels of urbanisation in rural and urban areas: namely, deep rural, farms, squatter camps, townships and towns/cities. Outcome measures and methods: Socio-economic and education profiles, dietary patterns, nutrient intakes, anthropometric and biochemical nutrition status, physical and mental health indicators, and risk factors for non-communicable diseases (NCDs) were measured using questionnaires developed or adapted and validated for this population, as well as appropriate, standardised methods for the biochemical analyses of biological samples.

Results

Subjects from the rural groups had lower household incomes, less formal education, were shorter and had lower body mass indices than those in the urban groups. Urban subjects consumed less maize porridge but more fruits, vegetables, animal-derived foods and fats and oils than rural subjects. Comparing women from rural group 1 with the urban group 5, the following shifts in nutrient intakes were observed: % energy from carbohydrates, 67.4 to 57.3; from fats, 23.6 to 31.8; from protein, 11.4 to 13.4 (with an increase in animal protein from 22.2 to 42.6 g day-1); dietary fibre, 15.8 to 17.7 g day-1; calcium, 348 to 512 mg day-1; iron from 8.4 to 10.4 mg day-1; vitamin A from 573 to 1246 μg retinol equivalents day-1; and ascorbic acid from 30 to 83 mg day-1. Serum total cholesterol, low-density lipoprotein cholesterol and plasma fibrinogen increased significantly across groups; systolic blood pressure >140 mmHg was observed in 10.4–34.8% of subjects in different groups and diabetes mellitus in 0.8–6.0% of subjects. Women in groups 1 to 5 had overweight plus obesity rates of 48, 53, 47, 61 and 61%, showing an increase with urbanisation. Subjects from group 2 (farm dwellers) showed the highest scores of psychopathology and the lowest scores of psychological well-being. The same subjects consistently showed the lowest nutrition status.

Conclusions

Urbanisation of Africans in the North West Province is accompanied by an improvement in micronutrient intakes and status, but also by increases in overweight, obesity and several risk factors for NCDs. It is recommended that intervention programmes to promote nutritional health should aim to improve micronutrient status further without leading to obesity. The role of psychological strengths in preventing the adverse effects of urbanisation on health needs to be examined in more detail.

Keywords

Nutrition transitionAfricansUndernutritionObesityNon-communicable diseasesHIV/AIDSNutritional status
Type
Research Article
Information
Public Health Nutrition , Volume 8 , Issue 5 , August 2005 , pp. 480 - 490
Copyright
Copyright © The Authors 2005

References

1Baron, P. Equity in 1998: an overview. In: Ntuli, A, ed. South African Health Review, 1998. Durban: Health Systems Trust, 1998; 1–6.Google Scholar
2Health Systems Trust. South African Health Review 2002. Durban: Health Systems Trust, 2002; 546p.Google Scholar
3Vorster, HH, Bourne, LT, Venter, CS, Oosthuizen, W. Contribution of nutrition to the health transition in developing countries: a framework for research and intervention. Nutrition Reviews 1999; 57(11): 341–9.CrossRefGoogle Scholar
4Vorster, HH, Wissing, MP, Venter, CS, Kruger, HS, Kruger, A, Malan, NT, et al. The impact of urbanization on physical physiological and mental health of Africans in the North West Province of South Africa: the THUSA study. South African Journal of Science 2000; 96: 505–13.Google Scholar
5MacIntyre, UE, Venter, CS, Vorster, HH. A culture-sensitive quantitative food frequency questionnaire used in an African population: 1. Development and reproducibility. Public Health Nutrition 2000; 4(1): 53–62.CrossRefGoogle Scholar
6MacIntyre, UE, Venter, CS, Vorster, HH. A culture-sensitive quantitative food frequency questionnaire used in an African population: 2. Relative validation by 7-day weighed records and biomarkers. Public Health Nutrition 2000; 4(1): 63–71.CrossRefGoogle Scholar
7MacIntyre, UE, Venter, CS, Vorster, HH, Steyn, HS. A combination of statistical methods for the analysis of the relative validation data of the quantitative food frequency questionnaire used in the THUSA study. Public Health Nutrition 2000; 4(1): 45–51.Google Scholar
8Venter, CS, MacIntyre, UE, Vorster, HH. The development and testing of a food portion photograph book for use in an African population. Journal of Human Nutrition and Dietetics 2000; 13(3): 205–18.CrossRefGoogle Scholar
9Langenhoven, M, Kruger, M, Gouws, E, Faber, M. MRC Food Consumtion Tables, 3rd ed. Parow: Medical Research Council, 1991.Google Scholar
10Willett, WC, Howe, GR, Kushi, LH. Adjustment for total energy intake in epidemiological studies. American Journal of Clinical Nutrition 1997; 65(Suppl. 4): 1220S–8S.CrossRefGoogle Scholar
11Kruger, HS, Venter, CS, Steyn, HS Jr. A standardised physical activity questionnaire for a population in transition: the THUSA study. African Journal for Physical Health Education 2000; 6(1): 54–64.Google Scholar
12Goldberg, DP, Hillier, VF. A scaled version of the General Health Questionnaire. Psychological Medicine 1979; 9(1): 139–45.CrossRefGoogle ScholarPubMed
13Kammann, NR, Flett, R. Affectometer 2: a scale to measure current level of general happiness. Australian Journal of Psychology 1983; 35: 259–65.CrossRefGoogle Scholar
14Antonovsky, A. Unravelling the Mystery of Health: How People Manage Stress and Stay Well. San Francisco, CA: Jossey-Bass, 1987.Google Scholar
15Diener, E, Emmons, RA, Larson, RJ, Griffen, S. The satisfaction with life scale. Journal of Personality Assessment 1985; 49: 71–5.Google Scholar
16Carver, CS, Scheier, MF, Weintraub, JK. Assessing coping strategies: a theoretically based approach. Journal of Personality and Social Psychology 1989; 56(2): 267–83.CrossRefGoogle ScholarPubMed
17Hobfoll, SE, Dunahoo, CL, Monier, J. Preliminary Test Manual: Strategic Approach to Coping (SACS). Kent, OH: Applied Psychology Center, Kent State University, 1994/5.Google Scholar
18Costa, PT, McCrae, RR. NEO PI-R: Professional Manual. Odessa, FL: Psychological Assessment Resources, 1992.Google Scholar
19Buss, AH, Durkee, A. An inventory for assessing different kinds of hostility. Journal of Consulting Psychology 1957; 21(4): 343–8.CrossRefGoogle ScholarPubMed
20Cohen, S, Kamarck, T, Mermelstein, R. A global measure of perceived stress. Journal of Health and Social Behavior 1983; 24(4): 385–96.Google Scholar
21Procidano, ME, Heller, K. Measures of perceived social support from friends and from family: three validation studies. American Journal of Community Psychology 1983; 11(1): 1–24.Google Scholar
22Landrine, H, Klonoff, EA. The African American Acculturation Scale: development reliability and validity. Journal of Black Psychology 1994; 20: 104–27.CrossRefGoogle Scholar
23Triandis, HC, Botempo, R, Betancourt, H, Bond, M, Leung, K, Brenes, A, et al. The measurement of the ethic aspects of individualism and collectivism across cultures. Australian Journal of Psychology 1986; 38: 257–67.Google Scholar
24Lemke, S, Vorster, HH, Jansen Van Rensburg, NS, Ziche, J. Empowered women, social networks and the contribution of qualitative research: broadening our understanding of underlying causes for food and nutrition insecurity. Public Health Nutrition 2003; 6(8): 759–64.Google Scholar
25Burger, HM. Changes in risk factors of breast cancer in African women during urbanisation. MSc dissertation, Potchefstroom University for Christian Higher Education, South Africa, 1998.Google Scholar
26Nell, TA. Changes in dietary risk factors of colon cancer in Africans during urbanisation. MSc dissertation, Potchefstroom University for Christian Higher Education, South Africa, 1998.Google Scholar
27Vorster, HH Jr, Venter, CS, Kruger, MC, Vorster, HH, Kruger, HS. The impact of urbanisation on risk factors for osteoporosis in postmenopausal black South African women. Journal of Endocrinology, Metabolism and Diabetes of South Africa 2002; 7(3): 92–9.Google Scholar
28MacIntyre, UE, Kruger, HS, Venter, CS, Vorster, HH. Dietary intakes of an African population in different stages of transition in the North West Province, South Africa: the THUSA study. Nutrition Research 2002; 22: 239–56.Google Scholar
29Van Rooyen, JM, Kruger, HS, Huisman, HW, Wissing, MP, Margetts, BM, Venter, CS, et al. An epidemiological study of hypertension and its determinants in a population in transition: the THUSA study. Journal of Human Hypertension 2000; 14(12): 779–87.CrossRefGoogle Scholar
30Kruger, HS, Kruger, A, Vorster, HH, Jooste, PL, Wolmarans, P. Urbanization of Africans in the North West Province is associated with better micronutrient status: the Transition and Health during Urbanization Study in South Africa. Nutrition Research 2005; 25: 365–75.CrossRefGoogle Scholar
31Oosthuizen, W, Vorster, HH, Kruger, A, Venter, CS, Kruger, HS, De Ridder, JH. Impact of urbanisation on serum lipid profiles – the THUSA survey. South African Medical Journal 2002; 92(9): 723–8.Google ScholarPubMed
32James, S, Vorster, HH, Venter, CS. Nutritional status influences plasma fibrinogen concentration: evidence from the THUSA survey. Thrombosis Research 2000; 98(5): 383–94.Google Scholar
33Vorster, HH, Cummings, JH, Veldman, FJ. Diet and haemostasis: time for nutrition science to get more involved. British Journal of Nutrition 1997; 77(5): 671–84.CrossRefGoogle ScholarPubMed
34Drenowski, A, Popkin, BM. The nutrition transition: trends in the global diet. Nutrition Reviews 1997; 55(2): 31–43.Google Scholar
35Vorster, HH, Oosthuizen, W, Jerling, JC, Veldman, FJ, Burger, HM. Nutritional Status of South Africans. A Review of the Literature from 1975–1996. Durban: Health Systems Trust, 1997; 122pp.Google Scholar
36Steyn, K, Fourie, J, Lombard, C, Katzenellenbogen, J, Bourne, L, Jooste, P. Hypertension in the black community of the Cape Peninsula, South Africa. East African Medical Journal 1996; 73(11): 758–63.Google Scholar
37Wyndham, CH. Mortality from cardiovascular diseases in the various population groups in the Republic of South Africa. South African Medical Journal 1979; 56(24): 1023–30.Google ScholarPubMed
38Mollentze, WF, Moore, A, Oosthuizen, GM. The prevalence of diabetes mellitus in two South African black populations [abstract]. Diabetologia. 1992;35(Suppl. 1). S11.Google Scholar
39Kruger, HS, Venter, CS, Vorster, HH. Obesity in African women in the North West Province, South Africa, is associated with an increased risk of non-communicable diseases: the THUSA study. British Journal of Nutrition 2001; 86(6): 733–40.Google Scholar
40Kruger, HS, Venter, CS, Vorster, HH, Margetts, BM. Physical activity is the major determinant of obesity in black women in the North West Province, South Africa: the THUSA study. Nutrition 2002; 18(5): 422–7.CrossRefGoogle ScholarPubMed
41Kruger, HS, Venter, CS, Vorster, HH. Physical inactivity as a risk factor for cardiovascular disease in communities undergoing rural to urban transition: the THUSA study. Cardiovascular Journal of South Africa 2003; 14(1): 16–23.Google ScholarPubMed
42Phometsi, M, Kruger, A, Van't Riet, H. Nutrition knowledge and barriers to dietary practices among school children in a farming community – FLAGH programme. Development South Africa 2005; in press.Google Scholar
43Mukuddem-Petersen, J, Kruger, HS. Association between stunting and overweight among 10–15 year old children in the North West Province of South Africa: the THUSA BANA study. International Journal of Obesity and Related Metabolic Disorders 2004; 28(7): 842–51.Google Scholar
44Kruger, HS, De Ridder, JH, Underhay, C. Prediction of body fat based on skinfold thickness provides satisfactory estimates of body fat percentage in grade 8 black children [abstract]. Presented at International Association for the Study of Obesity: First Regional Congress, Sun City, South Africa, 28–31 October 2004.Google Scholar
45Schutte, AE, Kruger, HS, Wissing, MP, Underhay, C, Vorster, HH. The emergence of the metabolic syndrome in urban obese African women: the POWIRS study. South African Journal of Science 2005; 101: 61–7.Google Scholar
46Kruger, HS. Pregnancy outcomes of overweight and normal weight women in a South African outpatient clinic. Journal of Human Ecology 2005; 13: 61–8.Google Scholar