South African Journal of Clinical Nutrition

The prescription before the procedure

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The gut microbiome and childhood growth: implications for microbiota-directed interventions

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Healthy childhood growth depends on complex interactions between nutrition, metabolism, immune function and the intestinal environment during the first 1 000 days of life. Increasing evidence indicates that the gut microbiome is an active contributor to these processes, providing a biological link between early-life nutrition and growth. While undernutrition has traditionally been attributed to inadequate dietary intake and recurrent infections, disruption of normal gut microbiome development is now recognised as an important factor contributing to growth faltering. Dysbiosis may impair nutrient utilisation, compromise intestinal barrier function, alter immune and endocrine signalling, and contribute to environmental enteric dysfunction (EED), thereby limiting the effectiveness of conventional nutritional rehabilitation. This review synthesises current evidence on the role of the gut microbiome in childhood growth, with particular emphasis on microbiota-directed nutritional interventions during the first 1 000 days of life. The review describes the normal development and metabolic functions of the infant gut microbiome, examines the mechanisms through which dysbiosis contributes to impaired growth, and evaluates established and emerging nutritional strategies that influence the developing microbiome. Breastfeeding and appropriate complementary feeding remain the cornerstone of healthy infant nutrition and are increasingly recognised as the first microbiota-directed nutritional intervention. More recently, microbiota-directed complementary foods have shown promising effects on microbial maturation, restoration of microbial metabolic function and improvements in child growth. By contrast, although prebiotics, probiotics and synbiotics can beneficially modify the gut microbiome, current evidence supporting consistent improvements in childhood growth remains limited. Advances in microbiome research provide a stronger biological basis for established infant and young child feeding recommendations while identifying new opportunities to optimise nutritional rehabilitation. Although microbiota-directed complementary foods represent a promising development, further evidence from well-designed clinical trials conducted in diverse populations is required before these interventions can be incorporated into routine clinical practice. For dietitians and other clinicians, microbiome science provides a biological framework that strengthens and refines evidence-based nutritional strategies to support healthy childhood growth.

Keywords: gut microbiome, childhood growth, microbiota-directed complementary foods, breastfeeding, complementary feeding, undernutrition

Weight regain after bariatric surgery: the role of surgical procedure and dietitian follow-up

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Introduction: Bariatric surgery (BS) is an effective long-term treatment for severe obesity, resulting in substantial weight loss (WL). However, weight regain (WR) is a common physiological response influenced by metabolic adaptation, plus physiological and behavioural factors, and may differ between surgery types. Postoperative dietitian follow-ups are vital for maintaining adherence and minimising WR.
Aim: To compare WR between two BS procedures (sleeve gastrectomy [SG] and Roux-en-Y gastric bypass [RYGBP]) and to evaluate the association between postoperative dietitian follow-up adherence and WR.
Methods: An observational ambispective (retrospective–prospective) analytical cohort study with a 10-year follow-up was conducted in Gauteng, South Africa, from March 2020 to January 2021. Adults (≥ 18 years) who underwent BS (SG or RYGBP) between 2009 and 2018 were included. Data on sociodemographics, anthropometry, and dietitian follow-up attendance were collected from multidisciplinary team retrospective medical records and cross-sectionally through structured telephone interviews (EvaSysTM).
Results: Amongst 100 participants, 70.0% underwent RYGBP. The median age was 48.0 years (yrs) (IQR: 43.0–55.5), with more females (79%, p = 0.047). Median preoperative body mass index (BMI) was 44.8 kg/m² (IQR: 41.5–50.9), and median follow-up duration was 6.9 yrs (IQR: 5.0–8.4); longer in SG (9.0 yrs vs. 6.3 yrs, p = 0.0001). Overall, 63.0% were classified as good responders (≥ 50 percentage excess weight loss [%EWL]), with a higher proportion in RYGBP than in SG (72.9% vs. 40%, p = 0.002). Overall, median %EWL was 59.9%, lower in SG than RYGBP (44.2% vs. 61.6%, p = 0.008). Excess WR (> 15%) occurred in 67.0% of participants by two years post-surgery. Median WR of 23.3% (IQR: 12.6–37.5), beginning at a median of 2.3 yrs (IQR: 1.5–
4.0), with SG showing higher median %WR than RYGBP (32.3% vs. 21.7%, p = 0.032). From the second postoperative year onwards, attendance at dietitian follow-up visits was poor (< 50%).
Conclusion: Approximately two-thirds achieved successful weight loss (≥ 50% EWL), with better outcomes observed following RYGBP compared with SG. However, excessive WR was common, occurring in 67% and beginning at about 2.3 yrs post-surgery. Poor attendance at dietitian follow-up visits was observed.

Keywords: excess weight loss (EWL), obesity, Roux-en-Y gastric bypass (RYGBP), sleeve gastrectomy (SG)

Knowledge attitudes and practices of perioperative nutrition management in gastrointestinal (GIT) surgery in South Africa

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Objective: To assess the knowledge, attitudes and practices (KAPs) of dietitians and surgeons regarding perioperative nutrition management in gastrointestinal surgery.
Design: Descriptive, cross-sectional study using an online questionnaire.
Setting: South Africa.
Subjects: Dietitians (n = 67) and surgeons (n = 35) in South Africa working with patients receiving gastrointestinal surgery.
Outcomes measured: An online questionnaire was developed to investigate the KAPs of dietitians and surgeons. The recommended surgical nutrition guidelines were the foundation for the knowledge questions. Open-ended questions were used for practices while attitudes were assessed via a 4-point Likert scale.
Results: Dietitians had a mean knowledge score of 57.6% (SD 1.68) with surgeons having a mean knowledge score of 64.4% (SD 1.27). Dietitians and surgeons typically fasted their patients from solids preoperatively at a mean of 7.5 hours (SD 4.33) and 6 hours (SD 0), respectively. Both groups delayed reinitiating nutrition postoperatively; dietitians by 8.3 hours (SD 11.6) and surgeons by 9 hours (SD 10.2). Regarding knowledge of reinitiating nutrition, a significant difference was found between knowledge and practice for dietitians (p = 0.007) and surgeons (p = 0.017). More than half (54.4%) of dietitians receive late referrals while 88.6% of surgeons operate on malnourished patients.
Conclusion: Although surgeons displayed a slightly higher level of knowledge, both healthcare professionals appear committed to ensuring effective nutritional practices, emphasising the vital role of nutrition in improving patient outcomes after surgery. Future efforts should focus on bridging the knowledge gap identified, enhancing training for healthcare
providers, and fostering team-based approaches to pre- and postoperative nutritional care.

Keywords: attitudes, dietitian, gastrointestinal, knowledge, nil per mouth, perioperative, practice, surgeon

Food insecurity and dietary diversity among women of reproductive age in an informal settlement in Tshwane, South Africa

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Objectives: Household food insecurity (HFI) is a public health concern, particularly in informal settlements, where women of reproductive age (WRA) are vulnerable to malnutrition. This study aimed to determine the HFI, dietary diversity and anthropometric status of WRA (18–49 years) residing in an informal settlement in Tshwane, South Africa. Additionally, differences between moderately food-insecure (MFI) and severely food-insecure (SFI) women were determined.
Design: Descriptive, cross-sectional study.
Setting: An informal settlement in Tshwane, South Africa.
Subjects: A convenience sample of WRA (n = 103).
Outcome measures: HFI and dietary diversity were assessed using the Household Food Insecurity Access Scale (HFIAS) and the Minimum Dietary Diversity for Women (MDD-W) tool, respectively. Anthropometric measurements were recorded, including mid-upper-arm circumference, height and weight.
Results: The median age of the participants was 30 (23.0–37.0) years, with a mean HFIAS of 14.0 (10.0–18.0). Most women were either moderately (17.5%) or severely (75.7%) food insecure. The median MDD score was 3.0 (2.0–4.0), and only 20.4% of study participants met the minimum dietary diversity criterion. A significant difference between MFI and SFI women was observed only in the consumption of the pulse food group (33.3% vs. 14.1%; p = 0.002). High rates of overweight (36.9%) and obesity (30.1%) were recorded in the study population, with no significant differences between MFI and SFI groups.
Conclusion: Most WRA in this informal settlement were SFI, overweight or obese and exhibited low dietary diversity, underscoring the importance of further research to identify strategies that improve access to affordable, diverse diets for households living in poverty.

Keywords: dietary diversity, food insecurity, informal settlements, overweight and obesity, women of reproductive age

Exploring the Saudi population’s knowledge of and attitude to food allergies: cross-sectional study

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Objectives: Food allergies are a serious health condition involving an abnormal immune response to specific food allergens, leading to adverse reactions upon exposure. This study aimed to assess the level of knowledge and awareness of food allergies among the Saudi population by exploring various related topics.
Design: Data were collected via a bilingual (Arabic and English) online survey. The study enrolled 11 790 healthy adult participants; individuals who did not provide consent, those with allergies, and caregivers for allergy sufferers were excluded. The questionnaire, adapted from a previously validated survey, gathered demographic information and assessed
knowledge of and attitudes towards food allergies. Statistical analysis was performed using IBM SPSS Statistics, and ethical guidelines were adhered to.
Results: All 11 790 participants completed the survey. The majority of respondents were female (77.8%) and of Saudi nationality (94.2%). Geographically, the highest participation rate was from the Western region (32.9%), while the lowest was from the Southern region (8.5%). Over half of the participants held a bachelor’s degree (62.8%). Knowledge levels varied across
different domains, with the highest scores observed in areas related to symptoms/severity and definition/diagnosis.
Conclusions: Enhancing public knowledge of food allergies is crucial, particularly concerning treatment options, management strategies, differentiating allergies from intolerances, and identifying risk factors. Therefore, implementing targeted educational programmes holds significant potential for improving overall public understanding and management of food allergies.

Keywords: Food allergy, Saudi population, Knowledge, Attitudes, Beliefs

Effect of egg powder-fortified Tom Brown on nutritional and academic performance among school-aged children in Wa Municipality, Ghana: a parallel-group randomised controlled trial

2026-09-09T18:12:38+00:00

Objective: This study investigated the impact of egg powder-fortified Tom Brown on classroom scores among resource-poor school-aged children aged between 5 and 12 years in the Wa Municipality, Ghana.
Design: A 24-week parallel-group randomised controlled trial was conducted with 136 primary school children from low-income communities. Participants were individually randomised within schools into intervention (n = 68) and control (n = 68) arms.
Setting: Wa Municipality, Ghana.
Participants: School-aged children in primary four in public primary schools in Wa Municipality.
Intervention and outcome measures: The intervention group received egg powder-fortified Tom Brown three times per week, while controls received the standard porridge. Academic performance was assessed pre/post-intervention using Ghana Education Service validated standardised tests in English and mathematics using linear mixed-effects models (LMM) to analyse scores, controlling for time, treatment, their interaction (fixed effects) and school-level clustering (random effects).
Results: The intervention group demonstrated significant improvement in test scores. English scores increased by 19.3 points at endline (vs. 3.8-point gain in controls; Time × Treatment interaction: b = 15.46, p < 0.001). Mathematics scores also improved by 18.8 points (41.5% improvement; interaction: b = 19.91, p < 0.001), while controls declined marginally. Baseline equivalence confirmed successful randomisation (English: p = 0.935 and mathematics: p = 0.715). Between-school heterogeneity was moderate with a variance partition coefficient of 9.6–10.7%.
Conclusion: Fortifying Tom Brown with egg powder is an effective and potentially scalable intervention to boost academic scores among Ghanaian schoolchildren. Integrating it into national programmes could help combat malnutrition and advance educational achievement in children.
Trial design: Parallel-group randomised controlled trial (allocation ratio 1:1)
Trial registration: Pan African Clinical Trial Registry, pactr.samrc.ac.za, identifier: PACTR202408897182810.

Keywords: school feeding, egg fortification, academic performance, malnutrition, Ghana, linear mixed-effects model

Anthropometric, lifestyle, dietary and diabetic status of Yemeni women with polyendocrine metabolic ovarian syndrome in Taiz City: a cross-sectional study

2026-09-09T18:12:39+00:00

Objective: Exploration of risk factors for polyendocrine metabolic ovarian syndrome (PMOS) across various populations has identified obesity, poor dietary habits, and absence of physical activity as key contributing factors. This study aimed to assess the anthropometric measurements, lifestyle, dietary habits, and diabetic status of Yemeni women with PMOS in Taiz City.
Methods: A cross-sectional study was conducted to collect anthropometric measurements, lifestyle factors, dietary habits, and diabetic status among 151 women with PMOS in Taiz City, Yemen. Data were collected using a structured questionnaire between March and August 2022.
Results: The most prevalent symptoms among participants were menstrual irregularities (66.2%), mood disorders (83.4%), dysmenorrhea (74.2%), and androgenic alopecia (72.8%) (p < 0.0001). The prevalence of type 2 diabetes was 45.7%, whereas high glucose levels were present in only one participant. The main finding of the anthropometric measurements was the high prevalence of overweight (45%) and obesity (13.3%). In contrast to the hypothetical equal frequency of healthy diet and physical activity categories, there were higher observed frequencies of no adherence to a healthy diet (73.5%) and absence of physical activities (76.2%) in participants, which was statistically significant (p < 0.0001). Dietary analysis revealed high daily consumption of white flour (90.1%), sugar (49%, 1–5 teaspoons), low intake of fruits (61.6%, 2–3 times/week), dairy products (44.4%, 2–3 times/week), and water (49%, one litre daily). Postprandial blood glucose exhibited hyperglycaemia in only 0.7%, which indicates good control with antidiabetic medications.
Conclusions: The study shows that Yemeni women with PMOS often have a high body mass index, an absence of physical activity, and an unhealthy diet, which is further complicated by a high incidence of diabetic status. The frequent manifestations of menstrual irregularities, dysmenorrhea, mood disorders, and androgenic alopecia can be alleviated by adopting a healthy lifestyle involving dietary changes and exercise.

Keywords: anthropometry, blood glucose, dietary, lifestyle, polyendocrine metabolic ovarian syndrome, Yemen

Phased nutritional management and growth recovery following surgical necrotising enterocolitis in a preterm infant: a case report

2026-09-09T18:12:39+00:00

Introduction: Necrotising enterocolitis (NEC) remains a leading cause of morbidity and mortality among preterm infants. Nutritional management is central to survival and recovery, but is complicated by bowel rest, surgical resections and malabsorption.
Case presentation: A male infant born at 29 weeks’ gestation (birthweight 1 150 g) developed Bell’s stage IIB NEC on day 20 of life. He required prolonged parenteral nutrition (PN) and ileal resection with ileostomy, preserving 130 cm of small bowel. PN was continued postoperatively with cautious trophic expressed breast milk (EBM) feeds. Enteral nutrition was advanced
gradually, later including semi-elemental formulas to manage malabsorption and high stoma output. Stoma reversal occurred on day 82, and full enteral autonomy was achieved by day 93. Despite severe growth restriction (< −3 z-score) on discharge, the infant demonstrated improved growth velocity (18 g/kg/day) following stoma reversal.
Discussion: This case illustrates phased nutritional management following surgical NEC. PN provided metabolic stability, while
early cautious enteral feeding promoted intestinal adaptation.

Keywords: necrotising enterocolitis, surgery, preterm infants, nutritional management

Activity 196

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Activity 196 available as a downloable pdf.

Activity 197

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Activity 197 available as a downloable pdf.

Please visit https://www.mpconsulting.co.za/courses to complete this activity for CEUs.

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