Relationship between protein deficiency and sarcobesity in older urban black Cape Town populations: a feasibility study of diet interventions

Lead Research Organisation: University of Stirling

Abstract

South Africa is a developing country with an ageing population and increasing prevalence of non-communicable diseases such as type II diabetes, high blood pressure, cardiovascular diseases, obesity etc. South Africa also suffers from a high burden of infectious diseases such as HIV/AIDS and tuberculosis. HIV medications prolong lifespan but HIV infection
speeds up the ageing process to the extent that a typical 50-year-old HIV patient would be considered an old person in need of care. Thus many individuals in South Africa are physically 'older' than their biological age. In the elderly muscle becomes smaller and weaker leading to frailty and decreased quality of life. Older people in these communities are at an increases risk of ill health: HIV infection predisposes to the development of metabolic and cardiovascular disease and with
ageing there is an increased prevalence of metabolic and cardiac diseases such as diabetes and heart disease. The elderly also suffer more from metabolic and cardiac diseases such as type 2 diabetes and heart disease.
A good diet can prevent both infectious disease and 'lifestyle' diseases like type 2 diabetes. Good nutrition, especially protein, is also essential to prevent muscle wasting in the elderly. We know that in South African townships people under 65 do not eat enough protein. This problem is likely to be worse in largely poor older black South Africans who most likely do not eat enough protein. This is due to relatively high costs of protein, typically from animals and diary products. As such,
it is likely that ageing muscle decline and frailty will be accelerated in the elderly, resulting in decreased overall health, reduced mobility, increasing disease rates, economic demands on healthcare systems and premature death. Frailty and lifestyle diseases in older black South Africans could be reduced by a healthy diet, especially adequate protein.
As many older black Cape Town inhabitants have multiple health complications they are regularly attending community healthcare clinics. These clinics provide an opportunity for clinicians and other healthcare professionals to provide information on a healthier diet that includes higher levels of protein. However it's very difficult to give advice because we do
not know what black older South Africans eat or can afford to eat. Complicating this many older South Africans also provide for their grandchildren and may compromise their own dietary needs to feed grandchildren. Thus, before offering advice to
an ageing black urban Cape Town population (aged 65-80), we need to answer several preliminary research questions:
1) What is the feasibility and validity of assessing dietary intake in this population?
2) Are black older South Africans protein deficient?
3) Does a lower protein intake contribute to accelerated ageing and increased frailty and disease?
4) How much can black older individuals afford to spend on food for themselves?
To answer these questions we will employ 2 Xhosa speaking field workers and 1 research assistants to recruit 150 individuals aged 65-80 (male and female) in the Cape Town Township of Khayelitsha over 12 months. We will carry out repeated dietary recall measurements, to assess for reliability and validate against urine measurements that indicate the
amount of protein eaten. We will also carry out laboratory based measurements at the University of Cape Town to assess muscle quality, frailty and risk of developing metabolic disease. Finally, we will use recently developed measurement tools to assess the food budget.
Effects of diet and food security is unexplored in older South Africans. It is anticipated that this study will produce extremely useful data to inform on health requirements, nutrition requirements and financial constraints for black older South Africans.
These data will also be extremely valuable for larger scale studies to assess the health effectiveness of altering diet in this population.

Technical Summary

Low and middle income countries (LMIC) are burdened with increasing non-communicable disease (NCD) against a background of high communicable disease (CD) prevalence. South Africa is no exception with a pre-existing background of e.g. HIV/AIDS and tuberculosis and increasing cardiometabolic disease. CD and NCD interact to increase the rate of ageing. The force of this effect is felt most by older people in South Africa and other LMIC. One contributor to loss of independence in old age is sarcopenia, the loss of muscle strength and mass that occurs in ageing. NCD and sarcopenia are considered diseases of ageing. It is well known that adequate nutrition can moderate both sarcopenia and NCD as well as protect against infection. Public health advice on proper nutrition could therefore make a large difference to health in LMIC just as such it did in developed nations in the early 20th century. To develop and disseminate advice policy makers need data on current dietary habits. We already know that 18-64 year old black South Africans are protein deficient. Older black South Africans are also likely protein deficient but the diet patterns and macronutrient intake of this population are unexplored. In this project, we will gather preliminary data on the dietary patterns and nutritional intake of older black South Africans. We will examine whether older black South Africans are protein deficient and how this relates to the prevalence of sarcopenia and both CD and NCD in this population. Finally, we will assess how economic restraints on nutrition might compromise the usefulness of nutritional advice for older black South Africans. Our aim is to generate data that can be used by individuals, communities and policy makers to provide nutritional advice which has a positive effect on the health and quality of life of older people in LMIC.
 
Description Household diet and health in South African Townships
Amount £10,000 (GBP)
Organisation University of Stirling 
Sector Academic/University
Country United Kingdom
Start 03/2020 
End 07/2020
 
Title Challenge to existing sarcopenia cut points 
Description Our data will challenge the existing cut point guidance for sarcopenia as our cohort demonstrated high functionality despite reduced skeletal muscle mass 
Type Of Material Physiological assessment or outcome measure 
Year Produced 2020 
Provided To Others? No  
Impact It is too premature to have any impact as we are preparing the relevant manuscript publication 
 
Title Cross sectional study on health and nutritional patters of older South Africa 
Description Cardiometabolic risk factors, dietary intake and food procurement 
Type Of Material Database/Collection of data 
Year Produced 2019 
Provided To Others? No  
Impact None as the manuscripts are yet to be submitted 
 
Description South African Township Nutrition Research Group 
Organisation Medical Research Council of South Africa (MRC)
Country South Africa 
Sector Public 
PI Contribution We have managed and driven the research project from Stirling and acted from feedback, on the ground, from our SA partners to successfully deliver the project.
Collaborator Contribution Our partners have managed and developed good relationships with township communities that enabled effective data collection. Importantly, these relationships will stand us in good stead for future research projects using this population.
Impact Outputs listed under publication section The collaboration is multidisciplinary: 1) physiology 2) nutrition 3) medical (gerontology) 4) health economics
Start Year 2017
 
Description South African Township Nutrition Research Group 
Organisation University of Cape Town
Department Faculty of Health Sciences
Country South Africa 
Sector Academic/University 
PI Contribution We have managed and driven the research project from Stirling and acted from feedback, on the ground, from our SA partners to successfully deliver the project.
Collaborator Contribution Our partners have managed and developed good relationships with township communities that enabled effective data collection. Importantly, these relationships will stand us in good stead for future research projects using this population.
Impact Outputs listed under publication section The collaboration is multidisciplinary: 1) physiology 2) nutrition 3) medical (gerontology) 4) health economics
Start Year 2017
 
Description South African Township Nutrition Research Group 
Organisation University of Copenhagen
Country Denmark 
Sector Academic/University 
PI Contribution We have managed and driven the research project from Stirling and acted from feedback, on the ground, from our SA partners to successfully deliver the project.
Collaborator Contribution Our partners have managed and developed good relationships with township communities that enabled effective data collection. Importantly, these relationships will stand us in good stead for future research projects using this population.
Impact Outputs listed under publication section The collaboration is multidisciplinary: 1) physiology 2) nutrition 3) medical (gerontology) 4) health economics
Start Year 2017
 
Description South African Township Nutrition Research Group 
Organisation University of Stellenbosch
Country South Africa 
Sector Academic/University 
PI Contribution We have managed and driven the research project from Stirling and acted from feedback, on the ground, from our SA partners to successfully deliver the project.
Collaborator Contribution Our partners have managed and developed good relationships with township communities that enabled effective data collection. Importantly, these relationships will stand us in good stead for future research projects using this population.
Impact Outputs listed under publication section The collaboration is multidisciplinary: 1) physiology 2) nutrition 3) medical (gerontology) 4) health economics
Start Year 2017
 
Description South African Township Nutrition Research Group 
Organisation University of the Witwatersrand
Country South Africa 
Sector Academic/University 
PI Contribution We have managed and driven the research project from Stirling and acted from feedback, on the ground, from our SA partners to successfully deliver the project.
Collaborator Contribution Our partners have managed and developed good relationships with township communities that enabled effective data collection. Importantly, these relationships will stand us in good stead for future research projects using this population.
Impact Outputs listed under publication section The collaboration is multidisciplinary: 1) physiology 2) nutrition 3) medical (gerontology) 4) health economics
Start Year 2017
 
Description Township presentation of findings held in church community hall 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact To present the research findings to the community but too also elaborate into an educational session about diet and health
Year(s) Of Engagement Activity 2019