Anthropometric profile and food consumption patterns of an emerging middle income community in Umlazi

Abstract

Introduction: The nutrition transition is a global phenomenon affected by developing economic prosperity. ‘Nutrition transition’ may be defined as changes in dietary patterns and nutrient intakes occurring in individuals, families, groups of people or whole populations when the food environment and other circumstances change. Post-1994 democratic elections in South Africa, economic laws called for the de-racialization of the economy. As a result of the annulment of the apartheid laws in the 1990s entrepreneurial opportunities became available for black people.

Based on the 2011 Census, the middle class constituted 8.3 million (17%) out of the 51 million population in South Africa. Blacks made up 51%, whites 34%, coloureds 9% and Indians 6%. This is a vast difference from two decades prior to this when blacks made up only 3.3% of the population, with coloureds making up 9.1% and Indians 18.5%.

In a number of Sub-Saharan African studies obesity has been shown to have a significant link to socio-economic status determined by access to water and electricity, smaller numbers of members residing in one household and increased amounts of money spent on food among other factors, which all promote a tendency to leading a more Westernised lifestyle. The main objective of the study was to determine the anthropometric status and analyse the food consumption of a community of emerging middle income status in Umlazi Township (Ward 84) outside Durban in the province of KwaZulu-Natal.

Methods: This study had a sample size of n=250 adult men (n=56) and women (n=194) who were heads of households or primary caregivers above the age of 19 years old with households receiving a total household income of more than R100 000.00 per annum/ more than R8000.00 per month. The study was quantitative and descriptive in nature with different tools used to measure the sample population. These included waist circumference and height and weight measurement to determine BMI and WHtR. A socio-demographic questionnaire was completed where the multi-dimensional poverty index (MPI) was established; a food frequency questionnaire (FFQ) and three 24-hour food recall were also administered to all participants; one weekend day recall and two weekday recalls. Data were analysed on SPSS and nutrient analysis done through Food Finder Version 3 Software and compared to the World Health Organisation standards recommendations for optimal health.

Results: The mean age of the group was 52 years old. Slightly more than half (51.6%; n=129) of the population was unemployed. Retired participants made up 27.2% (n=68) of the population. The majority (80%) of the households indicated that between one to three members contributed to the total household income. The MPI of the Ward 84 community amounted to 9.09. The prevalence of obesity was 37.59% (n=21) among men and 76.80% (n=149) for women. Women had a higher prevalence of risk factors linked to non-communicable diseases than men. Mineral and fat soluble vitamin intake was deficient; however protein and carbohydrates were consumed in excess with means of 187.70% and 111.43% respectively. Top 20 foods consumed lists indicated that little fruit or vegetables were consumed. The average food variety score was medium indicating the consumption of between >30 but <60 different foods across the total population. A positive relationship of statistical significance was found between food variety score and income (p=0.007).

Conclusion: The Ward 84 community consisted of an ageing population with households mostly supported by another member’s income from within or outside the household. The adults had sufficient education to have secured promotions in the employment arena and could afford a lifestyle similar to that of those who had always been more privileged. Although the Umlazi residents benefited from good housing and infrastructure and appeared to have averted poverty, the prevalence of overnutrition malnutrition was high and linked with an excessive intake of macronutrients.

Majority (70%) of the community of Ward 84 is ‘food secure’ as indicated by the number of participants’ households indicating never having a shortage of money to buy food. This correlates negatively with the high prevalence of overweight and obesity (BMI) (p=-0.029). According to literature a persistent issue in black communities is the acceptance of an overweight body image being perceived as ‘healthy’ and an indicator of affluence.

This community appears to be in the 4th stage/ pattern of the nutrition transition. It appears that a ‘westernised diet’ and lifestyle is more accessible and is embraced by this urban community as described in various literature and seen in the top 20 foods lists compiled from the 24 hour recalls. There is some oversight regarding the nutrient quality of a varied diet and achieving energy balance with macronutrient intake linked to informed nutritional choices. Suggested interventions could include the dissemination of information regarding nutrition and practical suggestions to achieve energy balance. In addition, future research could investigate the prospects of introducing participation in urban agriculture, investigate the issue of physical activity, and foster an environment for more physical activity and increase availability and access to micronutrient dense foods and investigate the development of a body mass index specifically for the black African population.