CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 5, June 2012
AFRICA
245
Cardiovascular Topics
Feeding the emergence of advanced heart disease in
Soweto: a nutritional survey of black African patients
with heart failure
SANDRA PRETORIUS, KAREN SLIWA, VERENA RUF, KAREN WALKER, SIMON STEWART
Summary
Aim:
To describe dietary habits and potential nutritional
deficiencies in black African patients diagnosed with heart
failure (HF).
Methods and Results:
Dietary intake in 50 consecutively
consenting HF patients (mean age: 47
±
18 years, 54%
female) attending a major hospital in Soweto, South Africa
were surveyed using validated quantitative food frequency
questionnaires. Food intakes, translated into nutrient data
were compared with recommended values. In women, food
choices likely to negatively impact on heart health included
added sugar [consumed by 75%: median daily intake
(interquartile range) 16 g (10–20)], sweet drinks [54%:
310 ml (85–400)] and salted snacks [61%: 15 g (2–17)].
Corresponding figures for men were added sugar [74%: 15
g (10–15)], sweet drinks [65%: 439 ml (71–670)] and salted
snacks [74%: 15 g (4–22)]. The womens’ intake of calcium,
vitamin C and vitamin E was only 66, 37 and 40% of the
age-specific requirement, respectively. For men, equivalent
figures were 66, 87 and 67%. Mean sodium intake was 2 372
g/day for men and 1 972 g/day for women, 470 and 294%
respectively, of recommended consumption levels.
Conclusions:
The nutritional status of black African patients
with HF could be improved by recommending healthier
food choices and by reducing the intake of sweet drinks and
excess salt.
Keywords:
heart failure, Africa, food preferences, malnutrition,
salt
Submitted 17/9/10, accepted 21/5/11
Cardiovasc J Afr
2012;
23
: 245–251
DOI: 10.5830/CVJA-2011-021
Heart failure (HF) has become a major public health problem in
that, unlike other cardiovascular diseases, the number of people
discharged from hospital with a diagnosis of HF is increasing.
1
In developed countries, HF can be observed in 2 to 3% of the
population and asymptomatic ventricular dysfunction is evident
in about 4% of the population.
2
This will increase with age,
and in the 70- to 80-year age group, HF can be observed in
between 10 and 20% of people.
2,3
The epidemic of cardiovascular
disease (CVD) has probably stabilised in developed countries,
but developing countries are increasingly suffering from the
emerging burden of CVD.
4
As populations in South Africa and sub-Saharan Africa
undergo economic development, the disease profile shifts
and CVD becomes a growing cause of death and disability.
5
Previously considered a rarity inAfrica and predominantly caused
by infectious disease or idiopathic dilated cardiomyopathy,
6
the
syndrome of heart failure (HF) has emerged as a challenging
public health problem in sub-Saharan Africa.
7
The Heart of Soweto (HOS) study
8
has documented a much
higher-than-expected burden of modifiable risk factors
9
and
advanced forms of heart disease
10
linked to epidemiological
transition in one of Africa’s largest urban concentrations of
black Africans. Data from the HOS study showed that during
the period from 2006 to 2008, of the 5 328
de novo
cases
captured with heart disease, 2 505 (47%) of these cases presented
with chronic heart failure.
11,12
Ominously, in addition to the
‘traditional’ causes of HF in Africa, such as idiopathic dilated
cardiomyopathy, rheumatic fever, HIV-related cardiomyopathy,
peripartum cardiomyopathy and hypertensive heart failure,
‘lifestyle’ factors, including hypertension, obesity, dyslipidaemia
and type 2 diabetes mellitis (particularly in women), appear to
have expanded the pathways to, and burden of, HF in this
community.
8
Although the natural history of HF in Africa is still different
from that of high-income countries, it results in the same high
level of preventable morbidity and premature mortality.
13,14
In those countries already in the midst of an epidemic of
HF, multidisciplinary management programmes targeting
the common factors leading to clinical instability have been
successfully developed.
15-17
Certain positive measures have been
implemented in low- and middle-income countries for disease
prevention, including WHO initiatives.
5
However, inadequate
funding hinders efforts to establish adequate multidisciplinary
management programmes targeting the common factors leading
to heart disease in South Africa.
5
Moreover, the role of dieticians
Soweto Cardiovascular Research Unit, Department of
Cardiology, Chris Hani Baragwanath Hospital, University of
the Witwatersrand, Johannesburg, South Africa
Sandra Pretorius, RD (SA),
Karen Sliwa, MD, PhD, FESC
Verena Ruf, MD
Baker IDI Heart and Diabetes Institute and Monash
University, Melbourne, Australia
Karen Walker, PhD, MND (APD)
Monash University, Melbourne, Australia
Simon Stewart, PhD, FCSANZ, NFESC, FAHA
