CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 5, June 2012
248
AFRICA
57% of women and 43% of men. Women, but few men also
reported eating stock cubes, 18% and 4% respectively, possibly
since the women were more aware that they were added during
food preparation. Conversely, more men than women reported
the consumption of takeaway foods, 48 and 32%, respectively.
Salted snacks were eaten by 74% of men and 61% of women,
while more men than women reported adding salt to cooked
food, 91% and 75% respectively. Despite differences in the
proportions of men and women selecting certain foods, the
median daily intake of foods eaten was broadly similar for men
and women. Specific differences included a higher median
intake for men of milk and milk products, and for cakes and
biscuits (both
p
<
0.05).
Median daily nutrient intake in this HF population group
is shown in Table 3. Although men consumed a significantly
greater quantity of protein (
p
<
0.05), protein as a percentage
of energy was similar (around 13%E) for both men and
women. Both men and women consumed high amounts of
carbohydrate (47–52%E). Although added sugar intake was
low (
<
10%E), fibre intake was moderately low, suggesting
that many carbohydrate foods eaten came from refined sources,
rather than from wholegrain cereals, as recommended. Both
women and men consumed
<
30%E from fat. Consumption
of saturated fat and trans fat was significantly lower in women
than men (
p
<
0.05,
p
=
0.001, respectively). Four men (18%)
consumed alcohol, with one reporting consumption equivalent to
27 g per day. Only one woman (3.5%) drank alcohol.
Table 4 indicates mean daily micronutrient intake for men
and women. In men, the mean intake of calcium and magnesium
and of vitamins C, D, E and folate was inadequate. Mean intakes
of these nutrients were also inadequate in women although mean
intakes of vitamin D and magnesium were only marginally low.
The mean intake of iron in women was only 50% of the level
recommended, while mean intakes of riboflavin, vitamin B
6
,
pantothenate and niacin were also moderately low.
Fig. 1 indicates that often over half of this patient group had
inadequate micronutrient consumption, while all the women and
the majority of men consumed excessive amounts of sodium.
Sodium intake was 470% above recommended intake levels in
men and 294% above recommended intake levels in women.
As seen in Fig. 2, most sodium came from bread and processed
foods. In the body, the ratio of sodium (in extracellular fluid) to
potassium (in intracellular fluid) is about 2:3. As seen in Table 4,
the intake of potassium in relation to sodium was too low, due to
the increased consumption of processed food and the inadequate
intake of fruits, vegetables and unrefined cereals.
The likely cost of consuming a healthy diet in Soweto was
calculated based on food prices relative to minimum income
support available in May 2008. Current food intake required
an expenditure of approximately 40% of the current disability
grant, which in 2008 was R940 per month. A recommended food
intake, where maize meal porridge is supplemented with mabella
(coarse), legumes, carrots, spinach, apples, oranges and full-
cream milk would require an expenditure of only 30% of this
benefit and therefore represents an attractive option both from a
financial and health status perspective.
Discussion
The most significant finding is the inadequate nutrient intake
and excessive salt consumption in this high-risk HF patient
cohort. Processed and convenience foods contributed to the
high intake of salt as well as saturated and trans fatty acids.
Low consumption of fruit and vegetables contributed to the
low micronutrient and dietary fibre intake. Overall, the pattern
TABLE 3. ENERGYAND DAILY NUTRIENT INTAKE
OF HF PATIENTS BASED ONA QUANTITATIVE
FOOD FREQUENCY QUESTIONNAIRE
Nutrient
Daily intake [median (interquartile range)]
Men (
n
=
22)
Women (
n
=
28)
Energy (kJ)
9 145 (6 857–12 879) 7 472 (5 568–9 478)
Protein (g)
% plant-derived
% total energy
74.0 (101–62)
42.8
13.8
58.8 (51–66)*
43.5
13.4
Total carbohydrate (g)
% total energy
272 (223–404)
47.6
245 (170–336)
52.5
Starch (g)
17.8 (13–27)
11.0 (8–17)
Dietary fibre (g)
20.6 (14–25)
16.2 (13–23)
Added sugars (g)
40.2 (23–76)
33.1 (19–69)
Total fat (g)
% total energy
65.7 (5–91)
26.6
47.4 (39–81)
23.5
Saturated fat (g)
% total energy
19.9 (16–29)
8.1
15.1 (12–20)*
7.5
Monounsaturated fat (g)
% total energy
22.9 (17–31)
9.3
17.0 (14–26)
8.4
Polyunsaturated fat (g)
% total energy
15.7 (11–22)
6.3
12.7 (9–25)
6.3
Total trans fat (g)
0.94 (0.62–1.8)
0.46 (0.28–0.67)**
Cholesterol (mg)
308 (177–403)
214 (160–307)
Significant difference between men and women, *
p
<
0.05, **
p
=
0.001.
TABLE 4. MICRONUTRIENT INTAKE OF HF PATIENTS IN
RELATION TO RECOMMENDED DIETARY INTAKES
Micronutrient
deficiency
Daily
intake
men
Difference
from DRI
(%)
Daily
intake
women
Difference
from DRI
(%)
Vitamin D (mcg)
4.5
–0.5 (90)
4.7
–0.3 (6)
Vitamin C (mg)
78
–12 (87)
47
–28 (37)
Magnesium (mg)
361
–59 (86)
292
–29 (9)
Vitamin E (mcg)
10
–5 (67)
9
–6 (40)
Calcium (mg)
655 –345 (66)
411
–789 (66)
Folate (mcg)
227 –173 (57)
187
–213 (53)
Iron (mg)
9
–9 (50)
Riboflavin (mg)
1.0
–0.1 (9)
Vitamin B
6
(mg)
1.2
–0.1 (8)
Pantothenate (mg)
4.6
–0.4 (8)
Niacin (mg)
13.4
–0.6 (4)
Potassium (mg)
1938 –0.62 (4)
Adequate intake
Sodium (mg)
2.372
+
1 872 (470) 1 972
+
1 472 (294)
Potassium (mg)
2512
+
0.512 (150)
Vitamin B
12
(mcg)
6.3
+
3.9 (260)
6.1
+
3.7 (254)
Pantothenate (mg)
6.5
+
1.5 (130)
Biotin (mcg)
39
+
9.0 (130)
34
+
4 (13)
Iron (mg)
11
+
3 (125)
Riboflavin (mg)
1.5
+
0.2 (115)
Niacin (mg)
18
+
2.0 (113)
Vitamin B
6
(mg)
1.4
+
0.1 (108)
Thiamine (mg)
1.3
+
0.1 (108)
1.1
0 (0)
Vitamin A (RE) (mcg)
949
+
49 (105)
970
+
270 (39)
