CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 5, June 2012
250
AFRICA
insulin resistance and obesity.
33
Fruit and vegetables provide alternative sources of
carbohydrates and contain many cardioprotective nutrients,
41
including potassium (lowers blood pressure), folate (reduces
plasma homocysteine), vitamin C and many polyphenolic
compounds (with antioxidant activities), and soluble fibre
(lowers cholesterol). Green leafy vegetables are also high in
magnesium (associated with a lower CVD risk). The SADG
therefore recommend an intake of five to eight portions (400–
600 g) of fruit and vegetables daily.
41
Black urban Sowetans
with HF however, consumed only around one piece of fruit
and one vegetable serving per day. Poor affordability and
availability probably accounted for this low intake.
41,42
The 1999
South African National Food Consumption Survey indicated
that where household income was less than R12 000 per annum,
few foods were found in the house (maize, salt, white sugar, tea,
fat/oils, white rice and white bread were most common) and
micronutrient intakes were frequently low.
42
This study has several limitations. Firstly, it was a preliminary
investigation, performed in a fairly homogeneous group of HF
patients. The study was unable to explore the effects of gender
roles (women in Soweto still buy and prepare most of the food),
effects of differences in average household income, and seasonal
variance or the availability of food. These factors limit the
extrapolation of these data to other patient populations. It would
be of interest in further studies to explore the effects of the media
on exposure to Western processed foods, as well as barriers to
knowledge on the selection and preparation of healthier foods.
However, data presented here were meticulously collected using
validated tools.
Conclusion
This study found that urbanised black Sowetans with HF
have high salt intakes and a nutrient-poor diet, placing them
at high risk for deteriorating cardiac function and a premature
death. Many poor households remain food insecure, which
limits their ability to improve their food choices and their
overall management, with potentially life-saving consequences.
Nutritional education should therefore focus on foods that are
varied, available, affordable, culturally acceptable and popular,
as well as consistent with the low-salt, low-fat, high-fibre
guidelines.
43
Home cooking should also be encouraged. By not
adding salt to cooking and not eating processed foods high in
salt, salt intake can be reduced,
35,36
while dietary compliance
can be improved by encouraging use of herbs and spices and by
providing recipes for appealing low-salt foods. Patient education
on reading food labels and recognising high-salt foods should
also be expanded.
Recommendations for future research include, therefore,
sustainable, practical self-management programmes for
black patients with HF living in developing urban areas,
where their socio-economic circumstances often remain poor.
When combined with other aspects of culturally specific
multidisciplinary care, the positive impact of such programmes
is likely to be profound.
The Heart of Soweto registry is supported by unconditional research grants
from Adcock-Ingram, the Medtronic Foundation and Servier. SP is support-
ed by the University of the Witwatersrand and is the recipient of an NIH/Wits
Non-Communicable Diseases Leadership Training award.
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