Noakes on children's nutrition, organ meats and the Karoo
Dr Lize van Stuijvenberg and Dr Ali Dhansay, Scientists at the South African Medical Research Council (MRC), Cape Town Letter submitted to the Cape Times (21 July 2014)
The articles (Cape Times 16 and 17 July 2014) by Tanya Farber on sport scientist Professor Tim Noakes' proposed research regarding the promotion of organ meat consumption in the Karoo, refer.
As scientists who have published research conducted on the subject, we are disturbed by certain aspects of the reports. Prof Noakes speaks about a long term project among farm workers and their families in the Karoo. We trust that the results of this ten year project will be valid, since there is no mention of a control group of farm workers on a different diet. It would be unethical to conduct a research study where the design may be seen to be flawed at the outset. We understand, though, that such details were not included in the article. The questions posed, however, do remain.
Of concern is his assumption that these communities do not eat offal. Research conducted by the MRC's Nutritional Intervention Research Unit in the Hantam Karoo showed that between 80 and 90% of the children under five years of age do eat liver. Further, contrary to what Prof Noakes claims, it is the low-income families that eat liver more often. This work was published in an international peer-reviewed journal (Van Stuijvenberg et al., 2012; Nelet al., 2013).
We urge restraint regarding the promotion of unlimited consumption of organ meat. Liver is an exceptionally rich source of vitamin A; too much liver may put young children at risk of vitamin A toxicity. One to two portions of liver per month are enough to meet vitamin A requirements, while eating more than two portions per week will exceed the Upper Intake limit defined by the Institute of Medicine (IOM).
A further concern is the risk of teratogenicity in pregnant women, especially those who consume liver more than once a week. The World Health Organisation warns against excessive intake of vitamin A during pregnancy, and health authorities in countries such as England, Finland and the Netherlands advise pregnant women to limit their intake of liver. Promoting liver intake in the socio-economically vulnerable and uninformed, without warning about the dangers of excess, would be unethical.We urge sport scientist Professor Noakes to exercise (no pun intended) caution when dealing with the complex matter of nutrition, especially childhood nutrition.
References Van Stuijvenberg ME, Schoeman SE, Lombard CJ, Dhansay MA. Serum retinol in 1-6-year-old children from a low socio-economic South African community with a high intake of liver: implications for blanket vitamin A supplementation. Public Health Nutr. 2012 Apr;15(4):716-24. doi: 10.1017/S1368980011002126. Nel J, van Stuijvenberg ME, Schoeman SE, Dhansay MA, Lombard CJ, du Plessis LM. Liver intake in 24-59-month-old children from an impoverished South African community provides enough vitamin A to meet requirements. Public Health Nutr. 2013 Nov 28:1-8.
Lisanne du Plessis, MNutrition, RD/RNT (SA) Senior Lecturer, Community Nutrition, Division of Human Nutrition, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University E-mail: email@example.com
As we draw closer to the target date of the Millennium Development Goals in 2015 and progress to the Sustainable Development Goals beyond this date, NUTRITION will remain part of these goals as it has been unequivocally linked to health, survival and performance. Very prominent in the nutrition component of these goals is the most natural and healthful first foods for babies, BREASTMILK and the act of BREASTFEEDING!
This year's World Breastfeeding Week theme ["Breastfeeding - a winning goal for life!"] asserts the importance of increasing and sustaining the protection, promotion and support of breastfeeding in the post 2015 agenda, and engaging as many groups and people as possible.
The Tshwane Declaration of support for breastfeeding in South Africa states that "promotion, protection and support of breastfeeding requires commitment and action from all stakeholders, including government and legislators, community leaders, traditional leaders and healers, civil society, healthcare workers (HCWs) and managers, researchers, the private sector, employers, the women's sector, the media and every citizen". This declaration recognises the multiple influences at different levels in a mother's environment which can either support or hinder her ability and efforts to optimally feed her children.
HCWs are a major source of infant and young child feeding (IYCF) information to mothers and the crucial link between policy and practice. It has been shown that counselling delivered by trained HCWs is effective in improving exclusive breastfeeding rates. Formula feeding does not provide a safe alternative to breastfeeding in SA, mainly because of poor caregiver knowledge and education, poverty and a lack of resources that result in poor hygiene and suboptimal IYCF practices. There is also a lack of family and community support for breastfeeding; a situation that has led to many mothers opting to formula feed. Other major identified barriers that must be overcome to successfully scale up breastfeeding promotion include the lack of public facilities for breastfeeding, challenges for working mothers, including insufficient maternity leave and facilities at work that are not supportive of breastfeeding.
The winning goals of the 2014 Football World Cup is still fresh in our minds and the theme of World Breastfeeding Week reflects this excitement of hard work and achievement. It is believed that interventions focussed on women of reproductive age, pregnancy and children in the first 2 years of life can turn the tide of the high present and future disease burden caused by malnutrition in these groups. One of the interventions that can aid this achievement is to support, promote and protect breastfeeding. Let's do it!
1. World Alliance for Breastfeeding Action. World Breastfeeding Week. Homepage on the internet. Available at: http://worldbreastfeedingweek.org/ (Accessed on 25 July 2014) 2. Department of Health. The Tshwane Declaration for the Support of Breastfeeding in South Africa. S Afr J Clin Nutr. 2011;24(4):214. 3. Du Plessis LM, Pereira C. Commitment and capacity for the support of breastfeeding in South Africa. S Afr J Clin Nutr. 2013;26(3)(Supplement):S120-S128. 4. Bhutta ZA, Das JK, Rizvi A, Gaffey MF,Walker N, Horton S. et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet 2013;382,452–477.