Total and Partial Starvation

**8**

*Nutrition in Health and Disease - Our Challenges Now and Forthcoming Time* 

Afferentation and the Gastrointestinal Tract: From Bench to Bedside. Rijeka: InTech Open Science/Open minds; 2014. DOI: 10.5772/57289. (ISBN

[11] Gy M, editor. Introductory chapter: the general problems of human clinical nutritional and pharmacological observation of capsaicin in human beings and patients. In: Capsaicin and its Human Therapeutic Development. London: InTech Open; 2018. pp. 3-9. DOI: 10.5772/intechopen.73124 (Print ISBN 978-1-78923-520-3; Online ISBN

978-953-51-1631-8)

978-1-78923-521-0)

[12] Mózsik G, Figler M. Metabolic Ward in Human Clinical Nutrition and Dietetics. Kerala: Research Signpost;

2005. ISBN 81-308-0035-7

**References**

A (III) 25. 1. §

Melania; 1998

[1] UN. The Universal Declaration of Human Rights. 10th December 1948. 217

[2] UN. Declaration on Social Progress and Development. General Assembly resolution. 2542 (XXIV) of 11 December 1969. Part II, 10b

[3] Cor Unum Papal Council Starvation in the world. Challenge for all of us: Solidarity Development

(Éhezés a világban. Kihívás

mindannyiunk számára: a szolidáris fejlődés) URL: https://katolikus.hu/ kereses/%C3%A9hez%C3%A9s%20 a%20vil%C3%A1gban (22 July, 2008)

[4] Varga P. Theory and Practice of Clinical Nutrition (A klinikai táplálás elmélete és gyakorlata). Budapest:

[5] Brown P. Culture and the evolution of obesity. Human Nature. 1991;**2**:31-57

[6] Ádány R, editor. Health condition of Hungarian Population in the millennium (A magyar lakosság egészségi állapota az ezredfordulón). Budapest: Medicina; 2003

[7] Kopp M, Csoboth C. Selfharming behaviours among Hungarian population (Önkárosító magatartásformák a magyar népesség körében.). Hungarian Oncology.

[8] WHO. Nutrition for health and development: A Global Agenda for Combating Malnutrition. 2002

From the plant cultivation to the production of the human medical drug. Akadémiai Kiadó, Budapest, 2009

[10] Gy M, OME A-S, Takeuchi K, editors. Capsaicin-Sensitive Neural

(ISBN 978 963 05 8694 8)

[9] Mózsik Gy, Dömötör A, Past T, Vas V, Perjési P, Kuzma M, et al. Capsaicinoids:

2001;**45**(2):139-141

Chapter 2

Abstract

and evaluation.

1. Introduction

and many others [1, 2].

11

Health Status and Permanent Loss

Longitudinal Study Subjects: Rural

Noncommunicable diseases (NCDs) are responsible for two out of three deaths worldwide with their profile changing from one country to another. But evidence to sustained these changes are still very limited in rural South African population. The well-characterized Ellisras Longitudinal Study (ELS) provides a unique

opportunity of mapping some of these changes in vulnerable adolescent and young adults. The objective is we determined the extent of NCD risk factors derived from anthropometric and blood pressure measurements affected Ellisras Longitudinal Study (ELS) subjects over time for those who died or permanently lost to

follow-up. A total of 2238 subjects aged 3–10 years (born between 1994 and 1986) were randomly selected to take part of the Ellisras Longitudinal Study (ELS) in November 1996. The attrition rate of ELS subjects based on death ranges between 0.71 and 3.73% for boys and 0.75 and 4.89% for girls. The prevalence of sever undernutrition ranges from 3.2 to 53%, moderate undernutrition ranges from 9.7 to 28.8%, while mild undernutrition ranges from 17.9 to 59.1% for both males and females. The prevalence of undernutrition was high while hypertension, obesity, and overweight were low in the population. The identification of appropriate NCD indicators for mortality in rural South African population needs more consideration

Keywords: mortality, epidemiology, nutritional status, cause of death, lifestyle

Noncommunicable diseases (NCDs) are a group of diseases that share similar risk factors resulting from long exposure to unhealthy diets, smoking, lack of exercise, and possibly stress [1]. Major risk factors are high blood pressure (BP), tobacco addictions, poor lipids profile, and diabetes. These result in high mortality rates due to stroke, heart attacks and nutrition-induced cancers, chronic bronchitis,

Monyeki K. Daniel, Siweya H. James, Kemper C.G. Han

to Follow up of Ellisras

South African Context

and Ramoshaba N. Elfas

#### Chapter 2

## Health Status and Permanent Loss to Follow up of Ellisras Longitudinal Study Subjects: Rural South African Context

Monyeki K. Daniel, Siweya H. James, Kemper C.G. Han and Ramoshaba N. Elfas

#### Abstract

Noncommunicable diseases (NCDs) are responsible for two out of three deaths worldwide with their profile changing from one country to another. But evidence to sustained these changes are still very limited in rural South African population. The well-characterized Ellisras Longitudinal Study (ELS) provides a unique opportunity of mapping some of these changes in vulnerable adolescent and young adults. The objective is we determined the extent of NCD risk factors derived from anthropometric and blood pressure measurements affected Ellisras Longitudinal Study (ELS) subjects over time for those who died or permanently lost to follow-up. A total of 2238 subjects aged 3–10 years (born between 1994 and 1986) were randomly selected to take part of the Ellisras Longitudinal Study (ELS) in November 1996. The attrition rate of ELS subjects based on death ranges between 0.71 and 3.73% for boys and 0.75 and 4.89% for girls. The prevalence of sever undernutrition ranges from 3.2 to 53%, moderate undernutrition ranges from 9.7 to 28.8%, while mild undernutrition ranges from 17.9 to 59.1% for both males and females. The prevalence of undernutrition was high while hypertension, obesity, and overweight were low in the population. The identification of appropriate NCD indicators for mortality in rural South African population needs more consideration and evaluation.

Keywords: mortality, epidemiology, nutritional status, cause of death, lifestyle

#### 1. Introduction

Noncommunicable diseases (NCDs) are a group of diseases that share similar risk factors resulting from long exposure to unhealthy diets, smoking, lack of exercise, and possibly stress [1]. Major risk factors are high blood pressure (BP), tobacco addictions, poor lipids profile, and diabetes. These result in high mortality rates due to stroke, heart attacks and nutrition-induced cancers, chronic bronchitis, and many others [1, 2].

NCDs are responsible for two out of three deaths worldwide with their profile changing from one country to the other [3]. Africa is expected to experience the largest increase in NCD-related mortality globally with about 46% of all mortality expected to be attributed to NCDs by 2030 [3, 4]. Exposure to the known risk factors account for about two-thirds of premature NCD deaths with an estimated half of NCD deaths attributed to weak health systems and poverty in sub-Saharan Africa [5]. However, the rising NCD burden will add great pressure to the overstretched health systems and pose a major challenge to the development in Africa given the fragmented literature information and the indigenous knowledge system deep rooted in rural areas of South Africa [6, 7]. While low-cost solutions and high-impact essential NCD interventions delivered through primary healthcare approach have been shown to have impacts on population level, the existing literature shows that the changing profile of NCDs has been inadequate and fragmented [8]. A well-formulated cohort study in Africa could answer major questions relating to the changing magnitude of NCD risk factor profiles in Africa. Furthermore, NCDs are no longer just an issue for older people, there were in fact 16 million deaths from NCDs in people under the age of 17 years in 2005 of which the World Heart Federation has plan to reduce these deaths by 25% in 2025 [9]. Documenting the profiles of NCDs over time will not only assist the policy makers to get to the bottom of the problem but the population will also be aware of their health status as they grow older. The South African National Development Plan vision of reducing NCDs mortality by 28% in 2030 requires a cohort study that focuses on NCDs from younger ages to older ages. The Ellisras Longitudinal Study and the Birth to Twenty Study are among other cohort studies in South Africa which are geared to achieving this goal [10, 11]. The concepts of relying on indigenous knowledge system to combat NCDs among rural South African population will be replaced by well-researched concepts of NCD profiles from young age to adulthood [7].

In South Africa, NCD such as cardiovascular disease (CVD) is the second leading cause of death after HIV accounting for up to 43% of deaths among adults [12]. The Ellisras Longitudinal Study (ELS) from rural areas of Ellisras in South Africa clearly reported that NCD profiles are changing rapidly over time from childhood to young adults.

The attrition rate for the ELS ranges from 2.4 to 70.3% (Table 1) due to migration to urban areas, illness, pregnancy, and death. However, the attrition rate of ELS subjects based on death ranges between 0.71 and 3.73% for boys and 0.75 and 4.89% for girls. Therefore, the aim of the study was to determine the extent of NCD risk factors derived from anthropometric and blood pressure measurements which affected ELS subjects over time who died or permanently lost to follow-up.

#### 2. Methods

#### 2.1 Geographical area

Ellisras is a deep rural area situated within the north-western area of the Limpopo province, South Africa. The population is about 50,000 residing in 42 settlements [13]. These villages are approximately 70 km from the Ellisras town (23°40S 27°44 W), now known as Lephalale, adjacent to Botswana border. The Iscor coal mine, Matimba and Medupi electricity power stations are the major sources of employment for many of the Ellisras residents, whereas the remaining workforce is involved in subsistence farming and cattle rearing, while the minority is in education and civil services [14, 15].

2.2 Study design and sampling

Table 1.

13

This study is part of the ongoing Ellisras Longitudinal Study (ELS), for which the details of the sampling procedure were reported elsewhere [16]. For the purpose

Period of measurements Males Females Total

Health Status and Permanent Loss to Follow up of Ellisras Longitudinal Study Subjects…

DOI: http://dx.doi.org/10.5772/intechopen.84141

Dropouts 95 7.9 55 5.2 150 6.7

Dropouts 55 4.5 0 0 55 2.4

Drop outs 202 16.8 133 12.6 335 14.9

Dropouts 194 16.2 130 12.3 324 14.4

Dropouts 168 14.0 83 7.9 251 11.1

Dropouts 217 18.1 117 11.1 334 14.8

Dropouts 195 16.2 106 10.1 301 13.3

Dropouts 265 22.1 147 14.0 412 18.3

Dropouts 239 19.9 120 11.4 359 15.9

Dropouts 287 23.9 169 16.0 456 20.2

Dropouts 311 25.9 201 19.1 512 22.7

Dropouts 259 21.6 146 13.9 405 18.0

Dropouts 328 27.3 196 18.6 524 23.2

Dropouts 347 28.9 224 21.3 571 25.3

Dropouts 681 56.7 483 45.8 1164 51.6

Dropouts 845 70.3 652 61.9 1497 66.4

Number and percentages (%) of longitudinal participants and dropouts over the years of measurements.

November 1996 1201 1054 2255 May 1997 1106 969 2075

November 1997 1146 1054 1890

May 1998 999 891 1890

November 1998 1007 894 1901

May 1999 1033 941 1974

November 1999 998 920 1918

May 2000 1006 918 1924

November 2000 936 877 1813

May 2001 962 904 1866

November 2001 914 855 1769

May 2002 890 823 1713

May 2003 942 878 1820

November 2003 911 828 1739

November 2009 854 800 1654

November/December 2013 520 541 1061

November/December 2015 356 372 728

N%N%N%


#### Health Status and Permanent Loss to Follow up of Ellisras Longitudinal Study Subjects… DOI: http://dx.doi.org/10.5772/intechopen.84141

#### Table 1.

NCDs are responsible for two out of three deaths worldwide with their profile changing from one country to the other [3]. Africa is expected to experience the largest increase in NCD-related mortality globally with about 46% of all mortality expected to be attributed to NCDs by 2030 [3, 4]. Exposure to the known risk factors account for about two-thirds of premature NCD deaths with an estimated half of NCD deaths attributed to weak health systems and poverty in sub-Saharan

In South Africa, NCD such as cardiovascular disease (CVD) is the second leading cause of death after HIV accounting for up to 43% of deaths among adults [12]. The Ellisras Longitudinal Study (ELS) from rural areas of Ellisras in South Africa clearly reported that NCD profiles are changing rapidly over time from childhood to young

The attrition rate for the ELS ranges from 2.4 to 70.3% (Table 1) due to migration to urban areas, illness, pregnancy, and death. However, the attrition rate of ELS subjects based on death ranges between 0.71 and 3.73% for boys and 0.75 and 4.89% for girls. Therefore, the aim of the study was to determine the extent of NCD risk factors derived from anthropometric and blood pressure measurements which affected ELS subjects over time who died or permanently lost to follow-up.

Ellisras is a deep rural area situated within the north-western area of the Limpopo province, South Africa. The population is about 50,000 residing in 42 settlements [13]. These villages are approximately 70 km from the Ellisras town (23°40S 27°44 W), now known as Lephalale, adjacent to Botswana border. The Iscor coal mine, Matimba and Medupi electricity power stations are the major sources of employment for many of the Ellisras residents, whereas the remaining workforce is involved in subsistence farming and cattle rearing, while the minority is in educa-

Africa [5]. However, the rising NCD burden will add great pressure to the overstretched health systems and pose a major challenge to the development in Africa given the fragmented literature information and the indigenous knowledge system deep rooted in rural areas of South Africa [6, 7]. While low-cost solutions and high-impact essential NCD interventions delivered through primary healthcare approach have been shown to have impacts on population level, the existing literature shows that the changing profile of NCDs has been inadequate and fragmented [8]. A well-formulated cohort study in Africa could answer major questions relating to the changing magnitude of NCD risk factor profiles in Africa. Furthermore, NCDs are no longer just an issue for older people, there were in fact 16 million deaths from NCDs in people under the age of 17 years in 2005 of which the World Heart Federation has plan to reduce these deaths by 25% in 2025 [9]. Documenting the profiles of NCDs over time will not only assist the policy makers to get to the bottom of the problem but the population will also be aware of their health status as they grow older. The South African National Development Plan vision of reducing NCDs mortality by 28% in 2030 requires a cohort study that focuses on NCDs from younger ages to older ages. The Ellisras Longitudinal Study and the Birth to Twenty Study are among other cohort studies in South Africa which are geared to achieving this goal [10, 11]. The concepts of relying on indigenous knowledge system to combat NCDs among rural South African population will be replaced by well-researched concepts of NCD profiles from young age to

Nutrition in Health and Disease - Our Challenges Now and Forthcoming Time

adulthood [7].

adults.

2. Methods

12

2.1 Geographical area

tion and civil services [14, 15].

Number and percentages (%) of longitudinal participants and dropouts over the years of measurements.

#### 2.2 Study design and sampling

This study is part of the ongoing Ellisras Longitudinal Study (ELS), for which the details of the sampling procedure were reported elsewhere [16]. For the purpose of the current study, only the subjects who died were included in the analysis. The cause of death for the majority of the subjects was unknown as it is a family secret given the indigenous knowledge system followed in the Ellisras rural population [6, 7]. A total of 373 boy and 613 girl subjects aged 8–26 years who were permanently lost to follow-up over time (November 1996–December 2015) (see Tables 2 and 3) were included in the analysis.

#### 2.3 Anthropometry

All participants underwent a series of anthropometric measurements [weight, height, waist circumference, hip circumference, and skinfold thickness (triceps, subscapular, biceps, and supraspinale)] were taken according to the standard procedures recommended by the International Society of the Advancement of Kinanthropometry (ISAK) from November 1996 to December 2015 [17, 18]. The weight was measured on an electronic scale to the nearest 0.1 kg. Martin anthropometric measurement was used to measure height to the nearest 0.1 cm, and waist circumference measurements were taken to the nearest 0.1 cm, using a soft measuring tape. Skinfold measurements were taken using a slime guide caliber to the nearest 10 mm.

#### 2.4 Blood pressure

Using an electronic Micronta monitoring kit, at least three blood pressure (BP) readings of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were taken after the child had been seated for 5 min or longer [19]. The bladder of the device contains an electronic infrasonic transducer that monitors the BP and pulse rate, displaying these concurrently on the screen. This versatile instrument has been designed for research and clinical purposes [19]. In a pilot study, conducted before the survey, a high correlation of 0.93 was found between the readings taken with the automated device and those with a conventional mercury sphygmomanometer. Hypertension, defined as the average of three separate BP readings where the SBP or DBP is ≥95th percentile for age and sex, was determined [20].

#### 2.5 Statistical analysis

Descriptive statistics for absolute body size were presented. Body mass index (BMI) was defined as weight (kg)/height height (m)2 . All children (under 18 years) were classified as underweight, normal, overweight, and obese according to Cole et al. [21, 22] cutoff points and the WHO [3] for adults using BMI. Waistto-height ratio (WHtR) cutoff point of 0.5 was used [23, 24] while cutoff point for the waist circumference [25], waist-to-hip ratio (WHR) was derived from the WHO [3]. Over fatness was defined as the 95% percentile by age and gender for the sum of four skinfolds thickness [26]. The correlation coefficient moment was used to assess the association between NCDs risk factors fat (i.e., sum of four skinfolds, BMI, WC, WHR, WHtR, BP, and pulse rate) at the first measurement and at all repeated measurements by gender. Statistical significance was set at p < 0.05. All the statistical analyses were done using the Statistical Package for the Social Sciences (SPSS).

November

15

May

November

May

November

May

November

May

November

May

November

May

May

November

November

1996

N Age

Ht Wt Waist

Hip BMI WHtR

WHR

S4sk SBP (mmHg)

DBP (mmHg)

Heart rate (beat/min)

Ht—height in cm; Wt—weight in kg; BMI—body mass index in kg/m2; WHtR

Table 2. Development

 over time of absolute body size and blood pressure of Ellisras rural males who dropped out of the study presently due to death aged 7–26 years.

19.3 (1.84)

 18.9

20.1 (4.35)

 21.0

21.7 (3.5)

 21.5

19.7 (4.16)

 20.6

20.8 (3.32)

 24.8

24.2 (10.71)

 22.1

22.5

27.6 (12.5) 29.4 (18.72)

(12.75)

(6.48)

(9.94)

(4.12)

(3.18)

(4.98)

(2.65)

–––––

–––––

–––––

69.9

76.1 (13.60)

 80.37

75.61 (11.66)

 74.9

74.6 (7.92)

 74.0

79.1

75.5 (11.59) 78.8 (18.74)

(10.57)

(12.95)

 skinfold in mm.

(11.2)

(15.52)

(12.57)

—waist-to-height

 ratio; WHR

—waist-to-hip

 ratio; S4sk

—sum of four (triceps, subscapular, biceps, and supraspinale)

60.3

61.1 (7.89)

 65.60

67.0 (10.12)

 62.8

61.0 (7.60)

 60.0

67.9

59.9 (9.89) 76.0 (19.6)

(10.27)

(7.67)

(6.80)

(9.94)

(7.51)

97.1

99.2 (9.67)

 101.9

101.9 (7.97)

 93.1

90.9 (8.10)

 102.2

105.4

101.6

134.6

(13.0)

(9.03)

(12.56)

(20.88)

(8.42)

(12.60)

(9.26)

0.92 (0.05)

 0.93

0.88 (0.41)

 0.90

0.88 (0.05)

 0.88

0.88 (0.04)

 0.89

0.88 (0.05)

 0.89

0.86 (0.05)

 0.87

0.85

0.87 (0.05) 0.83 (0.07)

(0.05)

(0.06)

(0.06)

(0.05)

(0.03)

(0.04)

(0.08)

0.42 (0.04)

 0.42

0.41 (0.03)

 0.41

0.41 (0.02)

 0.41

0.41 (0.02)

 0.41

0.41 (0.02)

 0.40

0.40 (0.02)

 0.40

0.39

0.38 (0.03) 0.47 (0.13)

(0.03)

(0.09)

(0.45)

(0.03)

(0.02)

(0.02)

(0.02)

13.1 (1.96)

 13.6

13.9 (1.33)

 14.6

14.5 (1.27)

 14.8

14.6 (1.47)

 14.8

15.1 (1.34)

 15.1

15.1 (1.60)

 15.5

15.8

16.4 (2.27) 24.0 (8.63)

Health Status and Permanent Loss to Follow up of Ellisras Longitudinal Study Subjects…

(2.17)

(2.08)

(2.16)

(1.92)

(1.31)

(1.39)

(1.63)

56.4 (6.25)

 59.2

60.6 (5.22)

 61.3

63.4 (4.74)

 63.3

64.8 (5.32)

 65.4

65.7 (5.95)

 66.3

66.2 (5.84)

 69.7

69.8

69.6 (7.56) 96.7 (17.11)

(7.69)

(7.54)

(8.12)

(6.27)

(5.19)

(4.00)

(5.66)

52.0 (5.43)

 54.7

53.4 (4.12)

 54.4

55.6 (3.93)

 55.9

56.7 (3.35)

 57.9

57.5 (4.11)

 58.3

58.8 (4.35)

 60.1

59.2

60.1 (5.46) 81.5 (21.24)

(5.59)

(4.39)

(5.27)

(4.13)

(4.00)

(3.96)

(4.04)

20.5 (3.33)

 22.7

23.7 (4.36)

 25.8

26.7 (4.52)

 27.6

28.4 (5.16)

 30.1

30.6 (6.02)

 32.4

33.1 (7.01)

 35.2

38.0

40.8 (9.75) 71.3 (21.47)

DOI: http://dx.doi.org/10.5772/intechopen.84141

(8.21)

(9.01)

(8.09)

(7.18)

(4.65)

(4.12)

(3.51)

125.4 (9.11)

 129.6

130.4

132.7

135.0 (8.84)

 136.0

138.9 (9.34)

 141.9

141.8

145.2

147.1

150.0

153.7

157.8

173.4 (8.54)

(10.66)

(10.14)

(10.37)

(10.70)

(10.79)

(10.41)

(10.81)

(9.61)

(8.26)

(10.48)

(9.12)

8.0 (1.29)

 8.6

9.2 (1.68)

 9.9

10.4 (1.60)

 10.6

11.2 (1.74)

 11.5

11.8 (1.79)

 12.5

13.0 (1.95)

 13.5

14.5

14.8 (1.79) 25.9 (2.10)

(1.79)

(1.76)

(1.73)

(1.75)

(1.76)

(1.59)

(1.36)

16

 17

 42

 31

 31

 33

 34

 35

 28

 28

 22

 23

 28

 25

8

1997

1997

1998

1998

1999

1999

2000

2000

2001

2001

2002

2003

2003

2015

#### 3. Results

Tables 2 and 3 present the development over time of cardiovascular risk factors derived from anthropometric measurements and blood pressure measurements of


#### Health Status and Permanent Loss to Follow up of Ellisras Longitudinal Study Subjects… DOI: http://dx.doi.org/10.5772/intechopen.84141

Table 2. Development

 over time of absolute body size and blood pressure of Ellisras rural males who dropped out of the study presently due to death aged 7–26 years.

of the current study, only the subjects who died were included in the analysis. The cause of death for the majority of the subjects was unknown as it is a family secret given the indigenous knowledge system followed in the Ellisras rural

Nutrition in Health and Disease - Our Challenges Now and Forthcoming Time

Tables 2 and 3) were included in the analysis.

2.3 Anthropometry

nearest 10 mm.

2.4 Blood pressure

2.5 Statistical analysis

3. Results

14

population [6, 7]. A total of 373 boy and 613 girl subjects aged 8–26 years who were permanently lost to follow-up over time (November 1996–December 2015) (see

All participants underwent a series of anthropometric measurements [weight, height, waist circumference, hip circumference, and skinfold thickness (triceps, subscapular, biceps, and supraspinale)] were taken according to the standard pro-

Using an electronic Micronta monitoring kit, at least three blood pressure (BP) readings of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were taken after the child had been seated for 5 min or longer [19]. The bladder of the device contains an electronic infrasonic transducer that monitors the BP and pulse rate, displaying these concurrently on the screen. This versatile instrument has been designed for research and clinical purposes [19]. In a pilot study, conducted before the survey, a high correlation of 0.93 was found between the readings taken with the automated device and those with a conventional mercury sphygmomanometer. Hypertension, defined as the average of three separate BP readings where the SBP

Descriptive statistics for absolute body size were presented. Body mass index

18 years) were classified as underweight, normal, overweight, and obese according to Cole et al. [21, 22] cutoff points and the WHO [3] for adults using BMI. Waistto-height ratio (WHtR) cutoff point of 0.5 was used [23, 24] while cutoff point for the waist circumference [25], waist-to-hip ratio (WHR) was derived from the WHO [3]. Over fatness was defined as the 95% percentile by age and gender for the sum of four skinfolds thickness [26]. The correlation coefficient moment was used to assess the association between NCDs risk factors fat (i.e., sum of four skinfolds, BMI, WC, WHR, WHtR, BP, and pulse rate) at the first measurement and at all repeated measurements by gender. Statistical significance was set at p < 0.05. All the statistical analyses were done using the Statistical Package for the Social Sciences (SPSS).

Tables 2 and 3 present the development over time of cardiovascular risk factors derived from anthropometric measurements and blood pressure measurements of

. All children (under

or DBP is ≥95th percentile for age and sex, was determined [20].

(BMI) was defined as weight (kg)/height height (m)2

cedures recommended by the International Society of the Advancement of Kinanthropometry (ISAK) from November 1996 to December 2015 [17, 18]. The weight was measured on an electronic scale to the nearest 0.1 kg. Martin anthropometric measurement was used to measure height to the nearest 0.1 cm, and waist circumference measurements were taken to the nearest 0.1 cm, using a soft measuring tape. Skinfold measurements were taken using a slime guide caliber to the


Table 3. Development over time of absolute body size and blood pressure factors of Ellisras rural females who dropped out of the study presently due to death aged 7–26 years.

Ellisras rural males and females mean aged 7–26 years who died. There was a gradual increase in mean height (125.4 cm SD 9.11), weight (20.5 kg SD 3.33) for males from November 1996 to November 2015 (height = 173.4 cm SD 8.54,

Health Status and Permanent Loss to Follow up of Ellisras Longitudinal Study Subjects…

Females showed a gradual growth increase in mean height (121.3 cm SD 8.40) and mean weight (19.0 kg SD 3.67) from November 1996 to November 2015 (mean height 163.0 = cm SD 8.86) and mean weight 61.1 kg SD 9.25) (Table 3). Similar trend was observed for blood pressure (mean systolic blood pressure = 97.1 mmHg SD 9.26 and mean diastolic blood pressure = 60.3 mmHg SD 7.51) from May 1999 to November 2015 (mean systolic blood pressure = 134.6 SD 20.88 and mean distolic blood pressure = 78.8 mmHg SD 18.74) for males (Table 2). For girls, mean systolic blood pressure (99.4 mmHg SD 11.62) and diastolic blood pressure (61.2 mmHg SD 8.28) increased from November 1996 to November 2015 (mean systolic blood pressure = 106.1 mmHg SD 8.75 and diastolic blood pressure = 70.8 mmHg SD 14.74). Table 4 shows the development of the prevalence of cardiovascular risk factors of Ellisras rural males and females aged 7–26 who died. The prevalence of sever undernutrition ranges from 3.2 to 53%, moderate undernutrition ranges from 9.7 to 28.8% while mild undernutrition ranges from 17.9 to 59.1% for both males and females. The prevalence of abdominal obesity ranges from 0 to 37.5%, while obesity, overweight, and over fatness was low (ranges from 0 to 12.5%) (Table 4). Table 5 presents moment correlation coefficient for the first measurement and subsequent measurements for the cardiovascular risk factors derived from anthropometric measurements for Ellisras rural males and females over time (November 1996 to November 2015). The correlation coefficient was low and insignificant for males and females for all cardiovascular risk factors over time. The correlation for blood pressure was significant (p ranges from 0.001 to 0.05) for systolic blood pressure (r<sup>2</sup> ranges from 0.42 to 0.95) and diastolic blood pressure (r<sup>2</sup> ranges from

The current study aimed to determine the extent of NCD risk factors derived from anthropometric and blood pressure measurements which affected ELS subjects over time who died or permanently lost to follow-up. The prevalence of undernutrition was high while obesity, overweight, abdominal obesity and hypertension was low. However, there was significant positive correlation between systolic and diastolic over time. The data presented the mortality rate owing to NCD in rural communities of Ellisras areas which differs to the urban area counterparts reported

In Amsterdam, Kemper et al. [29] reported a clear increase in prevalence of obesity from youth to adulthood with a decrease in physical activity. However, undernutrition and low physical activity was high in the Ellisras rural population [30, 31]. This might indicate that undernutrition as an indicator of NCD could be the cause of death or leads to permanent loss of follow-up of the ELS participants. The burden of NCD in rural South African population is substantial, and patients with this condition make significant demands on the health-care resources. Epidemiological data from South Africa and Tanzania reveal high prevalence of diabetes and hypertension [32, 33]. The burden of NCD is likely to increase in the next coming decade in rural South African population. The projection from Global Burden of Diseases Study suggests that by the year 2020, the proportion of overall burden in Africa due to NCD will increase to 42% among adults aged

weight = 71.3 kg SD 21.47) (Table 2).

DOI: http://dx.doi.org/10.5772/intechopen.84141

0.28 to 0.77) over time.

by Miranda et al. and Kengne et al. [27, 28].

4. Discussions

15–59 years [34].

17

#### Nutrition in Health and Disease - Our Challenges Now and Forthcoming Time

Health Status and Permanent Loss to Follow up of Ellisras Longitudinal Study Subjects… DOI: http://dx.doi.org/10.5772/intechopen.84141

Ellisras rural males and females mean aged 7–26 years who died. There was a gradual increase in mean height (125.4 cm SD 9.11), weight (20.5 kg SD 3.33) for males from November 1996 to November 2015 (height = 173.4 cm SD 8.54, weight = 71.3 kg SD 21.47) (Table 2).

Females showed a gradual growth increase in mean height (121.3 cm SD 8.40) and mean weight (19.0 kg SD 3.67) from November 1996 to November 2015 (mean height 163.0 = cm SD 8.86) and mean weight 61.1 kg SD 9.25) (Table 3). Similar trend was observed for blood pressure (mean systolic blood pressure = 97.1 mmHg SD 9.26 and mean diastolic blood pressure = 60.3 mmHg SD 7.51) from May 1999 to November 2015 (mean systolic blood pressure = 134.6 SD 20.88 and mean distolic blood pressure = 78.8 mmHg SD 18.74) for males (Table 2). For girls, mean systolic blood pressure (99.4 mmHg SD 11.62) and diastolic blood pressure (61.2 mmHg SD 8.28) increased from November 1996 to November 2015 (mean systolic blood pressure = 106.1 mmHg SD 8.75 and diastolic blood pressure = 70.8 mmHg SD 14.74).

Table 4 shows the development of the prevalence of cardiovascular risk factors of Ellisras rural males and females aged 7–26 who died. The prevalence of sever undernutrition ranges from 3.2 to 53%, moderate undernutrition ranges from 9.7 to 28.8% while mild undernutrition ranges from 17.9 to 59.1% for both males and females. The prevalence of abdominal obesity ranges from 0 to 37.5%, while obesity, overweight, and over fatness was low (ranges from 0 to 12.5%) (Table 4).

Table 5 presents moment correlation coefficient for the first measurement and subsequent measurements for the cardiovascular risk factors derived from anthropometric measurements for Ellisras rural males and females over time (November 1996 to November 2015). The correlation coefficient was low and insignificant for males and females for all cardiovascular risk factors over time. The correlation for blood pressure was significant (p ranges from 0.001 to 0.05) for systolic blood pressure (r<sup>2</sup> ranges from 0.42 to 0.95) and diastolic blood pressure (r<sup>2</sup> ranges from 0.28 to 0.77) over time.

#### 4. Discussions

The current study aimed to determine the extent of NCD risk factors derived from anthropometric and blood pressure measurements which affected ELS subjects over time who died or permanently lost to follow-up. The prevalence of undernutrition was high while obesity, overweight, abdominal obesity and hypertension was low. However, there was significant positive correlation between systolic and diastolic over time. The data presented the mortality rate owing to NCD in rural communities of Ellisras areas which differs to the urban area counterparts reported by Miranda et al. and Kengne et al. [27, 28].

In Amsterdam, Kemper et al. [29] reported a clear increase in prevalence of obesity from youth to adulthood with a decrease in physical activity. However, undernutrition and low physical activity was high in the Ellisras rural population [30, 31]. This might indicate that undernutrition as an indicator of NCD could be the cause of death or leads to permanent loss of follow-up of the ELS participants.

The burden of NCD in rural South African population is substantial, and patients with this condition make significant demands on the health-care resources. Epidemiological data from South Africa and Tanzania reveal high prevalence of diabetes and hypertension [32, 33]. The burden of NCD is likely to increase in the next coming decade in rural South African population. The projection from Global Burden of Diseases Study suggests that by the year 2020, the proportion of overall burden in Africa due to NCD will increase to 42% among adults aged 15–59 years [34].

November

16

May

November

May

November

May

November

May

November

May

November

May

May

November

November

1996

N Age

Ht Wt Waist

Hip BMI WHtR

WHR

S4sk SBP (mmHg)

Diastolic BP

(mmHg)

Pulse (beats/

min)

Ht—height in cm; Wt—weight in kg; BMI—body mass index in kg/m2; WHtR

Table 3. Development

 over time of absolute body size and blood pressure factors of Ellisras rural females who dropped out of the study presently due to death aged 7–26 years.

20.02 (3.16)

 19.4

22.1 (5.07)

 23.9

24.5 (4.78)

 24.1

25.0 (6.40)

 26.7

28.5 (7.14)

 26.5

27.63

31.92

30.56

34.71

33.8 (10.52)

(12.23)

(13.88)

(8.99)

(12.90)

(10.84)

(7.73)

(4.34)

99.4

100.4

104.3

103.3

99.1

97.6 (8.63)

 104.9

109.5

105.1 (12.3) 106.1 (8.75)

(12.41)

(9.39)

(11.62)

61.2

61.9 (9.05)

 67.6

67.4 (9.54)

 64.8

63.8 (7.10)

 61.9

68.7

62.0 (8.05) 70.8 (14.74)

(8.08)

(6.84)

(6.46)

(8.74)

(8.28)

79.1

75.3 (13.54)

 77.4

82.9 (14.24)

 77.8

79.1 (11.16)

 84.3

82.8

83.9 (15.52) 92.1 (12.33)

(15.68)

(12.53)

 skinfold in mm.

(11.37)

(16.00)

(10.73)

—waist-to-height

 ratio; WHR

—waist-to-hip

 ratio; S4sk

—sum of four (triceps, subscapular, biceps, and supraspinale)

(10.79)

(10.67)

(12.48)

(7.11)

(4.88)

(2.44)

0.92 (0.06)

 0.86

0.85 (0.05)

 0.86

0.85 (0.05)

 0.9

0.8 (0.05)

 0.8

0.8 (0.04)

 0.86

0.81 (0.05)

 0.79

0.80

0.78 (0.06) 0.79 (0.06)

(0.58)

(0.06)

(0.07)

(0.04)

(0.43)

(0.05)

(0.05)

0.42 (0.04)

 0.41

0.40 (0.04)

 0.40

0.41 (0.03)

 0.41

0.40 (0.02)

 0.40

0.4 (0.02)

 0.40

0.39 (0.03)

 0.39

0.39

0.38 (0.03) 0.49 (0.07)

(0.03)

(0.03)

(0.04)

(0.03)

(0.02)

(0.03)

(0.03)

12.8 (1.98)

 13.0

13.7 (2.09)

 13.9

14.1 (1.39)

 14.2

14.4 (1.55)

 14.5

14.8 (1.56)

 15.43

15.75 (2.09)

 16.28

16.57

17.53 (2.46) 23.11 (3.75)

(2.29)

(2.06)

(1.89)

(1.92)

(1.38)

(1.27)

(1.26)

55.8 (4.59)

 58.3

60.4 (5.00)

 60.7

63.3 (4.41)

 63.1

66.7 (5.20) 68.1 (6.1) 69.5 (6.40)

(8.40)

(4.04)

(3.44)

51.0 (4.08)

 50.3

51.3 (3.20)

 52.3

53.8 (3.56)

 55.5

56.0 (3.79)

 55.8

56.4 (3.90)

 57.8

58.1 (4.09)

 60.2

60.1

60.3 (4.90) 79.4 (10.4)

(4.81)

(5.10)

(4.47)

 67.5

71.9 (6.63)

 77.0

75.8

77.4 (8.35)

 100.4 (6.96)

Nutrition in Health and Disease - Our Challenges Now and Forthcoming Time

(8.43)

(7.73)

(6.22)

(4.57)

(3.32)

(3.86)

(2.74)

19.0 (3.67)

 19.8

22.3 (4.69)

 23.4

24.7 (4.14)

 26.4

27.6 (4.93)

 29.6

31.5 (5.83)

 33.7

35.7 (7.18)

 38.2

40.4

44.1 (7.22) 61.1 (9.25)

(7.62)

(7.71)

(6.79)

(5.87)

(4.25)

(3.89)

(2.80)

121.3 (8.40)

 123.6

127.6

129.6

132.0 (8.57)

 135.9

138.7 (8.82)

 142.3

145.2 (8.96)

 147.1

150.0 (9.15)

 152.6

155.5

158.4 (7.0) 163.0 (8.86)

(8.39)

(7.94)

(9.46)

(9.22)

(8.32)

(7.95)

(10.54)

(8.62)

7.6 (1.51)

 8.1

8.8 (1.74)

 9.3

9.8 (1.65)

 10.5

10.9 (1.51)

 11.3

11.8 (1.53)

 12.3

12.95 (1.43)

 13.3

14.20

14.8 (1.54) 26.2 (2.01)

(1.56)

(1.52)

(1.56)

(1.54)

(1.45)

(1.65)

(1.53)

31

 28

 54

 51

 51

 52

 52

 47

 46

 46

 47

 45

 44

 45

8

1997

1997

1998

1998

1999

1999

2000

2000

2001

2001

2002

2003

2003

2015


November

19

May

November

May

November

May

November

May

November

May

November

May

May

November

November

1996

% (n)

BMI

BMI

BMI

—

9.7 (3)

 10.7

14.8 (8)

 15.7

13.7 (7)

 28.8

25.0 (13)

 12.8

21.7 (10)

 15.2

19.1 (9)

 13.3

4.5 (2) 15.6 (7)

–

(6)

(7)

(6)

(15)

(8)

(3)

moderate

BMI

BMI

—

–

 –

 –

 –

 –

 –

 –

 –

 –

 –

 –

 ––

 –

25.0 (2)

overweight

BMI obese

WHtR

19.4 (6) 7.1 (2)

 7.4 (4)

 5.9 (3)

 7.8 (4)

 5.8 (3)

 5.8 (3)

 6.4 (3)

 2.2 (1)

 10.9

4.3 (2)

 4.4 (2) 4.5 (2)

 4.4 (2)

 37.5 (3)

(5)

abdominal

WHP obese Overfatness

BMI—body

Table 4. Development

 over time of prevalence

cardiovascular

 risk factors of Ellisras rural males and females who died aged 7–26 years.

 mass index;

SBP—systolic

 blood pressure;

 3.2 (1)

–

3.7 (2)

 5.9 (3) DBP—diastolic

 blood pressure; WHtR

 5.9 (3)

–

3.8 (2)

 4.3 (2)

—waist-to-height

 ratio.

 4.3 (2)

 8.7 (4)

 8.5 (4)

 6.7 (3) 4.5 (2)

–

12.5 (1)

 87.1 (27)

 67.9

64.8 (35)

 64.7

54.9 (28)

 73.1

44.2 (23)

 34.0

32.6 (15)

 50.0

17.0 (8)

 11.1

25.0

6.7 (3)

 12.5 (1)

(5)

(11)

(23)

(16)

(38)

(33)

(19)

–

 –

1.9 (1)

––––

2.1 (1)

–

 –

 –

 ––

2.2 (1)

–

—mild

 19.4 (6)

 17.9

37.0 (20)

 39.2

39.2 (20)

 28.8

32.7 (17)

 40.4

39.1 (18)

 37.0

46.8 (22)

 37.8

47.7

28.9 (13)

–

Health Status and Permanent Loss to Follow up of Ellisras Longitudinal Study Subjects…

(17)

(21)

(17)

(19)

(15)

(20)

(5)

—severe

 48.4 (15)

 53.6

27.8 (15)

 21.6

19.6 (10)

 17.3

17.3 (9)

 25.5

8.7 (4)

 6.5 (3)

 4.3 (2)

 2.2 (1) 4.5 (2)

 2.2 (1)

 12.5 (1)

(12)

(9)

(11)

(15)

—undernutrition

 % (n)

 % (n)

 % (n)

 % (n)

 % (n)

 % (n)

 % (n)

 % (n)

 % (n)

 % (n)

 % (n) % (n)

 % (n)

 % (n)

DOI: http://dx.doi.org/10.5772/intechopen.84141

1997

1997

1998

1998

1999

1999

2000

2000

2001

2001

2002

2003

2003

2015

#### Nutrition in Health and Disease - Our Challenges Now and Forthcoming Time


Health Status and Permanent Loss to Follow up of Ellisras Longitudinal Study Subjects… DOI: http://dx.doi.org/10.5772/intechopen.84141

> Table

4. Development over time of prevalence cardiovascular risk factors of Ellisras rural males and females who died aged 7–26 years.

November

18

May

November

May

November

May

November

May

November

May

November

May

May

November

November

1996

% (n)

Males

High SBP

High DBP

Hypertension

BMI

BMI

BMI

—

12.5 (2)

 17.6

28.6 (12)

 12.9

16.1 (5)

 21.2

14.7 (5)

 22.9

17.9 (5)

 14.3

13.6 (3) 8.7 (2) 25.0

(4)

(7)

12.0 (3)

Nutrition in Health and Disease - Our Challenges Now and Forthcoming Time

(8)

(7)

(4)

(3)

moderate

BMI

BMI

—

overweight

BMI

WHtR

25 (4)

 17.6

9.5 (4)

 9.7 (3)

 6.5 (2)

 6.1 (2)

 2.9 (1)

 8.6 (3)

 3.6 (1)

 21.4

–

8.7 (2)

–

4.0 (1)

 25.0 (2)

(6)

(3)

abdominal

WHP obese

Over fatness

Females

High SBP

High DBP

Hypertension

–––––

–––––

––––––

3.8 (2)

3.8 (2)

–

4.3 (2)

–

 –

 ––

 –

 –

 7.7 (4)

 8.5 (4) 13.0 (6) 4.3 (2)

5.8 (3)

 7.7 (4)

 4.3 (2)

 6.5 (3)

–

 –

 2.1 (1)

–

2.3 (1)

–

12.5 (1)

4.4 (2) 4.5 (2)

 4.4 (2)

–

–

 –

7.1 (3)

 9.7 (3)

 6.5 (2)

 9.1 (3)

 2.9 (1)

 2.9 (1)

 3.6 (1)

 7.1 (2)

 9.1 (2)

 8.7 (2) 3.6 (1)

 8.0 (2)

 12.5 (1)

 75.0 (12)

 70.6

38.1 (16)

 48.4

41.9 (13)

 30.3

32.4 (11)

 42.9

32.1 (9)

 42.9

27.3 (6)

 30.4

25.0

28.0 (7)

 12.5 (1)

(7)

(7)

(12)

(15)

(10)

(15)

(12)

—obese

–

 –

 –

 –

 –

 –

 –

 –

 –

 –

 –

 ––

 –

12.5 (1)

—mild

 25.0 (4)

 35.3

31.0 (13)

 38.7

41.9 (13)

 24.2

35.3 (12)

 40.0

39.3 (11)

 32.1

59.1 (13)

 34.8

32.1

24.0 (6)

(8)

(9)

(9)

(14)

(8)

(12)

(6)

–––

3.2 (1)

–

 –

 –

 –

 –

 –

 –

 ––

 –

12.5 (1)

—severe

 37.5 (6)

 17.6

11.9 (5) 3.2 (1)

 3.2 (1)

 6.1 (2) 11.8 (4) 5.7 (2)

 3.6 (1)

 17.9

9.1 (2)

 21.7

10.7

20.0 (5)

(5)

(3)

(5)

(3)

—undernutrition

–

 –

 –

 –

 –

 –

 –

 –

 –

 –

 –

 ––

 –

25 (2)-

–––––

–––––––

3.0 (1)

 2.9 (1)

5.7 (2)

 7.1 (2)

–

 –

4.3 (1) 3.6 (1)

 4.0 (1)

 25.0 (2)

 8.6 (3)

 3.6 (1)

–

 –

8.7 (2)

–

8.0 (2)

 62.5 (5)

 % (n)

 % (n)

 % (n)

 % (n)

 % (n)

 % (n)

 % (n)

 % (n)

 % (n)

 % (n)

 % (n) % (n)

 % (n)

 % (n)

1997

1997

1998

1998

1999

1999

2000

2000

2001

2001

2002

2003

2003

2015


20

#### Nutrition in Health and Disease - Our Challenges Now and Forthcoming Time

Table 5.

Moment correlation coefficient for the first measurement and subsequent measurements for cardiovascular risk factors measured over time among diseases Ellisras Longitudinal Study children.

By not taking action on NCDs in sub-Saharan Africa would mean that the development of effective measure for preventing and managing these NCDs will be compromised. Ideal health promotion should reach an individual at school-going age to ensure the adoption of a healthy lifestyle. Community involvement must empower people to promote and adopt a healthy lifestyle throughout their lives and identify and reach appropriate target groups. South Africa's school health curriculum needs to be developed. A health curriculum planning group representing stakeholders of various disciplines, particularly in rural area, needs to revise current curricula to address health promotion issues in all public schools in the rural areas. Education methods used in this curriculum should allow children to make healthy choice while simultaneously increasing their self-esteem. The curriculum should address smoking prevention, abstinence from alcohol usage, establishing healthy eating pattern, and exercise habits that could be sustainable for life time. The community should develop discernment skills to evaluate the impact of the adver-

Health Status and Permanent Loss to Follow up of Ellisras Longitudinal Study Subjects…

Despite the clear pattern of NCD risk that has emerged from the current study, there are some short comings that need to be considered when assessing the overall value of the present data. The small number of subjects could probably provide a biased sample, and these data must be viewed in the light of this situation. The socioeconomic status of the subjects and the cause of death might impact negatively

The early diagnosis and cost-effective management of patients with risk factors and early target organs damage particularly of those with high level of cardiovascular diseases risk is needed [35]. A comprehensive surveillance system should include indicators that monitor both the prevention and health service aspects of

The prevalence of undernutrition was high, while hypertension, obesity, and overweight were low in the population. The blood pressure showed a significant correlation over time, while other NCD risk indicators do not show significant correlation over time. The identification of appropriate NCD indicators for mortality in rural South African population needs more consideration and evaluation. Death information and feasibility and cost of generating such indicators are critical issues as most rural South African population regard the cause of death as a family issue. Death registration information and cost of generating such information are critical issues in moving away from the indigenous knowledge system. More thorough analysis of the variable data will be essential to investigate the quality of the information, and additional information is needed to assess the validity of the

tising industry on their lives.

the program.

5. Conclusion

indicators.

21

on the major findings of the present study.

DOI: http://dx.doi.org/10.5772/intechopen.84141

Health Status and Permanent Loss to Follow up of Ellisras Longitudinal Study Subjects… DOI: http://dx.doi.org/10.5772/intechopen.84141

By not taking action on NCDs in sub-Saharan Africa would mean that the development of effective measure for preventing and managing these NCDs will be compromised. Ideal health promotion should reach an individual at school-going age to ensure the adoption of a healthy lifestyle. Community involvement must empower people to promote and adopt a healthy lifestyle throughout their lives and identify and reach appropriate target groups. South Africa's school health curriculum needs to be developed. A health curriculum planning group representing stakeholders of various disciplines, particularly in rural area, needs to revise current curricula to address health promotion issues in all public schools in the rural areas. Education methods used in this curriculum should allow children to make healthy choice while simultaneously increasing their self-esteem. The curriculum should address smoking prevention, abstinence from alcohol usage, establishing healthy eating pattern, and exercise habits that could be sustainable for life time. The community should develop discernment skills to evaluate the impact of the advertising industry on their lives.

Despite the clear pattern of NCD risk that has emerged from the current study, there are some short comings that need to be considered when assessing the overall value of the present data. The small number of subjects could probably provide a biased sample, and these data must be viewed in the light of this situation. The socioeconomic status of the subjects and the cause of death might impact negatively on the major findings of the present study.

The early diagnosis and cost-effective management of patients with risk factors and early target organs damage particularly of those with high level of cardiovascular diseases risk is needed [35]. A comprehensive surveillance system should include indicators that monitor both the prevention and health service aspects of the program.

#### 5. Conclusion

The prevalence of undernutrition was high, while hypertension, obesity, and overweight were low in the population. The blood pressure showed a significant correlation over time, while other NCD risk indicators do not show significant correlation over time. The identification of appropriate NCD indicators for mortality in rural South African population needs more consideration and evaluation. Death information and feasibility and cost of generating such indicators are critical issues as most rural South African population regard the cause of death as a family issue. Death registration information and cost of generating such information are critical issues in moving away from the indigenous knowledge system. More thorough analysis of the variable data will be essential to investigate the quality of the information, and additional information is needed to assess the validity of the indicators.

May

20

November

May

November

May

November

May

November

May

November

May

May

November

November

1997

Waist

WHP

WHtR

BMI

Sum4sk

Systolic Diastolic

Pulse Girls

Waist

WHR

WHtR

BMI

Sum4sk

Systolic Diastolic

Pulse

WHR

Table 5.

Moment correlation

 coefficient for the first

measurement

 and subsequent

measurements

 for

cardiovascular

 risk factors measured over time among diseases Ellisras

Longitudinal

 Study children.

—waist-to-hip

 ratio; WHtR

—waist-to-height

 ratio; BMI—body

 mass index. \* P < 0.05; \*\* P < 0.01

0.079

0.042

0.030

–––––

–––––

–––––

0.63

0.08

 0.01

0.11

0.12

0.08

0.36

0.20

 0.35

 0.64

\*\*

\*\*

0.28\*

0.77\*\*

0.07

 0.12

 0.012

 0.72\*\*

0.08

 0.66\*\*

0.26

0.10

 0.95

\*\*

0.14

 0.25

 00.43

\*\*

0.67

0.42

0.02

\*\*

\*\*

0.022

0.003

0.129

0.017

0.169

0.182

0.141

0.208

0.202

00.445\*

00.969\*\*

 0.192

 0.239

0.047

 0.071

 0.021

0.053

0.127

0.010

0.074

0.112

0.112

0.216

0.021

 0.488

 0.373

 0.449\*

0.142

 0.230

 0.455\*

0.221

 0.394\*

0.344

 0.333

 0.210

 0.076

 0.103

0.035

 0.179

0.115

 0.088

0.162

 0.030

0.177

0.024

 0.041

0.133

0.181

 0.100

0.191

0.041

0.191

0.468

0.071

 0.129

0.228

0.097

 0.131

0.015

 0.280

 0.043

0.188

 0.061

0.136

0.057

0.136

 0.123

0.076

0.074

0.126

–––––

–––––

–––––

0.23

0.07

 0.18

 0.26

 0.12

0.19

 0.13

0.19

 0.65

Nutrition in Health and Disease - Our Challenges Now and Forthcoming Time

0.21

0.22

0.12

 0.37

 0.52

 0.53

0.05

 0.94

 0.05

 0.38

0.12

0.29

0.00

0.52

0.48

 0.88

 0.45

\*\*

0.30

0.289

0.122

0.003

0.349

0.226

0.077

0.139

0.418

0.513

0.417

0.150

 0.454

 0.411

 0.409

 0.364

 0.271

 0.273

 0.062

 0.194

 0.235

 0.492

 0.521

 0.094

 0.603

 0.785

 0.118

 0.198

 0.109

 0.313

 0.453

 0.530

 0.599\*

0.512

 0.176

 0.226

 0.034

 0.315

0.073

 0.676

0.103

0.169

0.505

 0.001

 0.085

0.069

 0.185

0.121

0.391

0.195

0.052

 0.291

0.052

 0.877

 0.201

 0.316

 0.342

 0.475

 0.613\*

0.651\*

0.626\*

00.775\*\*

0.031

 0.416

 0.128

 0.542

 0.128

0.180

1997

1998

1998

1999

1999

2000

2000

2001

2001

2002

2003

2003

2015

References

[1] Steyn K. Management of chronic diseases of lifestyle in South African population. Supplement to South African Medical Journal. 1994:49-50

DOI: http://dx.doi.org/10.5772/intechopen.84141

Oxford University Press; 2010.

[8] Yeates K, Lohfeld L, Sleeth J, Morales F, Rajkotia Y, Ogedegbe O. A global perspective on cardiovascular disease in vulnerable populations. The Canadian Journal of Cardiology. 2015;31(9):

[9] Yusuf SH, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potential modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): A case control study. Lancet. 2005;364:

[10] Steyn K, de Wet T, Richter L, Cameron N, Levitt NS, Morrell C. Cardiovascular diseases risk factors in 5 year old urban South African children— The birth to ten study. South African Medical Journal. 2000;90:719-726

[11] Monyeki KD, van Lenthe F, Styen NP. Obesity: Does it exist in Ellisras rural community children. International Journal of Epidemiology. 1999;28:

[12] Biying H, Sernsson P, Sundstrom J, Lind L. Effects of cigarette smoking on cardiovascular-related protein profiles in two community-based cohort studies.

[13] Sidiropoulos E, Jeffery A, Mackay S, Gallocher R, Forgey H, Chips C. South Africa Survey 1995/1996. Johannesburg: South African Institute of Race and Relations; 1996. pp. 234-360

[14] Bradshaw D, Stey K. Poverty and Chronic Disease in South Africa: Technical Report. Cape Town: Medical Research Council; 2001. pp. 38-45

[15] Statistics South Africa. Cause of Death in South Africa 1997–2001:

Atherosclerosis. 2016;254:52-58

pp. 152-163

Health Status and Permanent Loss to Follow up of Ellisras Longitudinal Study Subjects…

1081-1093

937-952

287-292

[2] Kemper HCG. Amsterdam Growth and Health Longitudinal Study: A 23 Year Follow Up from Teenager to Adult About Lifestyle and Health. New York:

[3] WHO. Non Communicable Diseases Country Profiles. Geneva: World Health

Karger Press; 2004. pp. 1-20

Organization; 2014. p. 207

[4] Dalal S, Beunza JJ, Volmink J, Adebamowo C, Bajunirwe F, Njelekela M, et al. Non-communicable diseases in sub-Saharan Africa: What we know now. International Journal of Epidemiology. 2011;40(4):885-901

[5] Nyaaba GN, Stronks K, Aikins AD, Kengne AP, Agyemang C. Tracing Africa's progress towards implementing the non-communicable diseases global action plan 2013–2020: A synthesis of WHO country profile reports. BMC Public Health. 2017;17(1):297

[6] Monyeki KD, Kemper HCG.

2009. pp. 41-56

23

Longitudinal development and tracking of anthropometric risk indicators for under nutrition of Ellisras rural children in South Africa. In: Muhongo SM, Gudyanga FP, Enow AA, Nyanganyura D, editors. Science, Technology and Innovation for the Socio-Economic Development: Success Stories from Africa. Pretoria: International Council for Science Regional Office for Africa;

[7] Monyeki KD, Kemper HCG, Twisk

hypertension in South African youth. In: O'Dea JA, Eriksen M, editors. Childhood Prevention—International Research, Controversies and Intervention. Sydney:

JWR. Trends in obesity and

#### Author details

Monyeki K. Daniel<sup>1</sup> \*, Siweya H. James<sup>2</sup> , Kemper C.G. Han3 and Ramoshaba N. Elfas1

1 Department of Physiology and Environmental, University of Limpopo, Sovenga, South Africa

2 Faculty of Science and Agriculture, University of Limpopo, Sovenga, South Africa

3 Health and Activity, Amsterdam Public Health Academic Research Institute, Vrije Universiteit, Amsterdam, The Netherlands

\*Address all correspondence to: kotsedi.monyeki@ul.ac.za

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Health Status and Permanent Loss to Follow up of Ellisras Longitudinal Study Subjects… DOI: http://dx.doi.org/10.5772/intechopen.84141

#### References

[1] Steyn K. Management of chronic diseases of lifestyle in South African population. Supplement to South African Medical Journal. 1994:49-50

[2] Kemper HCG. Amsterdam Growth and Health Longitudinal Study: A 23 Year Follow Up from Teenager to Adult About Lifestyle and Health. New York: Karger Press; 2004. pp. 1-20

[3] WHO. Non Communicable Diseases Country Profiles. Geneva: World Health Organization; 2014. p. 207

[4] Dalal S, Beunza JJ, Volmink J, Adebamowo C, Bajunirwe F, Njelekela M, et al. Non-communicable diseases in sub-Saharan Africa: What we know now. International Journal of Epidemiology. 2011;40(4):885-901

[5] Nyaaba GN, Stronks K, Aikins AD, Kengne AP, Agyemang C. Tracing Africa's progress towards implementing the non-communicable diseases global action plan 2013–2020: A synthesis of WHO country profile reports. BMC Public Health. 2017;17(1):297

[6] Monyeki KD, Kemper HCG. Longitudinal development and tracking of anthropometric risk indicators for under nutrition of Ellisras rural children in South Africa. In: Muhongo SM, Gudyanga FP, Enow AA, Nyanganyura D, editors. Science, Technology and Innovation for the Socio-Economic Development: Success Stories from Africa. Pretoria: International Council for Science Regional Office for Africa; 2009. pp. 41-56

[7] Monyeki KD, Kemper HCG, Twisk JWR. Trends in obesity and hypertension in South African youth. In: O'Dea JA, Eriksen M, editors. Childhood Prevention—International Research, Controversies and Intervention. Sydney: Oxford University Press; 2010. pp. 152-163

[8] Yeates K, Lohfeld L, Sleeth J, Morales F, Rajkotia Y, Ogedegbe O. A global perspective on cardiovascular disease in vulnerable populations. The Canadian Journal of Cardiology. 2015;31(9): 1081-1093

[9] Yusuf SH, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potential modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): A case control study. Lancet. 2005;364: 937-952

[10] Steyn K, de Wet T, Richter L, Cameron N, Levitt NS, Morrell C. Cardiovascular diseases risk factors in 5 year old urban South African children— The birth to ten study. South African Medical Journal. 2000;90:719-726

[11] Monyeki KD, van Lenthe F, Styen NP. Obesity: Does it exist in Ellisras rural community children. International Journal of Epidemiology. 1999;28: 287-292

[12] Biying H, Sernsson P, Sundstrom J, Lind L. Effects of cigarette smoking on cardiovascular-related protein profiles in two community-based cohort studies. Atherosclerosis. 2016;254:52-58

[13] Sidiropoulos E, Jeffery A, Mackay S, Gallocher R, Forgey H, Chips C. South Africa Survey 1995/1996. Johannesburg: South African Institute of Race and Relations; 1996. pp. 234-360

[14] Bradshaw D, Stey K. Poverty and Chronic Disease in South Africa: Technical Report. Cape Town: Medical Research Council; 2001. pp. 38-45

[15] Statistics South Africa. Cause of Death in South Africa 1997–2001:

Author details

South Africa

22

Monyeki K. Daniel<sup>1</sup>

and Ramoshaba N. Elfas1

\*, Siweya H. James<sup>2</sup>

Nutrition in Health and Disease - Our Challenges Now and Forthcoming Time

Vrije Universiteit, Amsterdam, The Netherlands

provided the original work is properly cited.

\*Address all correspondence to: kotsedi.monyeki@ul.ac.za

, Kemper C.G. Han3

1 Department of Physiology and Environmental, University of Limpopo, Sovenga,

2 Faculty of Science and Agriculture, University of Limpopo, Sovenga, South Africa

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

3 Health and Activity, Amsterdam Public Health Academic Research Institute,

Advance Release of Records of Death, PO309.2.2002. Pretoria, South Africa; 2002

[16] Monyeki KD, Cameron N, Getz B. Growth and nutritional status of rural South African children 3–10 years old: The Ellisras growth study. American Journal of Human Biology. 2000;12(1): 42-49

[17] Norton K, Olds T. Anthropometrica. Sydney: University of New South Wales Press; 1996. pp. 120-267

[18] Tanner JM, Whitehouse RH, Takaishi M. Standards from birth to maturity for height weight, weight velocity: British children, 1965. Archives of Disease in Childhood. 1996;41: 613-635

[19] National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114: 555-576

[20] National High Blood Pressure Education Program (NHBPEP) Working Group on Hypertension Control in Children and Adolescents. Update on the 1987 task force report on high blood pressure in children and adolescents: A working group report from the National High Blood Pressure Education Program. Pediatrics. 1996;98: 649-658

[21] Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ. 2000;320:1240-1243

[22] Cole TJ, Flegal KM, Nicholls D, Jackson AA. Body mass index cut offs to define thinness in children and adolescents: International survey. BMJ. 2007;335:194

[23] Ashwell M, Hsieh SD. Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. International Journal of Food Sciences and Nutrition. 2005;56(5):303-307

[30] Monyeki KD, Kemper HC. The risk factors for elevated blood pressure and how to address cardiovascular risk factors: A review in paediatric populations. Journal of Human Hypertension. 2008;22:450-459

DOI: http://dx.doi.org/10.5772/intechopen.84141

Health Status and Permanent Loss to Follow up of Ellisras Longitudinal Study Subjects…

[31] Matshipi M, Monyeki KD, Kemper H. The relationship between physical activity and plasma glucose level

amongst Ellisras rural young adult males and females: Ellisras longitudinal study. International Journal of Environmental Research and Public Health. 2017;14: 198. DOI: 10.3390/ijerph14020198

[32] Unwin N, Setel P, Rashid S, Mugusi F, Mbanya J, Katange H, et al. Non communicable diseases in Sub-Saharan Africa: Where do they feature in the health research agenda? Bulletin of the World Health Organization. 2001;79:

[33] Sekgala MD, Monyeki KD, Mogale MA, Ramoshaba NE. Performance of blood pressure to height ratio as a screening tool for elevated blood pressure in rural children: Ellisras Longitudinal Study. Journal of Human

[34] Murray C, Lopez S, editors. The Global Burden of Diseases. Boston, MA: Harvard University Press on behalf of WHO and the World Bank; 1996

[35] Steyn K, Bradshaw D. Noncommunicable diseases surveillance in developing countries. Scandinavian Journal of Public Health. 2001;29:

Hypertension. 2017;31:591

947-953

161-165

25

[24] Ashwell M, Gunn P, Gibson S. Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: Systematic review and metaanalysis. Obesity Reviews. 2012;13: 275-286

[25] Ahmad N, Adam SIM, Nawi AM, Hassan MR, Ghazi HF. Abdominal obesity indicators: Waist circumference or waist-to-hip ratio in Malaysian adults population. International Journal of Preventive Medicine. 2016;7

[26] Twisk JWR, Kemper HCG, van Mechelen W, Post GB, van Lenthe FJ. Body fatness: Longitudinal relationship of body mass index and the sum of skinfolds with other risk factors for coronary heart disease. International Journal of Obesity and Related Metabolic Disorder. 1998;22:915-922

[27] Miranda JJ, Kinra S, Casas JP, Smith GD, Ebrahim S. Non-communicable diseases in low and middle-income countries: Context determinants and health policy. Tropical Medicine & International Health. 2009;13(10): 1225-1234

[28] Kengne AP, Amoah AGB, Mbanya J. Cardiovascular complications of diabetes mellitus in sub-Saharan Africa. Circulation. 2005;112:3592-3601

[29] Kemper HCG, Post GB, Twisk JWR, van Mechelen W. Lifestyle and obesity in adolescent and young adulthood: Results from Amsterdam growth and health longitudinal study. International Journal of Obesity. 1999;22(3):S34-S40

Health Status and Permanent Loss to Follow up of Ellisras Longitudinal Study Subjects… DOI: http://dx.doi.org/10.5772/intechopen.84141

[30] Monyeki KD, Kemper HC. The risk factors for elevated blood pressure and how to address cardiovascular risk factors: A review in paediatric populations. Journal of Human Hypertension. 2008;22:450-459

Advance Release of Records of Death, PO309.2.2002. Pretoria, South Africa;

Nutrition in Health and Disease - Our Challenges Now and Forthcoming Time

[23] Ashwell M, Hsieh SD. Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. International Journal of Food Sciences and Nutrition.

[24] Ashwell M, Gunn P, Gibson S. Waist-to-height ratio is a better

screening tool than waist circumference and BMI for adult cardiometabolic risk factors: Systematic review and metaanalysis. Obesity Reviews. 2012;13:

[25] Ahmad N, Adam SIM, Nawi AM, Hassan MR, Ghazi HF. Abdominal obesity indicators: Waist circumference or waist-to-hip ratio in Malaysian adults population. International Journal of Preventive Medicine. 2016;7

[26] Twisk JWR, Kemper HCG, van Mechelen W, Post GB, van Lenthe FJ. Body fatness: Longitudinal relationship of body mass index and the sum of skinfolds with other risk factors for coronary heart disease. International Journal of Obesity and Related Metabolic Disorder. 1998;22:915-922

[27] Miranda JJ, Kinra S, Casas JP, Smith GD, Ebrahim S. Non-communicable diseases in low and middle-income countries: Context determinants and health policy. Tropical Medicine & International Health. 2009;13(10):

[28] Kengne AP, Amoah AGB, Mbanya J.

diabetes mellitus in sub-Saharan Africa.

[29] Kemper HCG, Post GB, Twisk JWR, van Mechelen W. Lifestyle and obesity in adolescent and young adulthood: Results from Amsterdam growth and health longitudinal study. International Journal of Obesity. 1999;22(3):S34-S40

Cardiovascular complications of

Circulation. 2005;112:3592-3601

2005;56(5):303-307

275-286

1225-1234

[16] Monyeki KD, Cameron N, Getz B. Growth and nutritional status of rural South African children 3–10 years old: The Ellisras growth study. American Journal of Human Biology. 2000;12(1):

[17] Norton K, Olds T. Anthropometrica. Sydney: University of New South Wales

Press; 1996. pp. 120-267

[18] Tanner JM, Whitehouse RH, Takaishi M. Standards from birth to maturity for height weight, weight velocity: British children, 1965. Archives of Disease in Childhood. 1996;41:

[19] National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114:

[20] National High Blood Pressure Education Program (NHBPEP) Working Group on Hypertension Control in Children and Adolescents. Update on the 1987 task force report on high blood pressure in children and adolescents: A working group report from the National High Blood Pressure Education Program. Pediatrics. 1996;98:

[21] Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: International survey.

[22] Cole TJ, Flegal KM, Nicholls D, Jackson AA. Body mass index cut offs to

adolescents: International survey. BMJ.

define thinness in children and

BMJ. 2000;320:1240-1243

2002

42-49

613-635

555-576

649-658

2007;335:194

24

[31] Matshipi M, Monyeki KD, Kemper H. The relationship between physical activity and plasma glucose level amongst Ellisras rural young adult males and females: Ellisras longitudinal study. International Journal of Environmental Research and Public Health. 2017;14: 198. DOI: 10.3390/ijerph14020198

[32] Unwin N, Setel P, Rashid S, Mugusi F, Mbanya J, Katange H, et al. Non communicable diseases in Sub-Saharan Africa: Where do they feature in the health research agenda? Bulletin of the World Health Organization. 2001;79: 947-953

[33] Sekgala MD, Monyeki KD, Mogale MA, Ramoshaba NE. Performance of blood pressure to height ratio as a screening tool for elevated blood pressure in rural children: Ellisras Longitudinal Study. Journal of Human Hypertension. 2017;31:591

[34] Murray C, Lopez S, editors. The Global Burden of Diseases. Boston, MA: Harvard University Press on behalf of WHO and the World Bank; 1996

[35] Steyn K, Bradshaw D. Noncommunicable diseases surveillance in developing countries. Scandinavian Journal of Public Health. 2001;29: 161-165

**27**

Section 3

Nutrition and Different

Diseases

### Section 3
