Die voedingsoorgang in Suid-Afrika: ’n uitdaging vir verbeterde voeding en die verligting van armoede

Suid-Afrika, soos ander ontwikkelende lande in Sub-Sahara Afrika, bly in gebreke om die Verenigde Nasies se Millennium Ontwikkelingsdoelwitte te haal. In hierdie artikel word daar verduidelik dat hierdie onvermoë waarskynlik verband hou met grootskaalse wanvoeding in Afrika. Ekonomiese ontwikkeling en modernisering het ’n verandering in leefstyl en eetpatrone veroorsaak wat tot oorgewig en verwante siektes lei, voordat die probleem van ondervoeding opgelos is. In Suid-Afrika is ’n derde van die kinders nog steeds ondervoed terwyl byna ’n derde van volwasse mans en meer as die helfte van volwasse vroue reeds oorgewig of vetsugtig is. Hierdie dubbele lading van ondervoeding en oorvoeding lei tot hoë vlakke van beide oordraagbare (infektiewe) en nie-oordraagbare kroniese siektes, wat saam met die menslike immuniteitsgebrekkige virus (MIV) en verworwe immuniteitsgebrek sindroom (VIGS) epidemie verantwoordelik is vir die afname in lewensverwagting in Afrika. Armoede lei tot wanvoeding in swanger vroue, tot wangevoede fetusse, epigenetiese programmering van metaboliese paaie in ‘n fetus, lae-geboortegewig babas en kinders met belemmerde fisiese en intellektuele ontwikkeling. Hierdie kinders ontwikkel in volwassenes met beperkte menskapitaal en het ’n verhoogde risiko vir oorgewig en kroniese siektes. Hulle vind dit moeilik om te ontsnap uit die intergeneratiewe siklus van armoede en wanvoeding. ’n Denkraamwerk word voorgestel as basis vir die beplanning van holistiese, transdissiplinêre en multisektoriale programme om ondervoeding en oorvoeding gelyktydig aan te spreek. Verder word daar aanbeveel dat Suid-Afrika meer openbare gesondheidsvoedingkundiges oplei en dat alle gesondheidswerkers beter toegerus word om die goeie voedingstrategieë van die Departement Gesondheid (Direktoraat Voeding) meer doeltreffend te implementeer.Developing countries, including South Africa, are lagging behind in reaching the United Nations’ Millennium Development Goals (MDGs). These countries are at present experiencing a nutrition transition that is an outcome of economic development, urbanisation and acculturation. In this article, the nutritional situation in South Africa based on anthropometric characteristics of its population, is briefly reviewed. The vicious cycle between poverty, undernutrition and an increased vulnerability for over-nutrition and related noncommunicable diseases (NCDs) is explained and hypothesised to be a major determinant of the coexistence of under-nutrition and over-nutrition in developing countries. In South Africa the coexistence of under-nutrition and over-nutrition underlies a double burden of high morbidity and mortality from both infectious and noncommunicable diseases, which is further exacerbated by the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) pandemic. Clearly, it would be difficult to escape this intergenerational vicious circle of poverty and malnutrition, without optimising the nutritional status of all women who plan to become pregnant. There are many psychological reasons, apart from nutrition transition, why people eat more than they need to, including an inherent partiality for refined, sweet, salty and fatty foods. A conceptual framework, based on the constitutional right to food and nutrition security, is proposed to guide policy makers to plan holistic, integrated, transdisciplinary and multisectorial interventions to address under-nutrition and over-nutrition simultaneously. Individuals should be empowered, facilitated and motivated by appropriate education and training programmes and by strategies to improve socio-economic situations to be able to buy or produce food and to make healthy choices. This food environment will be created only if there is a common agenda, or even legislation, to improve the nutritional status in multisectorial and transdisciplinary programmes. The Directorate of Nutrition in the South African Department of Health has an excellent integrated nutrition strategy, but lacks the required implementation capacity. More public health nutritionists should be trained and other health professionals should be better equipped to implement nutritional interventions in all poverty alleviation and health promotion programmes