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Poor diet puts SA children at risk of lifestyle diseases – Gqeberha study

A startling 43% of primary schoolchildren in Gqeberha run the risk of diseases like malnutrition, high blood pressure, diabetes and unhealthy cholesterol levels, according to research at 12 marginalised primary schools in the region, with experts saying the findings highlight the dire state of child nutrition in South Africa.

The researchers at Nelson Mandela University found that the pupils at these schools showed a high risk factor of getting one or more non-communicable diseases (NCDs), “which are either lifestyle-related or can be inherited”, said Dr Siphesihle Nqweniso, who conducted the study with Dr Danielle Dolley as part of their PhD research.

Their research – looking at the risk of illnesses like malnutrition, high blood pressure, diabetes and unhealthy cholesterol levels – is part of the KaziBantu programme, a school-based intervention focusing on NCD prevention strategies, reports News24.

“NCDs develop from eating an unhealthy diet high in fats, sugar and salt, and low in dietary fibre, as well as low physical activity levels,” said Nqweniso.

The highest NCD risk percentage, at 19%, was for children who are overweight or obese. This was linked to fast food, foods high in sugar and fat, and not enough healthy foods, like vegetables, Dolley noted.

A total of 13% of pupils in the research group were underweight due to insufficient nutrition and high rates of worm infections, mostly caused by poor water and sanitation.

Dolley said their results highlighted an urgent need for intervention.

“At their young age, these children are at higher risk of developing chronic diseases, which could seriously affect their health as they grow and progress into adulthood.

“It also has an impact on the national health system, with the associated economic implications. What it emphasises is the importance of intervening at a young age when we are able to reduce the risk,” she said.

Save the Children South Africa health and nutrition programme manager Marumo Sekgobela said child nutrition remained a significant challenge for the whole country, and the research reflected the reality for many South African children.

“One of the biggest challenges we see relates to food choices. That comes from the family, and children eat what is served in the home.

“This shows us families do not have balanced diets and are eating takeaways or refined foods.”

He said the situation required urgent intervention from government departments. “We can't wait until the child is obese – and then only intervene. We need to intensify community nutrition interventions.”

Being overweight in early childhood increases the risk for adult obesity, as well as associated conditions like high cholesterol, diabetes and high blood pressure, according to Child Count, a data and advocacy project by the Children’s Institute at the University of Cape Town.

It found that around 13% of South Africa’s children under five are already overweight, with obesity rates being significantly higher among older children.

The consumption of high-calorie diets, including those that are rich in salt, sugar and fats, was the main cause of overweight and obesity among children

Child Count data also found that under-nutrition was highly prevalent in South Africa, with stunting the most common manifestation of malnutrition, affecting 27% of children under five.

Study 1 details

Relationship between Body Mass Index and Physical Activity among Children from Low-Income Communities in Gqeberha, South Africa: A Cross-Sectional Study

Danielle Dolley, Rosa Du Randt, Uwe Pühse, Markus Gerber, Jacob Bosma, Ann Aerts, Larissa Adams, Patricia Arnaiz, Nandi Joubert, Ivan Müller, Siphesihle Nqweniso, Harald Seelig, Peter Steinmann, Jürg Utzinger, and Cheryl Walter.

Published in the International Journal of Environmental Research & Public Health on 20 January 2023


This study aimed to establish the prevalence of underweight, overweight and obesity, the level of moderate-to-vigorous physical activity (MVPA) and the association thereof among vulnerable children from low-income communities in South Africa. Cross-sectional data were collected from 916 children (467 boys and 449 girls) aged 8–13 years (x⎯⎯ = 10.4 ± 1.2 years) attending eight low-income schools in Gqeberha, South Africa. Measured outcomes included accelerometery-measured physical activity (PA), weight, height and body mass index (BMI). Analysis of variance was used to determine the mean difference of total MVPA stratified by sex and BMI classification. Overall, 13% of the cohort were underweight, 19% were overweight/obese and 64% engaged in 60 min of MVPA per day. Girls presented nearly twice the odds of being overweight or obese than boys (95% CI: 1.40–2.77). Underweight to normal-weight children (boys: OR = 3.89, 95% CI: 2.18–6.93; girls: OR = 1.78, 95% CI: 1.13–2.80) were more likely to engage in 60 min/day of MVPA than overweight to obese children. There is an inverse association between BMI categories and the duration of MVPA achieved per day. Special attention should be aimed at increasing awareness of healthy nutrition and promoting a variety of PA, especially among girls and children with excess weight.

Study 2 details

Mixed intervention effects and long-term changes in physical activity and cardiovascular outcomes among children at risk of cardiovascular diseases

Arnaiz, P., Seelig, H., Gerber, M., Adams, L., Degen, J., Dolley, D., Joubert, N., Nienaber, M., Nqweniso, S., Steinmann, P., Utzinger, J., du Randt, R., Walter, C., Pühse, U., & Müller, I.

Published in Current Issues in Sport Science (CISS) on 15 February 2023


Risk factors for chronic diseases such as insufficient physical activity (PA), overweight or hypertension are getting more predominant among children. While school-based interventions are promising preventive strategies, evidence of their long-term effectiveness, especially among vulnerable populations is scarce. KaziKidz is a physical education intervention that promotes healthy and active lifestyles among children from low-income communities. We aim at assessing the short- and long-term effects of KaziKidz on cardiovascular risk factors in high-risk children from disadvantaged communities.

The intervention was tested in a cluster-randomised controlled trial between January and October 2019 in eight primary schools in South Africa. Children with adverse cardiovascular profiles were defined as presenting at least one risk factor for (1) overweight, (2) elevated blood pressure, (3) glycaemia, and/or (4) cholesterolemia. After their identification, high-risk children were re-assessed 2-years post-intervention. Study outcomes include accelerometry-measured PA (MVPA), body-mass-index (BMI), mean arterial pressure (MAP), glucose (HbA1c), and lipid levels (TC/HDL). We conducted mixed regression analyses to assess intervention effects by cardiovascular risk profile, and Wilcoxon signed-rank tests to evaluate longitudinal changes in the high-risk subpopulation.

A significant intervention effect on MVPA during school hours was found for physically inactive children (B: 1.71, 95% CI: 0.14 – 3.35, p-value: 0.008), and among active (B: 1.80, 95% CI: -0.22 – 3.82, p-value: 0.035) and inactive (B: 2.03, 95% CI: 0.58 – 3.42, p-value: < 0.001) girls. In contrast, the intervention lowered HbA1c (B: -0.26, 95% CI: -0.52 – -0.01, p-value: 0.037) and TC/HDL (B: -0.11, 95% CI: 0.18 – -0.05, p-value: 0.002) only in children with normal glucose or lipid values, respectively. The intervention effects were not maintained in at-risk children at follow-up. A decline was observed in MVPA from 53.29 to 41.90 min/day (z = -1.95, p = 0.05, r = 0.26), and an increase in BMI-for-age (z = -0.34, p = 0.737, r = 0.03), MAP (z = -5.18, p < 0.001, r = 0.42), HbA1c (z = -1.63, p = 0.104, r = 0.25) and TC/HDL (z = -1.61, p = 0.11, r = 0.21).

We conclude that schools are key settings to promote PA and improve health; however, because the intervention effects were not maintained in children at risk of NCDs, structural changes that ensure effective interventions reach disadvantaged populations are necessary to achieve sustainable impact.


National Library of Medicine article (Open access)


CISS article (Open access)


News24 article – Gqeberha kids are at risk of lifestyle diseases, a new study suggests. They’re probably not alone (Restricted access)


See more from MedicalBrief archives:


Obese, overweight South Africans costing the country billions of rands


Number of young, obese South Africans doubled in 6 years


SA set to carry warning labels on ‘junk food’


Nelson Mandela Bay: Acute malnutrition cases increase while R67m distress grant remains unspent


SA kids score Cs and Ds in health report card






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