|
Nutrition,
health and old age – the case of south African urban elderly
Karen
E Charlton, MPhil (Epidemiol), MSc, SRD
Nutrition and Dietetics Unit, Department of Medicine, University
of Cape Town, Observatory, 7925
email: kc@uctgsh1.uct.ac.za
S
A J Clin Nutr 2000 February Vol. 13 No 1.
The southern
African region (Botswana, Lesotho, Nambia, South Africa, Swaziland,
Mozambique and Zimbabwe) has the continent’s highest percentage
of older inhabitants; 6.2% of the population in 1997 was estimated
to be 60 years or older. Within southern Africa, South Africa has
the highest proportion of older population. The 1996 census data
estimate than 2.8 million South Africans are aged 60 years and older,
which constitutes 7% of the total population. This percentage is
projected to increase to almost 11% of the population over the next
20 years. (Mostert W, Hofmeyr B, Oosthuizen K. Demographic projections
for South Africa. Pretoria: Human Sciences Research Council, 1997
– unpublished data.) It is the absolute number of elderly
people that determines the need for health and welfare services.
In this regard, the number is projected to more than double, to
6.3 million. (Mostert W, Hofmeyr B, Oosthuizen K. Demographic projections
for South Africa. Pretoria:Human Sciences Research Council, 1997-unpublished
data.)
In terms of
life expectancy at birth, differences are seen between the racial
groups in South Africa. Life expectancy for white South Africans
is currently about 8 - 10 years higher than for the black and coloured
populations, and about 5 years higher than for the Asian group.
(Mostert W, Hofmeyr B, Oosthuizen K. Demographic projections for
South Africa Pretoria: Human Sciences Research Council, 1997 –unpublished
data.) In all groups, older women outnumber men. The total population
growth rate in South Africa is falling as a result of declining
fertility rates. However, as more people reach old age, the growth
rate of the 60+ age group has come to exceed that of the total population,
and the gap will widen considerably in the future.
Socio-economic
considerations regarding the situation of the elderly in southern
africa
As
a result of the 40 years of apartheid policy, the black, coloured
and Asian populations had unequal opportunities and access to the
country’s resources and are consequently disadvantaged in
most areas of their lives when compared with their white counterparts,
particularly with regard to education, income and health status.
A countrywide multidimensional survey of a representative sample
of 4 400 South Africans aged 60+ years, which was conducted in 1990/91,found
that older black South Africans and non-urban dwellers more than
urban dwellers were particularly marginalised with regard to educational
and socio-economic attainment, provision for old age, indicators
of health status and perceived quality of life. Eighty per cent
of older blacks in non-urban areas and half in urban areas had received
no formal education. About two-thirds of the black and coloured
sample reported that they perceived their income to be inadequate
in terms of meeting their needs, as compared with only 22% of the
white subjects, and a similar trend was seen regarding reported
provison for old age.
In most countries
in southern Africa, the elderly are more likely than the total population
to reside in rural areas. This is a result of the migration of young
adults to cities and sometimes the return migration of older adults
from urban areas back to rural homes. Following the elimination
of the Group Areas Act in 1988, which permitted only male migrant
labourers to relocate to urban areas, South Africa has seen a massive
movement of persons from non-urban to urban areas, and a resulting
proliferation of informal settlements on urban fringes. From available
data it is not yet clear if older citizens are being adversely affected
by such movement (e.g. being left behind in rural areas with little
infrastructure, to raise grandchildren), or whether they are participating
in and benefiting from migration through better access to health
and pension systems. However, data from the 1996 census indicate
that 52% of the 60+ age group now live in urban areas, and that
this trend is similar to that of the total population, namely 54%
living in urban areas. Secondary analysis of data from the 1995
Western Cape Community Housing Trust (WCCHT) study of African settlements
in the metropolitan Cape Town area has provided important information
with regard to urbanisation and migration patterns of older subjects.
A sample of 920 households was categorised according to households
in which there were no members aged 60 and over (‘young’,
N = 807), and ‘elderly’ households (N = 113) with at
least one older person resident. Elderly households tended to be
larger, more prone to experience unemployment, and more likely to
be in formal houses rather than informal structures than young households.
Dependency ratio* was higher in the elderly households. In terms
of income, elderly households were significantly poorer than their
younger counterparts. In about half the elderly households, the
elderly appeared to be the sole source of income. Large numbers
of unemployed kinfolk, particularly the pensioner’s children
and grandchildren, clustered around old age pensioners. It was evident
that these households would not be viable without the contribution
of the pension and it was concluded that social pensioners in urban
areas are magnets for economically weaker persons. Further, it was
found that contrary to common belief, older citizen have participated
in the recent mobility upsurge, both intra-urban and rural-urban
migration, although on a somewhat smaller scale than their younger
counterparts. Although elderly urban households often form part
of an integrated urban/rural link with family members, and visits
back and forth are common, the practice of permanent return migration
to rural areas in old age appears to be dwindling.
South Africa
is the only country in Africa, apart from Namibia, where a non-contributory
but means-tested, state old-age pension system exists (R490 per
month in 1998). In other African countries the dominant form of
social support and care of the elderly remains the responsibility
of adult children and the extended family.
Most South African
pensioners, whether residing in urban or non-urban areas, live in
three-generation households where the social pension contributes
a substantial proportion to household budgets. In support of the
findings of the WCCHT data cited above, a qualitative study conducted
among urban, peri-urban and non-urban female pensioners in KwaZulu-Natal
reported that pension monies were used to support kin, primarily
to meet the basic needs of the family, especially food, clothing
and household utilities. In most cases food was the major expenditure
item on the household budget. However, without exception, the pension
was reported by subjects to be inadequate for meeting their family’s
needs. Nowhere is the sharing ethos (known as u b u n t u) more
evident than in the practice of ‘eating f rom the common pot’
in African families. In the peculiar case of South Africa, the social
pension affords elderly people independence and respect from younger
generations within the household. Møller argues that even
in the urban setting, the African extended family appears to be
intact; however, the d i rection of remittances (at least financial)
within a household unit appears to be from older to younger members.
The grandmother is an integral figure in the daily management of
the household, not only in terms of providing financially, but also
in items of food purchasing, meal preparation and housework. In
two studies of pensioners in Cape Town and West Coast towns, women
were found to expend more energy per week in activities than men,
using a validated physical activity questionnaire which included
indices of housework, yardwork, caring, recreation and exercise.
In both studies, the differences were attributed to the index of
household work, which included shopping. In urban areas, nutrition
education activities targeted at this age group may, therefore,
impact on the family unit as a whole.
Since
the start of the large-scale urbanisation trend in about
1989,
studies have been conducted on groups of elderly people in several
parts of the country, but predominantly in the Western Cape region.
The following stressors were identified as particularly affecting
the physical and mental health of the urban elderly. (Ferreira M.
The elderly: a high-risk group. Paper presented at the Medical Research
Council Workshop on Urban Health Policy for Southern Africa, Johannesburg,
March 1995.)
Violence
and crime
Violence
and a fear of crime were found to inhibit mobility and hence the
ability to access health care facilities. Isolation and loneliness
may result, with the ‘elderly being prisoners in their own
homes’.
Poor
access to health services
Identified
barriers to health care include lack of knowledge of where to obtain
health care, long distances to travel to facilities, inaccessibility
of transport, inaffordability of transport or the service itself,
and dissatisfaction with health care at State facilities. 3,11-16
New health care policies in South Africa have primarily targeted
women, children and youth, with the elderly not regarded as a priority.
Although the improvement of community-based care for older clients,
together with improved detection and control of risk factors and
chronic disease at the primary level were identified as two principal
health priorities in the health reconstruction plan, there is scant
evidence of any implementation of this policy goal. With the emphasis
shift from tertiary and secondary care to primary health care, dedicated
geriatric services have fallen by the wayside. The preventive, curative
and rehabilitative needs of older clients have for the main part
been integrated into general sessions at community clinics at the
primary care level. Numerous community nurses have been redeployed
from geriatric services, for example, to assist with immunisation
programmes for children. As a result, the elderly now have to wait
in long queues to receive treatment, together with young mothers,
children and everybody else.
A high level
of dissatisfaction with health care is not limited to elderly people
in urban areas, however. A study of retired people in farming towns
in the Western Cape found that even though three-quarters of the
subjects reported having ‘financial difficulties’, a
quarter of them stated that they chose to consult a private doctor
and to pay the doctor’s fee of about R50 - R60, rather than
use a government facility where as social pensioners they are entitled
to free health care.
Poor
health/physical impairment
High
percentages of the elderly in newly settled areas rate their health
as poor. Chronic diseases such as diabetes and hypertension are
either undetected and medically untreated, or in the case of those
who do receive treatment, the clinical management of the condition
is poor. Currently routine treatment for these conditions at primary
care facilities frequently involves little more than the dispensing
of medication on a monthly basis; there is little opportunity for
patient education regarding lifestyle management.
Lack
of knowledge and information
Low
literacy and education levels, lack of skills and unfamiliar urban
environments inhibit the older person’s ability to access
resources and services generally.
Mental
health stressors
A
high prevalence of depressive symptomatology, especially among urban
African women, has been found. Forty-four per cent of older women
in the relatively newly urbanised township of Khayelitsha in Cape
Town have been found to have symptoms of depression, compared with
27% of women of the same age in Langa, one of the oldest and most
established townships in the country. Economic factors, the burden
of caregiving and social dislocation and disorganisation were identified
as stressors to the mental health of elderly women.
Poor
urban environment and infrastructure
In
urban areas the elderly are most affected by poor housing infrastructure
(inadequate structures, overcrowding, few household conveniences)
and transport. As well as potential mutual benefits of living with
family members in multigenerational households, family conflict
and unsatisfactory living conditions associated with overcrowding
may be a stressor for some of the elderly.
Poverty
Despite
possibly easier access to pension pay-out centres in urban and peri-urban
areas, older people generally report that the pension (R490 per
month in 1998) is insufficient to meet their basic needs.
Gender
Older
women outnumber men and are more likely to be widowed, poorer and
burdened with caregiving and domestic responsibilities.
In the nationwide
multidimensional survey in 1991/92, it was found that the most serious
problems which older people in urban areas experienced were lack
of money, poor health, poor access to health care, depression and
a fear of being robbed.
All of the factors
listed above will impact on the well-being of an older person and
it is evident that those most likely to be at risk are older adults
who have recently migrated to the city. In terms of nutritional
status, as well as the influence of socio-economic and psychological
factors, physiological factors associated with ageing such as impaired
digestion, absorption or utilisation of nutrients associated with
chronic disease or drug-nutrient interactions, also place the older
adult at particular nutritional risk. Available information on the
nutritional status and dietary intake of older South Africans is
reviewed in the next section.
Dietary
habits and nutritional status of older south africans
Information
on the nutritional status of community-dwelling South Africans is
sparse and is largely limited to data from four studies: a sample
of urban blacks in the Free State (N = 400), a sample of urban blacks
from the BRISK study in the peri-urban settlements of Cape Town
(N = 148), a study of older coloured (mixed ancestry) subjects in
Cape Town (N = 200), and a sample of white elderly in Potchefstroom
(N = 100). The only published study on the nutritional status of
older non-urban South Africans, conducted in a sample of 100 subjects
in Pankop, assessed biochemical parameters and anthropometrical
measurements (dietary data were not collected) (see Table I). Macronutrient
intake and energy profiles Mean energy fell below the RDA for both
black and coloured men (1 725 (692) and 1 910 (776) kcal, respectively)
and women (1 224 (498) and 1 670 (531), respectively) in urban Cape
Town (see Table II). Between 27% and 32% of men, and 36 - 26% of
women in these two groups, respectively, had energy intakes below
67% of the RDA. Due to possible methodological biases between the
dietary studies of the elderly, it may be more appropriate to consider
the energy profiles of the groups. Dietary protein intake was similar
across all groups and comprised between 11% and 16% of total energy
intake. For urban black men and women in Cape Town and the Free
State, percentage energy (%E) from fat contributed about 25% of
total energy, compared with 39%E for white elderly, with the coloured
sample having an intermediate fat intake of about 32%E. The polyunsaturated/saturated
(P/S) ratio was notably higher in the coloured sample (0.8) than
for any of the other groups, which is related to their liberal use
of plant oils in cooking. Conversely, %E intake from carbohydrate
was lowest in the white sample (< 50 %E) than for the other groups
(> 56%), which is characteristic of a Western versus cereal -
based traditional diet. Mean dietary fibre intake did not meet the
prudent dietary recommendation of 30 g/day for any of the groups
except for black men in the Free State (31 (28) g/day) The sample
of black elderly in Cape Town had fibre intakes which were about
half those of the Free State sample (16(11) and 11 (7) g/day for
men and women, respectively).
Table I. Dietary surveys of older South Africans
| Sample
|
N
|
Age
range |
Dietary
method |
Place
|
Year
|
Reference |
| Urban
blacks |
400
|
65
- 116 |
24h
recall FFQ* |
Free
State |
1987
|
Bester
et al., 1993 19 |
| Urban
blacks |
148
|
60
- 89 |
24h
recall FFQ* |
Cape
Town |
1990
|
Charlton
et al., in press 20 |
| Coloured
|
200
|
65
- 92 |
24h
recall FFQ* |
Cape
Town |
1993
|
Charlton
et al., 1997, 21 |
| White
|
100
|
65
- 85 |
24h
recall Dietary history |
Potchefstroom
|
1989
|
Kruger
et al., 1993 23 |
| Rural
blacks |
100
|
60
- 88 |
Anthropometry
Biochemisty † |
Pankop
|
1988
|
Johnson
et al., 1992 24 |
| *
FFQ = food frequency questionnaire. † No dietary
assessment was performed. |
|
Table II. Comparison of the mean (SD) energy distribution,
P/S ratio, cholesterol and fibre intakes of older South Africans
| |
Recommended
25 |
Black
urban Cape Town 20 |
Black
urban Free State 19 |
Coloured
Cape Town 21 |
White
Potchefstroom 23 |
| N
|
|
148
|
400
|
200
|
100 |
| Men
|
|
74
|
182
|
104
|
48 |
| Women
|
|
74
|
218
|
96
|
52 |
| Age
group (years) |
|
60
- 89 |
65
- 116 |
65
- 92 |
65
- 84 |
| %
E protein |
13 |
|
|
|
|
| Men
|
|
15.7
(5.2) |
11.5
|
14.3
(2.5) |
15.4
(1.9) |
| Women
|
|
14.2
(4.5) |
12.1
|
14.7
(3.3) |
15.5
(2.5) |
| %
Animal/total protein |
|
|
|
|
| Men
|
|
57.6
(21.9) |
|
64
(10) |
|
| Women
|
|
52.4
(22.5) |
|
63
(10) |
|
| %
E Fat |
<
30 |
|
|
|
|
| Men
|
|
25.9
(10.4) |
25.1
|
31.8
(5.1) |
38.6
(5.2) |
| Women
|
|
24.1
(10.8) |
27.7
|
33.1
(5.6) |
36.8
(5.7) |
| P/S
ratio |
>1 |
|
|
|
|
| Men
|
|
0.69
(0.47) |
0.67
|
0.83
(0.24) |
0.5
(0.3) |
| Women
|
|
0.68
(0.48) |
0.59
|
0.84
(0.24) |
0.6
(0.3) |
| %
E Carbohydrate |
>
57 |
|
|
|
|
| Men
|
|
57.9
(15.8) |
59.9
|
56.3
(7.2) |
43.2
(7.3) |
| Women
|
|
64.8
(14.4) |
58.5
|
55.9
(7.3) |
45.9
(6.2) |
| %
E sugar |
<
10 |
|
|
|
|
| Men
|
|
12.1
(9.4) |
|
18.9
(8.0) |
12.2
(5.7) |
| Women
|
|
15.9
(10.5) |
|
16.2
(9.2) |
10.7
(6.9) |
| Dietary
fibre |
30
g |
|
|
|
|
| Men
|
|
16
(11) |
31
(38) |
17
(8) |
22
(8) |
| Women
|
|
11
(7) |
28
(19) |
16
(8) |
23
(7) |
| Cholesterol
|
<
300 mg |
|
|
|
|
| Men
|
|
300
(344) |
356
(348) |
285
(168) |
412
(193) |
| Women
|
|
175
(162) |
334
(318) |
225
(114) |
308
(108) |
| P/S
= polyunsaturated/saturated fat |
|
Micronutrient
intake
In
both men and women, mean intake did not meet the RDA for the following
micronutrients across all of the groups: vitamin D, calcium and
zinc (Table III). The black Cape Town sample generally had the lowest
mean micronutrient intakes compared with the other samples, which
is in line with their lower energy intakes.
Table III. Mean daily micronutrient intake of older urbanised
South Africans (mean (SD))
| |
|
Men |
Women |
| Vitamins |
RDA
Men/Women |
Black
(Cape Town) |
Black
(Free State) |
Coloured
(Cape Town) |
White
(Potch) |
Black
(Cape Town) |
Black
(Free State) |
Coloured
(Cape Town) |
White
(Potch) |
| Vitamin
A (RE) |
1
000/800 |
1
214 (4 456) |
3
458 (5523) |
1
185 (971) |
2142
(632) |
379
(425) |
2
866 (3197) |
987
(759) |
1
922 (761) |
| Thiamin
(mg) |
1.2/1.0
|
0.90
(0.63) |
1.70
(1.55) |
0.95
(0.47) |
1.4
(0.4) |
0.65
(0.42) |
1.48
(0.93) |
0.86
(0.36) |
1.2
(0.3) |
| Riboflavin
(mg) |
1.4/1.2
|
1.29
(2.52) |
1.66
(1.32) |
1.4
(0.9) |
1.8
(0.7) |
0.69
(0.44) |
1.56
(1.58) |
1.3
(0.7) |
1.7
(0.5) |
| Niacin
(mg) |
15/13
|
14.8
(10.6) |
15.5
(11.0) |
16.3
(8.5) |
20.7
(4.9) |
9.1
(6.0) |
14.4
(9.5) |
14.4
(6.2) |
18.6
(3.7) |
| Vitamin
B6 (mg) |
2/1.6
|
1.11
(0.73) |
1.06
(0.86) |
1.3
(0.7) |
1.6
(0.3) |
0.76
(0.50) |
1.1
(1.0) |
1.3
(0.6) |
1.6
(0.3) |
| Folate
(µg) |
200/180
|
210
(250) |
171
(124) |
236
(129) |
212
(84) |
125
(90) |
159
(122) |
210
(92) |
209
(69) |
| Vitamin
B12 (µg) |
2.0
|
9.2
(47.6) |
6.92
(14.0) |
8.9
(8.3) |
5.9
(3.1) |
2.2
(3.2) |
6.3
(1.4) |
6.8
(6.2) |
4.9
(2.1) |
| Vitamin
C (mg) |
60
|
49
(108) |
57.4
(60.7) |
61
(62) |
58.7
(23.6) |
23.5
(32.5) |
64.9
(154) |
65
(84) |
75.7
(49.5) |
| Vitamin
D (µg) |
5
|
2.0
(3.2) |
1.47
(1.47) |
3.6
(2.7) |
2.8
(2.3) |
1.6
(3.2) |
1.45
(1.95) |
2.8
(1.7) |
2.3
(1.9) |
| Vitmain
E (mg) |
10/8
|
6.2
(6.6) |
9.91
(8.91) |
14.7
(7.3) |
18.6
(7.1) |
2.6
(3.7) |
8.2
(6.5) |
13.2
(6.6) |
13.2
(4.7) |
| Minerals |
|
|
|
|
|
|
|
|
|
| Calcium
(mg) |
800
|
424
(234) |
513
(412) |
499
(263) |
819
(357) |
319
(237) |
631
(1401) |
482
(216) |
734
(357) |
| Iron
(mg) |
10
|
8.7
(6.8) |
14.8
(12.6) |
9.5
(4.8) |
13.3
(3.5) |
5.4
(3.0) |
12.8
(7.2) |
8.6
(3.8) |
11.4
(2.4) |
| Magnesium
(mg) |
350/280
|
253
(122) |
423
(314) |
260
(109) |
341
(108) |
181
(75) |
376
(234) |
235
(85) |
290
(69) |
| Phosphorus
(mg) |
800
|
917
(401) |
1207
(798) |
1030
(458) |
1367
(477) |
629
(288) |
1185
(1271) |
915
(327) |
1201
(285) |
| Zinc
(mg) |
15/12
|
9.2
(6.6) |
10.6
(7.4) |
9.3
(4.4) |
12.2
(3.1) |
6.5
(4.4) |
9.8
(6.8) |
8.0
(3.1) |
10.1
(2.5) |
| Copper
(mg) |
- |
1.8
(5.4) |
1.47
(1.67) |
1.5
(0.9) |
1.5
(0.5) |
0.7
(0.4) |
1.28
(1.07) |
1.5
(0.9) |
1.3 |
|
Anthropometric
status
For
both men and women the sample of older white South Africans appeared
to be between 5 and 10 cm taller in stature than the other groups,
which may be indicative of early chronic malnutrition (Table IV).
Mean BMI was highest for urban black women in Cape Town at 30.3
(6.9) and lowest for non-urban black women in the areas of Pankop
(25 (5.2)). For men, mean BMI fell below 25, except for the black
sample in Cape Town and the white sample in Potchefstroom. The prevalence
of obesity, indicated by a BMI of 30 and above, was fourfold higher
in urban black women in Cape Town than in women in non-urban Pankop.
A low prevalence of obesity was found in urban black men and no
cases were seen in non-urban black men.
Table IV. Comparison of anthropometric data in samples of
older South Africans (means (SD))
| Measurement |
Reference
range |
Urban
blacks (CT) |
Urban
blacks (OFS) |
Non-urban
blacks (Pankop) |
Urban
coloureds (CT) |
Urban
whites (Potch) |
| N
|
|
148
|
400
|
100
|
200
|
100 |
| Men
|
|
74
|
182
|
33
|
104
|
48 |
| Women
|
|
74
|
218
|
67
|
96
|
52 |
| Age
group yrs |
|
60
- 89 |
65
- 116 |
60
- 96 |
65
- 92 |
65
- 84 |
| Height
(cm) |
| Men
|
173.0*
|
165.9
(6.7) |
163.8
(7.3) |
164.4
(5.0) |
163.9
(7.8) |
175
(10) |
| Women
|
160.0*
|
154.9
(6.3) |
151.2
(6.4) |
152.7
(5.9) |
151.3
(6.7) |
160
(7) |
| Weight
(kg) |
|
|
|
|
|
|
| Men
|
77.0
* |
70.6
(14.3) |
59.6
(12.5) |
61.1
(13.4) |
65.0
(14.4) |
78.7
(12.2) |
| Women
|
65.0
* |
72.5
(16.2) |
62.4
(18.1) |
58.8
(14.4) |
65.7
(13.3) |
72.0
(11.8) |
| BMI |
| Men
|
18.5
|
25.7
(5.1) |
22.2
(4.1) |
22.6
(4.6) |
24.2
(5.1) |
25.7
(3.3) |
| Women
|
29.9
† |
30.3
(6.9) |
27.1
(7.3) |
25.0
(5.2) |
28.9
(5.7) |
27.6
(4.5) |
| Obesity
(%) (BMI > 30) |
| Men
|
|
17.6
|
5.0
|
0
|
14.0
|
2.3 |
| Women
|
|
51.3
|
19.9
|
13.4
|
38.0
|
23.1 |
| *
Persons aged 51+ years.† World Health Organisation
(1997). |
|
Health
status of older south africans
It
is to be expected that the nutrition transition associated with
increasing urbanisation trends in present and future cohorts of
older Africans will be accompanied by an increase in chronic diseases
of lifestyle (CDL), such as coronary heart disease, cerebrovascular
disease and diabetes. However, the link between diet, urbanisation
and the manifestation of chronic disease is not clear. The older
black Xhosa population living in urban Cape Town has been shown
to have markedly lower rates of hypertension (30.3%) than their
Sesotho-speaking counterparts of the same age in either urban (Manguang,
70.6%) or non-urban (QwaQwa, 56.7%) Free State. This finding has
also been reported for the younger black population of Cape Town,
as well as in a group of Xhosa-speaking lead factory workers in
the Eastern Cape. Urban exposure (a categorical variable, described
as 40% or more of life spent in a city) was identified as an independent
risk factor for diabetes in the black population of Cape Town by
Levitt et al. The age-adjusted prevalence of 8% is higher than any
previously reported for Africans in South Africa or the rest of
Africa.
The cardiovascular
risk factor profile of older South Africans in urban and non-urban
areas is shown in Table V. Older white, coloured and Asian South
Africans have been shown to be already at high risk for chronic
diseases. The older coloured population in Cape Town has been shown
to have a high prevalence of diabetes (28.7%, 95% CI = 21.7% - 35.7%),
which is among the highest reported for this age group worldwide,
accompanied by a high prevalence of hypertension (71.7%, 95% CI=68.5
- 74.9&). A sample of white South Africans aged 55 - 69 years
in Durban has been shown to have the least favourable serum cholesterol
levels compared with other groups of a similar age (53% had a high-risk
value > 6.5 mmol/l); however, obesity was surprisingly uncommon
(12%) in the same grou |