The fat and the thin--a survey of nutritional status and disease patterns among urbanized Black South Africans

The nutritional status of and disease patterns in 449 healthy and 803 hospitalized urbanized Blacks in Durban were surveyed. While unemployed males were generally less fat than controls, obesity (i.e. weight 40% over that expected) was extremely common among female factory (33%) and female hospital 'domestic' (65%) employees. Undernutrition was significantly more common amont patients and more marked in males, 82% having significantly reduced fat stores. Disease patterns were similar in malnourished male and female patients, with infective and respiratory diseases predominating. However, the pattern was different in overweight male and female patients, non-ischaemic cardiovascular diseases, particularly hypertension, predominating. The most common cause of death in males was respiratory disease, and in females cardiovascular disease. Overall, malnutrition was most common in the subgroup (N = 212) of patients who died. The results confirm the known associations between undernutrition and increased susceptibility to infection and mortality, and also between overnutrition and hypertensive cardiovascular disease. The observation that malnutrition and obesity can coexist within rapidly urbanized communities stresses the need for concurrent education on nutrition. The high incidence of 'hospital malnutrition' observed emphasizes the need for nutritional support in acutely ill patients.