Background: The prevalence of dementia is increasing in low-and-middle-income countries, including in South Africa. It is driven by the increasing burden of diet-related non- communicable diseases and population aging. Therefore, it is imperative to implement strategies to reduce dementia-incidence. Almost half of dementia is now shown to be potentially modifiable by reducing identified risk factors. Evidence supports that a healthy diet protects neurocognitive function and reduces dementia risk.

 

In South Africa, low-income households experience structural barriers to healthy eating, which result in chronic food insecurity and low dietary diversity. Additionally, reported adherence to national eating guidelines is low. Socio-cultural studies have shown that perceptions of health, diet and chronic disease strongly influence dietary behaviour.

There are currently no behavioural interventions to improve diet adherence in dementia-risk South Africans. The development of culturally-relevant interventions which effectively improve diet adherence may contribute significantly to dementia prevention. This includes an in-depth understanding of the socio-cultural perceptions related to healthy eating, which could facilitate dietary behaviour change for improved brain health.

 

Aims: The overall aim of the study is to explore factors associated with adherence to the South African Food-Based Dietary Guidelines (SA-FBDG), with specific focus on food insecurity, barriers to healthy eating and dietary change-readiness. In addition, this study aims to explore using in-depth interviews how barriers and facilitators to a healthy diet might be mitigated and strengthened respectively.

 

Methodology: Cross-sectional, mixed-methods approach using quantitative Barriers to Healthy Eating Scale, diet adherence and dietary change-readiness questionnaires. Hereafter, qualitative semi-structured interviews and focus group discussions will be conducted. 151 dementia-risk persons over the age of 60, with either / and diabetes, hypertension or high cholesterol, will be recruited from primary healthcare clinics in Khayelitsha, Cape Town.

 

Hypotheses:

1. Adherence to national dietary guidelines will be low.

2. Low diet adherence will be correlated with food insecurity, barriers to healthy eating and low dietary readiness-to-change.

3. In qualitative interviews, we expect poor awareness of dementia and a lack of understanding that a healthy diet protects brain health.

 

Conclusions: The rich contextual knowledge around facilitators of healthy eating will inform the development and testing of a culturally appropriate brain-healthy / dementia-diet behavioural intervention for application in South Africa. In addition to strengthening interdisciplinary research and promoting clinical nutrition, proposed research will advance efforts towards achieving the Sustainable Development Goals by reducing food insecurity and the burden of nutrition-related non-communicable diseases in South Africa.