Cognitive deficits may be characteristic for only a subgroup of first-episode psychosis (FEP) and the link with clinical and functional outcomes is less profound than previously thought. This study aimed to identify cognitive subgroups in a large sample of FEP using a clustering approach with healthy controls as a reference group, subsequently linking cognitive subgroups to clinical and functional outcomes.

204 FEP patients were included. Hierarchical cluster analysis was performed using baseline brief assessment of cognition in schizophrenia (BACS). Cognitive subgroups were compared to 40 controls and linked to longitudinal clinical and functional outcomes (PANSS, GAF, self-reported WHODAS 2.0) up to 12-month follow-up.

Three distinct cognitive clusters emerged: relative to controls, we found one cluster with preserved cognition (n = 76), one moderately impaired cluster (n = 74) and one severely impaired cluster (n = 54). Patients with severely impaired cognition had more severe clinical symptoms at baseline, 6- and 12-month follow-up as compared to patients with preserved cognition. General functioning (GAF) in the severely impaired cluster was significantly lower than in those with preserved cognition at baseline and showed trend-level effects at 6- and 12-month follow-up. No significant differences in self-reported functional outcome (WHODAS 2.0) were present.

Current results demonstrate the existence of three distinct cognitive subgroups, corresponding with clinical outcome at baseline, 6- and 12-month follow-up. Importantly, the cognitively preserved subgroup was larger than the severely impaired group. Early identification of discrete cognitive profiles can offer valuable information about the clinical outcome but may not be relevant in predicting self-reported functional outcomes.

South Africa (SA) is a developing country with an ageing population. Adequate nutrition and physical activity (PA) protect against the loss of muscle mass and physical function, both of which are important components of sarcopenia. This study aimed to measure the prevalence of sarcopenia in older black SA women and investigate its associations with PA and protein intake.

Older black SA women (age, 68 (range; 60–85 years) n = 122) completed sociodemographic questionnaires, 24 h urine collection (estimate protein intake), venous blood (hs-C-reactive protein (hs-CRP) and ferritin), functional tests (grip strength, 3 m timed-up-and-go (TUG), 10 m walk test) and PA monitoring (activPAL). Dual-energy x-ray absorptiometry whole-body scans assessed fat and fat-free soft tissue mass (FFSTM).

According to the European Working group on Sarcopenia in Older People (EWGSOP)2, 2.5% (n = 3) had confirmed sarcopenia of a low severity based on normal physical function. Of the total cohort, 9% (n = 11) had low grip strength, 22.1% (n = 27) had a low appendicular skeletal muscle index (ASMI), and no women had low TUG (s) or gait speed (m/s). Higher ASMI was associated with lower hs-CRP (p = 0.05; Rho = -0.209) and higher ferritin (Rho = 0.252; p = 0.019), grip strength (kg, Rho = 0.223; p = 0.015), and gait speed (m/s, Rho = 0.180; p = 0.050). Protein intake suggested intake of 41.8g/day/ or 0.51 g/kg of body mass/day. Higher total protein intake (g/24h), was associated with higher FFSTM (kg) and ASMI (p < 0.001). PA outcomes were not correlated with FFSTM or ASMI (p > 0.05), however, there was a strong positive correlation of TUG (s) and gait speed (m/s) with time spent: 1) stepping per day (min) and; 2) at a high cadence (> 100 steps/min) (all p < 0.01). Daily step count was 7137 ± 3233 (mean ± Standard deviation), with 97.9 ± 38.7 min of total time spent stepping and 12.6 ± 16.8 min spent stepping at a high cadence (> 100 steps/min). Of note, 13.9% (n = 17) of women were completing > 10,000 steps/day.

Based on the EWGSOP2 criteria, there is a low prevalence of sarcopenia in older black SA women, explained by the maintenance of strength and physical function that directly related to PA, especially that performed at higher intensities. In contrast, low muscle mass was relatively prevalent (22.1%) and was associated with low dietary protein and not PA. Notably, it may be important to review the cut-points of EWGSOP2 criteria to be specific to the older SA women from disadvantaged communities.

Osteoporosis was not a public health concern in black South African (SA) women, until recently when it was reported that the prevalence of vertebral fractures was 9.1% in black compared to 5.0% in white SA women. Accordingly, this study aimed to measure bone mineral density (BMD) of older black SA women and to investigate its association with risk factors for osteoporosis, including strength, muscle and fat mass, dietary intake and objectively measured physical activity (PA).

Older black SA women (age, 68 (range; 60–85 years) n = 122) completed sociodemographic and quantitative food frequency questionnaires (QFFQ), fasting venous blood samples (25-hydroxycholecalciferol: Vitamin D-25), 24 h urine collection (estimate protein intake), grip strength and PA monitoring (activPAL). Dual-energy x-ray absorptiometry (DXA) scans of the hip (femoral neck and total) and lumbar spine determined BMD and whole-body scans for fat and fat-free soft tissue mass (FFSTM). WHO classifications were used to determine osteopenia (t-score -2.5 to -1), and osteoporosis (t-score < -2.5).

At the lumbar spine 34.4% of the women (n = 42) had osteopenia and 19.7% (n = 24) had osteoporosis. Osteopenia at the left femoral neck was 32% (n = 40) and osteoporosis was 13.1% (n = 16) of participants. The total left hip BMD indicated osteopenia in 27.9% (n = 34) and osteoporosis in 13.1% (n = 16) of participants. Multinomial regression revealed no differences in age (y) or frequency of falls in the past year between all groups (p = 0.727). Compared to those with normal BMD, participants with osteoporosis at the hip neck and lumbar spine were shorter, weighed less and had a lower body mass index (BMI) (all p < 0.05). When adjusted for height, the osteoporotic group (hip neck and lumbar spine) had lower trunk fat (% whole body), FFSTM (kg) and grip strength (kg), compared to those with normal BMD (p < 0.05). Only protein intake (g; 24 h urine analyses) was lower in women with osteoporosis (all sites) compared to those with normal BMD. Fat, carbohydrate and micronutrient intakes (relative to total daily energy intake), and vitamin D concentrations were not associated with BMD (all sites). Number of daily step count and stepping time (min) were inversely associated with BMI (p < 0.05), but not with BMD (all sites; p > 0.05).

A high prevalence of osteopenia and osteoporosis was evident at the lumbar spine and hip in older black SA women. This study highlights the importance of strength, body composition, and protein intake in maintaining BMD and preventing the development of osteoporosis in older women.

To assess type, nutrient profile and cost of food items sold by informal vendors to learners; and to determine nutrient content of corn-based processed snacks frequently sold.

Cross-sectional survey.

Quintile 1 to 3 schools (n 36) randomly selected from six education districts; Eastern Cape, South Africa.

Informal food vendors (n 92) selling inside or immediately outside the school premises.

Food items sold at most schools were corn-based processed snacks (94 % of schools), sweets (89 %), lollipops (72 %) and biscuits (62 %). Based on the South African Nutrient Profiling model, none of these foods were profiled as healthy. Foods less commonly sold were fruits (28 % of schools) and animal-source foods; these foods were profiled as healthy. Mean (sd) energy cost (per 418 kJ (100 kcal)) was highest for animal-source foods (R2·95 (1·16)) and lowest for bread and vetkoek (R0·76 (0·21)), snacks (R0·76 (0·30)) and confectionery products (R0·70 (0·28)). The nutrient profiling score was inversely related to the energy cost of the food item (r = −0·562, P = 0·010). Compared with brand-name corn-based processed snacks, non-branded snacks had lower energy (2177 v. 2061 kJ; P = 0·031) content per 100 g. None of the brand-name samples contained sucrose; six of the nine non-branded samples contained sucrose, ranging from 4·4 to 6·2 g/100 g.

Foods mostly sold were unhealthy options, with the healthier food items being more expensive sources of energy.