South African Journal of Clinical Nutrition

Bridging the ‘missing middle’: classroom-based breastfeeding education for adolescents

2026-06-18T13:49:56+00:00

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The role of artificial intelligence in dietetic practice: a narrative review of current evidence and practical applications

2026-06-18T13:49:55+00:00

Background: The global nutrition landscape is shifting from population-based advice towards hyper-personalised clinical care, driven by a ‘data drown’ from wearable sensors and digitised health records. Artificial intelligence (AI) has emerged as a pivotal assistive technology to navigate this complexity, transitioning from a theoretical construct to a practical clinical ‘co-pilot’.
Objective: This review explores the integration of AI subfields, including machine learning (ML), deep learning (DL), and natural language processing (NLP), into the nutrition care process (NCP), and the specific regulatory and ethical landscape facing South African Registered Dietitians (RDs).
Discussion: AI-driven tools enhance the NCP by improving the accuracy of dietary assessments through computer vision, automating malnutrition screening via predictive modelling and optimising high-stakes interventions such as total parenteral nutrition (TPN) in neonatal care. Additionally, the review examines emerging applications of AI in institutional food service management, including intelligent menu planning, automated procurement and food waste reduction, domains that are integral to the South African Registered Dietitian’s scope of practice but have received comparatively limited attention in the literature. However, the transition to AI-augmented practice introduces risks of algorithmic bias, ‘de-skilling’ and AI ‘hallucinations’. Within the South African context, practitioners must navigate stringent requirements set by the Health Professions Council of South Africa (HPCSA) Booklet 20 and the Protection of Personal Information Act (POPIA). The use of clinical-grade prompt engineering, such as the PCCF (Persona, Context, Constraints, and Format) framework, is presented as a vital competency to ensure medically and culturally appropriate outputs.
Conclusion: AI should be positioned as a clinical co-pilot that amplifies the impact of the dietitian rather than a substitute for professional autonomy. By maintaining a ‘human-in-the-loop’ approach and adhering to local regulatory frameworks, South African dietitians can leverage AI to address the nation’s unique nutritional double burden and promote health equity.

Keywords: artificial intelligence, clinical dietetics, food service management, nutrition care process, precision nutrition, South
Africa, therapeutic nutrition

Assessment of food safety in public psychiatric hospitals in the Eastern Cape province, South Africa

2026-06-18T13:49:56+00:00

Objective: To evaluate the state of food safety practices, staff knowledge, and adherence to food safety regulations in food service units across four public hospitals in the Eastern Cape province, South Africa.
Design: A cross-sectional mixed-methods study was conducted using purposive sampling. Data collection included selfadministered questionnaires, semi-structured interviews, observations, and food safety audits conducted in accordance with national regulatory standards.
Setting: Four public hospitals in the Eastern Cape province, South Africa.
Participants: Ninety-one permanent healthcare employees in the public sector, including food handlers, foodservice managers, nurses, assistant directors of support services, and quality assurance officers.
Outcome measures: The principal areas of investigation included compliance with Regulation 638, adequacy and frequency of staff training, the standards of infrastructure and resources, and perceptions of management support for implementing food safety.
Results: Quantitative findings revealed that 84% of food handlers expressed a commitment to serving safe and nutritious meals, and 72% reported familiarity with food safety regulations. However, only 62% demonstrated adequate knowledge of hygiene principles, and just 45% understood the importance of maintaining appropriate food temperature control. No formal food safety training was reported between 2013 and 2018. Qualitative insights indicated that suboptimal handwashing was attributed to insufficient supervisory oversight and weak internal control mechanisms. All four hospital food service units had operated without a Certificate of Acceptability since 1994. Despite positive attitudes, institutional, systematic, and regulatory non-compliance reflects systemic governance weaknesses.
Conclusions: Despite food handlers’ awareness of basic safety principles, persistent gaps in food safety training, inadequate infrastructure, and regulatory non-compliance undermine safe meal delivery in public hospital settings. These systematic deficiencies, rooted in weak institutional oversight, poor enforcement of regulations, and insufficient investment in foodservice governance, pose risks to patient health and institutional credibility. Strengthening food safety in public hospitals requires a coordinated policy response, including infrastructure upgrades, accredited staff training, and enforcement of Regulation 638. Integrating food safety within broader health system accountability frameworks is vital for nutrition-sensitive care in hospital settings.

Keywords: compliance, food safety, institutional foodservice, management support, public hospitals

Consumer awareness and understanding, usage and attitude towards food labelling in Sunninghill and Alexandra, Sandton, South Africa

2026-06-18T13:49:57+00:00

Background: Overweight and obesity are major public health concerns in South Africa. To address this, the Department of Health (DOH) has proposed Regulation R3337, introducing front-of-pack nutrition labelling (FOPNL) to support healthier food choices. However, consumer understanding and use of food labels remain low. Without targeted education, the effectiveness of FOPNL may be limited, highlighting the need for context-specific nutrition label education.
Objective: The objective of the study was to assess awareness and understanding, usage and attitude towards food labels among consumers in Sandton, Gauteng.
Design: This study employed a cross-sectional design.
Setting: Sunninghill and Alexandra in Sandton, Gauteng, South Africa.
Subjects: South African adults (n = 385) were selected through convenience sampling, evenly divided between the two locations.
Outcome measure: Levels of perception and use of food labels were assessed through a structured interviewer-administered questionnaire.
Results: Participants from both locations demonstrated limited awareness and understanding of several food labelling components. Use of date labels (e.g. ‘best before’, ‘use by’ and ‘sell by’) was relatively similar across locations, with 20.7% of participants in Sunninghill and 20.3% in Alexandra reporting frequent use, p < 0.001. No significant difference was found between groups regarding the awareness and understanding, usage and attitude towards food labels p < 0.001.
Conclusion: Consumers demonstrated limited awareness and engagement with food labels, regardless of education, income or location. Consumer education on food labelling is needed to promote informed purchasing decisions.

Keywords: consumer, food labelling, understanding, usage, knowledge, communities

Nutritional status of patients receiving maintenance haemodialysis in Bloemfontein, South Africa

2026-06-18T13:49:58+00:00

Background: Identifying malnutrition in patients on maintenance haemodialysis (MHD) may be challenging in resource-limited sub-Saharan African settings, as several protein-energy malnutrition markers need to be interpreted in combination.
Methods: An observational cross-sectional study was conducted in 2017 in central South Africa to assess nutritional status based on anthropometry, biochemistry, and dietary intake (24-hour recall of typical intake of a non-dialysis day). Malnutrition was assessed using the 2008 International Society of Renal Nutrition and Metabolism (ISRNM) criteria.
Results: Amongst 75 participants (70.7% men; median age 50.5 [IQR: 41–59.6] years), malnutrition was identified in 20.0%. Median monthly income per person in the household of R2 375 (IQR: R817–R5 375) indicated low economic status. Based on body mass index (BMI), only 5.4% were underweight (< 18.5 kg/m2), 23.0% overweight (≥ 25.0 kg/m²) and 33.8% obese (> 30.0 kg/m²); 58.1% had high waist circumferences, and 66.2% high waist-to-height ratio (WHtR > 0.5), indicating central obesity. Overall, 18.9% simultaneously had a high BMI (≥ 25 kg/m²) with low arm muscle area (AMA ≤ 15th centile). Moreover, 49.3% had decreased serum albumin levels (< 35.0 g/l); however, C-reactive protein levels were unavailable. Total dietary protein (TDP) intake was estimated low (< 1.0 g/kg) in 32.4% and 50.7% had high carbohydrate intakes (> 60% of total energy).
Conclusions: In this population receiving MHD, with a low economic status and estimated low total dietary protein intake, poor nutritional status was marked by low muscle mass, and was masked by a high BMI and central obesity.

Keywords: body mass index, chronic kidney disease, dietary protein, malnutrition, muscle mass

Geospatial analysis of the urban food environment and diet quality of women living in Johannesburg, South Africa

2026-06-18T13:49:59+00:00

Objective: To assess the relationship between the urban food environment and diet quality in South Africa.
Design: This cross-sectional study assessed diet quality using Dietary Diversity Score (DDS) and the Minimum Dietary Diversity for Women (MDD-W) categories and the Rapid Eating Assessment for Participants – Shortened Version (REAP-S). The urban food environment was measured using geographic information systems (GIS) to map healthy and less healthy outlets within participants’ residential areas. The modified Retail Food Environment Index (mRFEI) and the Euclidean distances to food outlets were calculated.
Setting: Women in an urban suburb in Johannesburg, South Africa.
Subjects: A total of 427 generally healthy women were recruited between September 2022 and May 2023.
Outcome measured: Diet quality (DDS, MDD-W and REAP-S) and food environment (GIS, mRFEI and Euclidean distance).
Results: The mean DDS was 4.1 ± 1.4, with 64% of participants not achieving the MDD-W. The mean REAP-S score was 27.1 ± 3.3. Kernel density maps revealed that fast-food outlets were more densely clustered than grocery stores. The mean Euclidean distance from participants’ homes to the nearest grocery store was 464.4 metres, while fast-food outlets were 374.8 metres away. The mRFEI score of 31% indicated an obesogenic food environment. No association was found between diet quality and proximity to any food outlets.
Conclusion: The majority of the urban women showed poor diet quality; therefore, measures to improve this should include a combination of environmental and policy interventions. Recommendations include zoning regulations to limit fast-food outlet density near residential areas, health facilities and schools, and incentivising the establishment of grocery stores and fresh produce markets.

Keywords: urban food environment, South Africa, diet quality, modified Retail Food Environment Index (mRFEI); geographic
information systems (GIS)

Child-directed food marketing in urban South African supermarkets: which techniques are used and what type of foods are promoted?

2026-06-18T13:49:59+00:00

Objective: To examine the extent and types of marketing techniques used on the packaging of child-directed foods sold in South African supermarkets and to assess the nutritional quality of these foods.
Design: Cross-sectional observational study in which child-directed pre-packaged food and beverages were identified and photographed.
Setting: Four retail outlets in South Africa (three supermarkets in Pretoria and one online store).
Outcome measures: Nutrient content, labelling information, and child-directed marketing techniques were extracted from high-quality photographs. Foods were categorised into predefined food groups, and the INFORMAS stepwise approach guided systematic sampling. Nutrient profiling models from the draft food labelling Regulation (R.3337) were applied to determine nutritional quality. Descriptive statistics were used to quantify the presence and type of marketing techniques and to compare their use on healthy versus less healthy foods.
Results: A total of 516 foods were included in the study, of which 66% were classified as less healthy. The food categories contributing the highest proportion of child-directed products were confectionery (36% of foods), cereal and cereal products (15% of foods), dairy (13% of foods) and beverages (9.3% of foods). The most common marketing technique used was promotional characters (95% of foods), followed by claims (63.3% of foods) and premium offers (28.9% of foods).
Conclusion: Most child-directed foods available in South African supermarkets were classified as less healthy and frequently used multiple marketing techniques. These findings highlight the need for comprehensive food marketing and labelling regulations that better support healthy food choices for children.

Keywords: child-directed food marketing, food labelling regulations, nutrient profiling models, pre-packaged foods

Evaluating a DOHaD-informed breastfeeding education programme for adolescents in rural South African schools

2026-06-18T13:49:59+00:00

Background: Breastfeeding is essential for infant survival and health, yet South Africa’s exclusive breastfeeding rates remain below global targets, with adolescents, future parents, and influencers seldom engaged in breastfeeding education.
Methods: A quasi-experimental design study was conducted with 119 Grade 11 and 12 learners in two rural South African public schools. A standardised 40-minute education session, based on WHO guidelines and the Developmental Origins of Health and Disease (DOHaD) framework, was delivered in English and Tshivenda during regular school hours. Breastfeeding knowledge was assessed using a 10-item questionnaire administered before and after the intervention. Preferences for breastfeeding benefits were ranked post-intervention. Statistical analyses involved paired t-tests, McNemar’s test, chi-square tests, and logistic regression.
Results: Breastfeeding knowledge scores improved significantly, rising from a mean score of 6.45 ± 1.3–7.53 ± 1.2 (p < 0.001), with a large effect size (Cohen’s d = 0.83). Notable changes were observed in awareness of fathers’ roles in breastfeeding (54% to 83%, p < 0.001) and in awareness of the benefits for fathers (17% to 66%, p < 0.001). Adolescents found maternal (38.7%) and paternal (30.3%) benefits most interesting. Female sex was identified as a significant predictor of high engagement, defined as rating two or more breastfeeding benefit categories as most interesting (OR = 1.80, 95% CI: 1.05–3.20, p = 0.04).
Conclusion: A brief classroom intervention improved adolescents’ understanding and involvement in breastfeeding, emphasising parental roles. Integrating DOHaD-informed education in secondary schools may strengthen family and community support for breastfeeding in rural South Africa.

Keywords: adolescents, breastfeeding education, DOHaD, health promotion, parental roles, rural schools, South Africa

Nutrition knowledge, prevalence and correlates of elevated blood pressure among commercial drivers in Ondo, Nigeria

2026-06-18T13:50:00+00:00

Background: Commercial drivers are usually in transit and exposed to street foods. Their dietary choice and lifestyle could be influenced by nutrition knowledge, and predispose them to hypertension.
Objective: To determine the level of nutrition knowledge, elevated blood pressure (EBP), and associated factors.
Design: A cross-sectional study was conducted using an interviewer-administered questionnaire. Data were analysed through SPSS 29.0 at 5% level of significance (p < 0.05).
Setting: Three hundred commercial drivers were randomly selected from four motor parks in Ondo West local government area, Nigeria.
Results: Participants were all males with a mean age and daily income of 42.0 ± 10.42 years and ₦3 932 ± 2 897.61, respectively. The majority (69.0%) had secondary education, 44.7% travelled interstate, 13.7% smoked cigarettes and 39.7% drank alcohol, while 51.6% frequently ate outside the home, and 48.7% had adequate nutrition knowledge. Overweight, obesity and abdominal adiposity and EBP accounted for 45.0%, 6.7%, 84.3% and 29.3%, respectively. Nutrition knowledge was associated with level of education (aOR: 1.59, 95% CI: 1.03–2.47; p = 0.038), cigarette smoking (aOR: 3.23, 95% CI: 1.49–7.02; p = 0.003) and frequency of eating outside the home (aOR: 1.39, 95% CI: 1.15–1.68; p < 0.001) while EBP was associated with waist–hip ratio (aOR: 6.17, 95% CI: 1.01–37.64; p = 0.049), route of transportation (aOR: 1.94, 95% CI: 1.04–3.64; p = 0.038) and brisk walking (aOR: 1.96, 95% CI: 1.09–3.51; p = 0.023).
Conclusion: The findings indicate that inadequate nutrition knowledge predisposes to an unhealthy lifestyle, while abdominal adiposity and inactivity contribute to elevated BP. Incorporating nutrition and physical exercise into health education will help to alleviate cardiometabolic risk among commercial drivers in Nigeria.

Keywords: awareness, commercial drivers, elevated blood pressure, nutrition knowledge

Activity 194

2026-06-18T13:49:55+00:00

Activity 194

Activity 195

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Activity 195

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2026-06-18T13:49:54+00:00

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2026-06-18T13:49:55+00:00

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2026-06-18T13:49:55+00:00