Research Articles (Dietetics)

Permanent URI for this collectionhttps://hdl.handle.net/10566/16123

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Life-course trajectories and modifiable risk factors for incident walking limitation and mortality in 25 high-income, middle-income, and low-income countries (PURE): a prospective cohort study.
(Elsevier, 2026) Swart, Rina Elizabeth Catherina; Bangdiwala , Shrikant; Rangarajan, Sumathy
This prospective cohort study examined the incidence, trajectories, and modifiable risk factors associated with walking limitations and mortality among adults from 25 countries participating in the PURE (Prospective Urban Rural Epidemiology) study. A total of 150,221 participants aged 35–70 years without walking limitations at baseline were followed for an average of 14.5 years. The incidence of walking limitations was highest in low-income countries and lowest in China, with women experiencing higher rates than men. Individuals in low-income countries developed walking limitations approximately 12 years earlier than those in high-income countries. Key risk factors included low educational attainment, obesity, hypertension, low recreational physical activity, poor diet, and incident stroke. These factors were also strongly associated with mortality. The findings indicate that walking limitations and mortality share common modifiable risk factors, highlighting opportunities for integrated prevention strategies aimed at promoting healthy ageing and reducing disability across different socioeconomic settings.
Trends in ethical transgressions amongst South African dietetic practitioners
(Taylor&Francis, 2025) Baldassarre, A; Wilkenson, Jill; Nortje, M
This study investigated ethical transgressions amongst dietetic practitioners in South Africa, using publicly available data from the Health Professions Council of South Africa (HPCSA) in the period 2014–2023. The study is a follow-up on the study by Nortje and Hoffmann (2015) who analysed HPCSA transgression records for the period 2007–2013. The current study found only five transgressions committed by two dietitians out of 1 376 cases across all HPCSA-registered professions. In total, amongst the more than 4 200 registered dietetic practitioners in 2024, this constitutes a transgression rate of < 0.05% (2 of ∼4,190), a decline from the previously reported 0.24% in 2013. While possible explanations for the apparent decline in transgressions are considered, no definitive conclusion is reached. Despite limitations, the findings highlight consistently low misconduct rates among dietitians over the past two decades, potentially positioning the profession as a model for ethical adherence in healthcare. t is recommended that future research be conducted to explore factors driving the high rate of ethical compliance in dietetics and its potential application across other healthcare professions.
Patterns of unprofessional conduct by medical practitioners in South Africa, 2014-2023
(South African Medical Association, 2026) Hoffmann, Willem; Nortjé, Nico; Ravi, Neela
Background. Over the past decade, South Africa (SA)’s healthcare landscape has shifted significantly as a result of policy reforms, including the Consumer Protection Act and amendments to the National Health Act. These changes have reframed the doctor-patient relationship, introducing economic and systemic pressures that may influence ethical decision-making. Objectives. To revisit the patterns of professional misconduct of SA medical practitioners from 2014 to 2023, comparing findings with those of a previously published study (covering 2007-2013) to identify emerging trends and to reflect on the efficacy of past recommendations. Methods. A mixed-methods approach was used to analyse published disciplinary records from the Health Professions Council of South Africa, excluding 2019 owing to data unavailability. Quantitative data were analysed using statistical tests to assess differences in transgression frequencies and sanction patterns between time periods. Qualitative analysis was used to categorise transgressions into several general and specific types to assess shifts in the patterns of professional misconduct. Results. The average percentage of practitioners found guilty of misconduct decreased significantly from 0.164% (2007-2013) to 0.087% (2014-2023) of registered practitioners. However, the average number of guilty verdicts per practitioner remained statistically unchanged, indicating a persistent pattern of repeat offences. Notable shifts in transgression types included a decrease in fraudulent conduct and an increase in documentation-related negligence. Conclusion. Although fewer practitioners were found guilty over the period of the present study, professional misconduct transgressions remained concentrated among repeat offenders. The study underscores the value of reinforcing the social contract in healthcare by recommending individualised ethics coaching for transgressors and revising current sanctioning practices to more effectively deter repeat misconduct. © 2026, South African Medical Association.
Ethical transgressions by registered psychologists in South Africa during the period 2014–2023
(SAGE Publications Inc., 2026) Nortje, Nico; Nortje, Mila; Gezu, Yanet
This study examines the ethical transgressions of registered psychologists in South Africa between 2014 and 2023, following a similar analysis conducted by Nortje et al. The research aims to determine whether the ethical recommendations from the previous study have resulted in a reduction of ethical transgressions among registered psychologists. The data were gathered from the records published by the Health Professions Council of South Africa. It focuses on the frequency of ethical transgressions, the nature of the misconduct cases, and the penalties imposed for professional misconduct. The results indicate that fraudulent conduct, particularly the charging for services not rendered, has now become the most prevalent type of ethical transgressions. While the overall number of transgressions showed a slight decrease throughout the study, financial penalties were again the most common form of punishment. Although previous recommendations were to take part in a regular group reflection on ethical issues that might occur, it seems there is still a gap pertaining to the need for continued ethics education and it is recommended that continued efforts are required to address the ongoing systemic factors contributing to ethical transgressions among registered psychologists.
Ethical transgressions among healthcare professionals in South Africa from 2014 to 2023
(AOSIS (pty) Ltd, 2025) Nortje, Nico; Pontarelli, Maureen; Gezu, Yanet
Background: Patients have become more comfortable lodging complaints with professional regulatory bodies over the last several years, likely influenced by the trending nature of patient-centred care and consumerism in healthcare and increased access to information through social media. Aim: To analyse the frequency and nature of reported ethical transgressions and penalties among registered South African healthcare professionals from 2014 to 2023. Setting: The study took place in South Africa. Methods: A list of all sanctioned cases was obtained from the Health Professions Council of South Africa (HPCSA) (data were unavailable for 2019). A mixed-methods approach of quantitative and qualitative content analyses was followed. Results: The study analysed 1012 ethical transgressions among 452 registered medical practitioners, physiotherapists, psychologists, dietitians, dentists and occupational therapists. Fraudulent conduct accounted for the largest number (n = 507 [50.1%]) of transgressions across all professions. The most common penalty imposed was a fine of R1000 to R10000 (26% of total penalties). Both a fine and a suspension were imposed in 82% of cases. Completion of an ethics-based educational course accounted for only 3%. Conclusion: Fraudulent conduct remains the highest reported ethical transgression among registered healthcare professionals in South Africa. Individualised education that remediates deficiencies in ethical behaviours through analysis and reflection could be beneficial in mitigating ethical misconduct among healthcare professionals. Contribution: This study provides a comparative analysis of ethical transgressions and penalties among healthcare professionals in South Africa. It also offers insights into necessary areas of improvement of education and training and suggests a different approach to disciplinary action
Perceived healthfulness, nutrient content awareness, consumption, and intention to purchase selected ultraprocessed products among adults in South Africa
(John Wiley and Sons Ltd, 2025) Swart, Rina; Bopape, Makoma; De Man, Jeroen
Objective: To investigate the perceived healthfulness, nutrient content awareness, consumption, and intention to purchase selected ultraprocessed products (UPP) and their sociodemographic determinants. Design: Cross-sectional study involving secondary data analysis. Setting: This study was conducted in all nine provinces of South Africa. Participants: In total, 1951 adults (18–50 years), with 63.5% females and 66.3% from low socioeconomic group. Methods: Participants were shown A4 images of mock-branded UPP, with no nutrition information provided. Questions asked were based on the images to determine the nutrient content awareness, healthfulness perception, consumption frequency, and intention to purchase the UPP based on sociodemographic characteristics. Analysis: Descriptive statistics were conducted for nutrient content awareness, perceived healthfulness, consumption, and intention to purchase UPP. Associations with sociodemographic variables were determined using regression analyses: logistic regression for perceived healthfulness and nutrient content awareness, ordinary least square regression for UPP consumption, and intention to purchase was modeled as a latent variable in a multiple indicators multiple cause (MIMIC) model. Results: Over a third of participants (41.8%) were not aware that fruit juice is high in sugar. Only 13% of the participants perceived fruit juice as unhealthy and more than 50% showed the intention to purchase fruit juice, cereals, and yoghurt in the future. More than 50% reported consuming most UPP either daily or weekly. Perceived healthfulness was associated with gender, while UPP consumption was associated with education, age, gender, and being unemployed. Intention to purchase UPP was the only variable associated with socioeconomic status. Conclusion and Implications: Intervention strategies such as simplified front-of-pack labeling may have a role in improving nutrition awareness and discouraging UPP consumption.
Characterising “obesogenic” versus “protective” food consumption, and their value chain among Ghanaian households
(Cambridge University Press, 2025) Swart, Elizabeth C; Annan, Reginald Adjetey; Agyapong, Nana Ama Frimpomaa
Objectives: This paper explores the characteristics of Ghanaian households' consumption of obesogenic versus protective foods, including their retail, distribution, and origin. Design: A household food consumption survey was conducted using an adapted Prospective Urban and Rural Epidemiology study Food Frequency Questionnaire. Product pathways for selected obesogenic (processed meat, Sugar-Sweetened Beverages, and biscuits) and protective (cooked vegetables, legumes, and fish) foods were traced from retailers through distributors/wholesalers to producers. Setting: Rural and urban communities in the Ashanti Region and selected retail/wholesale/producers nationwide. Participants: 612 households, 209 retailers and 185 wholesalers/distributors. Results: About 20% of households consume Sugar-Sweetened Beverages (SSB) and confectionery weekly, and just 2% consumed processed meat. Of the protective foods, fish had the highest proportion of households consuming weekly (74.5%), followed by cooked vegetables (53.1%) and legumes (22.8%). Frequent SSB consumption is higher in younger (p<0.001), male (p=0.010), urban (p<0.001), and more educated (p<0.001) food purchaser households. Below 10% of households followed the healthiest dietary pattern (high-protective-and-low-obesogenic) but higher in older and more educated food purchaser households. In contrast, most households (about 80%) consumption patterns did not discriminate between obesogenic and protective foods. Generally, characteristics of purchasers from retail/wholesale outlets agree with those of households, where obesogenic foods were retailed to younger, less educated buyers than older, more educated ones. While the protective foods had a strong local producer presence, the obesogenic foods were predominantly imported. Conclusion: Household consumption and retail/distribution of obesogenic foods are associated with socio-demographic characteristics, but obesogenic foods are almost entirely produced outside Ghana. Policies that regulate importation on health grounds can promote a healthier food environment. © The Authors 2025.
Advance care planning conversations: What constitutes best practice and the way forward
(Elsevier GmbH, 2023) Nortje, Nico; Zachariah, Finly; Reddy, Akhila
Background: Advance Care Planning (ACP) conversations are a cornerstone of modern health care and need to be supported. However, research indicates that the uptake thereof is limited, regardless of various campaigns. ACP conversations are complex and specific elements thereof should be discussed at various timepoints during the illness trajectory. Objective: This narrative review delineates what ACP conversation should entail, and a way forward. Methods: A PEO (Population, Exposure, Outcome) search was performed using relevant keywords, and 615 articles were identified. Through screening and coding, this number was reduced to 24 articles. All the authors were involved in the final selection of the articles. Results: Various themes developed throughout the review which include timing early on in the disease trajectory; incorporating beliefs and culturally relevant contexts; conversations needing to be iterative and short; involving surrogates and family; applying various media formats. Discussion: ACP conversations are relevant. ACP is not static and needs to be dynamic as patients’ illness trajectories and goals change. The care team needs to guard themselves against having ACP conversations to satisfy a metric and should instead be guided by the patient's expressed values and wishes. A system-wide operational plan will help alleviate common barriers in having appropriate ACP conversations.
Cost of hospitalization associated with inpatient goals-of-care program implementation at a comprehensive cancer center: a propensity score analysis
(Multidisciplinary Digital Publishing Institute (MDPI), 2024) Hui, David; Nortje, Nico; Huang, Yu-Ting
The impact of goals-of-care programs on acute hospitalization costs is unclear. We compared the hospitalization cost in an 8-month period before implementation of a multimodal interdisciplinary goals-of-care program (1 May 2019 to 31 December 2019) to an 8-month period after program implementation (1 May 2020 to 31 December 2020). Propensity score weighting was used to adjust for differences in potential covariates. The primary outcome was total direct cost during the hospital stay for each index hospitalization. This analysis included 6977 patients in 2019 and 5964 patients in 2020. The total direct cost decreased by 3% in 2020 but was not statistically significant (ratio 0.97, 95% CI 0.92, 1.03). Under individual categories, there was a significant decrease in medical oncology (ratio 0.58, 95% CI 0.50, 0.68) and pharmacy costs (ratio 0.86, 95% CI 0.79, 0.96), and an increase in room and board (ratio 1.06, 95% CI 1.01, 1.10). In subgroup analysis, ICU patients had a significant reduction in total direct cost after program implementation (ratio 0.83, 95% CI 0.72, 0.94).
Enhancing oncologists’ comfort with serious illness conversations: The impact of serious illness conversation guide (sicg) training
(Springer, 2024) Nortje, Nico; Adaji, Enefe; Johnson, Monica
Providers oftentimes need to have difficult conversations with patients facing a poor prognosis. Research indicates that providers generally feel ill prepared for these conversations and that bad conversations may lead to more anxiety for patients. Communication skills development training programs have shown improvement in providers’ skills. Our cancer center embarked on skills development training to help providers improve their skills and comfort in having serious illness conversations. During our phased approach, about 500 physicians and advanced practice providers in the Division of Oncology were trained for over a year. Their level of comfort with serious illness conversations was measured before and after the training by using both quantitative and qualitative methods. We found that mean and median comfort scores increased from pre-training to post-training. The findings suggest that the improved comfort and confidence observed among providers who undergo communications skills training can lead to better provider-patient communication, more patient-centered care, and improved patient satisfaction.

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