South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde[JOURNAL]
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200 papers
The mysterious joint: Septic arthritis and acute osteomyelitis due to Fusarium species in a child with type II Chiari malformation.
Brijlal N, Mahabeer P, Govender S … +4 more , Mochankana K, Kampiire L, Archary M, Swe Swe-Han K
S Afr Med J · 2025 Dec · PMID 42246782 · Publisher ↗
Fungal bone infection due to Fusarium species is unusual. We report a case of a child who presented with septic arthritis and osteomyelitis due to Fusarium species. The lack of clinical trials and the organism's intrinsi...
Fungal bone infection due to Fusarium species is unusual. We report a case of a child who presented with septic arthritis and osteomyelitis due to Fusarium species. The lack of clinical trials and the organism's intrinsic resistance to most antifungal agents make antimicrobial management difficult. Our patient attained a favourable response to therapy with amphotericin B and voriconazole. This case report highlights a rare manifestation of joint- and bone-related Fusarium infection in a child.
New case definitions and thresholds for environmental notifiable medical conditions in South Africa: Pesticide, lead and mercury poisoning.
Mathee A, Stephen C, Nzenze SA … +1 more , Chandu L
S Afr Med J · 2025 Dec · PMID 42246781 · Publisher ↗
Notifiable medical conditions (NMCs) are diseases that pose significant public health risks, and may result in outbreaks, epidemics or pandemics with high morbidity and mortality rates. The World Health Organization prov...
Notifiable medical conditions (NMCs) are diseases that pose significant public health risks, and may result in outbreaks, epidemics or pandemics with high morbidity and mortality rates. The World Health Organization provides an overarching framework for countries to meet obligations related to data collection, processing and notification of and rapid response to, as needed, cases of NMCs. South Africa has recently introduced new case definitions for the three NMCs related to environmental exposures: poisoning by agricultural or stock remedies (pesticides), lead and mercury. In this article, the revised case definitions and processes for reporting of NMCs are outlined. We also discuss the benefits and challenges of processing and using NMC data, and urge more widespread and effective participation in the process of notifying these important environmental medical conditions.
Deaths from suspected mothball poisoning in children.
Dempster M, Erasmus L, Johnstone S … +8 more , Storath K, Letlhake O, Van der Merwe S, Lala SG, Madhi SA, Millen AME, Baijnath S, Dangor Z
S Afr Med J · 2025 Dec · PMID 42246780 · Publisher ↗
Childhood poisoning is a significant health concern in South Africa (SA), especially in densely populated informal housing settlements where children are frequently exposed to various household poisons. Poisoning account...
Childhood poisoning is a significant health concern in South Africa (SA), especially in densely populated informal housing settlements where children are frequently exposed to various household poisons. Poisoning accounts for 4 - 5% of paediatric hospital admissions in SA. The most common causes are fuels, pesticides and medicines, although many cases have unidentifiable causes. In this case series, three children, aged 3 - 5 years, were declared dead upon arrival at a public healthcare facility. Prior to death their symptoms included vomiting of a foam-like substance and distress (crying, shaking, fatigue). Postmortem fine-needle liver biopsies were obtained and underwent atmospheric pressure matrix-assisted laser desorption/ionisation mass spectrometry imaging (AP-MALDI-MSI) analysis. MSI analysis identified the presence of naphthalene-associated metabolites, the active component in household mothballs, suggesting death due to accidental ingestion. These cases highlight the urgent need for novel toxicology screening tools to accurately determine causes of death and guide targeted preventive strategies. Strategic efforts are needed to reduce childhood poisoning through robust toxicovigilance to monitor and regulate the sale of toxic substances and enhance access to toxicology testing.
SAMA's principled positioning in upholding global medical ethics.
Araie F, Hassan F, Jacub A … +4 more , London L, Mahomed H, Moolla MS, Shapiro L
S Afr Med J · 2025 Dec · PMID 42246779 · Publisher ↗
In October 2025, the South African Medical Association (SAMA) suspended all professional and bilateral relations with the Israeli Medical Association (IMA) and called for its suspension from the World Medical Association...
In October 2025, the South African Medical Association (SAMA) suspended all professional and bilateral relations with the Israeli Medical Association (IMA) and called for its suspension from the World Medical Association, citing the IMA's failure to uphold medical ethics amid Israel's ongoing military assault on Gaza's health system. This decisive action follows similar, though less forceful, motions by other national associations, including the British Medical Association, and reflects SAMA's commitment to ethical accountability under international humanitarian law. Drawing historical parallels with the medical profession's complicity during apartheid, this article argues that SAMA's stance constitutes ethical stewardship rather than politicisation, affirming that neutrality in the face of systematic violations of medical ethics equates to complicity. The piece situates SAMA's decision within a broader call for global medical solidarity, ethical clarity and adherence to the principles of medical neutrality and human rights.
The horrific health crisis in Gaza - the World Medical Association and the entire medical community must unequivocally support healthcare professionals and advocate for the end of atrocities perpetrated by the Israeli government.
Greco D
S Afr Med J · 2025 Dec · PMID 42246778 · Publisher ↗
The atrocities committed by the Israeli government in Gaza have included the killing of nearly 2 000 health workers and tens of thousands of Palestinian civilians. Gaza's health workers deserve universal praise for their...
The atrocities committed by the Israeli government in Gaza have included the killing of nearly 2 000 health workers and tens of thousands of Palestinian civilians. Gaza's health workers deserve universal praise for their unwavering dedication to this population suffering under theIsraeli invader. The World Medical Association and the entire medical community have remained silent or have taken insufficientpositionsin support of these selfless individuals, and have.
Reviewer Thank you.
Dhai A
S Afr Med J · 2025 Dec · PMID 42246777
Abstract loading — click title to view on PubMed.
COP30, climate injustice and health inequity.
Dhai A
S Afr Med J · 2025 Dec · PMID 42246776
Abstract loading — click title to view on PubMed.
Transforming obesity care: Evidence-based guideline for South Africa.
Conradie-Smit M, May W
S Afr Med J · 2025 Nov · PMID 41378668 · Publisher ↗
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Clinical Practice Guideline For The Management Of Obesity In Adults In South Africa.
Dhai A
S Afr Med J · 2025 Nov · PMID 41378665
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Weight management over the reproductive years for adult women living with obesity.
Dire Z, Hellig J, Conradie-Smit M … +1 more , May W
S Afr Med J · 2025 Nov · PMID 41378664 · Publisher ↗
RECOMMENDATIONS These recommendations pertain to the management of weight over the reproductive years for adult women living with obesity (i.e. body mass index ≥30 kg/m2) with a singleton pregnancy, who are ≥18 years of...
RECOMMENDATIONS These recommendations pertain to the management of weight over the reproductive years for adult women living with obesity (i.e. body mass index ≥30 kg/m2) with a singleton pregnancy, who are ≥18 years of age and do not have pre-existing diabetes or gestational diabetes. General advice. We recommend that healthcare providers (HCPs) should discuss weight management targets specific to the reproductive years with adult women living with obesity: pre-conception weight loss (Level 3, Grade C); gestational weight gain of 5 - 9 kg over the entire pregnancy (Level 4, Grade D); and postpartum weight loss of - at minimum - gestational weight gain (Level 3, Grade C), to reduce the risk of adverse outcomes in the current or a future pregnancy. Combined behaviour change interventions. HCPs should offer behaviour change interventions, including both nutrition and physical activity, to adult women living with obesity who are considering a pregnancy (Level 3, Grade C), who are pregnant (Level 2a, Grade B) and who are postpartum (Level 1a, Grade A),[16] in order to achieve weight targets. Nutrition counselling alone. We recommend that HCPs encourage and support pregnant women with obesity to consume foods consistent with a healthy dietary pattern in order to meet their target gestational weight gain (Level 3, Grade C). Physical activity counselling alone. We recommend that HCPs encourage and support pregnant women with obesity who do not have contraindications to exercise during pregnancy to engage in at least 150 minutes per week of moderate-intensity physical activity to assist in the management of gestational weight gain (Level 3, Grade C). Pharmacotherapy. HCPs should not prescribe metformin for managing gestational weight gain in women with obesity (Level 1b, Grade A). We suggest no weight management medications during pregnancy or breastfeeding (Level 4, Grade D). Breastfeeding. We recommend that women with obesity be offered additional breastfeeding support owing to decreased rates of initiation and continuation (Level 3, Grade C).
Emerging technologies and virtual medicine in obesity management.
Van Zyl FH, Noeth M, Diab PN … +2 more , Conradie-Smit M, May W
S Afr Med J · 2025 Nov · PMID 41378663 · Publisher ↗
RECOMMENDATIONS 1. Implementation of strategies in the management of obesity can be delivered through web-based platforms (e.g. online education on medical nutrition therapy and physical activity) or mobile devices (e.g....
RECOMMENDATIONS 1. Implementation of strategies in the management of obesity can be delivered through web-based platforms (e.g. online education on medical nutrition therapy and physical activity) or mobile devices (e.g. daily weight reporting through a smartphone phone application) (Level 2a, Grade B). 2. We suggest that healthcare providers incorporate individualised feedback and follow-up (e.g. personalised coaching or feedback via phone or email) into technology-based management strategies to improve weight loss outcomes (Level 4, Grade D). 3. The use of wearable activity-tracking technology should be part of a comprehensive strategy for weight loss (Level 1a, Grade A).
Commercial products and programmes in obesity management.
Bayat Z, Bhana SA, Conradie-Smit M … +1 more , May W
S Afr Med J · 2025 Nov · PMID 41378662 · Publisher ↗
RECOMMENDATIONS 1. For adults living with overweight or obesity, some commercial programmes exist that should achieve mild-to-moderate weight loss over the short or medium term, and a mild reduction in glycated haemoglob...
RECOMMENDATIONS 1. For adults living with overweight or obesity, some commercial programmes exist that should achieve mild-to-moderate weight loss over the short or medium term, and a mild reduction in glycated haemoglobin values over a short term in adults with type 2 diabetes compared with usual care or education. 2. We do not recommend the use of over-the-counter commercial weight loss products for obesity management, owing to lack of evidence (Level 4, Grade D). 3. We do not suggest that commercial weight loss programmes be used for improvement in blood pressure and lipid control in adults living with obesity (Level 4, Grade D).
Primary care and primary healthcare in obesity management.
Diab PN, Dire Z, Hellig J … +2 more , Conradie-Smit M, May W
S Afr Med J · 2025 Nov · PMID 41378661 · Publisher ↗
RECOMMENDATIONS 1. We recommend that PHPs identify PLWO, and initiate patient-centred, health-focused conversations with them (Level 3, Grade C). 2. We recommend that PHPs ensure that they ask PLWO for their permission p...
RECOMMENDATIONS 1. We recommend that PHPs identify PLWO, and initiate patient-centred, health-focused conversations with them (Level 3, Grade C). 2. We recommend that PHPs ensure that they ask PLWO for their permission prior to discussing weight or taking anthropometric measurements (Level 3, Grade C). 3. Primary care interventions should be used to increase health literacy in individuals' knowledge about and skills in weight management as an effective intervention to manage weight (Level 1a, Grade A). 4. PHPs should refer PLWO to primary care multi-component programmes with personalised obesity management strategies as an effective way to support obesity management (Level 1b, Grade B). 5. PHPs can use collaborative deliberation with motivational interviewing to tailor action plans to individuals' life context in a way that is manageable and sustainable to support improved physical and emotional health, and weight management (Level 2b, Grade C). Features of primary care and primary healthcare community-based interventions for PHPs and developers: 6. Interventions that target a specific ethnic group should consider the diversity of psychological and social practices with regard to excess weight, food and physical activity as well as socioeconomic circumstances, as they may differ across and within different ethnic groups (Level 1b, Grade B). 7. Longitudinal primary care interventions should focus on incremental, personalised, small behaviour changes (the 'Small Changes' approach) to be effective in supporting people to manage their weight (Level 1b, Grade B). 8. Primary care multi-component programmes should consider personalised obesity management strategies as an effective way to support PLWO (Level 1b, Grade B). 9. Primary care interventions that are behaviour based (nutrition, exercise, lifestyle), alone or in combination with pharmacotherapy, should be utilised to manage PLWO (Level 1a, Grade A). 10. Group-based nutrition and physical activity sessions informed by the Diabetes Prevention Program and the Look AHEAD (Action for Health in Diabetes) programme should be used as an effective management option for PLWO (Level 1b, Grade A). 11. Interventions that use technology to increase reach to larger numbers of people asynchronously should be a potentially viable lower-cost method in a community-based setting (Level 1b, Grade B). Educational recommendations to support development of obesity management skills in the primary healthcare clinical workforce: 12. Educators in undergraduate, graduate and continuing education programmes for PHPs should provide courses and clinical experiences to address the gaps in skills, knowledge of the evidence, and attitudes necessary to confidently and effectively support PLWO (Level 1a, Grade A).[20].
Metabolic and bariatric surgery: Postoperative management.
Skelton J, Murphy A, Conradie-Smit M … +1 more , May W
S Afr Med J · 2025 Nov · PMID 41378660 · Publisher ↗
RECOMMENDATIONS 1. HCPs can encourage PLWO who have undergone MBS to participate in and maximise their access to behavioural interventions and allied health services at an MBS centre (Level 2a, Grade B). 2. We suggest th...
RECOMMENDATIONS 1. HCPs can encourage PLWO who have undergone MBS to participate in and maximise their access to behavioural interventions and allied health services at an MBS centre (Level 2a, Grade B). 2. We suggest that MBS centres communicate a comprehensive care plan to primary HCPs for patients who are discharged, including MBS procedure, emergency contact numbers, annual blood tests required, long-term vitamin and mineral supplements, medications, behavioural interventions, and when to refer back (Level 4, Grade D, Consensus). 3. We suggest that after a PLWO has been discharged from the MBS centre, HCPs should annually review nutritional intake, activity, compliance with multivitamin and mineral supplements and weight, as well as assess comorbidities, order laboratory tests to assess for nutritional deficiencies, and investigate abnormal results and treat as required (Level 4, Grade D, Consensus). 4. We suggest that HCPs consider referral back to the MBS centre or to a local bariatric medicine specialist for technical or gastrointestinal symptoms, nutritional issues, pregnancy, psychological support, weight regain, or other medical issues related to MBS as described in this chapter (Level 4, Grade D, Consensus). 5. We suggest that MBS centres provide appropriate follow-up and laboratory tests at regular intervals after surgery with access to appropriate HCPs (dietitian, nurse, social worker, surgeon, bariatric physician, psychologist/psychiatrist) until discharge/referral to primary care level is deemed appropriate for the patient (Level 4, Grade D, Consensus).
Metabolic and bariatric surgery: Surgical options and outcomes.
Lubbe J, Smit JGM, Koto MZ … +2 more , Conradie-Smit M, May W
S Afr Med J · 2025 Nov · PMID 41378659 · Publisher ↗
RECOMMENDATIONS 1. MBS is recommended for individuals with a BMI >35 kg/m2, regardless of the presence, absence or severity of comorbidities,* to: a) reduce long-term overall mortality (Level 2b, Grade B) b) induce signi...
RECOMMENDATIONS 1. MBS is recommended for individuals with a BMI >35 kg/m2, regardless of the presence, absence or severity of comorbidities,* to: a) reduce long-term overall mortality (Level 2b, Grade B) b) induce significantly better long-term weight loss compared with medical management alone (Level 1a, Grade A)[4] c) induce control and remission of T2DM, in combination with best medical management, over best medical management alone (Level 2a, Grade B) d) significantly improve QoL (Level 3, Grade C) e) induce long-term remission of most obesity-related diseases, including dyslipidaemia (Level 3, Grade C),[8] hypertension (Level 3, Grade C) and MASLD (Level 3, Grade C). 2.MBS should be considered for individuals with metabolic disease and a BMI of 30 - 34.9 kg/m2*. 3.We suggest that the choice of metabolic and bariatric procedure be decided according to the patient's need, in collaboration with an experienced MDT (Level 4, Grade D, Consensus). 4.We suggest that adjustable gastric banding should not be offered owing to unacceptable complications and long-term failure (Level 4,Grade D). 5.We suggest that one-anastomosis gastric bypass should not be routinely offered owing to long-term complications in comparison with standard Roux-en-Y gastric bypass (Level 4, Grade D). *Recommendation 1 (Level 5, Grade D) and Recommendation 2 (Level 2a, Grade B).
Metabolic and bariatric surgery: Selection and preoperative work-up.
Smit JGM, Lubbe J, Murphy A … +4 more , Mawson K, Koto MZ, Conradie-Smit M, May W
S Afr Med J · 2025 Nov · PMID 41378658 · Publisher ↗
RECOMMENDATIONS 1. We suggest that a comprehensive medical and nutritional evaluation be completed and nutrient deficiencies corrected in candidates for MBS (Level 4, Grade D). 2. We suggest screening for and treatment o...
RECOMMENDATIONS 1. We suggest that a comprehensive medical and nutritional evaluation be completed and nutrient deficiencies corrected in candidates for MBS (Level 4, Grade D). 2. We suggest screening for and treatment of obstructive sleep apnoea in people seeking MBS (Level 4, Grade D). 3. Preoperative smoking cessation can minimise postoperative complications (Level 2a, Grade B).
Pharmacotherapy for obesity management.
Noeth M, Van Zyl FH, Hellig J … +2 more , Conradie-Smit M, May W
S Afr Med J · 2025 Nov · PMID 41378657 · Publisher ↗
RECOMMENDATIONS 1. Pharmacotherapy for obesity management can be used for individuals with a BMI ≥30 kg/m2, or ≥27 kg/m2 with adiposity-related complications, in conjunction with medical nutrition therapy, physical activ...
RECOMMENDATIONS 1. Pharmacotherapy for obesity management can be used for individuals with a BMI ≥30 kg/m2, or ≥27 kg/m2 with adiposity-related complications, in conjunction with medical nutrition therapy, physical activity and psychological interventions (semaglutide 2.4 mg weekly [Level 1a, Grade A] liraglutide 3.0 mg daily [Level 2a, grade B], naltrexone/bupropion 16 mg/180 mg twice a day [BID] [Level 2a, Grade B], orlistat 120 mg three times a day [TID] [Level 2a, Grade B]). 2. Pharmacotherapy may be used to maintain weight loss and to prevent weight regain (liraglutide 3.0 mg daily [Level 2a, Grade B], orlistat 120 mg TID [Level 2a, Grade B]). 3. Pharmacotherapy for obesity management in conjunction with health behaviour changes for people living with prediabetes and overweight or obesity (BMI ≥27 kg/m2) can be used to delay or prevent T2DM (liraglutide 3.0 mg daily [Level 2a, Grade B], orlistat 120 mg TID [Level 2a, Grade B]). 4. Obesity pharmacotherapy can be used in conjunction with health behaviour changes in people living with T2DM and a BMI ≥27 kg/m2, for weight loss and improvement in glycaemic control (semaglutide 2.4 mg weekly [Level 1a, Grade A], liraglutide 3.0 mg daily [Level 1b, Grade A], naltrexone/bupropion 16 mg/180 mg BID [Level 2a, Grade B], orlistat 120 mg TID [Level 2a, Grade B]). 5. Pharmacotherapy can be considered in conjunction with health behaviour changes in treating people with obstructive sleep apnoea and a BMI ≥30 kg/m2, for weight loss and associated improvement in the apnoea-hypopnoea index (liraglutide 3.0 mg daily [Level 2a, Grade B]). 6. Pharmacotherapy can be considered in conjunction with health behaviour changes in treating people living with metabolic dysfunction- associated steatohepatitis (MASH) and overweight or obesity, for weight loss and improvement of MASH parameters (liraglutide 1.8 mg daily [Level 3; Grade C], semaglutide 2.4 mg [Level 4 Grade D]). 7. Metformin and psychological treatment (such as cognitive behavioural therapy) should be considered for prevention of weight gain in people with severe mental illness who are treated with antipsychotic medications associated with weight gain (Level 1a, Grade A). 8. For people living with overweight or obesity who require pharmacotherapy for other health conditions, we suggest choosing medications that are not associated with weight gain (Level 4, Grade D, Consensus). 9. We do not suggest the use of prescription or over-the-counter medications other than those approved in SA for obesity management (Level 4, Grade D, Consensus).
Effective psychological and behavioural interventions in obesity management.
Bantjes J, Arendse C, Conradie-Smit M … +2 more , May W, Mawson K
S Afr Med J · 2025 Nov · PMID 41378656 · Publisher ↗
RECOMMENDATIONS 1. The recommendations outlined below are summarised in the model presented in Fig. 1 and supported by the evidence summarised in Table 1. 2. Multi-component psychological interventions (combining behavio...
RECOMMENDATIONS 1. The recommendations outlined below are summarised in the model presented in Fig. 1 and supported by the evidence summarised in Table 1. 2. Multi-component psychological interventions (combining behaviour modification [goal setting, self-monitoring, problem solving], cognitive therapy [reframing] and values-based strategies to alter nutrition and activity) should be incorporated into care plans for weight loss and improved health status and QoL (Level 1a, Grade A)[1-8] in a manner that promotes adherence, confidence and intrinsic motivation (Level 1b, Grade A). 3. HCPs should provide longitudinal care with consistent messaging to PLWO to support the development of confidence in overcoming barriers (self-efficacy) and intrinsic motivation (personal, meaningful reasons to change), to encourage the patient to set and sequence health goals that are realistic and achievable (Level 1a, Grade A), to self-monitor behaviour (Level 1a, Grade A), and to analyse setbacks using problem solving and adaptive thinking (cognitive reframing), including clarifying and reflecting on values-based behaviours (Level 1a, Grade A). 4. HCPs should ask patients' permission to educate them that success in obesity management is related to improved health, function and QoL resulting from achievable behavioural goals, and not the amount of weight loss (Level 1a, Grade A). 5. HCPs should provide follow-up sessions consistent with repetition and relevance to support the development of self-efficacy and intrinsic motivation. Once an agreement to pursue a behavioural path has been established (health behaviour and/or medication and/or surgical pathways), follow-up sessions should repeat the above messages in a fashion consistent with repetition (the provider role) and relevance (the patient role) to support the development of self-efficacy and intrinsic motivation (Level 1a, Grade A).
Physical activity in obesity management.
Conradie-Smit M, Fourie G, May W
S Afr Med J · 2025 Nov · PMID 41378655 · Publisher ↗
RECOMMENDATIONS 1. Aerobic PA (30 - 60 minutes of moderate to vigorous intensity most days of the week) can be considered for adults who want to: a. achieve small amounts of body weight and fat loss (Level 2a, Grade B) b...
RECOMMENDATIONS 1. Aerobic PA (30 - 60 minutes of moderate to vigorous intensity most days of the week) can be considered for adults who want to: a. achieve small amounts of body weight and fat loss (Level 2a, Grade B) b. achieve reductions in abdominal visceral fat (Level 1a, Grade A) and ectopic fat such as liver and heart fat (Level 1a, Grade A),even in the absence of weight loss c. favour weight maintenance after weight loss (Level 2a, Grade B) d. favour the maintenance of fat-free mass during weight loss (Level 2a, Grade B) e. increase cardiorespiratory fitness (Level 2a, Grade B)[9] and mobility (Level 2a, Grade B). 2. For adults living with overweight or obesity, resistance training may promote weight maintenance or modest increases in muscle mass or fat-free mass and mobility (Level 2a, Grade B) 3. Increasing exercise intensity, including high-intensity interval training (HIIT), can achieve greater increases in cardiorespiratory fitness compared with moderate-intensity aerobic activity, and reduce the amount of time required to achieve similar benefits (Level 2a, Grade B). 4. Regular PA, with and without weight loss, can improve many cardiometabolic risk factors in adults who have overweight or obesity, including: a. hyperglycaemia and insulin sensitivity (Level 2b, Grade B) b. high blood pressure (Level 1a, Grade B) c. dyslipidaemia (Level 2a, Grade B). 5. Regular PA can improve health-related quality of life, mood disorders (i.e. depression, anxiety) and body image in adults with overweight or obesity (Level 2b, Grade B).
Medical nutrition therapy in obesity management.
Fourie VR, Conradie-Smit M, May W
S Afr Med J · 2025 Nov · PMID 41378654 · Publisher ↗
RECOMMENDATIONS • We suggest that nutrition recommendations for adults of all body sizes should be personalised to meet individual values, preferences and treatment goals to support a dietary approach that is safe, effec...
RECOMMENDATIONS • We suggest that nutrition recommendations for adults of all body sizes should be personalised to meet individual values, preferences and treatment goals to support a dietary approach that is safe, effective, nutritionally adequate, culturally acceptable and affordable for long-term adherence (Level 4, Grade D). • PLWO should receive individualised MNT provided by a registered dietitian (when available) to improve weight outcomes (body weight, BMI), waist circumference (WC) and glycaemic control, and to establish lipid and blood pressure (BP) targets (Level 1a, Grade A). • PLWO and impaired glucose tolerance (prediabetes) or type 2 diabetes (T2DM) may receive MNT provided by a registered dietitian (when available) to reduce body weight and WC and improve glycaemic control and BP (Level 2a, Grade B). • PLWO can consider any of the many medical nutrition therapies to improve health-related outcomes, choosing the dietary patterns and food-based approaches that support their best long-term adherence: • CR dietary patterns emphasising variable macronutrient distribution ranges (lower, moderate or higher carbohydrate with variable proportions of protein and fat) to achieve similar body weight reduction over 6 - 12 months within a CR plan (Level 2a, Grade B). • Mediterranean dietary pattern to improve glycaemic control, high-density lipoprotein cholesterol (HDL-C) and triglycerides (Level 2b, Grade C), reduce cardiovascular events (Level 2b, Grade C), reduce risk of T2DM (Level 2b, Grade C) and increase reversion of metabolic syndrome (Level 2b, Grade C),[11] with little effect on body weight and WC (Level 2b, Grade C) • Vegetarian dietary pattern to improve glycaemic control and established blood lipid targets, including low-density lipoprotein cholesterol (LDL-C), and reduce body weight (Level 2a, Grade B), risk of T2DM (Level 3, Grade C), and coronary heart disease incidence and mortality (Level 3, Grade C). • Portfolio dietary pattern to improve established blood lipid targets, including LDL-C, apolipoprotein B (apo B) and non-HDL-C (Level 1a, Grade B),[16] and reduce C-reactive protein (CRP), BP and estimated 10-year coronary heart disease risk (Level 2a, Grade B) • Low glycaemic index dietary pattern to reduce body weight (Level 2a, Grade B), improve glycaemic control (Level 2a, Grade B) and established blood lipid targets, including LDL-C (Level 2a, Grade B), and reduce BP (Level 2a, Grade B)[20] and the risk of T2DM (Level 3, Grade C) and coronary heart disease (Level 3, Grade C). • Dietary Approaches to Stop Hypertension (DASH) dietary pattern to reduce body weight and WC (Level 1a, Grade B), improve BP (Level 2a, Grade B), established lipid targets, including LDL-C (Level 2a, Grade B), CRP (Level 2b, Grade B)and glycaemic control (Level 2a, Grade B), and reduce the risk of T2DM, cardiovascular disease, coronary heart disease and stroke (Level 3, Grade C). • Nordic dietary pattern to reduce body weight (Level 2a, Grade B)[26] and body weight regain (Level 2b, Grade B), improve BP (Level 2b, Grade B)[27] and established blood lipid targets, including LDL-C, apo B (Level 2a, Grade B)[28] and non-HDL-C (Level 2a, Grade B), and reduce the risk of cardiovascular and all-cause mortality (Level 3, Grade C) • Partial meal replacements (replacing one to two meals per day as part of a CR intervention) to reduce body weight, WC and BP and improve glycaemic control (Level 1a, Grade B). • Intermittent and continuous CR achieved similar short-term body weight reduction (Level 2a, Grade B) • Pulses (i.e. beans, peas, chickpeas, lentils) to improve body weight (Level 2, Grade B), glycaemic control (Level 2, Grade B), established lipid targets, including LDL-C (Level 2, Grade B), and systolic BP (Level 2, Grade C), and reduce the risk of coronary heart disease (Level 3, Grade C). • Vegetables and fruit to improve diastolic BP (Level 2, Grade B) and glycaemic control (Level 2, Grade B),[39] and reduce the risk of T2DM (Level 3, Grade C) and cardiovascular mortality (Level 3, Grade C). • Nuts to improve glycaemic control (Level 2, Grade B) and established lipid targets, including LDL-C (Level 3, Grade C) and reduce the risk of cardiovascular disease (Level 3, Grade C). • Whole grains (especially from oats and barley) to improve established lipid targets, including total cholesterol and LDL-C (Level 2, Grade B). • Dairy foods to reduce body weight, WC and body fat and increase lean mass in CR diets, but not in unrestricted diets (Level 3, Grade C), and reduce the risk of T2DM and cardiovascular disease (Level 3, Grade C). • PLWO and impaired glucose tolerance (prediabetes) should consider intensive behavioural interventions that target a 5 - 7% weight loss to improve glycaemic control, BP and blood lipid targets (Level 1a, Grade A), reduce the incidence of T2DM (Level 1a, Grade A)[48] and microvascular complications (retinopathy, nephropathy and neuropathy) (Level 1a, Grade B), and reduce cardiovascular and all-cause mortality (Level 1a, Grade B). • PLWO and T2DM should consider intensive behavioural therapy that targets a 7 - 15% weight loss to increase the remission of T2DM (Level 1a, Grade A) and reduce the incidence of nephropathy (Level 1a, Grade A) obstructive sleep apnoea (Level 1a, Grade A) and depression (Level 1a, Grade A) • We recommend a non-restrictive dietary approach to improve QoL, psychological outcomes (general wellbeing, body image perceptions), cardiovascular outcomes, body weight, physical activity, cognitive restraint and eating behaviours (Level 3, Grade C).
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